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Advances in Social Sciences Research Journal – Vol. 11, No. 8
Publication Date: August 25, 2024
DOI:10.14738/assrj.118.17416.
Fan, K.-Y., & Wu, P.-F. (2024). Exploring the Application of Digital Nostalgia System in Dementia Care from the Perspective of
Narrative Gerontology. Advances in Social Sciences Research Journal, 11(8). 147-160.
Services for Science and Education – United Kingdom
Exploring the Application of Digital Nostalgia System in Dementia
Care from the Perspective of Narrative Gerontology
Kuang-Yi Fan
National University of Tainan, (Taiwan)
Pei-Fen Wu
National Changhua University of Education (Taiwan)
ABSTRACT
In recent years, modern medical technology has advanced significantly, increasing
the average lifespan of Taiwanese individuals. However, dementia, a common
disease among the elderly, has also become more prevalent. The cognitive decline
caused by dementia can severely impact the physical, mental, and spiritual health
of patients. This study aimed to explore the impact of using digital nostalgia
technology to provide cognitive stimulation for patients with dementia, specifically
through the use of the "Recall" system developed by our research team. We
analyzed the narrative context of patients and employed a pre-test and post-test
experimental design, inviting five mild dementia patients to participate. The
research methodology mainly involved qualitative research, and we conducted
semi-structured interviews with patients using nostalgic photos, divided into four
topics: personal background description, most memorable experiences, specific
themes, and personal photo sharing. We used NVivo qualitative analysis software
to analyze the interview transcripts by coding and classifying the nodes to explore
the differences in the patient's narrative context before and after the intervention.
This study found that patients participating in the digital experimental activities
were more eager to share their old photos. These stimulated memories and led to
good subjectivity, continuity, coherence, and correspondence with
autobiographical memory. Compared with the non-digital group, patients in the
digital group were more willing to share their memories and stories from the past,
and they provided positive feedback on the presentation of digital photos and the
use of Taiwanese voiceovers. In terms of narrative context, this study identified six
main narrative contexts, including contentment, achievement, positivity, social
interaction, family affection, and instability. Most patients focused on the
"contentment," "family affection," and "achievement" parts. This study can serve as
a useful reference for applying digital nostalgia technology to improve the quality
of life and mental health of dementia patients, as it provides a deeper
understanding of their narrative content and needs.
Keywords: Autobiographical memory, dementia, narrative gerontology, reminiscence
therapy.
INTRODUCTION
With the global aging trend, dementia has become a common disease. According to statistics,
there are currently over 55 million people worldwide with dementia, and 60% of them reside
in low- and middle-income countries. It is concerning that three-quarters of dementia patients
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Advances in Social Sciences Research Journal (ASSRJ) Vol. 11, Issue 8, August-2024
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have yet to receive a proper diagnosis. Furthermore, nearly 62% of healthcare professionals
consider dementia as a normal part of the aging process [1], leading to delayed diagnosis and
treatment, causing greater harm to patients. This paper highlights the global concern of
dementia in aging societies and the need for better diagnosis and treatment. Taiwan became an
aging society by the end of March 2018. According to statistics from the Ministry of the Interior
until the end of December 2021, the population of elderly people aged 65 and above in Taiwan
has reached 3.93 million, with over 300,000 people suffering from dementia, representing
approximately one in every 13 people [2]. Narrative Gerontology is crucial for evoking
memories in older adults with dementia. It emphasizes exploring life experiences from a
narrative perspective and considers the aging process from a "life as story" viewpoint [3]. It is
not limited to specific theories or methods. By telling personal stories, Narrative Gerontology
can facilitate the development of interpersonal relationships, socialization, and social status
and establish personal identity. Therefore, this study aims to enhance self-affirmation and
awareness and increase self-esteem and a sense of identity by recalling patients' past life
experiences. Through reminiscence therapy, patients can re-experience their past experiences,
leading to increased confidence and happiness [4]. Caregivers can gain a deeper understanding
of the patient's past through reminiscence therapy and, together, reflect on past events and how
to solve them [5].
This study aims to Investigate the impact of digital nostalgia systems on the narrative of
patients with mild dementia and compare the differences in narratives before and after the
intervention. Emphasis is placed on the autobiographical and narrative memory of patients
with mild dementia to understand their narrative content and thought context.
LITERATURE REVIEW
Non-pharmacological Reminiscence Therapy for Dementia
Non-pharmacological therapy has been recognized as an important component of dementia
care. Reminiscence therapy is a non-pharmacological treatment method involving the elderly,
which was introduced as early as 1970 and is related to the nursing and treatment of older
people. Using nostalgic items, photos, videos, and music as aids for activities can evoke the
memories, experiences, or conversations of dementia patients from the past and help them
regain lost memories. Reminiscence therapy can slow down the physiological and
psychological deterioration caused by aging, improve interpersonal relationships and social
interaction, delay the decline of cognitive, language, and communication abilities, and also
enhance the patient's speaking skills, self-esteem, and sense of identity [4, 6-8]. At the same
time, reminiscence therapy can allow caregivers to understand the patient's past life
experiences and recall and reflect on past events with the patient, further increasing the
patient's confidence and the caregiver's understanding of the patient [5]. Since dementia is a
progressive disease, reminiscence therapy is beneficial for elderly progressive dementia
patients. Being diagnosed with dementia may lower a patient's confidence. Still, reminiscence
therapy can evoke long-term memory, enabling patients to recall the past and highlight their
strengths, reducing the experience of frustration [9].
Narrative Gerontology Intervention in Nostalgia Therapy
Narrative gerontology is a concept that has developed based on the ideas of autobiographical
and narrative memories. Autobiographical memory refers to experiences and memories
related to past events, including personal recollections, experiences, expectations, and
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Fan, K.-Y., & Wu, P.-F. (2024). Exploring the Application of Digital Nostalgia System in Dementia Care from the Perspective of Narrative Gerontology.
Advances in Social Sciences Research Journal, 11(8). 147-160.
URL: http://dx.doi.org/10.14738/assrj.118.17416
anticipations. Conway [10] proposed the autobiographical model, which suggests that
autobiographical memory consists of two components: semantic and episodic.
Autobiographical memory follows coherence and correspondence principles. Coherence refers
to individuals establishing temporal and event relations between past, present, and future,
creating a causal event process. Correspondence refers to the ability of narrators to compare
and contrast the previously mentioned fragments to find the corresponding content to maintain
narrative integrity and consistency [11]. The semantic component of autobiographical memory
involves recollecting specific events from the past by extracting general content from long-term
memory (e.g., "I was a teacher when I was young") or recurring themes (e.g., "I used to go to
church every Sunday"). The episodic component refers to specific personal experiences that
occur at a particular time and place (e.g., "Last year on Mother's Day, I received a bouquet of
carnations"). This distinction is crucial for describing the re-experience of autobiographical
memory.
The common interventions to retrieve autobiographical memories include reminiscence
therapy, music therapy, and technology-assisted approaches, which can assist individuals in
defining themselves and constructing meaningful life stories [12]. However, individuals with
dementia may experience a decline in these abilities due to the disease's impact, affecting their
self-awareness and self-image and potentially leading to a decrease in self-identity
consciousness [12]. Therefore, using these approaches to assist individuals with dementia in
retrieving their autobiographical memory may positively impact their physical and mental
health.
According to Holm, Thomsen, and Bliksted's [13] study, using Conway's autobiographical
memory model as the assessment direction, the experimental participants were randomly
divided into a control group and an experimental group, including patients with ICD-10
schizophrenia and healthy individuals. The participants engaged in a narrative activity of life
stories, and their temporal order, coherence, and correspondence during the narrative process
were evaluated. The results showed that although patients could maintain the coherence of the
narrative, their coherence would decrease when recalling negative events from the past.
Applying Photos and Life Story Books as Narrative Therapy
Life stories often accompany a person's growth and journey. Therefore, the life stories of older
adults are crucial for us to understand their lives and provide feedback. However, diseases such
as dementia threaten our self-worth in the world. People transmit their personal life
experiences through storytelling, and the narrative of these experiences contains three core
features: continuity, inspiration, and subjectivity [14]. Continuity refers to how the story's
events are extended and related to other content due to previously mentioned information.
Therefore, the listener must extract specific events and observe them in the storyteller's
context to understand the story's meaning. Inspiration refers to how storytelling allows people
to recall the past and helps organize their thoughts and observe the meaning of their lives.
Finally, subjectivity refers to the creation process of story thinking with a subjective belief
involving personal background, personality, and experience. Therefore, storytelling can help
people organize their identities and consciousness, provide resilience, and delay the
progression of dementia [15-16]. Adler [17] conducted a study focused on narrative
subjectivity and coherence, inviting cases receiving psychotherapy to explore their thoughts,
feelings, and experiences during the therapy process. Through analyzing the subjectivity and