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The Efficacy of Reminiscence Therapy 1

Running Head: THE EFFICACY OF REMINISCENCE THERAPY

The Efficacy of Reminiscence Therapy Modalities: A Systematic Review

Amanda Barr

and

Jakki Ruzich

Touro University, Nevada


The discussion of one’s life as a reflective process is highly regarded within specific

cultures and backgrounds. This form of communication also known as reminiscing has been used

amongst families to convey past history and lived experiences from generation to generation. In

1958 the term reality orientation was coined which stated that people should live in the present

and that dwelling in the past was not beneficial (Lin, Dai & Hwang, 2003). This focus on the

present moment was one of the first interventions used with those suffering from confusion and

dementia. Generally those in the medical profession viewed reminiscing as a cause of mental

deterioration and discouraged the fixation on one’s past experiences Conversely, others felt that

the act of reminiscence was beneficial for relaying one’s life by retrieving past memories and

bringing them to the present (Chin, 2007).

In 1963, Dr. Robert Butler created planned reminiscence as a therapeutic intervention

based on Erickson’s theory of life stages. Specifically, the theory and intervention involve being

able to move through the phases of life with acceptance which then constitutes having lived a

complete and fulfilled life (Woodrow, 1998). Interestingly, older individuals most frequently

tend to recall events experienced between the ages of 10 to 30 years which is considered the

reminiscence bump. This 20 year phase of life is thought to be the solidifying point of one’s

identity (Knez, 2006). Acceptance of one’s life, especially within this time frame, is believed to

assist with the evaluation and continuity of one’s past which ultimately leads to a sense of

closure. Butler’s planned reminiscence became a form of life review which focused on helping

individuals to confront their life experiences and move through the various stages of life. Later

these concepts of reminiscence branched out to form life review and reminiscence therapy as two

distinct treatment interventions (Woodrow, 1998).


In the early 1970s, the first experimental study of reminiscence was reported (Lin et al,

2003). This led to a surge in its popularity and the use of reminiscence was mainstreamed within

the health field. Between 1978 and 1979, the Reminiscence Aids Project funded by the

Department of Health and Social Security helped to further alter the health care environment by

placing value on the importance of social interaction. This encouraged people to spend more

time with one another and empowered patients to take a more active role in their health care

decisions. During the 1980’s occupational therapists, nurses, social workers and psychologists

widely used reminiscence therapy in caring for older adults living in institutionalized settings

and in the home environment

According to Haight & Burnside (1993), reminiscence therapy is a psychosocial

intervention that focuses mainly on past events and experiences as a reflective process. This

exploration allows older adults to review their past which may help them to resolve unfinished

business and successfully adjust to old age (Taft, 1989). Past research has intertwined the term

reminiscence with life review due to the similarity in their context of memory use for an

intervention strategy (Haight & Burnside, 1993). These studies presented various definitions and

theories that have made it challenging to interpret data and to determine the value of

reminiscence for the elderly population (Lin et al, 2003). Research conducted in the 1980’s

looked at a global scale of published works and began to discern reminiscence therapy

interventions from other similar therapeutic methods such as life review or guided

autobiographies (Chin, 2007).

Both life review and reminiscence therapy use memory and recall to guide the process,

yet life review emphasizes the analysis of one’s past life in a one on one format in a structured


setting (Haight & Burnside, 1993). Within reminiscence therapy, the individual uses spontaneous

recall of memories when presented with themes during an open format that usually takes place in

a group setting. The supportive atmosphere of reminiscence therapy emphasizes interaction by

promoting a natural process of communication and personal expression.

In the past three decades, reminiscence therapy has been shown to promote overall

psychological well-being in older adults especially those suffering from depression and dementia

(Haight & Burnside, 1993). Compared to other treatments modalities reminiscence therapy has

few side effects, yet may lead to disappointments when accessing memories. Facilitators such

as occupational therapists can help to provide an outlet for expressing such negative emotions.

Due to the steady increase in the elderly population, reminiscing has become a popular technique

for use in hospitals, day care, nursing homes, and other settings (Lin et al., 2003).

In current time there is still some convergence between reminiscence therapy and life

review, yet researchers are trying to clearly distinguish the two distinct therapeutic interventions

The various techniques and activities used to trigger memories in reminiscence therapy, such as

the use of simple journaling or personalized culinary experiences has also caused confusion over

what reminiscence therapy encompasses. The lack of refinement within the methodology of

reminiscence therapy has led to it being one of the least defined of the psychosocial therapies

(Haight & Burnside, 1993).

The previous systematic reviews on reminiscence therapy (Chin, 2007; Woods, Spector,

Jones, Orrell & Davies, 2005; Hsieh & Wang, 2003; Lin, Dai & Hwang, 2003; Spector, Orrell,

Davies & Woods, 2000; Burnside & Haight, 1994) used various definitions of reminiscing and a

host of different treatment modalities. They agree that the ambiguous definition makes

comparisons difficult for research studies to associate relationships amongst past reminiscence


documentation. All of these reviews concluded that the effects differed widely depending on the

type of therapy implemented with well elderly and those suffering from depression or dementia.

These researchers also state that it is difficult to compare reminiscence therapy studies based on

the many treatment goals, the data collection tools and the range of outcomes measured. This

systematic review has compiled studies that focused on applying reminiscence therapy as the

sole intervention. The basis of this research is to present the different forms of reminiscence

therapy modalities and to further understand the efficacy associated with each type of treatment.

Methods of the Review

Inclusion/Exclusion Criteria

Studies that investigated reminiscence therapy intervention with the use of various modalities

with the elderly were included in this review. Research studies were reviewed and included from

the United States and other countries with the additional inclusion criteria of the written language

in English format. Studies that did not focus on reminiscence therapy and the application of a

specific type of approach for use with the elderly were excluded.

Search Strategy

A computerized search of the following journals: PubMed, CINAHL, Science Direct, OTSeeker,

Sage and The American Journal of Occupational Therapy were initially conducted using the

term “reminiscence”. Other key terms that were included in the search of the databases were

“reminiscence therapy”, “reminiscence therapy and older adults” and “reminiscence therapy and

elderly”. Various reminiscence therapy modalities were noted throughout the abstract reviews

and articles. These intervention methods were then extracted and used as key terms to further

the search. Potential studies were also identified by manual search from the references of related


papers and journals, specifically: Geriatric Nursing Journal, Physical & Occupational Therapy in

Geriatrics and American Journal of Occupational Therapy.

Selection Method

All searched studies were determined for eligibility based on abstract screening with irrelevant

studies being discarded by the authors based on discussion and agreement. Full text copies were

obtained directly from the searches or from the interlibrary loan system at Touro University,

Nevada. The articles which are included involve Reminiscence Therapy as the intervention

technique with the use of various modalities such as photos, journals and music to help facilitate

reminiscing with older adults.

Data Extraction

Data extraction forms were completed independently by the two assessors (authors) for each

included study. They were then compared to establish consensus of the study design, hypothesis,

outcomes and clinical implications.

Organizational Plan

The information was categorized based on extracted information regarding specific criteria such

as group versus individual, the specific reminiscence therapy intervention modality, and by

specific diagnoses. Any discrepancies noted between the reviewers were discussed and resolved.

Data Analysis/Synthesis Plan

The identified studies are very diverse based on the design, population and treatment modality

applied; therefore, a narrative form of analysis will be used in this review. Tables will be

presented to summarize the efficacy of each identified Reminiscence Therapy method on the

various outcomes addressed in the studies.


Results

With the use of the general term “reminiscence”, PubMed generated 735 studies and

CINAHL provided 169 articles. The more specific term of “reminiscence therapy” was used to

narrow the search; PubMed provided 243 articles and CINAHL supplied 96 articles. After

allocating the search to reminiscence therapy and older adults, results were fewer and provided

the authors with information on specific diagnoses and the terms of “dementia and reminiscence

therapy” and “depression and reminiscence therapy” were included to further limit the database

search. A total of 10 studies that met all eligibility criteria are included in this review. Of the 10

studies, there were six different treatment modalities noted. There were two included studies

each based on: culinary experiences, writing, photos, and group conversation and one study each

in the areas of Tai Chi and music.

Culinary

A culinary study was conducted by Huang et al. (2009) at a long term care facility with mild to

moderate dementia participants that had visual or hearing impairments. The group culinary

sessions were conducted by the authors and involved the participants selecting remembered

dishes from their childhoods. The cooking sessions consisted of a 10 minute introduction, 20

minutes of food preparation, a 30 minute period for eating and sharing as a group and concluded

with a 30 minute individual interview. These culinary sessions used familiar foods that

emphasized positive memories that were connected to the participants’ past.

Another culinary study by Nawate et al. (2008) with a similar format provided culinary based

reminiscence by an occupational therapist in a community center. Multiple cooking sessions

were implemented with dementia patients utilizing recipes related to childhood and adult


memories. The occupational therapist provided open ended questions and used the various

ingredients throughout the nine sessions. To elicit reminiscence amongst the participants,

specific topics were provided that included self introduction/proverbs, memories related to one’s

home town, playing, school, seasons, marriage, home and work, trips, and a final review session

to conclude the treatment. The purpose of the intervention was not on completion of the culinary

activity, but on stimulating reminiscence and developing interaction amongst the participants.

Writing

The study by Elford et al. (2005) took place in a long term care facility with participants who

exhibited low cognitive impairment. A booklet was given to the participants each week for four

weeks that contained portions of others’ autobiographies with photographs to stimulate their own

solitary reminiscence process. The sessions included questions focused on four areas: childhood,

neighborhood, work days, and holidays that helped the participants access their memories. Six

months after completion of the booklets a questionnaire was provided to the manager to

determine the influence on the participants.

Hagens et al. (2003) conducted a case study of group reminiscence sessions with individual

interviews and the construction of remembering boxes. Each box contained meaningful objects

and photos collected by family members and poems developed during the group sessions. The

poems were constructed during the reminiscing activity by the first author using various words

and fragments of sentences by the participants. All items included in the remembering boxes

were utilized as a basis of communication and interaction between participants and staff, peers

and family members.

Photos and Videos


Three case studies focusing on individuals with depression were evaluated by Plastow (2006) in

a long term care setting over the course of six months. The researchers, care staff and family

assisted participants in the creation of life history books through the use of memorabilia,

photograph and anything else meaningful to the participant. Prior to the implementation of the

activity, an occupational therapist assessed their physical ability, cognitive function and ability to

reminiscence. During the construction process simple reminiscence methods were employed to

discuss the person’s life and establish a theme for their book.

The study of visual media within an outpatient memory clinic by Yasuda et al. (2009) was with

participants diagnosed with Alzheimer’s disease. They used an ABCA single subject treatment

design in order to eliminate bias. The intervention began with a 10 minute biography photo video

(A) that consisted of 40 photographs depicting positive experiences of the participants’ lives. The

video included simple narration with background music. Then a TV variety show (B) and a TV

news show (C) were shown for 10 minutes each. Lastly the biography photo video (A) was

shown again with the total length of the treatment session lasting 40 minutes. Participants were

videotaped during the session to observe levels of concentration and distraction.

Group Conversation

Haslam et al. (2010) conducted a study in a long term care facility for six weeks comparing three

groups of patients with dementia. The reminiscence group used objects from different time

periods in life: childhood, schooldays, domestic life, weddings, family life and holidays. The

individual reminiscence sessions used the same procedure but in a one on one format with

participant and facilitator. The control group played a table top game and was encouraged to give

each other feedback throughout the activity. A questionnaire and cognitive assessment were


administered one month prior to treatment to establish a baseline and was re-administered after

completion.

Okumura et al. (2008) was a study that took place within a group home, hospital and community

center with elderly participants with dementia and Alzheimer’s disease. The intervention group

began with a short introduction that included a greeting and transitioned to discussing childhood

themes to encourage group reminiscence amongst members. The themes of childhood included

helping with housework, school memories and memories revolving around the seasons. The

control group engaged in everyday conversations without the use of themes, otherwise all other

aspects between the groups were similar. Verbal fluency tasks were then conducted with both

groups using names of animals, Japanese words beginning with A, KA and words related to the

various themes. Word fluency and recall were assessed one minute after the treatment session.

Tai Chi

The study by Gibb et al. (1997) assessed a group based intervention within a long term care

facility over seven weeks for a total of 13 sessions. The sessions began with a greeting and

introduction and then the subjects were asked to participate in Tai Chi and deep breathing

exercises. Reminiscence in small groups or pairs involved a cognitive component of writing and

a psychomotor component of cutting and pasting. Sessions included pasting magazine cut outs in

various arrangements, writing letters to deceased parents and drawing sociograms to indicate

emotional closeness to their families. The intervention was adjusted to include more conversing

prior to the fourth session due to the difficulty of the psychomotor component. Assistance was

provided through the use of tangible cues and guided imagery from photo albums to enhance the

participants’ interaction and engagement in the activity.


Music

A music study was conducted by Ashida (2000) in a long term care setting with residents

suffering from dementia. The treatment was conducted in four small groups ranging from four to

seven participants. It was a single subject design with each patient serving as his or her own

control. The first week consisted of a pretest period with depression forms of participants

completed by staff. The second week was a no treatment phase with a second set of forms

completed. The third week entailed five daily music reminiscing sessions and the final

depression forms were completed after the last session. Staff members interacted with

participants for at least five minutes after the treatment sessions and discussed participants

interaction and behaviors with the nurses. A video camera was placed behind the therapist to

record verbal and non-verbal behaviors of the participants. The music therapist used an acoustic

guitar, an African drum and a song library that ranged from 1890 to 1930’s during the sessions.

Each participant performed one on one drumming with the music therapist in order to assess

mood and behavior at the beginning of the session. Then a topic was discussed which varied

from day to day such as hobbies, travel and nature. The therapist played and sang familiar songs

on guitar related to the theme of the day and asked questions to initiate discussion. Each session

ended with the same drumming activity for the therapist to give participants attention and to

reassess their moods.

Table 1 summarizes the characteristics of the included studies according to demographic

information.

Table 1. Summary of demographic characteristics of the 10 studies

n Mean Age

%M/F

Diagnosis Frequency & Duration

Group vs. Individual

Outcomes


CulinaryHuang et al. (2009) 11 65-90 63.6/36.4 Dementia

& vision or auditory

impairment

2x/wk (90 min)x 8 wks

Group CognitionDepression

Social ParticipationMood

CulinaryNawate et al. (2008) 11 88.5 27/73 Mild- Moderate

Dementia1x/wk (60 min)

x 9 wksGroup Cognition

Mood

WritingElford et al. (2005) 5 80 20/80 Cognitive

Impairment1 booklet/ q wk x

4 wksIndividual Cognition

Social participationWellbeing

Remembering Boxes

Hagens et al. (2003)

5 83.5 20/80 Cognitive Impairment

Or Dementia

7 sessions (1 hr)x 14 wks

& Interview w/1 participant

Group & Individual

CognitionSocial Participation

Mood

Life History BookPlastow (2006) 3 80.6 33/67 Well elderly &

Mild Depression

6 months Individual CognitionDepression

Social Participation

Photo VideoYasuda et al. (2009) 15 75.1 26.7/73.3 Alzheimer’s

disease1 session(40 min)

Individual Cognition

Group vs. Individual

Haslam et al. (2010)

73 76.5 18.7/81.3 Mild Dementia 1x/wk (30 min)x 6 wks

Group CognitionSocial Participation

Wellbeing

Reminiscence vs. ConversationOkumura et al.

(2008)

16 84 0/100 Alzheimer’s disease

1x/wk (60 min)x 5 wks

Group & Individual

CognitionSocial Participation

Mood

Tai ChiGibb et al. (1997) 9 79.77 33/67

Multi-infarct Dementia and Alzheimer’s

disease

2x/wk x 7 wks GroupCognition

Social participationMood

Wellbeing

MusicAshida (2000) 20 86.2 15/85 Dementia with

depression symptoms

5 sessions of music therapy in 1 wk: Study length:

3 wks

Individual DepressionSocial Participation

Mood

To examine the efficacy of the various intervention modalities, four common outcomes were

selected if at least three studies included them in the data collection. The four outcomes noted

were: cognition, depression, social participation, and mood/behavior.

Cognition


Nawate et al. (2008) found significant changes in cognition in participants after implementing

culinary reminiscence measured at both one week and four weeks post treatment. Participants’

concentration improved and distraction decreased significantly in the study by Yasuda et al.

(2009) while watching their personalized biography videos compared to when watching a variety

and news show. The reminiscence group in the study by Haslam et al. (2010) showed

significantly greater memory improvement over individual reminiscence and the control group.

In the study by Okumura et al. (2008), the mean verbal fluency score showed significant changes

for both groups studied. The reminiscence group’s score increased while the conversation

group’s score decreased as the sessions progressed. There was also a significant difference

between the two groups on total number of words recalled. The above results provided

supportive data towards the application of reminiscence modalities in improving associated areas

of cognitive function.

Depression

Huang et al. (2009) found that the application of culinary based reminiscence significantly

improved the mental state of participants based on the data of the EEG measures taken pre and

post treatment. In the study by Ashida (2003), use of a standardized depression scale provided a

measure of tracking weekly changes in levels of depression. There were significant decreases in

depressive symptoms of participants during the five days of reminiscence focused music therapy

treatment. Both of the studies assessed the prolonged effects of reminiscing on participants’

symptoms of depression and mental state. According to Plastow (2006), the creation of life

history books helped to decrease depression in the three case studies. One participant no longer

showed symptoms of depression compared with pretest depression scores with the other two; the

intervention prevented their depression from becoming more severe.


Social Participation

Huang et al. (2009) found an increase in personal interaction to be statistically significant in

regards to positive communication, interaction and participation. Personal interaction improved

amongst participants and between the participants and caregivers which helped to foster a

nurturing atmosphere. According to Haslam et al. (2010), there was a significant increase in

shared social identification expressed amongst the members of the reminiscing group. Okumura

et al. (2008) found that there was a significant difference for non-verbal communication items

pre to post treatment for the reminiscence group, but the conversation group’s level of non-

verbal communication remained the same. Ashida (2000) stated that social interaction skills

improved during and right after the reminiscing music sessions with increases in active

participation levels and decreases in passive participation levels. The percentage of levels was

calculated by the two observers with an interobserver reliability of 0.92. The resulting outcomes

of social participation support the application of reminiscence therapy in improving participants’

social skills and the formation of relationships.

Mood/Behavior

According to Huang et al. (2009), data based on standardized behavior scales found that group

treatment provided a significant change in the participants’ feelings of participation. The three

categories of feelings were: stress relief, adaptation, and impression. Nawate et al. (2008) found

the behaviors of participants and acts toward caregivers were significantly improved after one

week of culinary reminiscence treatment but was not significant at four weeks post-treatment.

The reminiscence group in the study by Okumuru et al. (2008) reported significantly greater

levels of happiness than the conversation group. The results of the reminiscence treatments


found improvements in the participants’ composure and they were able to regulate their

behaviors more effectively.

Although well-being was not statistically significant in any of the studies, a couple of

them included this as a main outcome and found improvements. Elford et al. (2005) found that

applying a solitary form of writing through reminiscence gave the participants a sense of

meaning and purpose by producing a finished product. The booklet was kept and shared by the

participants which led to enhanced sense of control, self-efficacy and well-being. Gibb et al.

(1997) stated that the expression of life stories may contribute to enhanced self knowledge and

identification through the use of reminiscence and Tai Chi. Unfortunately, researchers use a

plethora of variables under the heading of well-being which creates difficulty in compiling the

terms into a definitive outcome. Due to the broad classification of the term well being, the

decision was made to mention the above studies although the findings were not included as one

of the research outcomes.

Table 2 presents the different reminiscence therapy modalities and the effects they had on the

four main outcomes.


Table 2: Efficacy of treatment modalities on outcomes measured

Intervention Type Cognition Depression Social Participation

Mood/Behavior

CulinaryHuang et al. (2009) _ + + +

CulinaryNawate et al. (2008) + +

WritingElford et al. (2005) _ _

Remembering BoxesHagens et al. (2003) _ _ _

Life History BookPlastow (2006) _ + _

Photo VideoYasuda et al. (2009) +

Group vs. IndividualHaslam et al. (2010) + +

Reminiscence vs. Conversation

Okumura et al. (2008)+ + +

MusicAshida (2000) + + _

Tai ChiGibb et al. (1997) _ _ _

Legend+ Significant

Improvement- Not

Significant Improvement

Discussion


This review shows that each of the six modalities of reminiscence therapy offered its

own unique way of helping older adults to reminisce about their lives. The treatment that

impacted the majority of outcomes appears to be reminiscence group therapy with a culinary

modality; cooking remembered childhood recipes with the use of familiar ingredients. The two

included studies showed significant outcomes in all four categories: cognition, depression, social

participation and mood/behavior. It also appears that the use of group interventions is more

beneficial than solitary reminiscing or one on one format especially for improvements in

cognition, depression and social participation. The two most common outcomes with the most

significant findings were cognition and social participation. For the majority of the studies,

cognition entailed the analysis of memory and recall with social participation was based

primarily on social exchange including verbal and non-verbal communication.

There were also many beneficial modalities used such as Tai Chi, life history books,

personal poems and remembering boxes. Due to these designs being qualitative or of a case

study nature, some researchers did not use assessment tools to measure for significant changes.

Although well-being was measured after the interventions, it is difficult for the therapists to

detect changes in a participant’s judgment of his/her own feelings about life. On the contrary,

depression and mood/behavior reflect a person’s reaction to events happening to him/her which

enables assessments to easily monitor and measure changes over time. Reminiscence therapy

mainly focuses on positive recall and provides a pleasurable and relaxing atmosphere; therefore,

it is logical to expect that levels of depression and mood/behavior will be positively affected by

various modalities of reminiscing.

Other preceding systematic reviews on reminiscence therapy focused on similar

outcomes but not on the specific treatment modalities and their individual effects on such


outcomes. The review by Chin (2007) found significant benefits of reminiscence therapy on

mood and depression in older adults, whereas Lin et al. (2003) stated that reminiscence may

improve the outcomes of depression, mood, cognition and well-being. Amongst the studies

researched by Woods et al. (2009), there were significant improvements in the areas of

cognition, mood and communication amongst participants with dementia. Our review further

investigated the various modalities of reminiscence therapy and the impact that each treatment

modality had on the similar outcomes. Providing our research on the efficacy of various

reminiscence therapy modalities invites future research to specifically study designated outcomes

that can be improved with the various modalities of treatment.

Limitations of this review

This review presented results of a varied nature due to the different types of modalities, various

outcomes measured, small populations and the use of several settings and diagnoses. Half of the

included studies were of qualitative design and thus did not supply definitive results. This limits

in the ability to make direct comparisons and to generalize the results. Only one or two studies

within each modality were included in this review which narrowed the amount of data we could

analyze and categorize. Further limitations were noted due to the exclusion of unpublished

works and studies in languages other than English. The broad scope of reminiscence therapy

research presented our review with difficulty in attaining cohesive elements to draw conclusions

for the efficacy of this intervention.

Future research

It will be of the utmost importance for future research to include more randomized controlled

trials of reminiscence therapy with larger sample sizes. These studies will need to provide clear

treatment protocols in order to precisely define what each modality entails and their benefits. The


different types of reminiscence therapy modalities need to measure similar outcomes amongst

the target population and in the same setting in order to provide specific results. These results

will then allow for more specificity in the area of reminiscence therapy that can be generalized to

specific population. It would be beneficial for studies to apply reminiscence therapy for an

extended duration and to continue monitoring the long term effects for assessing the longevity of

the treatment. The clear defining of outcomes for areas such as well-being and quality of life

could further the development of measuring tools for data collection that has been lost due to the

ambiguity of the terms. The summation of the noted limitations of this review inhibits

reminiscence from becoming a strong evidence based type of intervention.

Implications for practice

The knowledge of reminiscence may give occupational therapists the ability to cultivate

relationships with clients and be able to provide individual care based on their particular needs.

It may also increase confidence in their ability to successfully use these interventions with the

appropriate diagnoses to enhance the quality of care in the therapeutic setting. It is also

recommended for practitioners to include caregivers and family and to consider the impact that

they may have on the therapeutic process. Occupational therapy researchers could design

programs and train students and staff to analyze and compare studies to further the understanding

of the reminiscence process. To employ more standardized procedures for using reminiscence

therapy within the occupational therapy field will develop a more definitive mode of treatment.

This could develop a specialty area amongst older adults within the Occupational therapy scope

of practice.

Conclusion


This systematic review furthered the research by assessing the different modalities within

reminiscence therapy and the efficacy on various populations of people: healthy adults, those

who suffer from depression, bereavement and cognitive impairment. The numerous modalities

and outcomes were ambiguous which caused difficulty in drawing definite conclusions, albeit

the modalities may be helpful in improving cognition, depression, social participation,

mood/behavior and well-being in older adults. The studies reviewed presented a trend amongst

the outcomes with cognition and social participation being the most commonly measured and

significant findings. This review found that the application of group based reminiscence with a

culinary intervention provided the most significant impact on the largest number of outcomes.

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