Dementia has been recognised as a significant health and social threat which is increasingly affecting individuals, families and societies. Recent conceptualizations of dementia argue that it represents an existential threat that is more than a series of technical challenges to the skill of carers. In this regard, dementia increases dependency, threatens identity and self-esteem which may ultimately lead to social isolation and compromise a person’s ability to find meaning in their life. While reminiscence therapy is frequently used with people with dementia, research findings are unclear as to whether this has any psychological benefits. With convincing evidence from experimental psychology, it may be that one of the factors determining whether reminiscence is of benefit is whether or not a nostalgic memory is evoked. Nonetheless, this has not been investigated among people with dementia. The main aim of this research is to explore the psychological impact of nostalgic memories compared to non-nostalgic memories on people affected by dementia using a randomised controlled experimental study. By investigating this, the research may be able to shed light on the way in which nostalgia buffers the psychological challenges of living with dementia. For instance, we may be able to identify more precisely how to help people with dementia maintain a psychological equilibrium, and thereby improve their quality of life and psychological wellbeing.

1. The psychological impacts of
nostalgia for people with
dementia: an experimental study
Sanda Ismail
Prof Richard Cheston
Dr Gary Christopher

2. Symptoms
• Memory loss
• confusion
• problems with
speech and
understanding

3. Dementia: a significant health and social
threat
• About 35.6 million people have been estimated to have
dementia worldwide
• By next year (2015) 850, 000 will be living with dementia
in the UK
• This That’s translates enough to pay into the annual a total energy cost bill of of every £26.3 household billion in the per country
year.
• There is no cure for dementia…
(Alzheimer’s Society, 2014)

4. Dementia goes beyond the
neurological process….
It has been regarded as a
disease of the entire person
rather than a mere illness of
the brain

5. Recent conceptualisations
of dementia argue that it
represents an
(Cheston, 2011)

6. Ultimate concerns/
Existential realities
Freedom
Death
Existential
isolation Meaninglessness

7. In this regard….
• Dementia increases
dependency and eventually
leads to death
• Threatens identity and self-esteem
which may ultimately
lead to…
• social isolation
• and compromise a person’s
ability to find meaning in their
life
60,000 deaths a year are
directly attributable to
dementia
18% are not living well with
dementia
61% felt depressed or
anxious recently
40% felt lonely recently
34% do not feel part of their
community
28% are not
able to make
decisions
about how
they spend
their time
Alzheimer’s Society, 2014

8. Existential concerns are implicit within the dementia care
literature; research literature and clinical literature involving
interventions
Dementia care literature
• attachment needs (Van Assche et al, 2013,
Stephens, Cheston and Gleeson, 2013)
• how meaning or purpose in life is established
(McGovern, 2012)
• how the potential loss of identity is
negotiated (Eustache et al, 2013, Steeman et
al, 2013)

9. Research literature
Various studies have suggested that the early stages of
dementia, after receiving a diagnosis, generally cause
profound psychological effects on :
• self-esteem (Steeman et al, 2006)
• meaning/ purpose in life (Lingler et al, 2006, Macquarrie,
2005)
• social connectedness (Hatch, 2013)
• general psychological wellbeing (Piiparinen and Whitlatch,
2011).

10. Clinical literature involving interventions
• Reminiscence therapy attempt to
use various elements of the past
to provide various psychological
functions for people with
dementia
• However, the efficacies of these
activities are still debated
• Substantial pieces of research by leading dementia care researchers, found very
little or no significant effects of these activities on psychological wellbeing for
people with dementia (Wang, Hsu and Cheng; 2005;Woods et al, 2005; Wang,
Yen and OuYang, 2009; Gudex et al, 2010; Woods et al, 2005; Forsman,
Schierenbeck and Wahlbeck, 2011; Woods et al, 2012).

11. It is therefore not
clear which of the
active components
in these activities
significantly
contribute to
enhancing the
psychological
equanimity for
people with
dementia (Moos
and Bjorn, 2006).

12. From a different
perspective (existential
perspective)
evidence base of
counteracting existential
threats
nostalgia could be
the active
ingredient in
reminiscence

13. What is nostalgia?
• Nostalgia is defined as a “sentimental
longing for the past” (The New Oxford
Dictionary of English, 1998; p. 1266)
• Different from reminiscence and
ordinary autobiographical memory
• “One can remember without being
nostalgic, but one cannot be nostalgic
without remembering” (Batcho, 2007; p.
362).

14. The use of nostalgia by people with dementia to
provide desirable psychological functions is not
clear and has not been explored among people with
dementia
Aim of the
research
To explore the psychological
impacts of nostalgic
memories compared to non-nostalgic
memories on
people affected by
dementia.

15. Methodology
1 2
SYSTEMATIC
REVIEW
PATIENT AND
PUBLIC
INVOLVEMENT
3
EXPERIMENTAL STUDY

16. Systematic review
• Involves the use of systematic,
clear and detailed methods to
identify, critically appraise
relevant studies and analyse
data from such studies in
order to answer a formulated
question (Moher et al., 2009).
• What is the strength of
evidence relating to a range of
psychosocial functions of
nostalgia including self-esteem,
social connectedness
and meaning in life within the
general population?

17. Flow of information through the different phases of the systematic review
Included Eligibility Screening Identification
# of reports identified through electronic database
searching = 1879 :
MEDLINE= 279; PsychINFO= 768; CINAHL Plus= 99;
The Cochrane Library= 3; British Nursing Index= 7;
Social Care Online = 3; EMBASE= 271; ScienceDirect=
144; ISI Web of Science= 163; Applied Social Sciences
Index and Abstracts (ASSIA) = 109; Social Service
Abstracts = 33
# of additional reports identified through other
sources = 103 :
NRR= 0; UKCRN= 0; SIGLE= 46; Grey
Literature Report= 0; The British Library= 14;
Index of Conference Proceedings= 0; Zetoc= 14;
Southampton Nostalgia Group page = 29;
References from included studies = 3
# of reports after duplicates removed = 1439
The Psychologist= 0. .
# of reports = 1985
# of reports screened = 1439
# of reports obtained = 54
# of studies included in the review =
39
# of reports excluded by reading titles = 1309
Reasons: They were irrelevant to the hypothesis of the review
# of reports excluded by reading abstracts = 76
Reasons for exclusion:
27 = explain the concept of nostalgia
5 = focus on reminiscence
13 = focus on the relationship between nostalgia and consumer behaviour but
not psychological outcomes
8 = did not focus on any aspects of nostalgia.
5 = commentary on other articles, editorial reports or letters to editors of
journals
4 = could not find or access abstract of articles
6 = nostalgia was investigated more as an outcome than an intervention
5 = Non-experimental studies.
2 = focus on homesickness
1 = investigated physiological functions of nostalgia
# of studies in reports assessed for
eligibility = 132
# of studies excluded = 93
Reasons for exclusion:
44 = Non-experimental studies
13= did not investigate targeted psychological outcomes
18 = nostalgia was assessed as an outcome
6 = characterised features of nostalgia
2 = comparing effects of different forms of nostalgia or not
comparing nostalgia with ordinary autobiographical memories
6 = examine nostalgia proneness
3 = cannot access full text

18. Patient and public involvement (PPI)
• Memory cafés organised by the Alzheimer’s Society in
Bristol
• Feedback will be obtained from this group on:
 the design of the experimental study
 the acceptability of the manipulation of nostalgia
 ability to identify and provide three favourite nostalgic
songs
 ability to understand and complete the outcome measures.

19. Experimental study
• This will be done by adapting and extending similar experimental studies looking
at the impact of two specific forms of nostalgia (narrative and music-evoked
nostalgia) within the general population.
• Population = people diagnosed with dementia and having mild to moderate
cognitive impairment
• Setting = memory clinics
• Sample size = 86
• Independent variable = narrative nostalgia and music-evoked nostalgia
• Dependent variables/outcomes = self-esteem, social connectedness and meaning
in life
• Moderators/ mediators = affect, neuroticism, resilience, nostalgia proneness,
belongingness orientation, degree of cognitive impairment

20. Figure 1: Research process showing recruitment of participants, manipulation of
nostalgia, data collection and mood repair
Potential participants identified by researcher or clinical staff
Patients meeting eligibility criteria approached and invited to participate in
the research and 3 favourite nostalgic songs requested from participants
who wish to take part in the research.
Consent requested from participants
Randomisation
Narrative control
Manipulation check
Music- control
Manipulation check
Outcomes
Narrative nostalgia
Manipulation check
Music-nostalgia
Manipulation check
Outcomes
Outcomes
Outcomes
(Moderators/ Mediators measured)
Distraction (Word puzzle)
Mood repair Mood repair
21
Narrative
nostalgia
Narrative control
Music-evoked
nostalgia
control
21
22 22
Study 1
Study 2

21. Significance of the research
• Theoretically: strengthen arguments perceiving dementia
as an existential threat.
• Also, while reminiscence therapy is frequently used with
people with dementia, research findings are unclear as to
whether this has any benefit. It may be that one of the
factors determining whether reminiscence is of benefit is
whether or not a nostalgic memory is evoked
• Clinically: may be able to shed light on the way in which
nostalgia buffers the psychological challenges of living with
dementia

22. References
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