Life satisfaction is a cognitive evaluation of an individual’s overall life status; in other words, it is an estimation of how much an individual likes his life (Erikson, 1980). The concept of life satisfaction denotes the overall evaluation of life, which contrasts with the “subjective well-being” in response to a person’s current feelings or specific psychosomatic symptoms (Veenhoven, 1996). Early studies have linked many factors to life satisfaction in older adults. Jelicic and Kempen (1999) exam-ined community-dwelling elderly persons’ life experiences and found that the more chronic conditions they had, the lower their life satisfaction levels. Another study found that older adults with better financial and social support and higher education had higher life satisfaction (Chi & Chou, 1999). Another previous study showed that social interaction, perceived control, social position, and health are predictors of life satisfaction in community-dwelling older adults (Pinto & Neri, 2013). A meta-analysis confirmed that social position, social networks, and sense of well- being are positively associated with life satisfaction in older adults (Pinquart & Forstmeier, 2012).
It has been suggested that narrating one’s life story can improve life satisfaction in older adults (Roesler, 2006). According to Erikson (1980), each older adult has eight psychosocial life stages span across the life cycle that consists of “trust versus mistrust, autonomy versus shame and doubt, initiative versus guilt, industry versus inferiority, identity versus role confusion, intimacy versus isolation, generativity versus self-stagnation, and ego integrity versus despair.” In terms of human developmental status, these eight stages can be classified into four stages: child-hood, adolescence, adulthood, and old age (Erikson, 1963).
Butler (1963) extends Erickson’s work by proposing that “ego integrity can be attained through recalling one’s past from an analytical and evaluative viewpoint,”which indicates the important function of reminiscence and life review in an older adult’s successful life adaptation. Reminiscence is a spontaneous and naturally occurring process of recalling the past as an older person when triggered by thoughts of one’s approaching death (Butler, 1974). According to Butler (1974), an older person loses his or her sense of competency as a productive individual, leading to discrepancies in self-concept, which may initiate a life review process. Haight (1988) introduced using life review as a therapeutic intervention to decrease depres-sion by allowing an individual to identify with his or her past accomplishments and affirm present self-worth.
Many published papers have examined the effectiveness of the life review pro-cess for older adults, but few studies have focused on its influence on life satisfac-tion. Haight (1988) conducted a life review process for 60 homebound older adults in the United States and found a significant improvement in life satisfaction in the intervention group. Serrano et al. (2004) used life review therapy as an autobio-graphical retrieval practice in depressed elderly aged 65 to 93 years. Their results showed an increased life satisfaction score at two weeks post-intervention com-pared with the control group. Meléndez Moral et al. (2015) found a significant improvement in life satisfaction for older adults in the reminiscence group than in control groups. More recent studies on older adults in nursing homes found that residents in the life review group had better life satisfaction levels than the control group (Lan et al., 2018; Ejaz et al., 2022). However, in a subsequent study, Lai et al. (2018) found no significant difference between the life review and the control group in life satisfaction scores of community-dwelling older adults in Hong Kong. Hanaoka and Okamura (2004) reported no significant difference between the life review and control groups in life satisfaction scores of older adults in Japan. However, they suggested that an older adult’s context may influence the life satis-faction they derive from a life review. Ligon et al. (2012) examined the effect of life review on life satisfaction among older adults, with no significant difference between the two groups. However, there was a significant difference 10 weeks later, implying that a life-story review may improve life satisfaction among older adults over time. A meta-analysis reported that older adults did not receive any beneficial effects on life satisfaction via reminiscence (Chin, 2007). In contrast, two other meta-analyses found that the effect of reminiscence on older adults on life satisfac-tion was from moderate (d = 0.54) to small (d = 0.22) (Bohlmeijer et al., 2003; Pinquart & Forstmeier, 2012). However, no conclusive results from previous studies suggest that further experimental studies need to be conducted to examine the potential effects on different ethnic groups. This study aimed to examine the impacts of life-story book creation for older adults on their life satisfaction. We hypothesized that participants in the life-story book group would have a better life satisfaction than the control group.
Methods
Design, Setting, and Sample
This is a randomized controlled trial design, and subjects were enrolled at one com-munity center in Singapore, and the data collection was covered for 8 months. All subjects were community-dwelling Singaporean older adults aged 60+ years. They communicated in either Mandarin or English easily without a hearing aid and were able to read and sign the consent form. We excluded those who had a medical diag-nosis with either Parkinson’s disease, dementia, or Alzheimer’s disease. Also excluded are those receiving medications, such as hypnotics, sedatives, antidepres-sants, antihistamines, tranquilizers, and/or melatonin, because of the potential of these medicines to affect their cognitive function (Katzung, 2018; Polit & Beck, 2022). In addition, subjects allocated to the life-story group who did not wish to be audio-recorded were excluded because audio transcripts were required to create their life-story book.
The required samples were based on the difference between the life-story and control groups on life satisfaction levels. A previous study conducted by Ligon et al. (2012) reported that the effect size on life satisfaction levels for older adults by using reminiscence-related activities was 0.41 compared with the control group. Assuming a similar effect size and based on a repeated measures design for this study. The PASS 11 (Hintz, 2011) showed that at least 48 subjects (24 per group) would be needed to achieve 80% power on between groups (effect size = 0.41), 82% power on within-time (effect size = 0.51), and 81% power on the interaction (effect size = 0.51) effects at 5% significance levels.
All potential subjects were recruited using convenience sampling at one com-munity center. In total, 119 older subjects were approached and 91 participated (response rate = 76.5%). Each participant was asked randomly to pick up a ball from a bag to assign him or her into either the life-story book or control group, while the bag contained two balls only one labeled as “life-story” and the other as “control”. After an initial screening by our interviewers, who are registered nurses, 47 out of 91 were eligible. There were 23 and 24 subjects randomly assigned to the life-story and control group, respectively, and all 47 subjects com-pleted the study.
Measures
The instrument has two sections: Section 1 collected subjects’ demographic (e.g., age, gender, and education) characteristics and health (e.g., existing chronic illness, hypertension, diabetes, and depression levels) information. The 15 items Geriatric Depression Scale (GDS-15) was used to assess the depressive symptoms of each subject (Chan, 1996). Section 2 used the 20 items Life Satisfaction Index A (LSIA) scale to collect subjects’ life satisfaction levels (Adams, 1969). The two-point scor-ing was selected instead of the three-point scoring because it is simpler and easier for subjects to answer. There are no significant statistical differences between them (Neugarten et al., 1961). For the two-point scoring, “No = 0” represented unsatisfied in each question, and “Yes = 1” represented satisfaction with life. Hence, 20 and zero were the maximum and minimum scores of LSIA, respectively. A higher total score indicated better life satisfaction. LSIA has a good internal consistency (Cronbach’s α) in the English (0.86) and Chinese (0.67) versions (Neugarten et al., 1961; Lou et al., 2008).
Training fortheInterviewers
All interviewers were required to attend a training course before starting the inter-view process. The training course focused on understanding the skills of conducting a life-story interview with the older adults by practicing how to talk appropriately with the elderly using the interview guide questions. A role-play interview was included in the training to ensure a standardized and reliable intervention. To ensure good inter-rater reliability, all interviewers were required to rate the same standard-ized subjects’ LSIA scores (intra-class correlation coefficient = 0.84). Samples of the life-story books were shown to the interviewers, which facilitated the under-standing of the book production process.
Life-Story and Control Groups The research process of creating the life-story book for the participant in the inter-vention group was through interviews and took place in his/her home. A set of semi-structured questions helped guide each interview developed from the previ-ous studies (Chan et al., 2013; Birren & Deutchman, 1991), which span the human development into childhood, adolescence, adulthood, and old age stage. All con-versations between the interviewer and participants were audio-recorded for 30–45 minutes. The interview sessions included memory recall assisted by sharing their stories and expressing their feelings. The subjects’ life stories were transcript into text and included with related photographs. A bounded book was compiled and presented to them on week 8. The interviewer will collect participants’ life satisfaction 4 times per week in the first 4 weeks and 1 time in week 8. While sub-jects from the control group also met with the interviewers in their homes. The number of visits was the same as the intervention group. However, no life-story sharing during the meeting and the interviewer collect their life satisfaction levels at each meeting.
Ethical Issues
Ethical approval was obtained from the target community center and the Institutional Review Board (NUS-IRB: 12–161). Subjects had to sign the consent before partici-pating in the study. At the same time, they are on a voluntary base and free to with-draw at any time point.
Statistical Analysis Descriptive statistics (e.g., mean, standard deviation, frequency, and percentage) were used to describe subject profiles. Independent t-test, Mann–WhitneyU test, χ2 test, and Fisher’s exact test were used to compare groups on demographic and health information to ensure homogeneity. A generalized estimating equation (GEE) method was used to determine the impacts of the life-story book creation on life satisfaction levels while adjusted by demographic and health factors. IBM SPSS v23 performed all data analyses, and significant levels were set at a 5% alpha level.