The Effectiveness of Structural Reminiscence on Anxiety and Aggression in Older Adults Living in Nursing Homes

Anxiety and aggression are common problems in old age, which is often accompanied by feelings of inadequacy and physical decline. Older adults are more prone to anxiety and aggression due to decreased self-confidence, reduced activity and mobility, loss of loved ones, chronic diseases, and similar factors. Therefore, this study aimed to determine the effectiveness of structured reminiscence on anxiety and aggression in older people living in nursing homes. The research design was quasi-experimental with a pretest-posttest control group design. The statistical population included all older adults living in nursing homes in Mashhad in 2024, among which one nursing home was randomly selected. The statistical sample included 30 older adults selected using convenience sampling and based on inclusion and exclusion criteria. Participants were randomly assigned to an experimental group (15 people) and a control group (15 people). The experimental group underwent the structured reminiscence protocol in eight weekly 90-minute sessions. The data collection tools included Eysenck and Wilson’s aggression questionnaire and Beck’s anxiety inventory. Data were analyzed through univariate analysis of covariance (ANCOVA) in SPSS-26 software. The findings of the study showed that structured reminiscence was effective in reducing anxiety and aggression in older adults. Therefore, it can be concluded that structured reminiscence has a positive effect on improving the psychological well-being of older adults. Therefore, the social workers, counselors, psychologists, and health care providers working in the field of aging are recommended to take advantage of structured reminiscence in their treatment programs and intervention measures.
EXTENDED ABSTRACT
Introduction
Studies indicate that the global population is undergoing an aging transition. Aging is a natural process resulting from biological, physiological, and biochemical changes in the body’s cells. These changes affect cellular function and typically become evident after the age of 60. One of the effects of aging appears to be an increase in anxiety among older adults. Anxiety is a prevalent issue in old age. Older adults experience increased anxiety due to reduced self-confidence, reduced activity, loss of friends and loved ones, reduced financial and physical independence, and the onset of chronic illnesses. Another significant variable in old age seems to be aggression. Aggression among older adults refers to behaviors, actions, and even speech that harm their physical and mental health, as well as that of others. Most older adults experience one or more underlying illnesses that impact their levels of anxiety and aggression, leading to decreased self-esteem, impaired function, reduced social activities, and mental confusion. It has been found that one approach that can be used to improve the condition of older adults is structured reminiscence. Structured reminiscence, also known as life review, focuses on the integration of positive and negative memories. Therefore, the aim of the present study was to evaluate the effectiveness of structured reminiscence on anxiety and aggression in older adults.
Method
The present research was an applied study in terms of its objective, using a quasi-experimental method with a pretest-posttest control group design. The statistical population included all older residents of nursing homes in Mashhad in 2024, among which one nursing home was randomly selected. The statistical sample comprised 30 older individuals, selected through convenience sampling and based on the inclusion and exclusion criteria, and randomly assigned to experimental (15 individuals) and control (15 individuals) groups. The experimental group underwent the structured reminiscence protocol over eight weekly 90-minute sessions. Data collection tools included Eysenck and Wilson’s Aggression Questionnaire and Beck’s Anxiety Inventory. Participants had to meet five inclusion criteria: (1) age over 60 years, (2) having above-average scores on the anxiety and aggression questionnaires, (3) absence of psychotic disorders, (4) basic literacy, and (5) willingness to participate. Data analysis was performed using univariate analysis of covariance (ANCOVA) in SPSS-26 software.
Results
Prior to data analysis, it was determined that the assumptions of normal distribution of data, homogeneity of variances, and homogeneity of regression coefficients, were confrimed using the Kolmogorov-Smirnov test (K.S), Levene’s test, and Fisher’s F-test, respectively. Therefore, it was concluded that the behavior or distribution pattern of the collected data in the mentioned variables was natural and did not significantly differ from a normal distribution. Based on this, the data were evaluated using ANCOVA, the results of which indicated that structured reminiscence had a significant effect on reducing anxiety and aggression in older adults.
According to Table 1, it can be said that there is a significant difference in the mean score of anxiety in terms of group (experimental and control) in the post-test, with F value of 81.256 (P<.001). This finding indicates a significant reduction in anxiety following the structured reminiscence sessions. According to the results in Table 1, F value for aggression is 46.056 (P<.001). As the P-value is smaller than the assumed error level of 0.05, the null hypothesis is rejected, and it can be concluded with 95% confidence, that there is a significant difference between the pre-test and post-test mean score of aggression after the structured reminiscence sessions. Additionally, the mean score of aggression of older adults before participating in the structured reminiscence sessions was 98.93, which decreased to 78.13 after the sessions. Given that ANCOVA confirms the significance of this change, it can be said that the hypotheses are confirmed. In other words, holding structured reminiscence sessions has been effective in reducing aggression and anxiety among older adults.
Conclusion
The results of the present study indicated that structured reminiscence sessions were effective in reducing anxiety among older adults. Considering that anxiety is related to emotional components, it appears that by expressing their past memories, older adults externalize both positive and negative emotions towards the past, allowing them to reconcile with the present and subsequently alter their attitude. Furthermore, actively participating in structured reminiscence enhances self-confidence and a sense of usefulness in older adults, which may contribute to a reduction in their anxiety levels. The second hypothesis of this study, which proposed that structured reminiscence would be effective in reducing aggression among older adults, was also confirmed. In other words, holding structured reminiscence sessions was effective in reducing aggression among older adults. structured reminiscence is believed to be associated with increased self-esteem and a stronger sense of meaning in life, protecting individuals against common psychological symptoms such as negative self-evaluation, hopelessness, and the belief in the inability to control negative events. The reminiscence intervention helps older adults by focusing on, affirming, and recalling their strengths, thereby empowering them and aiding them in effectively coping with feelings of helplessness, failure, or self-blame.
Ethical Consideration
Ethical Code
The plan was submitted for approval and permission from the Hekmat Razavi Higher Education Center, Khorasan Razavi Welfare Organization, and Mashhad Welfare Management.
Financial Support
This study received no financial support.
Authors’ Contributions
Z.N: Methodology, Writing – Original Draft, Data Curation, Formal Analysis; Gh.Gh: Conceptualization Software, Validation, Visualization, Project Administration, Supervision
Conflict of Interest
The authors had no conflicts of interest.
Acknowledgments
The authors extend their sincere gratitude and appreciation to the Deputy of Research at Hekmat Razavi Higher Education Institute in Mashhad, Khorasan Razavi Welfare Organization, Mashhad Welfare Management, and the management, staff, and residents of the Salamat older Center in Mashhad for their kind cooperation in conducting this research.
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