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. 2025 Nov 5;25:847. doi: 10.1186/s12877-025-06484-6

Effectiveness of reminiscence therapy on multiple health outcomes for older adults: an umbrella review

Yongliang Jiao 1,2, Kexin Huang 1, Hebing Liu 1, Hayley Gains 3, Yong Jia 1,✉, Li Chen 1,✉
PMCID: PMC12587503  PMID: 41193992

Abstract

Background

Many systematic reviews and meta-analyses have reported the effect of reminiscence therapy (RT) on older adults. However, results highlight inconsistent outcomes. Our aims of this study are to summarize the evidence and evaluate the effectiveness of reminiscence therapy (RT) in older adults by using an umbrella review methodology.

Methods

An umbrella review of systematic reviews and meta-analyses including randomized controlled trials (RCTs) investigating the effects of reminiscence therapy (RT) on older adults. Ten databases including PubMed, the Cochrane Library, Embase, Web of Science, CINAHL, APA PsycNet, CNKI, VIP, SinoMed, and Wanfang Database were searched to identify articles in English or Chinese from inception to November 9, 2023. Two authors of this review independently selected the studies, assessed their quality and extracted the data from the included studies. A quality assessment of eligible reviews was conducted using the AMSTAR 2.0 tool, PRISMA, and GRADE tool. Estimated 95% prediction intervals and heterogeneity were also calculated.

Results

A total of 21 systematic reviews and meta-analyses were included in this umbrella review, examining the effects of RT in older adults. Collectively, these reviews encompassed 246 RCTs involving a total of 18,177 participants and evaluated 12 outcomes, which were classified into 4 domains (emotional outcomes: depression, anxiety, loneliness, apathy and self-esteem; cognitive outcomes: cognitive function; behavioral outcomes: agitation behavior, functional behavior, communication and interaction; overall well-being: quality of life, life satisfaction and well-being). The overall methodological quality of the included reviews was rated as critically low according to the AMSTAR-2.

Conclusions

While the existing evidence suggests that RT may have potential benefits in enhancing self-esteem, communication and interaction, functional activities, and reducing loneliness, these findings should be interpreted with caution given that most included reviews were rated as critically low quality. Current evidence does not support the effectiveness of RT in improving well-being, agitation behaviors, or apathy, and mixed results were observed for other outcomes. To draw more definitive conclusions regarding the efficacy of RT, future research should employ rigorous methodological designs, involve larger and more diverse samples, and ensure longer follow-up periods.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-025-06484-6.

Keywords: Reminiscence therapy, Older adults, Umbrella review, Health

Introduction

With the advancement of medical technology, the expected lifespan of the global population is increasing, leading to a global phenomenon of population aging [1]. It is projected that older adults worldwide will increase from 9.3% in 2020 to 16.0% in 2050 [1]. With a rapid increase of the prolonged life expectancy and aging population, age-related morbidities have become major public health concerns [2].

As the physiological function and social abilities of older adults gradually decline, they are more prone to facing numerous health challenges in both physiological and psychological domains [3]. Physical frailty [4], reduced mobility [4] and increased risk of chronic diseases [5] including heart disease, stroke, and diabetes are some of the physiological problems they may encounter. Studies have shown that older adults are highly affected by chronic diseases. For instance, 180 million people (accounting for 75% of the total older adults), experience disability or semi-disability. Meanwhile, the psychological effects can include feelings of loneliness, anxiety and depression as they grapple with changes in their roles, relationships and social connections [6]. Older adults are at a heightened risk of experiencing both social isolation and loneliness, due to factors such as the loss of friends and family members, limitations in mobility, and cognitive decline [7]. According to the National Mental Health Blue Book of China, nearly one-third of elderly individuals experience depressive symptoms. Anxiety symptoms have been found among 12.15% [8]. Depression significantly impacts the overall well-being and quality of life of older adults, evidenced by a notable 8.3-year gap in quality-adjusted life expectancy between those suffering from depression and those without the condition [9]. It is therefore essential to seek an effective intervention to improve the quality of life and overall health of the older adults.

Currently, the main therapeutic interventions for older adults include pharmacological and non-pharmacological treatments. There is a widely acknowledged phenomenon whereby a significant proportion (30%) of older adults have problematic compliance with their medication [10], and non-compliance often leads to worsening of symptoms and other age-related comorbidities [11]. Therefore, implementing non-pharmacological treatments could be a method to improve the health of older adults.

Reminiscence therapy (RT), is a non-pharmacological treatment for older adults [12]. RT has been widely used for many years in several countries and has become one of the most popular psychological interventions for the older adults [13]. Initially proposed by Robert Butler in 1963 and influenced by Eric Erickson's growth theory, reminiscence is now characterized as either volitional or nonvolitional recollection of memories from a person's past [14]. This process can affect various psychological functions [15]. The American Nursing Interventions Classification System recognizes RT as a psycho-social intervention that can be implemented independently, and defined it as a process of reviewing past events, emotions, and thoughts to help individuals increase happiness, improve quality of life and enhance adaptation to the current environment [16]. RT includes escapist reminiscence, compulsive reminiscence, narrative reminiscence, communicative reminiscence, instrumental reminiscence, and comprehensive reminiscence [17]. Comprehensive reminiscence therapy is further divided into individual and group reminiscence therapy. Whether it is individual or group reminiscence, based on the depth of memories, it can be divided into simple reminiscence, life review, and life review therapy [18].

In recent years, many studies have made progress in exploring the effectiveness of RT for improving multiple health outcomes among older adults. RT has been shown to alleviate negative emotions [12, 19], reduce depression [18, 20, 21] and anxiety [22, 23], and enhance self-esteem [24]. Evidence also suggests its potential in reducing loneliness [25]. Cognitive outcomes have been reported in several studies, indicating improvements in cognitive function [26, 27]

In recent years, many studies have made progress in exploring the effectiveness of RT for improving multiple health outcomes among older adults. RT has been shown to alleviate negative emotions [12, 19], reduce depression [18, 20, 21] and anxiety [22, 23], and enhance self-esteem [24]. Evidence also suggests its potential in reducing loneliness [25]. Cognitive outcomes have been reported in several studies, indicating improvements in cognitive function [26, 27]. In addition, RT has been associated with improvements in functional behavior as well as communication and interaction [13], and agitation behavior [13]. Furthermore, evidence indicates that RT can enhance quality of life and life satisfaction among older adults [12, 22]. The growing evidence base for the benefits of RT has led to its increasing application in diverse settings, such as nursing homes, hospitals, and community centers. However, despite its widespread adoption, the conclusions of these systematic reviews display some inconsistencies. This highlights the need for a comprehensive synthesis of the available literature to evaluate the overall effectiveness of RT across different health domains in older adults. Umbrella reviews, a methodological approach, allow for the systematic and integrative assessment of evidence from multiple systematic reviews and meta-analyses on a given topic [28]. To the best of our knowledge, no umbrella review has yet synthesized the evidence on RT for older adults.

Accordingly, the present umbrella review aims to systematically and comprehensively evaluate the effectiveness of RT in improving multiple health outcomes among older adults. By synthesizing the findings from various studies, we hope to gain a deeper understanding of the mechanisms and boundaries of RT's benefits, as well as contribute to the development of more targeted and effective interventions for improving the mental health and well-being of older adults.

Methods

The umbrella review complied with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) (Supplementary Table S1) reporting checklist and was registered at the International Prospective Register of Systematic Reviews (registration number: CRD42023466487).

Inclusion criteria

Inclusion and exclusion criteria for literature screening were developed according to the PICOS strategy [29].

Population

The participants in the included studies were older adults aged 60 years or above, regardless of gender, ethnicity, or residential setting. Studies were eligible whether participants had cognitive impairment or mental disorders.

Intervention and control conditions

The intervention in the included studies was required to involve RT as the sole primary component, including individual or group-based formats, regardless of delivery method. Studies were excluded if RT was combined with other structured psychological or behavioral interventions. The control condition was required to include at least one comparison group. Acceptable control groups could receive either a single or a combination of interventions, such as usual care, routine care, waiting list, health education, standard support, or placebo, provided they did not involve structured RT.

Outcome measures

All included studies had to include the effect of reminiscence therapy on a health outcome, including emotional outcomes (depression, anxiety, loneliness, apathy and self-esteem), cognitive outcomes (cognitive function), behavioral outcomes (agitation behavior, functional behavior, communication and interaction), overall well-being (quality of life, life satisfaction and well-being). The studies had to report an outcome using at least one reliable and valid scale. The results had to contain sufficient statistical data for further statistical analysis. In addition, studies were excluded if they displayed problematic data such as, incomplete data.

Types of studies

The umbrella review included systematic reviews and meta-analyses of RCTs.

Search strategy

Searches were conducted on ten databases including: PubMed, the Cochrane Library, Excerpt Medica Database (Embase), Web of Science, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), American Psychological Association PsycNet (APA PsycNet), China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), SinoMed (CBM) and Wanfang Database. The searches included literature from the establishment of the database to November 9, 2023 and were last updated on June 26, 2024. The search terms “reminiscence”, “nostalgia”, “life story book”, “life review”, “older people”, “elder people”, “systematic review”, “meta”, and related synonyms, were used in the search terms. In addition, references from previous relevant meta-analyses and reviews were manually checked to identify potentially eligible studies. Two researchers independently reviewed the titles and abstracts and carefully read the full text of potentially eligible studies to determine inclusion. A third researcher resolved any disagreements. Details of the search strategy are provided in Supplementary Text S1.

Study selection and data extraction

The process of study selection and data extraction was carried out independently by two researchers. Discrepancies were resolved through discussion with a third researcher. After excluding duplicates, the study titles and abstracts were screened using the inclusion criteria to identify potentially eligible studies. Then, the full texts of the potentially eligible studies were obtained and reviewed again for final inclusion. Data was extracted to include the first author's name, publication year, country, sample size, number of included RCTs, intervention contents for the intervention and control groups, intervention duration, and risk of bias. If the published data were insufficient, we contacted the authors to obtain the necessary data. If the author did not respond within a week, we sent another email. If the author still did not answer, the study was excluded.

Quality assessment

Methodological quality assessment

The Assessment System for Evaluating Methodological Quality 2 (AMSTAR-2) was used to evaluate the methodological quality of the included literature [30]. The AMSTAR-2 consists of 16 items, with items 2, 4, 7, 9, 11, 13, and 15 being the key domains. The detailed evaluation criteria are presented in Supplementary Table S2. The RCTs are considered “high quality” when there is no or only one noncritical weakness, “moderate quality” when there is more than one noncritical weakness, “low quality” when there is only one critical few with or without noncritical deficiencies, and “critically low quality” when there is more than one crucial few with or without noncritical weakness.

Confidence in the cumulative evidence

The quality of the evidence reported in the included systematic reviews was evaluated using the Grades of Recommendation, Assessment, Development and Evaluation profiler Guideline Development Tool (GRADEpro GDT). The GRADEpro GDT categorizes the quality of evidence based on randomized controlled trials (RCTs) as high, considering five factors for downgrading: risk of bias, indirectness, inconsistency, imprecision and publication bias. The final quality of evidence can be assessed as “high”, “moderate”, “low”, or “very low”.

The convincing of the evidence

Following the methodology adopted in previous umbrella reviews [31, 32], the strength of the observed associations was graded using predefined quantitative criteria. These criteria considered the following: significance at P ⩽0.05 and P ⩽0.001,inclusion of over than 500 or 1000 cases for binary outcomes (more than 2500 or 5000 total participants if the metric was continuous); absence of considerable heterogeneity (I2 < 75%); 95% PI excluding the null value and absence of small study effects.

Based on these criteria, nominally statistically significant associations (P < 0.05) from meta-analyses evaluating the effectiveness of RT were classified into 5 levels [32]:

  • Convincing evidence Significance at P ≤ 0.001; > 1000 cases (or > 5000 total participants if the metric was continuous); no large amount of heterogeneity among studies (I2 < 50%); 95% PI excluding the null value.

  • Highly suggestive evidence Significance at P ≤ 0.001; > 1000 cases (or 5000 total participants if the metric was continuous); no considerable heterogeneity among studies (I2 = 50–75%).

  • Suggestive evidence Significance at P ≤ 0.001; 500–1000 cases (or 2500–5000 total participants if the metric was continuous).

  • Weak evidence Significance at P ≤ 0.05.

  • No evidence Significance threshold not reached (P > 0.05).

Statistical analysis

The Corrected Covered Area (CCA) method was applied to quantify the degree of overlap in RCTs across all included reviews [33]. A CCA score of 0% indicates that each review comprised entirely distinct RCTs, whereas a score of 100% reflects complete overlap, with all reviews including the same trials. Overlap was categorized using the following thresholds: slight (0–5%), moderate (6–10%), high (11–15%), and very high (> 15%).

For each meta-analysis, we recalculated all associations included in the umbrella study, including 95% confidence interval (95% CI), 95% prediction interval (95% PI), and heterogeneity (Cochran's Q-test and I2). First, we use a random effects model to analyze the meta-analyses and determine the overall effect size and its 95% CI. The 95% PI, as long as it is used for the real range of effects expected in the future environment, indicates the outcome of the patient’s treatment [34]. As a test of homogeneity of effect sizes, we calculated the I-square (I2) statistic [35] and Cochran's Q statistic. I2 values of 25%, 50% and 75% were considered low, medium and high heterogeneity, respectively. Cochran's Q statistic was used to evaluate the heterogeneity among studies, and heterogeneity was considered to be present when P < 0.05.

Results

Study selection

The searches of 10 databases resulted in the identification of of 585 records. Of these, 227 duplicate studies were removed through computer automation tools and manually. Then, title and abstracts were screened resulting in the exclusion of 295 papers. The remaining 63 studies were screened by reading the full text. This resulted in the final inclusion of 21 systematic review and meta-analysis. Please refer to Fig. 1 for a detailed overview of the literature screening process and results.

Fig. 1.

Fig. 1

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Flow diagram of the search and selection of studies

Characteristics of the included studies

Table 1 reports the information of all reviews that met the inclusion criteria. There were 21 included reviews of 246 RCTs with populations ranging from 79 to 2,752. All reviews were published between 2008 and 2023. The studies were conducted in China (n = 14), the UK (n = 1), Korea (n = 1), Sweden (n = 1), Ireland (n = 1), Netherlands (n = 1) Canada (n = 1) and Oman (n = 1). The intervention methods in the intervention group included group reminiscence therapy, individual reminiscence therapy, life review, and storybooks. The intervention methods in the control group included blank control, routine care, health education, routine treatment and supportive care. The duration of treatment ranged from 1 to 96 weeks. With regards to population characteristics, the research population in 4 systematic reviews was older adults with depression, while the population in 9 systematic reviews was older adults with dementia. One systematic review focused on older adults in nursing homes, one on older adults with life-threatening conditions, and one on older adults with terminal cancer. The quality assessment tools used in the systematic review were the Joanna Briggs Institute RCT checklist and the Cochrane Handbook.

Table 1.

Selected characteristics of the included literature

Author, year Country Number of included studies (Sample size) Participants Intervention group Control group Treatment duration Risk of bias tool
[20] Oman 15 (963) Older adults with depression Life review No intervention 4–52 weeks JBI RCT checklist
[36] China 3 (251) Older adults in pension institutions Group reminiscence therapy (n = 3) Health education 6–36 weeks CRBT
[37] China 7 (571) Older adults with depression Life review (n = 7)

No intervention (n = 2);

Wait list (n = 2);

Usual care (n = 2)

Health education (n = 1)

 1–48 weeks CRBT
[25] Canada 2 (211) Older adults Individual reminiscence therapy (n = 2)

No intervention (n = 1);

Writing on neutral topics (n = 1)

 6–8 weeks CRBT
[26] China 12 (1,325) Older adults with dementia

Individual reminiscence therapy (n = 1);

Group reminiscence therapy (n = 11);

Usual care (n = 5)

No interventions (n = 5)

 5–12 weeks CRBT
[27] China 13 (1,128) Older adults with dementia

Reminiscence therapy (n = 10);

Group reminiscence therapy (n = 2);

Simple reminiscence (n = 1);

 Routine interventions 4–48 weeks CRBT
[38] Sweden 3 (135) Older adults with depression Reminiscence therapy Wait list 6–12 weeks CRBT
[39] China 2 (79) Older adults with dementia Reminiscence therapy Unclear Not reported CRBT
[40] China 21 (1,235) Older adults with dementia

Individual reminiscence therapy (n = 11);

Group reminiscence therapy (n = 7);

Individual Life story book (n = 3)

 Routine interventions 3–24 weeks CRBT
[41] China 13 (1,847) Older adults with mild-to-moderate dementia Group reminiscence therapy (n = 13)

Routine interventions (n = 6);

No interventions (n = 7)

 6–40 weeks CRBT
[42] China 10 (527) Older adults

Individual reminiscence therapy (n = 2);

Group reminiscence therapy (n = 3);

Reminiscence therapy (n = 5)

Routine care (n = 7)

Wait list (n = 1)

Health education (n = 2)

Attention control activities (n = 2)

 6–10 weeks CRBT
[22] China 34 (2,752) Older adults with life-threatening illnesses

Individual reminiscence therapy (n = 12); Group reminiscence therapy (n = 12);

Mixed (n = 1);

Reminiscence therapy (n = 4);

Individual life story book (n = 1);

Individual life review (n = 3)

Passive control activities (n = 6);

Routine interventions (n = 21);

No interventions (n = 4);

Unclear (n = 3)

 4–12 weeks CRBT
[43] China 14 (612) Older adults with dementia

Individual occupational reminiscence therapy (n = 1);

Group reminiscence therapy (n = 8);

Reminiscence therapy (n = 5)

Routine interventions (n = 10)

No interventions (n = 4)

 6–24 weeks CRBT
[44] Korea 24 (1,763) Older adults with dementia

Individual reminiscence therapy (n = 5);

Group reminiscence therapy (n = 19);

Usual care (n = 15)

No interventions (n = 2)

Supportive care (n = 5)

Exercise therapy (n = 2)

 4–18 weeks CRBT
[45] China 4 (109) Older adults Reminiscence therapy Placebo Not reported CRBT
[24] China 10 (740) Older adults Group reminiscence therapy Traditional mental health education 5–12 weeks CRBT
[46] Ireland 2 (40) Older adults with dementia

Individual life review

Life story book

 Usual care 8–12 weeks CRBT
[47] China 4 (270) Older adults with depression Group reminiscence therapy (n = 4) No interventions 3–62 weeks CRBT
[23] China 8 (955) Older adults with terminal or advanced cancer Individual life review Routine care 2–12 weeks CRBT
[48] Netherlands 11 (903) Older adults

Group reminiscence therapy (n = 5);

Individual reminiscence therapy (n = 5);

Mixed (n = 1)

Usual care (n = 7)

Wait list (n = 4)

 5–12 weeks CRBT
[13] UK 16 (1,761) Older adults with mild dementia

Group reminiscence therapy (n = 11);

Individual reminiscence therapy (n = 2);

Individual life review (n = 3)

Usual treatments (n = 9);

No treatments (n = 2);

Usual care (n = 1);

Support care (n = 2);

Others (n = 2)

 4–96 weeks CRBT
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CRBT Cochrane risk of bias tool, RCT Randomized Controlled Trial, UK United Kingdom, JBI RCT checklist, Joanna Briggs Institute RCT checklist

Result of quality assessment

Methodological quality assessment

The 16-item AMSTAR 2.0 was used to assess the methodological quality of the 21 eligible systematic reviews. All the included systematic reviews had one or more critical flaw(s) and several noncritical flaws. 95.2% (20/21) of the studies did not pass item 2 and item 7, and 90.5% (19/21) failed to pass item 3. All studies failed to pass item 10. All studies were rated as critically low. The detailed results and rating criteria are shown in Supplementary Table S2.

Quality assessment of the report

The PRISMA statement assessed the quality of the reports included in the studies. The detailed results can be found in Supplementary Table S3. The total score for the included meta-analyses ranged from 14.5 to 26.5, with an average score of 22.4. 16 were deemed to be relatively complete (> 21 points), while five reports had some deficiencies (> 15 and ≤ 21 points).

Evaluation of the quality of evidence

The GRADE tool was used to evaluate the evidence quality for 50 outcomes in 21 articles. Among these outcomes, one (2%) was rated as high quality, 18 (36%) were rated as moderate quality, 28 (56%) were rated as low quality, and 3 (6%) were rated as very low quality. The detailed results and rating criteria are shown in Supplementary Table S4.

Summary effect sizes

The summary effect sizes of RT on older adults are shown in Table 2 and overlap of depression, cognitive function, agitation behavior, functional behavior, quality of life, life satisfaction and well-being in the included reviews is presented in Supplementary Table S5a-g. All P-values reported below were derived from Z-tests in the included meta-analyses. As for emotional outcomes, 14 out of 19 studies reporting on depression demonstrated statistically significant effects of RT, with P < 0.001. One study showed significance (P < 0.05), while the remaining 4 studies reported non-significant results (P > 0.05). The CCA of the depression outcome was calculated to be 3.3% representing only slight overlap. Regarding anxiety, 1 of the 2 included studies reported a statistically significant effect (P < 0.05), whereas the other did not reach statistical significance (P > 0.05). Interventions targeting loneliness and self-esteem yielded statistically significant effects in the included studies (P < 0.001). In contrast, the outcome of apathy did not show statistically significant results (P > 0.05).

Table 2.

Evidence-rating results based on the quantitative synthesis outcomes of meta-analyses

Summary effect
Reference Effect size (95%CI) P-value 95% PI I2 (95%CI) Evidence
Depression
[20] SMD = −0.80 (−1.47, −0.14)  < 0.001 (−19.12, −0.03) 94.88% (92.95%−96.28%) Weak
[36] SMD = −6.58 (−10.62, −2.54)  < 0.001 NE 0.00% (NE) Weak
[37] SMD = −2.20 (−0.87, −3.50) 0.007 (−94.22, −0.05) 97.30% (96.00%−98.00%) Weak
[26] SMD = −0.49 (−0.70, −0.28)  < 0.001 (−1.03, −0.23) 55.90% (0.00%−69.00%) Weak
[27] MD = −2.55 (−3.12, −1.99)  < 0.001 NE 0.00% (NE) Weak
[38] SMD = −1.01 (−1.39, −0.63)  < 0.001 (−2.40, −0.42) 0.00% (NE) Weak
[40] SMD = −0.86 (−1.06, −0.66)  < 0.001 (−1.35, −0.55) 18.00% (0.00%−61.00%) Weak
[41] SMD = −0.40 (−0.54, −0.26)  < 0.001 (−0.74, −0.22) 39.00% (0.00%−64.00%) Weak
[22] SMD = −1.07 (−1.52, −0.63)  < 0.001 (−10.41, 0.11) 94.00% (92.00%−96.00%) Weak
Mao et al., 2022 SMD = −0.36 (−0.79, 0.07) 0.100 (−3.27, 0.16) 84.00% (68.00%−92.00%) No
[44] SMD = −0.54 (−0.85, −0.23)  < 0.001 (−1.94, −0.15) 84.00% (75.00%−89.00%) Weak
[45] SMD = −0.64 (−1.04, −0.25) 0.001 (−12.12, −0.03) 45.80% (0.00%−82.00%) Weak
[24] MD = −2.66 (−3.13, −2.20)  < 0.001 (−101.98, 0.07) 92.50% (67.00%−91.00%) Weak
[46] SMD = −0.28 (−0.91, 0.35) 0.380 NE 0.00% (RE) No
[47] SMD = −0.54 (−0.81, −0.26) 0.001 (−1.81, −0.16) 38.40% (0.00%−79.00%) Weak
[23] SMD = −0.09 (−0.30, 0.12) 0.420 NE 0.00% (RE) No
[48] SMD = 1.01 (0.56, 1.44)  < 0.001 (0.20, 4.99) 91.37% (88.00%−95.00%) Weak
[13] SMD = –0.03 (−0.15, 0.10) 0.690 (−0.04, 0.14) 32.00% (0.00%−67.00%) No
[42] MD = −3.75 (− 4.67, − 2.83)  < 0.001 (−58.13, −0.24) 71.00% (45.00%−85.00%) Weak
Anxiety
[22] SMD = −3.54 (−5.52, −1.56) 0.005 (−1677.46, −0.01) 98.00% (97.00%−99.00%) Weak
[23] SMD = 0.11 (−0.01, 0.33) 0.290 (−0.02, 1.31) 0.00% (RE) No
Loneliness
[25] SMD = −0.40 (−1.98, −1.17)  < 0.001 NE 95.00% (85.00%−98.00%) Weak
Apathy
[22] SMD = −1.11 (−4.18, 1.95) 0.480 NE 97.00% (96.00%−98.00%) No
Self-esteem
[24] MD = 2.88 (1.93, 3.83)  < 0.001 NE 0.00% (RE) Weak
Cognitive function
[26] SMD = 0.18 (0.05, 0.30) 0.007 (−0.07, 0.50) 0.00% (NE) Weak
[27] MD = 4.48 (4.16, 4.49)  < 0.001 (0.32, 61.78) 89.00% (83.00%−93.00%) Weak
[39] MD = −10.42 (−19.36, −1.41)  < 0.001 NE 0.00% (NE) Weak
[40] MD = 2.02 (1.72, 2.32)  < 0.001 (0.25, 16.27) 65.00% (45.00%−77.00%) Weak
[41] MD = 1.70 (1.34, 2.06)  < 0.001 (0.01, 252.42) 98.10% (87.00%−95.00%) Weak
Mao et al., 2022 MD = 1.92 (0.46, 3.39) 0.010 (0.01, 254.85) 91.00% (86.00%−94.00%) Weak
[44] MD = −0.33 (−0.59, −0.64) 0.015 (−0.62, −0.17) 50.70% (0.00%−76.00%) Weak
[46] SMD = 0.57 (−0.07, 1.21) 0.080 NE 0.00% (RE) Weak
[13] SMD = 0.11 (0.00, 0.23) 0.050 (−0.03, 0.86) 9.00% (0.00%−47.00%) No
Agitation behavior
Mao et al., 2022 SMD = −0.17 (−0.36, 0.02) 0.090 (−1.43, 0.01) 40.00% (0.00%−78,00%) No
[13] SMD = 0.03 (−0.17, 0.24) 0.240 NE 0.00% (RE) No
Functional behavior
[13] SMD = 0.24 (0.69, 0.21)  < 0.001 (0.05, 1.13) 90.94% (82.00%−95.00%) Weak
[40] MD = −2.52 (−3.08, −1.96)  < 0.001 (−3.47, −1.83) 0.00% (NE) Weak
Communication and interaction
[13] SMD = −0.51 (−0.97, −0.05) 0.030 (−4.98, −0.04) 62.00% (8.00%−84.00%) Weak
Quality of life
[27] MD = 6.78 (5.11, 8.45)  < 0.001 NE 89.00% (83.00%−93.00%) Weak
[41] MD = 1.66 (0.57, 2.74) 0.030 (0.11, 20.87) 55.00% (11.00%−77.00%) Weak
[22] SMD = 0.87 (0.34, 1.41)  < 0.001 (0.11, 6.80) 92.00% (89.00%−95.00%) Weak
Mao et al., 2022 SMD = 6.37 (0.54, 12.2) 0.040 NE 94.00% (82.00%−98.00%) Weak
[44] SMD = 0.38 (0.08, 0.68) 0.014 (0.07, 1.75) 76.60% (58.00%−87.00%) Weak
[23] SMD = 0.35 (0.15, 0.56) 0.008 (0.04, 3.45) 91.00% (79.00%−96.00%) Weak
[13] SMD = 0.11 (−0.12, 0.33) 0.340 (−0.15, 0.35) 59.00% (10.00%−81.00%) No
Life satisfaction
[22] SMD = −1.44 (−0.55, 3.43) 0.160 NE 95.00% (93.00%−97.00%) No
[24] MD = 1.23 (0.40, 2.07) 0.040 NE 0.00% (RE) Weak
[42] MD = 7.55 (3.48, 11.62) 0.003 NE 91.00% (77.00%−97.00%) Weak
Well-being
[23] SMD = 0.33 (0.12, 0.53) 0.078 NE 24.00% (0.00%−68.00%) No
[22] SMD = −0.12 (−0.44, 0.19) 0.450 NE 0.00% (NE) No
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Abbreviation: 95% CI 95% confidence interval, 95% PI 95% prediction interval, MD Mean Difference, SMD Standardized Mean Difference

RE: Can't calculate according to the original literature data 95% CI

NE: Not estimable because fewer than three studies were available for each meta-analysis

P-values were calculated using Z-tests

With regard to cognitive function, 4 out of 9 studies reported statistically significant improvements following RT at a threshold of P < 0.001, and 3 studies reported significance at P < 0.05. The remaining 2 studies found no statistically significant effects (P > 0.05). The CCA of the cognitive function was calculated to be 10.0% representing only moderate overlap.

In terms of behavioral outcomes, functional activities showed statistically significant improvements with P < 0.001, while communication and interaction demonstrated significance at P < 0.05. In contrast, agitation behaviors did not show statistically significant effects (P > 0.05). The CCA of the agitation behaviors and functional activities shared 15.3% and 15.6% of their variance, respectively, indicating a very high degree of overlap.

For overall well-being, 2 out of 3 studies on life satisfaction reported statistically significant results (P < 0.05), while the remaining study did not reach statistical significance P > 0.05). Regarding quality of life, 2 out of 7 studies showed significant improvements at P < 0.001, and 4 studies reported significance at P < 0.05. The remaining study did not report statistically significant effects (P > 0.05). In contrast, studies assessing well-being did not demonstrate statistically significant results (P > 0.05). According to the established thresholds, the CCA values for life satisfaction, quality of life, and well-being were 1.0%, 10.7%, and 0%, respectively, indicating slight overlap for life satisfaction and well-being, and moderate overlap for quality of life.

Overall, the statistically significant findings suggest that RT may be effective in enhancing self-esteem, communication and interaction, and functional activities, as well as in reducing loneliness among older adults. However, for outcomes such as well-being, agitation behaviors, and apathy, the available evidence did not support a statistically significant effect of the intervention. Other remaining outcomes yielded mixed results across studies.

Heterogeneity

For the inter-study heterogeneity of 21 studies, there were 13 studies with high heterogeneity (I2 > 75%) and 2 studies with moderate heterogeneity (I2 = 50—75%). When we calculated the 95% PI to assess inter-study heterogeneity further, we found 9 studies of the following outcomes that included the null value: depression (n = 4), cognitive function (n = 2), anxiety (n = 1), quality of life (n = 1), and agitation behaviors (n = 1).

Robustness of evidence

There were 37 studies providing weak evidence and 13 studies providing no evidence of an effect. 37 studies provided weak evidence in support of: depression (n = 15), cognitive function (n = 8), quality of life (n = 6), anxiety (n = 1), life satisfaction (n = 2), loneliness (n = 1), communication and interaction (n = 1), functional activities (n = 2), and self-esteem (n = 1). 13 studies provided no evidence of an effect on: depression (n = 4), cognitive function (n = 18), quality of life (n = 1), anxiety (n = 1), life satisfaction (n = 1), well-being (n = 2), agitation behaviors (n = 2), and apathy (n = 1).

Discussion

Summary and interpretation

This umbrella review synthesized the available evidence on the effectiveness of RT in promoting multiple health outcomes among older adults. Across the 21 included reviews, 12 outcomes were identified and analyzed. The pooled evidence indicates that RT may be associated with improvements in self-esteem, communication and interaction, functional activities, and reductions in loneliness. However, no significant benefits were observed for well-being, agitation behaviors, or apathy, and results for other outcomes were inconsistent. While the findings suggest that RT may hold potential as a non-pharmacological approach to improving certain aspects of mental and physical health, these conclusions should be interpreted with considerable caution. All included systematic reviews were rated as critically low in methodological quality according to AMSTAR 2, and only 2% of the evidence was graded as high-quality using the GRADE approach. Given the low methodological and evidence quality, these findings provide only limited support for the effectiveness of RT.

Several factors may explain the low reliability and strength of the evidence identified in this umbrella review. First, many of the primary RCTs included in the systematic reviews enrolled relatively small sample sizes, which could reduce statistical power, widen confidence intervals, and increase the likelihood of random error. Second, substantial heterogeneity was observed in intervention characteristics, including delivery format, frequency, duration, and outcome measures. Such variability may have diluted the pooled effects, contributed to inconsistent findings across studies, and ultimately lowered the overall certainty of the evidence. These limitations underscore the need for more rigorously designed trials to clarify the true effects of RT on health outcomes among older adults. Future studies should ensure adequate sample sizes, employ standardized intervention protocols, adopt consistent and validated outcome measures, and incorporate longer follow-up periods to improve precision, comparability, and external validity. Such methodological improvements will enhance both the reliability and applicability of the evidence base for RT in this population.

The results showed that RT may be associated with improvements in self-esteem, communication and interaction, functional activities, and reductions in loneliness. Self-esteem showed a large pooled effect size (MD = 2.88) [24], a change of clear clinical relevance given its links to lower depressive symptoms, greater resilience, and enhanced social participation in older adults [49]. Loneliness demonstrated a moderate effect (SMD = − 0.40) [25], indicating perceptible reductions in social isolation, while communication and interaction also improved moderately (SMD = − 0.51) [13], reflecting enhanced social engagement. Gains in functional behavior may translate into greater independence in daily living and reduced caregiver burden [13, 40]. Although the certainty of evidence was rated as weak, the observed effect sizes indicate that RT can yield clinically relevant benefits in key domains influencing quality of life, supporting its use within multidimensional interventions for older adults.

Beyond the quantitative findings, the potential mechanisms underlying the observed benefits of RT merit consideration. These results suggest that incorporating reminiscence-based therapy alongside a comprehensive caring program could stimulate and sustain a positive mood among older adults, which could be beneficial to process active ageing. Reminiscence can serve a positive emotional function by storing positive emotions Fabio etnull al., 2008. Analyzing reminiscence stories reveals that they mostly involve positive elements. In comparison to recalling everyday experiences, research subjects recount more positive emotions and perceive the past more positively when reminiscing about their reminiscence experiences [50]. From an emotional repair perspective, reminiscence is a longing and nostalgia for the past, and the past that individuals long for is not absolutely objective, but a projection of present emotions onto the past. In this process, individuals reorganize and construct the past, filtering out and removing some negative emotions and memories [51]. Remembering past pleasant experiences has a certain compensatory effect on negative emotions [50].

In addition, reminiscence can maintain and enhance self-motivation. It can help individuals avoid threats and restore positive self-concepts and self-esteem. Studies have shown that research subjects with nostalgic feelings have higher levels of self-esteem than those without [52]. In addition to enhancing self-esteem, reminiscence can also enhance social connections and a sense of belonging. Reminiscence can maintain social connections with others, providing a sense of security for individuals when they feel excluded and lonely. Research subjects with nostalgic feelings show better social connection, feeling more cared for and protected, and have stronger interpersonal skills [53].

A considerable degree of heterogeneity was observed across the included studies, which may be attributable to multiple interrelated factors. First, the diversity in RT formats, including individual versus group delivery, structured versus unstructured approaches, and variations in session frequency and duration, likely contributed to discrepancies in reported outcomes. Prior evidence suggests that different RT modalities may engage distinct psychological mechanisms, thereby influencing therapeutic efficacy [54]. Second, cultural context appears to play an important moderating role. Cultural norms and values influence how individuals interpret and reconstruct past experiences [55], which in turn shapes the emotional and cognitive responses to reminiscence. For example, a cross-cultural study by Hofer et al. [56] found that self-negative reminiscence is related to obstacles in satisfying basic psychological needs, and different types of reminiscence may have differences in meaning. Third, high heterogeneity is also related to the population. Out of the 21 studies included in this study, six studies reported no effectiveness of RT for older adults. These studies focused on populations of critically ill, terminal cancer patients and elderly individuals with dementia. The progressive decline in cognitive function in dementia patients is irreversible and worsens over time [57, 58]. Research has shown that RT is not feasible in improving cognitive function, depression, neuropsychiatric symptoms, dependency, or quality of life in severely demented patients [59].

Strengths and limitations

The primary strength of this umbrella review, compared with previous studies, is its inclusion of a broader spectrum of health outcomes potentially influenced by RT, enabling a more comprehensive synthesis of the available evidence. Nevertheless, given that the methodological quality of most included systematic reviews and meta-analyses was rated as critically low, the present findings should be interpreted with caution and cannot be considered fully conclusive. Several limitations should be acknowledged. First, the literature language searched in this study is limited to Chinese and English, which may introduce some selection bias. Second, the scope of the review varies greatly, including a wide range of RTs and control types, which leads to heterogeneity. Third, we did not identify and analyze the included original studies, which may result in the simultaneous inclusion of RCTs, potentially leading to bias. Fourth, the quality of most included systematic reviews and meta-analyses is extremely low. Future efforts are needed to improve the quality of methods and standardize the reporting process of meta-analysis for RT interventions. Finally, a limitation of this umbrella review is that it synthesized evidence only at the qualitative level without conducting a meta-analysis. Future research should incorporate meta-analysis to generate more precise effect size estimates.

Implications

The present umbrella review provides a comprehensive overview of the current research status regarding the effectiveness of RT in promoting various health outcomes among older adults. Our findings indicate that while there is promising evidence suggesting potential benefits of RT, the heterogeneity in study designs and outcomes necessitates a more standardized approach in future research. This includes the need for rigorous methodologies, larger sample sizes and longer follow-up periods to confirm the efficacy of the RT. Furthermore, there is an urgent call for further exploration of the mechanisms underlying the observed positive effects, to enable personalization of interventions for different subgroups of older adults. Looking ahead, under the guidance of emerging technologies, RT is gradually breaking free from the constraints of traditional tangible and visible material carriers and developing towards a three-dimensional, multi-dimensional, and dynamic digital form. Xu [60] proposed a narrative design framework for virtual reality reminiscence scenes, realizing the construction of a high-immersion virtual reality reminiscence scene system. In the future, the deep integration of RT with digital technologies may offer more efficient, engaging, and intelligent approaches to care delivery for older adults [61].

Conclusion

In conclusion, this umbrella review comprehensively summarizes 21 systematic reviews and meta-analyses on reminiscence therapy for older adults. Existing evidence indicates that RT could increase self-esteem, communication and interaction, functional activities and reduce loneliness. Regarding well-being, agitation behaviors, and apathy, reminiscence therapy was ineffective. However, these findings should be interpreted with caution given that most included reviews were rated as critically low quality. To draw more definitive conclusions regarding the efficacy of RT, future research should employ rigorous methodological designs, involve larger and more diverse samples, and ensure longer follow-up periods.

Supplementary Information

Supplementary Material 1 (135.1KB, docx)

Acknowledgements

None.

Authors’ contributions

JYL conceived and designed the article, processed the statistics, analyzed and interpreted the results, and wrote the paper; JYL, HKX, LHB collected and organized the data; JY, CL and HG revised the paper; CL was responsible for the overall article and supervised the management.

Funding

This research is supported by the Educational Commission of Jilin Province of China (JJKH20241173KJ).

Data availability

The datasets analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Footnotes

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

Yong Jia, Email: jiayong@jlu.edu.cn.

Li Chen, Email: chen_care@126.com.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplementary Material 1 (135.1KB, docx)

Data Availability Statement

The datasets analysed during the current study are available from the corresponding author on reasonable request.

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