The Effect of Reminiscence Therapy on the Assessment of Depression, Anxiety and Self‐Esteem in Community‐Dwelling Older Adults: An Intervention Study

ABSTRACT

Background

Reminiscence therapy (RT) is a widely used approach to promote well‐being among older adults and is an effective intervention method for older adults with diverse health conditions, including community‐dwelling older adults.

Objectives

The aim of the study was to determine the impact of group RT on assessments of depression, anxiety and self‐esteem in older adults living in the community.

Methods

We implemented sessions of group simple RT. The sample consisted of 24 older adults living in the community who attended a 12‐week RT course. The duration of each reminiscence session was 60 min. The average age of the sample was 74.7 years. We used the Geriatric Depression Scale, the Geriatric Anxiety Inventory, the Rosenberg self‐esteem scale, the Older adults' Quality of Life—Brief version and the Sense of Coherence scale to assess mental health outcomes before and after intervention.

Results

After intervention, we observed statistically significant improvements in assessments of depression (p < 0.001), anxiety (p = 0.011), self‐esteem (p = 0.007) and the comprehensibility dimension of the sense of coherence scale (p = 0.039). Depression showed the largest effect size (Cohen's d = 0.870; 95% CI: 0.392 to 1.335), indicating a large effect, followed by self‐esteem (Cohen's d = 0.612; 95% CI: −1.044 to −0.170) and anxiety (Cohen's d = 0.543; 95% CI: 0.108 to 0.967), both of which demonstrated a moderate effect.

Conclusions

We found group RT to be effective for several outcomes among older adults. Reminiscence is a good non‐invasive treatment for the promotion of mental health in community‐dwelling older adults.

Implications for Practice

As research has now established RT to be an essential component of activities for older adults in senior care facilities, we should also offer it to those living in the community as an effective activity for the promotion of healthy aging among older adults.

Summary.

• What does this research add to existing knowledge in gerontology?

  • ○
    Reminiscence therapy may influence a wide range of outcome variables in cognitively intact older adults.
  • ○
    We demonstrated group reminiscence therapy to be effective in reducing symptoms of depression and anxiety while also enhancing self‐esteem among community‐dwelling older adults.
• What are the implications of this new knowledge for nursing care for and with older adults?

  • ○
    To support mental health in older adults living in the community, we can offer reminiscence therapy as a cost‐effective intervention.
  • ○
    Reminiscence therapy is straightforward to implement compared to other interventions.
• How could the findings be used to influence practice, education, research, and policy?

  • ○
    The findings might encourage policymakers to offer reminiscence therapy to older adults living in the community as an effective activity for promoting healthy aging among older adults.
  • ○
    Reminiscence therapy is cost‐effective, has minimal adverse effects and is easy to implement, making it a valuable approach for supporting the mental health of older adults.

1. Introduction

Reminiscence is an activation and validation method of working with older adults based on the recognition of the value of memories to the life of each person, which contributes to the enhancement of human dignity, helps to establish contact and improves communication (Janečková, Čížková, and Nentvichová Novotná ²⁰¹⁵). Reminiscence involves reflecting on or recounting of past experiences that hold personal significance (Pinquart and Forstmeier 2012). Examining one's life becomes a pivotal endeavour in old age, and reminiscence increasingly serves as a therapeutic method among older adults to foster self‐acceptance and psychological well‐being. Reminiscence therapy (RT) draws from gerontopsychiatry (Liu et al. 2021) and occurs as either individual or group therapy, structured or unstructured. The literature identifies three primary reminiscence modalities (Pinquart and Forstmeier 2012): simple reminiscence, life review and life review therapy. Simple reminiscence primarily involves informal autobiographical storytelling aimed at communication or sharing information, with a focus on recalling positive past events and enhancing positive emotions. In contrast, life review takes a more structured approach, typically covering one's entire lifespan and conducted one‐on‐one situation. In addition, life review involves re‐evaluating past events and integrating both positive and negative experiences into a cohesive life narrative. Life review therapy, on the other hand, specifically addresses individuals with serious mental health issues such as depression, aiming to reduce feelings of bitterness and boredom, while fostering a positive outlook on one's past (Gaggioli et al. 2014; Kleijn et al. ²⁰¹⁹; Pinquart and Forstmeier ²⁰¹²; Shin et al. ²⁰²³).

Professionals such as psychologists, nurses and social workers began using RT as a method of working with older adults in the 1960s (Coleman 2005), and it appeared in the Czech Republic in the late 1990s. The Nursing Interventions Classification (NIC) system recognises RT as an important nursing intervention, particularly for enhancing the health of older adults residing in the community (Butcher et al. 2017). However, in the Czech Republic, RT remains available only in facilities that provide social services (Siverová and Bužgová 2018).

RT, through targeted activities that use of memories, serves both older adults living in the community and those in institutional care facilities. Despite its benefits, RT remains relatively inaccessible to those residing in the community (Shin et al. 2023). Multiple geriatric syndromes, including depressive symptoms, frequently affect older adults living in the community (Naviganuntana, Kerdcharoen, and Rawdaree ²⁰²²; Shin and Cho ²⁰²²; Schlechter, Ford, and Neufeld ²⁰²³; Volkert et al. ²⁰¹³; Wang, Hu, et al. ²⁰²⁴; Wang, Li, et al. ²⁰²⁴). According to meta‐analyses focusing on individuals aged 60 years and above, the worldwide prevalence of depression stands at 28.4% as determined by cut‐offs scores (Hu et al. 2022). Nevertheless, many studies typically rely on sum scores to assess depression among older demographics, overlooking crucial dynamics within depressive symptom networks that could provide deeper insights (Schlechter, Ford, and Neufeld ²⁰²³). Variability in how depressive symptoms manifest throughout life may contribute to the under‐recognition of depression (Schaakxs et al. 2017).

Global projections indicate a rise in the proportion of individuals aged 65 years or older between 2022 and 2050. In 2022, around 10% of the global population was 65 years or older, a figure expected to rise to nearly 12% by 2030 and 16% by 2050. Projections suggest that by 2050, one out of every four individuals in Europe and Northern America might be 65 years of age or older (UN ²⁰²²). The swift growth of the older adult population could put a strain on medical and welfare facilities due to the heightened occurrence of physical and mental health issues. Therefore, in ‘super‐aged’ society, healthcare for older adults should adopt a prevention‐centred, community‐based approach, which involves actively engaging older adults within the community (Shin et al. 2023).

2. Background

Common mental disorders such as depression and anxiety result in significant declines in health and functioning (WHO ²⁰¹⁷). In adults, depression links to disability, whereas in older adults, it reduces quality of life, increases mortality rates from all causes and serves as a key factor connecting illnesses, unhealthy behaviours and psychological conditions (Brasileiro et al. 2024).

Recent studies observe a high prevalence of depression and anxiety symptoms among community‐dwelling older adults (Brasileiro et al. 2024; Peng et al. ²⁰²⁴; Yalçın Gürsoy and Uçan Yamaç ²⁰²⁴), with depression ranging from 10.4% (Peng et al. 2024) to 17.1% (Yalçın Gürsoy and Uçan Yamaç ²⁰²⁴) and anxiety at between 11.3% (Peng et al. 2024) and 16% (Yalçın Gürsoy and Uçan Yamaç ²⁰²⁴). The frequent occurrence of depression and depressive symptoms in older adults residing in community settings at a global level (Brasileiro et al. 2024) emphasises the importance of implementing preventive interventions.

RT is a widely used approach to promote well‐being among older adults. Researchers recognise it as an effective intervention method for older adults with diverse health conditions (Shin et al. 2023), particularly in patients with dementia (Huang et al. 2015; Woods et al. ²⁰¹⁸; Saragih et al. ²⁰²²). In recent years, RT has proven to be a highly beneficial and inexpensive psychosocial intervention popular in intervention studies among older adults without cognitive impairment (Tam et al. 2021; Wang, Hu, et al. ²⁰²⁴; Wang, Li, et al. ²⁰²⁴; Wu et al. ²⁰²³). To promote positive well‐being in cognitively intact adults, Pinquart and Forstmeier (2012) recommend using simple reminiscence or life review RT therapy. A systematic review based on the results of 16 papers identified several advantages of RT including the follwing: enhancement of cognitive abilities, reduction in anxiety and depressive symptoms, boosting of self‐esteem, greater life satisfaction and improved interpersonal interaction (Yen and Lin 2018). RT has proven effective in studying mental well‐being and quality of life of older individuals in diverse circumstances, yielding significant results. Nevertheless, the full scope of RT outcomes remains uncertain (Yan et al. 2023; Lu et al. ²⁰²³).

3. Aim

In our study, we aimed to determine the effect of group RT on the assessment of depression, anxiety and self‐esteem in older adults living in the community.

4. Methods

4.1. Design

We used a prospective uncontrolled pretest/post‐test intervention study, and we used EQUATOR network guidelines for quantitative (STROBE) data to report the study.

4.2. Participants

The sample consisted of Czech older adults living in the community who attended a course of RT within the Center for Prevention and Promotion of Healthy Aging at the Faculty of Medicine, University of Ostrava, Czech Republic. We invited potential participants to participate in a course of RT via informational leaflets. The centre regularly promotes its activities on its website, through state libraries, older adults' clubs and general practitioners. Inclusion criteria were age 60 years and above, without diagnosis of dementia, ability to understand Czech and a signed informed consent form. Exclusion criteria were self‐reported history of bipolar disorder, schizophrenia, current substance abuse and current psychotherapy. We obtained a signed informed consent form from each participant prior to the beginning of course. We elected to use convenience sampling. In total, 31 participants enrolled in the RT groups. However, only 24 participants attended all the sessions and completed the questionnaires. We excluded participants who did not take part in the second measurement. The main reason for not participating in the second measurement was acute illness.

We calculated the number of participants to ensure a sufficient sample size for demonstrating the impact of RT. With α = 0.05 and a power of 90%, SPSS software indicated that 13 subjects were needed for the study. The effect size (GDS, Liu et al. ²⁰²¹) was approximately 1 (mean difference = 3.83, SD = 3.74).

4.3. Intervention

We implemented group RT for the study, choosing semi‐structured simple RT as the most effective approach for cognitively intact older adult individuals. Simple RT focuses on recalling positive autobiographical events to promote positive emotions.

From February 2022 to November 2023, we organised four RT groups with different participants. Each group had one session a week for 12 weeks, with each session lasting 60 min. Group sizes ranged from six to eight participants, and the same leader/facilitator led all sessions. The leader of the sessions and reminiscence facilitator was a Registered Nurse with a specialisation in psychiatric nursing care and with long‐term experience in psychiatric care. The leader also completed specific training to be a RT leader prior to the start of the courses to guarantee she had an adequate level of expertise in the techniques and to be better able to oversee the quality of the RT programme.

All sessions took place in the same room, free of distractions. The facilitator decorated the room before each session with familiar objects, predominantly vintage items, old books or photographs to stimulate memories and encourage reminiscence. She selected objects carefully in relation to the topic of session. In general, the structure of each RT session aimed to create a stimulating and supportive environment for participants in which to share their memories and to promote emotional well‐being and social interaction. The facilitator made additional efforts to create a warm and inviting atmosphere during reminiscence sessions to aid relaxation and open communication. She encouraged participants to express their thoughts, memories and emotions openly during every session. The facilitator did not comment on the memories of participants. Negative memories which evoked tears were also respected without comment. The facilitator was on hand to offer individual support and consultations, but no participant required them.

The structure of each session consisted of several components: introduction, topic, sharing and reflection, support, summary and feedback. At the beginning of the session, the facilitator served tea or coffee to create a welcoming atmosphere. We guaranteed confidentiality regarding all memories shared during the sessions, ensuring that they remained within the group. At the end of each session, the facilitator announced the topic for the next session and encouraged participants to bring photos or objects relevant to the topic. The facilitator used various materials during each session to evoke reminiscence and align with the subjects under discussion. Reminiscence topics focused on family and childhood; school and school attendance; home and household; cooking, baking and dining; leisure, hobbies and collecting; occupation and employment; culture, favourite movies, singers and actors; travelling and trips and favourite destinations; vacation and recreation; fashion and handicrafts; holidays—christmas and easter. The last session of the course focused on summarising all previous topics, included a brief course evaluation and concluded the course. Czech authors (Janečková, Čížková, and Nentvichová Novotná ²⁰¹⁵) inspired the selected reminiscence structure and topics.

4.4. Data Collection

Researchers collected data before and after the intervention, with each data collection session taking approximately 25 min to complete the questionnaires. None of participants required assistance to complete them. We used standardised questionnaires for assessment of mental health outcomes for data collection. We distributed questionnaires marked with assigned numbers to participants in print form at the Center for Prevention and Promotion of Healthy Aging at Faculty of Medicine, University of Ostrava where the RT session were held. We administered instruments in Czech language. After the final reminiscence session, we distributed the questionnaires to participants. Most participants sent the completed questionnaires by post.

4.5. Instruments

4.5.1. Depression

We used the Geriatric Depression Scale (GDS‐15) to evaluate depression. The GDS‐15 contains 15 items which respondents answer with yes/no (Yesavage et al. 1982; Sheikh and Yesavage ¹⁹⁸⁶). The total score ranges from 0 to 15, whereby scores of 0–5 points indicate normal affect, 6–10 points indicate mild depression and 11 or more points indicate severe depression. The GDS has good psychometric properties with a reliability of 0.92 (Sheikh and Yesavage 1986). The GDS‐15 has a sensitivity of 97% and a specificity of 95% when the cut‐off is five points and more (Nyunt et al. 2009). GDS‐15 was translated into Czech and published by Jirák (2004). Heissler et al. (2020) published Czech normative study where authors presented psychometric properties. The reliability measured by McDonald's ω was 0.72.

4.5.2. Anxiety

We used the Geriatric Anxiety Inventory (GAI) to evaluate anxiety, which comprises a total of 20 items with which respondents can agree/disagree. The total score ranges from 0 to 20, whereby higher scores indicate higher levels of anxiety. Scores above 8–9 points indicate more severe anxiety and scores above 10–11 points suggest generalised anxiety disorder (Pachana et al. 2007). The scale measures dimensional anxiety in older adults. Cronbach's alpha for the original scale was 0.91 among normal older adults. The Czech version was validated by Heissler et al. (2018).

4.5.3. Self‐Esteem

We measured self‐esteem with the Rosenberg self‐esteem scale (RSES). Respondents answered all 10 items of the scale using a four‐point Likert scale format ranging from strongly agree to strongly disagree. The scale ranges from 0 to 30. Higher scores indicate higher self‐esteem. Scores between 15 and 25 are within normal range; scores below 15 suggest low self‐esteem (Rosenberg 1965). The Czech version was published by Blatný and Osecká (1994) and Osecká and Blatný (1997), who conducted a structural analysis on a population of high school and college students. A previous Czech study found the RSES to have very good reliability—Cronbach's α = 0.81 (Bužgová et al. 2023).

4.5.4. Quality of Life

We assessed quality of life using the Older adults' Quality of Life—Brief version (OPQOL‐BRIEF), a standardised questionnaire developed from OPQOL‐35. The OPQOL‐BRIEF contains 13 items. Respondents indicate to what extent they agree with each statement by selecting one of five possible options (‘strongly disagree’, ‘disagree’, ‘agree or disagree’, ‘agree’ and ‘strongly agree’). The total score ranges from 13 to 65. Higher total scores indicate a higher quality of life (Bowling et al. 2013; Bužgová et al. ²⁰²²). The previous study (Bužgová et al. 2022) evaluated psychometric properties of Czech version. The single‐factor model of the OPQoL‐brief scale (CFI = 0.971, TLI = 0.959, RMSEA = 0.061, SRMR = 0.034 and GFI = 0.960) was confirmed, for which excellent reliability was found (α = 0.921 and ICC = 0.904) (Bužgová et al. 2022).

Overall quality of life (Total QoL) is evaluated by one separate item, for which respondents can rate their overall quality of life as follows: very bad—1, bad—2, satisfactory—3, good—4 and very good—5. This item is not included in the total score of the OPQOL‐BRIEF. The reliability of the Czech version is 0.921 (Bužgová et al. 2022).

4.5.5. Sense of Coherence

We measured sense of coherence—a way of seeing the world which facilitates successful coping with the innumerable, complex stressors confronting us in the course of life (Antonovsky 1987, 1993)—by the short version of The Sense of coherence scale (SOC‐13), containing 13 items including three dimensions: comprehensibility (SOC_C)—five items; manageability (SOC_MA)—four items; and meaningfulness (SOC_ME)—four items. Respondents express their level of approval or disapproval on a seven‐point scale. The score ranges between 13 and 91 points, with a higher score indicating a higher sense of coherence (Antonovsky 1987, 1993). The Sense of Coherence scale has high internal consistency. The previous study evaluated psychometric properties of the Czech version of the SOC‐13 where the scale demonstrated excellent reliability (0.92) (Bužgová et al. 2023). In addition, a validation study conducted by Tušl et al. (2024) further supported the robust psychometric properties of the Czech SOC‐13 scale.

4.6. Ethical Considerations

We carried out the study according to the provisions of the Declaration of Helsinki, and it was approved by the Ethics Committee of University of Ostrava (no. 14/2020). All subjects gave their informed consent to inclusion before participating in the study. We assigned a number to each participant, ensuring anonymity throughout the study. Informed consent forms and questionnaires only referenced these assigned numbers rather than participants' names or other identifying data.

4.7. Data Analysis

We selected descriptive statistics (absolute and relative frequency, mean, standard deviation, median and IQR—interquartile range) to describe the data. We chose the Spearman correlation coefficient to calculate the correlations between the variables and the Wilcoxon test to measure the differences between the first and second measurements (before and after the intervention). We measured the size effect of the intervention on the selected variables using Cohen's d, whereby d = 0.2 represents a mild effect, d = 0.5 a medium effect and d = 0.8 a large effect. We set the significance level for all statistical level analyses at p < 0.05. We used the STATA statistical program, v. 24, to process the data.

5. Results

The average age of the sample was 74.7 (SD 4.9; min. 62, max. 83), with most respondents out of the total of 24 in the 71–80 age group (74.9%). The majority of participants were female (95.8%), while 45.8% were widowed, 50% lived alone, and 45.8% were non‐religious (see Table 1).

TABLE 1.

Sample characteristics (n = 24).

	N	%
Age
60–70 years	4	16.7
71–80 years	18	74.9
> 80 years	2	8.4
Gender
Male	1	4.2
Female	23	95.8
Marital status
Single	0	0
Married	8	33.3
Divorced	5	20.8
Widow	11	45.8
Employment
Part‐time job	3	12.5
No	21	87.5
Living with
Alone	12	50.0
Spouse	10	41.7
Children	2	8.3

The average GDS‐15 depression score was 4.50, indicating normal affectivity. The average anxiety score on the GAI was 6.29, which does not suggest severe anxiety. The average self‐esteem score was 18.0, falling within the normal range. The majority of respondents rated their overall quality of life as good (see Table 2).

TABLE 2.

Depression, anxiety, self‐esteem and quality of life scores (n = 24).

	Mean	Median	Min.	Max.
Depression (GDS‐15)	4.50	3.0	0	15
Anxiety (GAI)	6.29	5.0	0	20
Self‐esteem (RSES)	18.00	18.0	0	30
SOC‐13	60.50	62.5	13	91
Total QoL	3.83	4.0	1	5
Quality of life (OPQOL‐BRIEF)	53.54	54.0	25	65

Abbreviations: GAI, geriatric anxiety inventory; GDS‐15, geriatric depression scale; OPQOL‐BRIEF, older adults' quality of life—brief; RSES, Rosenberg self‐esteem scale; SD, standard deviation; SOC‐13, sense of coherence; Total QoL, overall Quality of Life (1 item).

We found the strongest statistically significant negative correlations between the assessment of overall quality of life and depression (r = −0.828, p = 0.001). Participants with better subjective assessments of quality of life had lower levels of depression. The second strongest negative correlation was between self‐esteem and depression (r = −0.662, p = 0.001). Participants with higher self‐esteem had lower levels of depression. We found other statistically significant correlations between self‐esteem and sense of coherence (r = 0.721, p = 0.001) and between self‐esteem and overall quality of life (r = 0.667, p = 0.001). The results are presented in Table 3.

TABLE 3.

Correlation (r) between variables before intervention (first assessment).

	Age	Depression	Anxiety	Self‐esteem	SOC‐13	Total QoL	OPQOL‐Brief
Age	1.000
Depression p	0.416* 0.043	1.000
Anxiety p	0.082 0.705	0.588** 0.003	1.000
Self‐esteem p	−0.322 0.125	−0.662** < 0.001	−0.420* 0.041	1.000
SOC‐13 p	−0.342 0.102	−0.500* 0.013	−0.308 0.144	0.721** < 0.001	1.000
Total QoL p	−0.470* 0.020	−0.828** < 0.001	−0.532** 0.007	0.667** < 0.001	0.495* 0.014	1.000
Quality of life (OPQOL‐BRIEF) p	−0.354 0.090	−0.604** 0.002	−0.357 0.087	0.611** 0.002	0.302 0.151	0.637** < 0.001	1.000

Abbreviations: OPQOL‐BRIEF, older adults' quality of life—brief; SOC‐13, sense of coherence; Total QoL, overall quality of Life (1 item).

*Correlation is significant at the level of 0.05; ** correlation is significant at the level of 0.01.

Following the intervention (Table 4), we found similarly strong negative correlations between the assessment of overall quality of life and depression (r = −0.793, p = 0.001) and between self‐esteem and depression (r = −0.726, p = 0.001).

TABLE 4.

Correlation (r) between variables after intervention (second assessment).

	Depression	Anxiety	Self‐esteem	SOC‐13	QoL	OPQOL‐Brief
Depression	1.000
Anxiety p	0.683** < 0.001	1.000
Self‐esteem p	−0.726** < 0.001	−0.409* 0.047	1.000
SOC‐13 p	−0.609** 0.002	−0.536** 0.007	0.646** < 0.001	1.000
Total QoL p	−0.793** < 0.001	−0.495* 0.014	0.563** 0.004	0.475* 0.019	1.000
Quality of life (OPQOL‐BRIEF) p	−0.250 0.239	−0.040 0.854	0.366 0.079	0.146 0.497	0.595** 0.002	1.000

Abbreviations: OPQOL‐BRIEF, older adults' quality of life—brief; SOC‐13, sense of coherence; Total QoL, overal quality of life (1 item).

*Correlation is significant at the level of 0.05; **correlation is significant at the 0.01 level.

The mean GDS‐15 score for depression before intervention was 4.50 (median = 3.0, IQR = 2.0–7.0), while after intervention it was 3.33 (median = 2.5, IQR = 1.3–5.0). The mean GAI score for anxiety was 6.29 (median = 5.0, IQR = 1–10.8) before intervention and 5.08 (median = 4.0, IQR = 1.0–7.5) after intervention (see Table 5).

TABLE 5.

Effect of RT—comparison of assessment before and after intervention.

Scales	First assessment before intervention			Second assessment after intervention			Wilcoxon test
	Mean	Median	IQR	Mean	Median	IQR	z	p
GDS‐15	4.50	3.0	2.0–7.0	3.33	2.5	1.3–5.0	−3.361	< 0.001
GAI	6.29	5.0	1–10.8	5.08	4.0	1.0–7.5	−2.548	0.011
RSES	18.00	18.0	15.3–20.8	18.75	19.0	16.3–20.0	−2.688	0.007
SOC‐13	60.50	62.5	52.3–66.0	62.08	63.5	51.0–70.0	−1.533	0.125
SOC_C	21.29	21.5	17.5–24.8	22.71	22.5	19.0–26.8	−2.069	0.039
SOC_ME	20.92	21.5	18.0–23.0	21.21	22.0	18.0–24.0	−0.548	0.583
SOC_MA	18.29	18.0	15.0–20.8	18.58	19.0	15.0–21.5	−0.283	0.777
Total QoL	3.83	4.0	3.0–4.0	3.92	4.0	4.0–4.0	−0.707	0.480
OPQOL_brief	53.54	52.5	51.0–57.5	54.21	54.0	49.3–60.5	−0.394	0.694

Note: P values in bold are statistically significant. Abbreviations: GAI, geriatric anxiety inventory; GDS‐15, geriatric depression scale; OPQOL‐BRIEF, older adults' quality of life—brief; RSES, Rosenberg self‐esteem scale; SOC_C, comprehensibility dimension; SOC_MA, manageability dimension; SOC_ME, meaningfulness dimension; SOC‐13, sense of coherence; Total QoL, quality of life (1 item).

Group RT proved to be effective in improving several outcomes among older adults. After intervention, there were statistically significant improvements in the assessments of depression (p < 0.001), anxiety (p = 0.011), self‐esteem (p = 0.007) and the comprehensibility dimension of the Sense of Coherence scale (p = 0.039). We observed the largest effect‐size for depression (Cohen's d = 0.870; 95% CI: 0.392 to 1.335), indicating a large effect, followed by self‐esteem (Cohen's d = 0.612; 95% CI: 1.044 to −0.170) and anxiety (Cohen's d = 0.543; 95% CI: 0.108 to 0.967) for which the effect was moderate. We observed no significant improvement after RT in the total quality of life, the OPQOL brief and the other two dimensions of the Sense of Coherence scale.

6. Discussion

The main aim of the presented study was to determine the effect of group RT on the assessment of depression, anxiety and self‐esteem in older adults living in the community. RT is a good non‐invasive treatment for the promotion of mental health in older adults. In the course of RT, memories are stimulated and developed in a variety of ways in order to improve quality of life, activate psychosocial functions and strengthen identity and self‐worth awareness. Engaging in RT can assist older individuals in reflecting on their memories, experiences and achievements, thereby facilitating successful aging (Yen and Lin 2018). Compared to other interventions, RT is straightforward to implement. In addition, it is cost‐effective with minimal adverse effects.

RT in our sample of older adults proved to be an effective intervention to improve assessments of anxiety, depression, self‐esteem and the comprehensibility dimension in the Sense of Coherence scale. The improvement in assessment before and after the RT intervention was statistically significant. Quality of life also improved; however, the difference was not statistically significant.

In our sample, RT showed the greatest effect in alleviating symptoms of depression. Although older adults in our cohort did not exhibit obvious depression, their depressive symptoms assessment improved. Our findings are consistent with previous studies confirming that depressive symptoms in older adults significantly decreased after RT (Pinquart and Forstmeier 2012; Liu et al. ²⁰²¹). The high prevalence of depressive symptoms in older adults in the community emphasises the urgency of preventive and more precisely tailored interventions (Brasileiro et al. 2024). Depression frequently goes unnoticed among older adults, and inadequate treatment can result in persistent impairment (Barry et al. 2012).

In our sample of older adults, we found RT to have had a large effect on depressive symptoms. Huang et al. (2015) have shown RT to have a small effect on cognitive functions and a moderate effect on depressive symptoms. Therefore, in their systematic review, they recommend RT as a standard component of care for older individuals with dementia to enhance cognitive functions and alleviate depressive symptoms.

Another interesting result was the improvement in sense of coherence after RT in older adults. We measured sense of coherence with the SOC scale, which is a reliable, valid and cross‐culturally applicable instrument to measure how people manage stressful situations and stay well (Eriksson and Lindström 2005). The SOC seems to be a health‐promoting resource, which strengthens resilience and develops a positive subjective state of health (Eriksson and Lindström 2006). The sense of coherence construct refers to the global orientation to one's inner and outer environments which is hypothesised to be a significant determinant of location and movement on the health ease/disease continuum (Antonovsky 1993). Although assessments for the overall SOC scale and all three of its dimensions improved after RT in our sample, only the change in the comprehensibility dimension was statistically significant. Comprehensibility refers to the extent to which one perceives internal and external stimuli as rationally understandable, and as information that is orderly, coherent, clear and structured as opposed to noise—that is, chaotic, disordered, random, unexpected and unexplained (Erikson, 016). Sense of coherence is a psychological process that influences the mental health status of patients, subsequently impacting their physical health (Galletta et al. 2019).

Reports suggest RT has a moderate effect on the relief of anxiety symptoms in healthy older adults and in other patient groups (Pinquart 2024), for example, cancer patients (Zhang et al. 2021; Chen et al. ²⁰²⁴). A group of postoperative gastric cancer patients undergoing RT exhibited a decrease in the percentage experiencing anxiety (Zhang et al. 2021). A recent systematic review (Pinquart 2024) found minor to moderate enhancements in anxiety symptoms following RT.

Several secondary studies have investigated the positive effects of reminiscence‐based interventions on older adults, including quality of life, life satisfaction, cognitive abilities and mental health indicators such as depressive symptoms. Additionally, these interventions have shown some positive impact on daily functioning, self‐esteem, well‐being and caregiver burden (Yan et al. 2023). Other findings of systematic reviews similarly confirm that RT significantly reduces symptoms of depression, improves life satisfaction (Xu et al. 2023) and improves physical and mental health and cognitive function of older adults living at home (Shin et al. 2023).

We chose group RT for our study. The findings of systematic reviews repeatedly confirm a greater impact of group RT compared to one‐on‐one sessions (Liu et al. 2021; Shin et al. ²⁰²³). The duration of the intervention is equally important in terms of RT effectiveness. To enhance the self‐esteem and quality of life of older adults in the community, Shin et al. (2023) recommend providing at least 12 sessions of group RT. For our study, we chose a 12‐week duration of group RT. A group size of 7–12 participants is common and considered optimal for group RT (Yen and Lin 2018), and we selected this ideal number of participants for each group in our study. In a small group setting, the leader can more effectively manage the RT process, allowing for better observation of participants' reactions, providing opportunities for feedback and ensuring equal participation for all.

6.1. Limitations and Strengths

There are several limitations to this study. The greatest limitation lies in the convenience sampling and low number of participants, which prevents the generalisation of the results to the entire populations of older adults living in the community. The second limitation is the unbalanced gender sample—only one man was included in our sample. Improving the balance between male and female participants could enhance the clarity of the results. The third limitation is that all measuring instruments were developed in other countries.

On the other hand, a strength of this study is its use of different instruments to reveal the effect of RT on different outcomes in older adults.

6.2. Implications for Practice

As research has now established RT to be an essential component of activities for older adults in care facilities, it should also be offered to older adults living in the community as an effective activity for promoting healthy aging among older adults. Implementing RT in community‐based settings can enhance cognitive function, emotional well‐being and social interaction, which are critical to maintaining independence and quality of life in aging populations. Furthermore, integrating this therapeutic approach into routine primary care may facilitate early interventions for cognitive decline and provide a non‐pharmacological means to address symptoms of depression and anxiety. Health professionals should receive targeted training on how to effectively deliver RT in diverse settings. By incorporating this evidence‐based intervention into community healthcare models, we can foster a more holistic approach to aging, addressing both mental and physical health in older adults.

7. Conclusion

We have demonstrated RT to be effective at alleviating depressive symptoms and anxiety, improving self‐esteem and sense of coherence. There was no significant impact of RT on the quality of life of cognitively healthy older adults. This therapy can be offered as a useful non‐pharmacological intervention for promoting the mental health of older individuals residing in the community. We recommend further studies with a larger sample size to validate our findings and support the hypothesis that RT is a non‐invasive intervention to support mental health among community‐dwelling older adults.

Author Contributions

In accordance with the International Committee of Medical Journal Editors guidelines, all authors meet the authorship criteria and all authors are in agreement with the manuscript. Study design: R.B.; data collection and analysis: R.Z., R.B., J.H., K.B. and R.K.; and manuscript preparation: R.Z. and R.B.

Ethics Statement

The study was carried out according to the provisions of the Declaration of Helsinki and was approved by the Ethics Committee of University of Ostrava (no. 14/2020). All subjects gave their informed consent to inclusion before participating in the study. Each participant was assigned a number, ensuring anonymity throughout the study. Informed consent forms and questionnaires only referenced these assigned numbers rather than participant names or identifying data.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.