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Table 1 Characteristics of included studies and quality assessment

From: The use of life stories and its influence on persons with dementia, their relatives and staff – a systematic mixed studies review

Authors/Country Title Aim Design Research type Sample, including participants’ characteristics Intervention Outcome Summary of relevant findings Quality assessment
Buron 2010 [53] USA Life history collages. Effects on nursing home staff caring for residents with dementia. To compare changes in nursing staff knowledge of individual residents and their perceptions of knowing the person, staff- to- resident, communication, and staff –to-staff communication before and after exposure to life history collages. A pilot study. A pretest-posttest, quasi-experimental design. Quantitative A convenience sample of five residents with dementia (3 intervention, 2 control) and 36 nursing staff members (18 intervention, 18 control), resident in two nursing homes. Person with dementia: Age: 63–95 years Gender: 1 woman and 4 men Length of stay: 10–11 months MMSE score: 1–11
Staff: Age: 19–62 years Gender: 30 women and 6 men
Profession: 1 RN and 35 other
Length of employment: 0- ≥ 10 years
Interviews with each resident’s surrogate were conducted and tangible (e.g., photos) and intangible (e.g., verbal description) information about each resident in three areas were collected: family, job/careers and likes/dislikes/interests. A graphic design artist used the information to create the essence of each resident’s participant’s life in the form of a life history collage that were placed on the residents’ room walls for a period of 4 weeks. Nursing staff knowledge - author developed questionnaire
Nursing staff perceptions of individualized care
- IC-KNOW
- IC-COMMUNICATION-SR
- IC-COMMUNICATION-SS
The intervention group members’ knowledge of residents’ family, job/careers, and likes/dislikes/interests improved significantly at posttest and at 3 weeks post intervention. The perceptions of individualized care/person centered care practices did not improve significantly. Medium
Haight, Gibson, Michel 2006 [50]
Northern Ireland
The Northern Ireland life review/life storybook project for people with dementia. To test the effectiveness of a structured life review/life storybook process. A controlled pilot study. Pre- and posttest. Quantitative A convenience sample of 30 older people (15 intervention, 15 control) who had mild to moderate dementia, resident in six assisted-living facilities. Person with dementia: Age: 60–99 years Gender: 25 women and 6 men
MMSE score: mean 17.84 at pretest
A series of semistructured interviews guided by the tool The Life Review and Experiencing Form (LREF) was conducted during 8 weeks. A life storybook was constructed by care staff and the participants in dyads. The life storybook was an illustrated loose-leaf binder with photographs and explanatory captions by using the elderly person’s own words. The participants
- cognition (MMSE)
- depression (CSDD)
- mood (AMS)
- function (FIM)
- communication (CS)
- behaviors (MBS)
Significant differences between experimental and control groups were found in 4 out of 6 measures: cognition, depression, positive mood and communication. Medium
Kellett, Moyle, McAllister, King, Gallagher 2010 [52]Australia Life stories and biography: a means of connecting family and staff to people with dementia. To assess the Family Biography Workshop (FBW) designed to support family and staff to co- construct the history of the person with dementia in residential care. A pilot study. Focus group interviews. Qualitative A purposeful sample of seven family careers and their relatives in care, seven care staff and one researcher in long term dementia care.
Person with dementia:
Gender: 1 woman and 6 men
Relatives:
Relationship to the person with dementia: 5 spouses and 2 children
Staff:
Profession: 8 other
The FBW process consisting of a series of six weekly two-hour sessions, involved families and staff completing a set of exercises designed to help them build a biography of the life of the person with dementia. Between the sessions, incrementally, both family members and staff shared biographical materials with the residents, and thus, involving the person with dementia.
The FBW was used to provide a structured process and a defined role for family caregivers to assist staff in personalizing nursing care.
Family-staff caregiver
- attitudes
- perceptions of roles
- conflict
- subsequent management of
stress
For family caregivers “standing outside” four characteristics: freeing the family from the present, breaking free of the disease-saturated narrative, gaining insight into grieving and healing and learning something about my relative not previously appreciated, were found.
For staff “opening possibilities” four characteristics: having a point of reference to communicate with resident and family, appreciating the resident and family member as people bound by a family history, developing insight and understanding into behavior and developing confidence to relate as a person, were found. For person with dementia “knowing how” two characteristics shared by staff and family: knowing how to stimulate and provoke memories and knowing how to calm the person with dementia using biography, were found.
“Complementing the organization” concerning organization issues, three characteristics: promoting community, the challenges of integrating FBW in practice and the complexities of division of labour and responsibility, were found.
Medium
McKeown, Clarke, Ingleton, Ryan, Repper 2010 [48] United Kingdom The use of life story work with people with dementia to enhance person-centred care. To explore the use of taking a Life Story Work (LSW) approach with people with dementia. To investigate the ways in which LSW:
- is understood and developed
in practice
- is experienced by all
participants
- affects the delivery of care
- affects outcomes of care
A multiple case study. Conversations, observations, interviews, and documentary analysis. Qualitative A purposeful sample of four people with dementia across four care settings for people with dementia, 12 multi-professional staff and three relatives.
Person with dementia:
Age: 80–88 years
Gender: 2 women and 2 men
Relatives:
Gender: 3 women
Relationship to person with dementia: 1 spouse and 2 children
Staff:
Profession: 1 RN and 11 other
A practice development approach with six key themes was applied to the LSW intervention. Participant were given the opportunity to develop the use of LSW in whichever way they choose; encouraging the use of creativity in practice. Three cases developed a life story book and one a pen picture. Person-centered outcomes Using LSW can enhance person-centred care. Three main themes: “from patient to person”, “can you hear me?” and “pride and enjoyment”, were found.
For family careers: allowed them to uphold their relative’s personhood.
For care staff: enabled them to see the person behind the patient.
For the person with dementia: enabled their voice to be heard and enabled them to feel proud about themselves and their lives.
Medium
McKeown, Ryan, Ingleton, Clarke
2015 [49] United Kingdom
‘You have to be mindful of whose story it is’: the challenges of undertaking life story work with people with dementia and their family carers. To critically appraise some of the challenges that may emerge through the process of undertaking Life story work (LSW).
Recommend how such challenged may be overcome or minimized.
Contribute to what is currently a gap in the LSW literature.
A multiple case study.
Conversations, observations, interviews, and documentary analysis.
Qualitative A sample of four people with dementia across four care settings for people with dementia, 12 multi-professional staff and three relatives.
Person with dementia:
Age: 80–88 years
Gender: 2 women and 2 men
Relatives:
Gender: 3 women
Relationship to person with dementia: 1 spouse and 2 children
Staff:
Profession: 1 RN and 11 other
A practice development approach with eight principles was applied to the life story work intervention. Three cases developed a life story book and one a pen picture. Experiences of people with dementia, family careers and care staff in using life story work. Several challenges may occur during the process of undertaking LSW. Four main themes “personal disclosures”, “whose story is it?”, “quality of life story books”, and “under and overuse of life story books”, were found. Medium
Subramaniam,Woods, Whitaker 2014 [51] United Kingdom Life review and life story books for people with mild to moderate dementia: a randomised controlled trial. To evaluate the effect of different pathways for developing a life story book (LSB) for people with dementia. A preliminary, randomized single blind controlled trial, with two parallel arms Quantitative A sequential individual-based randomization sample of 23 people with dementia (11 intervention, 12 control) living in 11 care homes participated, 23 relatives and 68 care staff.
Person with dementia:
Age: 73–99 years
Gender: 16 women and 7 men
Length of stay: 25–51 months
CDR: Mild to moderate dementia
Relatives:
Age: 44–83 years
Gender: 15 women and 8 men
Relationship to person with dementia: 13 children and 10 other
Staff:
Age: 20–64 years
Gender: 62 women and 6 men
Profession: 3 RNs and 68 other
Length of employment:
1–40 years
Life review /life story book intervention.
Persons with dementia received 12 individual sessions undertaking the life review process leading to their own life storybook (LSB). Initially the focus is on childhood and adulthood, then family, home and adulthood. Finally there is a summary.
Life story book as gift intervention.
The researcher worked closely with the participant’s relative, meeting them 5–6 times over 12 weeks. Together they developed a life storybook illustrated with photos and pictures to be given as a gift for their relative who was not involved in the process.
The persons with dementia: Primary outcome:
- quality of life (QOL-AD)
Secondary outcome:
- depression (GDS-12R)
- autographical memory (AMIE)
- relationship with their relatives
(QCPR)
Staff:
- approaches to dementia (ADQ) - knowledge about residents
(author developed
questionnaire)
Relatives:
- relationship with the person with dementia (QCPR)
For persons with dementia: A significant between-group difference was found immediately after the life review session had been completed in favor of LSB group. No differences in quality of life between the LSB intervention and the LSB as gift intervention groups were found six weeks after receiving the LSB. For both groups QOL-AD had improved. At 12-week assessment, there was a significant improvement in scores for the LSB group compared with the LSB as a gift group.
There was no significant differences in between the groups on depression. After twelve weeks relationship warmths, rated by the person with dementia, had improved in the LSB group.
For staff: Six weeks after the LSB had been available, staff attitude had improved significantly. Staff knowledge regarding the residents improved significantly at twelve-week follow-up assessment.
For relatives: Quality of relationship improved significantly after the LSBs were produced by either pathways.
High