FYI Research: Reminiscing helps to ease aging

Bettie Carter had been diagnosed with Alzheimer's, and her children wanted a second opinion. They brought her to Carolina's Geriatric Assessment Clinic, where the first person she saw was Florence Soltys.

"She wouldn't make eye contact; she just looked down," said Soltys, associate clinical professor of social work and associate clinical professor of medicine. At first, Carter answered Soltys' questions with just one or two words. But she became more responsive as Soltys encouraged her to talk about her life. She told of rearing her brothers and sisters after their mother had died when Carter was only nine. When she was 17, she married a tobacco farmer.

Then she told Soltys that she had been having visions of scenes from the Bible. "Right away, I thought, `that's why she was diagnosed as having dementia,' " Soltys said. Carter then said that for almost 40 years, she'd been sculpting these Bible scenes out of red clay that she found in her back yard. But lately, she hadn't felt like it.

To Soltys, it became apparent that Carter didn't have Alzheimer's -- she was depressed. "She was very clear, she could make judgements, she made complete sentences and responded appropriately with me," Soltys said. Carter started taking antidepressants and began sculpting again. Her mention of having visions from the Bible and her lack of communication was probably what had led to the incorrect Alzheimer's diagnosis, Soltys said.

Soltys has helped many elderly people by encouraging them to reminisce. "I don't have a form, and my questions are open-ended. I give the person permission to go where they want to go," she said. Reminiscing can help patients realize the meaning of their lives as they near death, or to deal with depression or dementia. For those with dementia, for example, remembering times when they were healthier can increase their self-esteem and help put their current health status in perspective.

Soltys uses reminiscing in the geriatric clinic and at local senior centers, and she encourages other clinicians to use it more often. In 1994, She and LaRue Coats, formerly of the School of Nursing, developed the SolCos Reminiscence Model to facilitate reminiscence therapy. "As far as we know from the literature, we were the first to actually define reminiscence therapy and formalize it in a model," she said. In 1996, Soltys helped form the International Reminiscence and Life Review Society, of which she's still a board member.

Her reminiscence model includes factors for caregivers to consider, such as the patient's historical perspective, education, ethnic background, and health status. It also encourages the use of stimuli such as crafts, pictures, or music.

The skills required for facilitating reminiscence therapy are basic but often overlooked in end-of-life care: listening, talking, and touching. That last one might give some people pause, but Soltys feels that physical contact is very important because so many older people are isolated. "In the clinic, I often hug the patient, or they'll take my hand and hold it while we talk. I've never let that be a concern to me."

When training certified nurse assistants, who often give nursing-home patients their daily care, Soltys encourages them to use reminiscence, even if only for five minutes. "I say to them, this was somebody's mother, this may have been your first grade teacher, this may have been a university president. It's important to hear who they were. What you're seeing is a person who looks frail and sick. But that person once was strong."

For Bettie Carter, reminiscing not only helped Soltys diagnose her correctly, it also helped her leave her mark. Carter told Soltys that before she died, she wanted to find out if her homemade sculptures were worth anything. Soltys called Roger Manly, then curator of the North Carolina State Folk Art Museum, and the next day he drove to Carter's house. Excited, he brought back a roomful of sculptures. He was sure he could sell them on the New York folk-art market or interest a museum in them. Carter decided to leave them to two North Carolina museums, which now exhibit parts of the Bettie Carter Collection.

Carter died three years after Soltys met her. "I spent more and more time with her when she was dying, really talking to her about her life, and it was a great pleasure for me to be with her when she died," Soltys said. An unexpected aspect of Soltys' model is that it lists not only benefits for the patient, but also for the caregiver. "Every individual you work with leaves a little bit of themselves with you," Soltys said. "It helps define who you are and your career as well."

Provided by Graduate Studies and Research

Writer: Angela Spivey

Editor: Neil Caudle