The Use of the Life Story Work for older people with and
without cognitive impairment
The Use of LSB Work for the Cognitively Intact and the
Cognitively Impaired
Claudia K Y Lai, RN, PhDAssociate Professor, School of NursingThe Hong Kong Polytechnic University
President, Pi Iota ChapterHonor Society of Nursing Sigma Theta Tau International
The Healing Role of Storytelling(Dean, 1998)
Alcoholics Anonymous
Groups focus on other addictions (food, sex, narcotics, etc.)
Potential Benefits of Sharing a LS (Atkinson, 1998)
1. A clearer perspective on personal experiences and feelings, which brings greater meaning to one’s life.
2. Greater self-knowledge and a stronger self-image and self-esteem.
3. Cherished experiences and insights are shared with others; helps creates community and may show that we have more in common with others than we thought.
4. Joy, satisfaction, and inner peace in sharing one’s story with others.
Cont. Potential Benefits (Atkinson, 1998)
5. Purging, or releasing, certain burdens and validating personal experiences that is central to the recovery process.
6. An inspiration to help others change something in their lives.
7. Others will get to know us and understand us better, in a way that they hadn’t before.
8. By understanding our past and present, we also gain a clearer perspective on our goals for the future.
Uses Haight (2001 - of life review and LSB
work): To promote orderly thinking Decrease depression and burden for people
who are stressed Builds self-esteem and independence
Uses of Autobiography (Birren & Birren, 1996)
As a source of psychological and social science research material.
As a source of historical material for family and community.
As a means of promoting personal insight.
As preparation for changes in life.
Using Memory Books in NH Care(Bourgeois et al., 2001) Results: Revealed improvement on a variety of
quantitative conversational measures (e.g., duration of speaking time, frequency of utterances) between treatment and control conditions as a function of memory book use.
The quality of conversations, as measured by the frequency of discourse characteristics (e.g., facilitative behaviors), improved as a function of memory book use for treatment dyads.
Nursing aides’ judgment of residents’ depressive symptoms improved with memory aid use, suggesting changes in resident quality of life as a result of the information that enhanced information sharing and social closeness.
Uses in those afflicted by Alzheimer’s Disease (Cohen, 2002)
Research has found that although biographical videos do not increase the patient’s memory over time, they enhance memories during a given visit and positively alter the experience for the patient and visitor.
Research has shown that viewing the video with the supervision and added interaction of the visitor enhances patient engagement and level of comfort.
Uses in nursing home residents with dementia – a randomized controlled
trial
Lai, C. K. Y., Chi, I., & Kayser-Jones, J. (2004). A randomized controlled trial of a specific
reminiscence approach to promote the well-being of nursing home residents with dementia.
International Psychogeriatrics, 16 (1), 33-49.
Fig 1. Lubinski’s Social breakdown syndrome as applied to communication
Fig 3. Merits of the LSB as an Intervention as suggested by the Literature
Fig 4. Postulations of the Study’s Conceptual Framework
Study Design A randomized controlled trial - single-
blinded, parallel groups (N=101)
One intervention group (n=36) One comparison group (n=35) One control [no-intervention] group (n=30)
Outcome measures: SES & WIB Data collection points: T0, T1, & T2
Interview of staff participated in the study (N=26)
Recruitmentand consent
Random Assignment
Control group
Comparison group
Intervention group
Control group
Comparison group
Facility data
Resident data Demographics SES WIB RAI- ADL
MMSE
Staff data
Resident data Demographics SES WIB RAI-ADL
Resident data Demographics SES WIB MDS
Same asT0 Same as T1Process
Data tocollect
Operational Schedule of the Study
PreparatoryStage
6 weeks 6 weeksT0 T1 T2
Time Period
Continuous cycle until the sample sizerequirement is met
Staff interview Staff interview
MMSE MMSE
Intervention group
Statistical Analysis No significant changes were found in the C-MMSE
& MDS-ADL when compared the time periods T1 & T0, T2 & T1, and T2 & T0 for each group.
Examined whether the intervention could bring about any significant differences in outcome between the groups over time - no significant differences within subject effects (F=.581, p=.794).
Grouping was examined for any between-subject effects – no significant differences were found for both the SES (F=.049, p=.952) and WIB scores (F=.270, p=.764).
Comparing Outcomes of the Three Groups Using p Values: The ITT Sample
Paired Outcomes(Wilcoxon signed rank test)
Control Group
Comparison Group
Intervention Group
T1-T0 SES 0.143 0.057 0.169
T2-T0 SES 0.514 0.005* 0.032*
T2-T1 SES 0.287 0.103 0.657
T1-T0 WIB 0.198 0.063 0.014*
T2-T0 WIB 0.596 0.094 0.075
T2-T1 WIB 0.943 0.835 0.951
* p<.05
A Resident’s Story
Key Findings from the Study Enhanced social QOL is possible through
the LSB intervention Appropriate care is possible only through
knowing the person Caring is relating, which occurred at a
deeper level through the intervention
Outcomes of Using a Life Story Activity Approach for Community-
Dwelling Elderly
Claudia K. Y. Lai,1 Mabel M. H. Wong, 2 & Amanda C. Y. Chow 3
1 School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University; President, Pi Iota Chapter, Honor Society of Nursing, Sigma Theta Tau International2 H.K.S.K.H. Lady MacLehose Centre, Dr Lam Chik Suen District Elderly Community Centre3 Shatin Integrated Elderly Service, Evangelical Lutheran Church Hong Kong
Paper presented at the Annual Congress of Gerontology, Hong Kong, Nov 26, 2005
Objective & Method Aims at examining whether the production of a
life story book (LSB) would lead to a higher level of life satisfaction and an increased sense of self-esteem for older people in the community.
A pre- and post-intervention design comparing outcomes between three different groups
Convenience sampling with participants recruited from 2 NGOs
Recruited participants will be assigned to 3 different groups based on the inclusion and exclusion criteria.
Immediate outcomes (T1) of the intervention will be compared against baseline measurements (T0), and with outcomes three months later (T2).
Inclusion & Exclusion Criteria – General
older adults aged 60 & >; community dwelling; able to communicate most
of the time (as defined according to the criteria of the Resident Assessment Instrument [RAI] communication scale); and
able to understand and speak Cantonese
any active major psychiatric illnesses, including schizophrenia, bipolar disorders, and depression;
any acute or unstable chronic medical conditions including cardiac or lung diseases;
any active psychosocial crises such as bereavement or relationship problems;
blindness (RAI - vision scale); and
inability to hear even with hearing aids (deafness) (RAI – hearing scale).
Inclusion & Exclusion Criteria – Specific
Criteria Group 1By Self
Group 2Volunteer-
facilitated (VF1)
Group 3 Volunteer-
facilitated (VF2)
Inclusion Able to write up one life story book
Unable to write up own life story book because of inadequate literacy level
Unable to write up own life story book because of inadequate literacy level; GDS score 5 –
Exclusion Geriatric Depression Scale (GDS) scoring 5 or above
GDS scoring 5 or above
GDS scoring between 0 – 4 and 8 & >
Measures Outcome Measures
Life Satisfaction Scale Rosenberg’s Self-Esteem
Scale General Health
Questionnaire-30
Control measures
Barthel Index GDS Presence of financial
strain Revised Life Events Scale
Discussion The preliminary results of quantitative data
comparing T0 and T1 did not support the effectiveness of the intervention in promoting life satisfaction or self-esteem, the research team did observe some qualitative differences in various individuals.
It is possible that the instruments are not sensitive enough to capture changes of a finer magnitude.
It is also possible that the dose of the intervention is not enough.
Conclusion about the effect of LSB work for community dwelling elderly Findings inconclusive at the moment Presently still collecting data Need to compare the outcomes over time
(T0-T1, T1-T2, T0-T2) Need to examine the qualitative data
collected
Use of LSB Work as a Stand Alone Therapy(Rybarczyk & Bellg, 1997) By themselves, standard reminiscence or
life review techniques may serve best as an approach to improving the life satisfaction and adjustment of “worried but well” elderly people.
Benefits to Staff Staff gained improved knowledge of
clients’ identity. Development of collaborative approach
between client, relatives and staff. Provision of specific information about
client care that is important for Staff training Care planning
Uses in Clinical Situations(Bender et al., 1999)
Child care Moving of a unit
Uses in Counseling and Therapy Atkinson (1998): when the narrative
approach is used by therapists, counselors, or other professional helpers as a guided means for assisting their clients to get to the details of their lives that may prove insightful for understanding long-term patterns, issues, struggles, or dilemmas they are dealing with.
Uses in Research In education In gerontology In studying culture and gender issues
LSB Work for Seniors
What do you think of LSB work?Is it a worthwhile endeavor to promote the
wellbeing of our seniors?How do you think it should be done?Is there anything that we can apply?
References Atkinson, R. (1998). The life story interview. Thousand Oaks, Ca.: Sage. Bender, M., Bauckham, P., & Norris, A. (1999). The therapeutic purposes of
reminiscence. London, UK: Sage. Birren, J. E., & Birren, B. A. (1996). Autobiography: Exploring the self and
encouraging development. In J. E. Birren & G. M. Kenyon (Eds.), Aging and biography: Explorations in adult development (pp.283-299). New York: Springer.
Bourgeois, M. S., Dijkstra, K., Burgio, L., & Allen-Burge, R. (2001). Memory aids as augmentative and alternative communication strategy for nursing home residents with dementia. AAC Augmentative and Alternative Communication, 17, 196-210.
Cohen, G. D. (2002). Creative interventions for Alzheimer’s disease. Geriatrics, 57 (3), 62, 65-66.
Haight, B. K. (2001) Life reviews: Helping Alzheimer’s patients reclaim a fading past. Reflections on Nursing Leadership, 27 (1), 20-22, 45-46.
Lai, C. K. Y. (2003). Improving the Quality of Life for Nursing Home Residents with Dementia: A Life Story Approach. Unpublished doctoral dissertation. The University of Hong Kong: Hong Kong.
Rybarczyk, B., & Bellg, A. (1997). Listening to life stories: A new approach to stress intervention in health care. New York: Springer.
