L’objectif principal est d’examiner les effets de la thérapie de rétrospective de vie sur les troubles dépressifs, la détresse psychologique et le bien-être subjectif de personnes âgées institutionnalisées. Vingt personnes institutionnalisées âgées de 65ans et plus ont été recrutées et aléatoirement réparties dans deux groupes (rétrospective de vie et accompagnement usuel). Les participants du groupe rétrospective de vie ont bénéficié de cinq séances individuelles de rétrospective de vie afin d’en examiner les effets. Le recueil des données a eu lieu avant et après l’intervention. Après avoir fait bénéficier les participants du groupe expérimental de la thérapie de rétrospective de vie, un effet positif significatif sur les niveaux de dépression, de détresse psychologique et de bien-être subjectif a été observé. Aucune amélioration significative n’a été constatée parmi les participants du groupe d’accompagnement usuel. La thérapie individuelle de rétrospective de vie peut être considérée comme une approche potentiellement efficace qui vise à améliorer l’état psychologique de la personne âgée et à favoriser son adaptation à son lieu de vie.

For some residents, life in a nursing home is associated with deterioration of quality of life and psychological well-being as well as increased risk of depression and anxiety symptoms. Identifying sub-depressive states in institutions is therefore important in order to offer appropriate interventions to alleviate the suffering of these people as well as to prevent the onset of a depressive disorder (Antoine et al. [13Antoine P., Antoine C., Nandrino J.L. Development and validation of the Cognitive Inventory of Subjective Distress Int J Geriatr Psychiatry 2008 ;  23 : 1175-1181 [cross-ref]

Cliquez ici pour aller à la section Références]). Psychotherapy adapted to elderly people with depressive and subthreshold depressive disorders generally receives positive reviews. Cognitive-behavioral and life review therapies are more beneficial to this population (Pinquart et al. [18Pinquart M., Duberstein P.R., Lyness J.M. Effects of psychotherapy and other behavioral interventions on clinically depressed older adults: A meta-analysis Aging Ment Health 2007 ;  11 : 645-657 [cross-ref]

Cliquez ici pour aller à la section Références], Cuijpers et al. [21Cuijpers P., van Straten A., Smit F. Psychological treatment of late-life depression: a meta-analysis of randomized controlled trials Int J Geriatr Psychiatry 2006 ;  21 : 1139-1149 [cross-ref]

Cliquez ici pour aller à la section Références]). One of the main goals of life review therapy is to foster the kinds of reminiscences generating positive emotional states (Cappeliez et al. [27Cappeliez P., Guindon M., Robitaille A. Functions of reminiscence and emotional regulation among older adults J Aging Stud 2008 ;  22 : 266-272 [cross-ref]

Cliquez ici pour aller à la section Références]): integrative and instrumental reminiscences are associated with indices of positive adjustment. People with better mental and physical health make more use of these two types of reminiscence compared to individuals with signs of poor mental and physical health. Integrative and narrative reminiscences induce, prolong and/or amplify a positive emotional state (Cappeliez P, et al. [27Cappeliez P., Guindon M., Robitaille A. Functions of reminiscence and emotional regulation among older adults J Aging Stud 2008 ;  22 : 266-272 [cross-ref]

Cliquez ici pour aller à la section Références]). Although numerous studies show the benefits of interventions based on life review in North America, this type of intervention remains marginal in France.

The aim of this pilot study was therefore to exam the efficiency of life review therapy on the intensity of depressive moods and on psychological distress characteristic in sub-depressive states, as well as on subjective well-being of elderly people living in nursing homes in France. More precisely, the hypothesis was that people who participate in individual life review sessions would experience a significant clinical improvement on a number of these variables immediately after the intervention, and that these changes would not be seen in a comparison group who received normal care.

The 20 volunteers, residents in a nursing home, were randomly assigned to one of two groups: “life review” or “usual care” (10 in each group). In addition to activities organized by the nursing home, the participants in the “life review” group took part in five weekly individual life review sessions lasting 45minutes. The participants in the “usual care” group took part in the usual activities organized by the nursing home. A series of questionnaires was distributed to the 20 participants at the start of the study and then six weeks later during individual interviews: Montgomery and Asberg Depression Rating Scale to evaluate the level of depression, the Cognitive Inventory of Subjective Distress to explore specific psychological distress in elderly people (Antoine P, et al. [13Antoine P., Antoine C., Nandrino J.L. Development and validation of the Cognitive Inventory of Subjective Distress Int J Geriatr Psychiatry 2008 ;  23 : 1175-1181 [cross-ref]

Cliquez ici pour aller à la section Références]) and a subjective well-being questionnaire to measure life satisfaction as well as the positive and negative effects of living in a geriatric institution.

The “life review” group improved clinically. The level of depression decreased and the changes in responses generally concerned sadness and suicidal thoughts. The majority of distress scores lowered, showing the scale of the improvements on cognitive schemas of abandonment, dependence, lack of interest, loss of individuality and vulnerability. The increase in subjective well-being revealed another aspect of the intervention: the improvement in indicators of life satisfaction. This impact was more limited in the emotional field as only the score on the anxiety-depression scale improved. In contrast, no clinical improvement was observed for the “usual care” group. The only two clinical changes were negative.

Life review therapy had a double positive impact reducing psychological distress whilst improving life satisfaction of the residents in the nursing home. In contrast, life review, applied individually, did not seem to lead to an improvement in positive emotions, which are largely associated with social life according to the residents. Integrative life review implies a recall of past experiences, which give a feeling of meaning and purpose in life. It also implies the acceptance of negative past experiences, commitment to a positive reevaluation of personal successes, reconciliation between ideals and reality, and aims to reinforce the feeling of continuity between the past and the present.