6533b7d8fe1ef96bd126a04b

RESEARCH PRODUCT

Reminiscencia en adultos mayores no institucionalizados de República Dominicana: seguimiento de una intervención

subject

description

Es de interés tener en cuenta los aspectos que influyen en la calidad de vida del adulto mayor y como optimizar su desarrollo. Es por ello que surgen intervenciones no farmacológicas que pretende facilitar la adaptación del adulto mayor a los cambios que se producen tanto a nivel intrapersonal como en los diferentes contextos de desarrollo donde el sujeto interactúa, suministrándole mecanismos para que adquieran estrategias compensatorias que les ayuden a dar respuestas eficaces ante las demandas del contexto. La reminiscencia constituye una forma de mantener el pasado personal y de perpetuar la identidad de la persona, siendo ésta una técnica muy completa ya que utiliza la estimulación, la comunicación, la socialización y el entretenimiento. Además, algunos autores la plantean como una actividad mental organizada, compleja y que posee una finalidad importantísima ya que permite el desarrollo personal del adulto mayor cuando sus capacidades psicofísicas y relacionales comienzan a perder vitalidad. Los objetivos del presente estudio fueron: primero analizar mediante modelos de ecuaciones estructurales la influencia de las funciones de reminiscencia sobre la salud mental en una muestra de adultos mayores de la República Dominicana y luego aplicar un programa de reminiscencia integrativa e instrumental para mejorar variables personales, adaptativas, así como las funciones de la reminiscencia en adultos mayores no institucionalizados con un seguimiento a los tres meses. Método: 160 participantes adultos mayores no institucionalizados de Republica Dominicana, fueron divididos en dos grupos, 80 grupo tratamiento y 80 controles; se llevó a cabo una evaluación pre, postratamiento y de seguimiento a los 3 meses. Los instrumentos fueron: Mini Examen Cognitivo (MMSE), Escala de Depresión Geriátrica (GDS), Índice de Satisfacción Vital (LSI-A), Escalas de Bienestar Psicológico, Escala de Autoestima de Rosenberg, Brief Resilient Coping Scale (BRCS), Afrontamiento del Estrés (CAE) y Funciones de la Reminiscencia (RFS). El programa fue desarrollado en 10 sesiones de 120 minutos. Resultados: se desarrolló un modelo estructural en el que las tres funciones de la reminiscencia self positivo, self negativo y prosocial predicen un factor de salud mental con ajuste adecuados 2 (g.l. = 47) = 89,89, p > 0,001 (CFI = ,936, RMSEA = .077 (90% = CI = ,052 - ,100). En cuanto a los efectos de la intervención los datos revelaron la no existencia de efecto principal significativo el nivel cognitivo (MEC) de los participantes (p = 0,518). Una reducción significativa en la sintomatología en la variable depresión (p .001 (CFI = .936, RMSEA = .077 (90% = CI = .052 - .100). As for the effects of the intervention the data revealed no significant main effect of cognitive level (MEC) of participants (p = .518); a significant reduction in depressive symptoms (p < .001) in the treatment group, as well as an improvement in life satisfaction (p < .001). Regarding the psychological well-being, significant results were obtained in the dimensions: autonomy, (p = .001), environment mastery (p < .001), self-acceptance, (p < .001), personal growth (p < .001) and purpose in life (p = .036) with improvements in the treatment group. Resilience no showed significant main effects (p = .341). As for coping in the dimensions oriented in problem solving effects were obtained in: focused on problem solving (p = .016), positive reevaluation (p < .001) and seeking social support (p = .002) with improvements in the treatment group; in dimensions oriented in emotion effects were observed in: negative self-targeting (p = .047), opened emotional expression (p < .001) and avoidance (p = .019) with a worsening in the control group; no significant main effect on the religion dimension (p = .419) was obtained. In relation to the Reminiscence Functions Scale (RFS) first was studied the dimensions in the self-positive function: the identity dimension did not obtain a significant main effect (p = .600), whereas the effects were significant in problems resolution (p < .033) and for death preparation (p < .001); in the self-negative function the dimension boredom reduction obtained a significant main effect (p = .004) as well as maintenance of privacy (p < .001); finally in the dimensions of self-prosocial function, the conversation dimension showed significant main effects (p = .001). Conclusion: The results support a three functions model of reminiscent which predict a latent construct composed of positive mental health measures of depression, satisfaction, resilience and self-esteem. The self-positive, show a positive and significant relationship with positive mental health, being the identity and problem solving which have greater weight. The self-negative function presents a negative and direct relationship in the prediction of positive mental health, being boredom reduction and maintaining privacy which affect more negatively. Prosocial function shows a positive and significant relationship with positive mental health with similar weights in his two dimensions. Reminiscence therapy leads to a decrease in depressive symptoms, although we should be cautious with this result because three months later the treatment group returns to baseline. It should be noted that the scores still are significantly lower, as the control group shows a steady increase in depressive symptoms. There has been a significant increase in the ability to achieve pleasure in activities of daily living, improving the perception of the significance of its self and its vision and image to a more positive attitude, that is, greater life satisfaction. It is concluded that reminiscence therapy has a positive impact on life satisfaction in the short and long term. Reminiscent intervention has produced increases in the autonomy of the treatment group in short-term, improving their independence, self-determination and the ability to resist social pressures, helping to regulate the conduct. Reminiscent intervention has improved and maintained the ability of subjects to make effective use of its context (domain environment), as well as better adaptation. This effect of improvement remains in the follow-up in the treatment group, whereas in the control group there is a significant decrease. Reminiscence therapy achieves that subjects in the treatment group show a more positive attitude towards themselves and the recognition of their positive and negative attitude as well as well-being for others (self-acceptance). It has managed to develop and maintain a sense of growth and openness to new experiences, promoting an optimal aging. Reverse a steady decline in the control group. Therapy reminiscence has not had a generator effect although has maintained the existing levels in terms of sense of purpose, direction and sense of meaning in the present and the past and maintaining beliefs that give meaning to life, while controls decrease significantly in long term. In relation to coping reminiscence therapy has achieved an increase in the dimensions of coping aimed at solving the problem. Therefore, this procedure produces improvements in coping active forms; thus improves the use of cognitive and behavioral strategies of problem solving, although at long-term return to baseline levels, but be still significantly better than those of the controls which show a continued decline. There has also been an adaptive modification of meaning to stressful situations (positive reappraisal), while controls reduce their levels to promote a positive vision. Faced with no further modification of the controls, the TR achieved an initial improvement of the levels of social support as an adaptive strategy although in the follow-up it returned to baseline. Referring to emotion focused coping, has not achieved a quantitative improvement in these strategies, although a maintenance is observed compared with a maladaptive increase in the control group; facing increased maladaptive use in the control group, that is, a greater used of self-blame and self-criticism strategies (negative self-targeting), it has managed to maintain the baseline levels in the treatment group; moreover, it has managed to maintain the expressive manifestations by negative reactions that occur in the process of stress in the treatment group while the control group showed a significant increase in maladaptive emotional expression; finally no significant improvements have been obtained in avoidance as a withdrawal stressful transaction or facing an environment that is not contingent with needs, although differences between groups were observed after the application of the therapy. With regard to the effect obtained in the functions of reminiscence, the therapy had a positive impact on the functions of self-positive, which is kept short and long term by promoting consistency, significance and continuity of the self, although no effects were obtained in identity. On the contrary, it has improved the memory as a way of solving problems, improving the observation of it from a positive and motivating vision and thus encouraging the memory as adaptive and instrumental strategy. Reminiscence therapy also achieves that those memories generate an attitude towards death (preparation for death), the increase in this function is critical to achieving integrity in this stage of development. With regard to the functions of the self-negative reminiscence therapy the treatment group shows a maintenance of this type of memory, although significant increases were observed in the control group, and therefore greater use of maladaptive memory and away from the optimum aging. These increases are reflected in the use of memory as reducing boredom which leads to a state of remorse and frustration of missed targets and involves an evasion from present to past situations; the memory of significant people which we are separated mainly by death also increase (maintaining privacy) which entails a process of internal duel that may hold the person in his own world. Finally, in prosocial functions with influence in emotional regulation a positive effect was observed to experience positive emotions in social encounters using the conversation as a way to improve adaptation.