Abstract
Background and aim
Considering the growth of the elderly population in Iran and the prevalence of cognitive and physical illnesses among them, identifying strategies to enhance subjective vitality and a sense of purpose in life is crucial. This study aimed to evaluate the effect of group poetry reading on meaning in life and subjective vitality in older adults attending a daycare center.
Methods
In this clinical trial study, 73 older adults who visited a daycare center were enrolled and randomly assigned to an intervention group (n = 37) or a control group (n = 36). The intervention group participated in 60–90-minute group poetry sessions twice weekly for 6 weeks, while the control group attended the regular programs in the center. Both groups completed the Subjective Vitality Scale and Meaning in Life Questionnaire pre- and post-intervention. The data collected were analyzed using ANCOVA, independent t-tests, and paired t-tests in SPSS version 22.
Results
Post-intervention, a significant difference was observed between groups in meaning in life (p = 0.031), with higher scores in the intervention group (60.02 ± 7.15 vs. 53.55 ± 6.88). For subscales, the intervention group showed significantly greater improvement in “search for meaning” (p = 0.009) but not in “presence of meaning” (p = 0.339). Both groups exhibited increased subjective vitality post-intervention (intervention: p = 0.046; control: p < 0.001), but no significant difference between groups emerged (p = 0.377).
Conclusion
The results of this study showed that holding group poetry reading sessions can promote meaning in life, especially in the domain of “searching for meaning” among the elderly. But results showed no significant difference between the two groups’ Subjective Vitality mean scores after the intervention. Therefore, holding such classes in elderly day care centers or nursing homes are recommended to improve meaningful life in the elderly.
Trial registration
IRCT20190727044347N7 (Registration date: 04/12/2024).
Keywords: Aging, Poetry reading, Meaning in life, Subjective vitality
Background
Aging represents a natural and inevitable biological process [1, 2], universally recognized as beginning at age 60 [3]. This demographic transformation stems from two fundamental trends: sustained declines in mortality rates and rising life expectancy, occurring alongside decreasing fertility rates [4]. Advances in public health infrastructure, medical technologies, and socioeconomic conditions have dramatically extended longevity, making population aging a defining global phenomenon of the century [5]. Current demographic projections indicate that the global population aged 60 and older will nearly double from 12% in 2015 to 22% by 2050 [6]. Iran aging profile mirrors these global patterns. National census data reveals that adults over 60 constituted 9.3% (7.4 million) of the Iranian population in 2016. Demographic models project that this group will expand to 19.4% by 2041 and 26.1% by 2051, reflecting one of the most rapid aging transitions worldwide [7].
Late adulthood represents a critical life stage where addressing the unique needs of this population becomes essential [8]. Older adults frequently experience multiple chronic conditions, which significantly compound their physical health challenges [9, 10]. These physical health issues often lead to psychological consequences [11]. The onset of these problems typically results in social withdrawal, disengagement from personal and social activities, and ultimately exacerbates feelings of depression and loneliness [12].
A crucial intervention in elderly mental health involves helping individuals find meaning in life, which can assist them in managing psychological stressors and difficulties [13]. The concept of meaning in life has attracted considerable attention as a key factor influencing mental health. It refers to developing a sense of order and coherence in one’s existential life, having purpose, or striving toward purposeful goals [14]. Individuals perceive their lives as meaningful when certain fundamental needs are met: having a purposeful life direction, feeling competent and in control of their affairs, possessing a value system, and maintaining a stable foundation for positive self-regard [15, 16]. When present, meaning in life is associated with optimism, better environmental adaptation, self-esteem, well-being, and quality of life [17]. Conversely, difficulty finding meaning in life can lead to despair, boredom, depression, and even suicide [16, 18]. A lack of meaning in life indicates diminished feelings of life’s value and reflects the belief that life is a negative experience. From Frankl’s perspective, meaninglessness and lack of purpose represent fundamental vulnerabilities in human existence [17, 18].
The pursuit of meaning in life is complemented by subjective vitality as a positive psychological factor that can enhance mental health in older adults. Ryan and Frederick conceptualize subjective vitality as a multidimensional construct encompassing high energy levels, enthusiasm, alertness, and the absence of fatigue or burnout [19, 20] Individuals with high subjective vitality demonstrate enhanced personal productivity and engagement and positively influence those around them through contagious energy transmission, thereby serving as a robust indicator of psychological well-being [21]. Contemporary gerontological research consistently demonstrates that successful aging transcends genetic predisposition or mere access to health resources. Instead, it critically depends on active lifestyle regulation and behavioral modifications that foster subjective vitality [22]. This vital psychological resource facilitates goal-directed behaviors and purposeful actions that promote mental health [23, 24].
Research evidence indicates that various interventions, including yoga, osteopathy, pharmacotherapy, and art therapy, can contribute to psychological improvement in older adults [25, 26]. As an established mental health approach, art therapy utilizes creative artistic expression to enhance physical, psychological, and emotional well-being across all age groups. This modality is grounded in the principle that creative engagement facilitates conflict resolution while developing interpersonal skills, behavioral management, anxiety reduction, self-esteem enhancement, and self-awareness [27]. Among creative arts therapies, poetry reading shows particular promise for positively influencing psychological status and subjective vitality in the elderly [28]. As an innovative form of art therapy, poetry employs motivational texts for therapeutic and personal growth purposes [28, 29], providing a particularly suitable chance for group work with individuals experiencing mental health disorders, substance abuse issues, and age-related challenges [30, 31]. The unique verbal nature of poetry allows it to establish deeper connections than other art forms through linguistic expression. When incorporating aesthetic qualities, poetry can foster profound internal resolution [32]. Empirical studies demonstrate that the therapeutic application of poetry and other literary forms yields significant benefits, including enhanced social interactions, reduced impulsivity, improved reality orientation, better self-care practices, strengthened interpersonal relationships, and increased social participation [33]. Furthermore, poetry reading serves as a pathway to discovering meaning in life, a particularly relevant pursuit for individuals confronting health challenges in later life. Clinical findings confirm the effectiveness of poetry in addressing behavioral issues such as aggression, anxiety, and depression. This intervention offers exceptional practical advantages, requiring minimal resources while delivering optimal therapeutic outcomes in relatively short timeframes [28, 30, 34, 35]. The approach combines cost-effectiveness with rapid implementation potential, making it particularly valuable for diverse clinical and community settings serving elderly populations [36].
The aging process invariably leads to progressive physical decline and compromised independence, frequently resulting in heightened dependency and diminished quality of life[37]. Concurrently, age-related physical and psychological challenges often disrupt core psychological domains, especially subjective vitality and meaning in life [38]. These concerning developments acquire urgent significance given the irreversible global demographic shift toward aging populations [39] and the disproportionately high prevalence of psychological distress among older adults, compelling evidence that underscores the critical need for developing targeted interventions to enhance mental well-being in this vulnerable population [40–42]. The growing body of empirical support for arts-based therapeutic approaches, with particular emphasis on the efficacy of poetry therapy, provided the scientific foundation for this investigation examining the impact of structured poetry reading sessions on both meaning in life constructs and subjective vitality levels among elderly adults attending a daycare center [34, 43, 44]. Therefore, the present study aimed to examine the effect of group poetry reading on meaning in life and subjective vitality among older adults attending a day care center.
Methods
Study design and setting
This sequential clinical trial with a pretest-posttest design was performed in the Soroush Daycare Center of Shiraz, Iran, in 2024.
Participants
The study population consisted of adults aged 60 years and older. Eligibility criteria included a minimum age of 60, voluntary participation with written informed consent, full cognitive awareness and communication capacity, no concurrent engagement in comparable therapeutic interventions, first-time exposure to this specific treatment protocol, and a lack of substance use disorders (including narcotics, sedatives, or alcohol). Exclusion criteria were withdrawal from the study during trial participation, incomplete questionnaire, pre-existing psychological conditions documented in medical records, and absenteeism exceeding two intervention sessions. This rigorous selection process ensured participants’ homogeneity while maintaining methodological integrity throughout the investigation.
Ethical consideration
The present study was approved by the Ethics Committee of Shiraz University of Medical Sciences (IR.SUMS.NUMIMG.REC.1402.140). It was registered in the Iranian Registry of Clinical Trials (IRCT) with registration number IRCT20190727044347N7 on 2024-04-12. All necessary permissions for conducting the research were obtained from the relevant administrators, and all methods were performed in accordance with the applicable guidelines and regulations. Furthermore, a session was held after participant selection to explain the study objectives and procedures. Written informed consent forms were also obtained from all participants by the researchers.
Personal information was collected only by authorized members of the research team and was coded using unique participant identification numbers. Identifiable information was stored separately from study data in secure, password-protected files accessible only to the research team. Participant confidentiality was maintained throughout the study, and no identifiable information was disclosed in any reports or publications.
Sample size
The sample size was calculated using G*Power 3 software with α = 0.05 (Type I error), β = 0.20 (Type II error), a 95% confidence level, and 80% power. According to the research by Khoshknab [35], with Cohen’s d = 0.598 (effect size = 0.299) and a 0.3 correlation between measurement time points, the initial sample size was estimated at 60 participants. Given a minimum 10% attrition rate, the final required sample size was 66 participants (33 per group).
Randomization
In the city where this study was conducted (Shiraz, Iran), there are two elderly daycare centers. Before the study began, one of these two centers was chosen due to the larger number of visitors and the presence of elderly people from different parts of the city.
After determining the target center, the sampling process commenced. The study employed a two-phase recruitment strategy that combined initial convenience sampling of volunteers with subsequent permuted block randomization (block size = 4) to allocate the participants into either the poetry reading intervention or standard care control group. This approach balanced practical recruitment needs with rigorous methodological standards throughout the allocation process (Fig. 1).
Fig. 1.
CONSORT flow diagram of the clinical trial
To ensure allocation concealment, the randomization sequence was generated by an independent statistician using computer-based permuted block randomization. The researcher responsible for participant recruitment did not have access to the allocation list and was unaware of the upcoming assignment for each participant. Group allocation was revealed sequentially according to the concealed computerized list.
Interventions
This study was conducted in the summer of 2024. Following randomization (intervention group: n = 37, control group: n = 36) and in line with ethical principles in research, the research objectives were explained to participants in both groups so that they could voluntarily decide whether to participate.
The initial parallel data collection plan was adjusted due to unexpected interest of the control group participants in attending poetry sessions after the first-class meeting. To maintain the integrity of the study and prevent cross-group contamination, the research team changed to a sequential data collection approach. First, the control group participants were contacted to complete baseline assessments, including the demographic questionnaire, the Meaning in Life Questionnaire, and the Subjective Vitality Scale. After six weeks, the control group participants filled out the study questionnaires again. The poetry intervention then commenced with an introductory session in which researchers explained the study objectives, obtained informed consent, and the leading facilitator (a PhD expert in Persian literature and Hafez studies) explained how poetry sessions would be held. The 12-session poetry intervention (conducted twice a week, Saturdays and Mondays, 10 am-11 am for six weeks) followed a standardized protocol; each session began with the recitation and analysis of preselected poems emphasizing the themes of hope, joy, and life purpose, followed by guided discussions connecting the poetic content to daily life experiences. Participants were encouraged to engage in reciting related verses, share personal interpretations, and participate in brief group poetry exchanges. Post-intervention assessments were administered immediately following the final session. It should be noted that as the data for the control group (before and 6 weeks later) had been collected, participants in the control group were not restricted from attending poetry reading classes in the intervention group, and they were allowed to participate in these classes if they wished. But after the intervention, only the data of intervention group was gathered.
Elderly participants in both groups (intervention and control) were allowed to participate in other educational programs at the day center, such as painting, pottery, English, and …, according to their interests. However, as stated in the inclusion criteria, participants were not allowed to participate in classes similar to the intervention, including singing and mental health workshops.
Due to the sequential data collection design, the duration of this study was 3 months and was conducted during the summer season. All data collection was performed by the research staff. Given the nature of the intervention, blinding of the researchers was not possible, only the statistical consultant was unaware of the group’s allocation during the analysis.
Outcome measures and follow-up
Demographic questionnaire
A researcher-developed demographic questionnaire was administered to all participants before the intervention. This instrument, designed based on a literature review and expert consultation, collected key participant characteristics including age, gender, marital status, and educational attainment. Research assistants administered the questionnaire to both groups under standardized conditions.
Meaning in Life Questionnaire (MLQ)
The MLQ [45] is a 10-item instrument using a 7-point Likert scale to assess two distinct dimensions: Presence of Meaning (items 1, 4, 5, 6, and 9 with reverse coding) and Search for Meaning (items 2, 3, 7, 8, and 10) [45]. The original validation study reported strong internal consistency (Cronbach’s α = 0.86 for Presence; 0.87 for Search) and acceptable reliability coefficients (α = 0.70 and 0.73, respectively) [45]. The Persian adaptation revealed comparable psychometric properties, with test-retest reliability coefficients of 0.84 (Presence) and 0.74 (Search) over a two-week interval, alongside internal consistency estimates of 0.78 and 0.75 [46].
Subjective Vitality Scale (SVS)
The SVS [47] evaluates individuals’ perceived energy and liveliness via 7 Likert-type items (7-point scale), yielding total scores ranging from 7 to 49. The interpretation of scores follows these thresholds: 7–17 (low), 17–38 (moderate), and > 38 (high vitality). The original validation reported excellent internal consistency (α = 0.92) and satisfactory factor structure [47]. The Persian version demonstrated strong reliability (α = 0.88; split-half = 0.85) and good model fit in confirmatory factor analysis (RMSEA = 0.04; CFI = 0.98; NFI = 0.95; AGFI = 0.91; GFI = 0.96). Convergent validity was established through significant positive correlations with the Oxford Happiness Questionnaire (all coefficients significant at p < 0.10) [48].
Statistical analysis
Data analysis was conducted using SPSS software. A per-protocol analysis was conducted. Only participants who completed the study, and provided complete questionnaire data were included in the final analysis. The following statistical tests were employed to compare pre- and post-intervention data: analysis of covariance (ANCOVA), independent samples t-test, and paired samples t-test. Quantitative data were presented using mean and standard deviation, while qualitative data were summarized with frequency and percentage distributions. The chi-square test was used to examine potential differences in demographic characteristics between the intervention and control groups. All post-test values are adjusted, and missing data were excluded from the analyses. Before conducting the primary analyses, the normality of data distribution was confirmed using the Kolmogorov-Smirnov test, which indicated that the data followed a normal distribution.
Results
The results indicated no significant differences between the two groups in demographic and background variables, including age, gender, marital status, education level, income, living situation, or participation in other classes (p > 0.05) (Table 1).
Table 1.
Demographic data of the participants
| Variable | Category | Intervention Group (n = 37) | Control Group (n = 36) | p-value |
|---|---|---|---|---|
| Age (years) | 60–74 | 30 (81.1%) | 30 (83.3%) | 0.39 |
| 75–90 | 7 (18.9%) | 6 (16.7%) | ||
| Total | 37 (100%) | 36 (100%) | ||
| Gender | Male | 4 (10.8%) | 4 (11.1%) | 1.00 |
| Female | 33 (89.2%) | 32 (88.9%) | ||
| Total | 37 (100%) | 36 (100%) | ||
| Marital Status | Single | 2 (5.4%) | 3 (8.3%) | 0.058 |
| Married | 21 (56.8%) | 29 (80.6%) | ||
| Divorced | 2 (5.4%) | 0 (0%) | ||
| Widowed | 12 (32.4%) | 4 (11.1%) | ||
| Total | 37 (100%) | 36 (100%) | ||
| Education Level | without high school diploma | 7 (18.9%) | 1 (2.8%) | 0.072 |
| Diploma | 25 (67.6%) | 27 (75%) | ||
| Bachelor’s degree | 5 (13.5%) | 8 (22.2%) | ||
| Total | 37 (100%) | 36 (100%) |
Table 2 presents the mean and standard deviation scores for Meaning in Life and its subscales (assessed by Steger’s Meaning in Life Questionnaire) before and after the intervention in both groups. Baseline comparisons revealed significantly higher meaning in life scores in the intervention group than the controls (p < 0.001), with mean scores of 56.080 ± 7.900 versus 50.220 ± 5.340, respectively. Post-intervention, mean scores increased to 60.020 ± 7.150 in the intervention group and 53.550 ± 6.880 in the control. ANCOVA analysis (controlling for baseline differences) showed a statistically significant between-group difference following the intervention (p = 0.031). Paired t-tests demonstrated significant within-group improvements for both the intervention (p = 0.003, d = 0.523) and the control group (p = 0.004, d = 0.541) (Table 2).
Table 2.
Comparison of the mean scores of meaning in life and its subscales (presence of meaning and search for meaning) in the intervention and control groups before and after the intervention
| Variable | Groups | Before Intervention (Mean ± SD) |
After Intervention (Mean ± SD) |
P-ValueW(CI95%) | Effect size **** |
Difference (Mean ± SD) CI 95% for diff |
|---|---|---|---|---|---|---|
| Meaning in life (Total) | Intervention | 56.08 ± 7.90 | 60.02 ± 7.15 | p = 0.003** | 0.523 |
3.94 ± 7.42 (1.47,6.42) |
| Control | 50.22 ± 5.34 | 53.55 ± 6.88 | p = 0.004** | 0.541 |
3.33 ± 6.40 (1.16,5.50) |
|
| Between-group: | p < 0.001*** | p = 0.031* | 0.707ǂ | |||
| Search for Meaning | Intervention | 29.19 ± 4.07 | 30.76 ± 3.84 | p = 0.035** | 0.397 |
1.56 ± 4.34 (0.11,3.01) |
| Control | 26.50 ± 3.38 | 26.97 ± 4.58 | p = 0.541 | 0.117 |
0.47 ± 4.59 (-1.08,2.02) |
|
| Between-group: | p = 0.003*** | p = 0.009* | 0.633ǂǂ | |||
| Presence of Meaning | Intervention | 26.89 ± 4.51 | 29.27 ± 4.16 | p < 0.001** | 0.549 |
2.37 ± 3.98 (1.05,3.70) |
| Control | 23.72 ± 2.53 | 26.58 ± 4.23 | p < 0.001** | 0.821 |
2.86 ± 4 (1.50,4.21) |
|
| P-Valueb(CI95%) | p < 0.001*** | p = 0.339* | 0.607ǂ | |||
All post-test values are adjusted, and missing data were excluded from the analyses
*P-values between groups were obtained using ANCOVA
**P-values within groups were obtained using paired t-test
***Independent t-test was used for initial comparison between groups
****Effect size was calculated based on Cohen’s d
ǂǂ Independent t-test was used for comparison between groups
ǂ Mann Whitney Test was used for comparison between groups
P-values between groups were obtained using chi-square test
The examination of meaning in life subscales produced clinically relevant findings. For the search for meaning subscale, baseline measurements indicated significantly higher scores in the intervention group than the controls (p = 0.003). Subsequent ANCOVA analysis - controlling for these initial differences - confirmed between-group significance post-intervention (p = 0.009). Within-group comparisons revealed statistically meaningful improvement exclusively in the intervention group (p = 0.035, d = 0.397), while control participants demonstrated no significant change (p > 0.05) (Table 2).
An independent samples t-test demonstrated significant baseline differences between the groups for the meaning subscale (p < 0.001). Subsequent ANCOVA analysis - controlling for these initial variations revealed no statistically significant between-group differences following the intervention period (p = 0.339). Notably, paired samples t-tests indicated clinically meaningful within-group improvements for both the poetry intervention group (p < 0.001, d = 0.549) and control participants (p < 0.001, d = 0.821), suggesting comparable efficacy of both conditions in enhancing the participants’ sense of existential purpose (Table 2).
In addition to the variables described above, analysis of the Subjective Vitality score revealed that, before the intervention, the intervention group had a mean ± SD of 39.080 ± 6.130, while the control group score was 34.470 ± 4.210. An independent-samples t-test indicated that this baseline difference was statistically significant (p < 0.001). To account for the pre-test discrepancy when comparing post-intervention scores, analysis of covariance (ANCOVA) was performed; the results showed no significant difference between the two groups’ mean Subjective Vitality scores after the intervention (p = 0.377). Within-group comparisons using paired-samples t-tests demonstrated a significant increase in Subjective Vitality in the intervention group following the program (p = 0.046, d = 0.388), and the control group also exhibited a significant change over time (p < 0.001, d = 0.751) (Table 3).
Table 3.
Comparison of the mean score of subjective vitality in the intervention and control groups before and after the intervention
| Variable | Groups | Before Intervention (Mean ± SD) |
After Intervention (Mean ± SD) |
Within-group P-value | Effect size **** |
Difference (Mean ± SD) CI 95% for diff |
|---|---|---|---|---|---|---|
| Subjective Vitality | Intervention | 39.08 ± 6.13 | 41.27 ± 5.16 | p = 0.046** | 0.388 |
2.18 ± 6.42 (0.04,4.33) |
| Control | 34.47 ± 4.21 | 38.19 ± 5.70 | p < 0.001** | 0.751 |
3.72 ± 5.14 (1.98,5.46) |
|
| Between-group: | p < 0.001*** | p = 0.377* | 0.074ǂ | |||
All post-test values are adjusted, and missing data were excluded from the analyses
*P-values between groups were obtained using ANCOVA
**P-values within groups were obtained using a paired t-test
*** An independent t-test was used for initial comparison between groups
****Effect size was calculated based on Cohen’s d
ǂ Mann Whitney Test was used for comparison between groups
As Table 4 showed, based on the p-values for the interaction effects of the variables (subjective vitality, meaning in life, search for meaning, and presence of meaning) all of which were greater than 0.05, the interaction between time and group was not statistically significant. Therefore, any observed changes in the mean scores of subjective Vitalities, meaning in life, search for meaning, and presence of meaning after the intervention can be attributed to the intervention itself. Due to the lack of homogeneity between the groups before the intervention, the diff analysis was applied (Fig. 1).
Table 4.
Generalized Linear Model (GLM) results for the effects of group, time, and their interaction
| Variable | Source | Sum of Squares | df | Mean Square | f | P-value | Effect Size | Power |
|---|---|---|---|---|---|---|---|---|
| Subjective Vitality | group | 538.770 | 1 | 538.770 | 25.127 | 0.125 | 0.962 | 0.306 |
| Time | 318.811 | 1 | 318.811 | 14.869 | 0.162 | 0.937 | 0.238 | |
| group×Time | 21.441 | 1 | 21.441 | 0.746 | 0.389 | 0.005 | 0.138 | |
| Meaning in Life | group | 1387.078 | 1 | 1387.078 | 405.114 | 0.032 | 0.998 | 0.886 |
| Time | 483.424 | 1 | 483.424 | 141.190 | 0.053 | 0.993 | 0.649 | |
| group×Time | 3.424 | 1 | 3.424 | 0.072 | 0.789 | 0.001 | 0.058 | |
| Search for Meaning | group | 382.349 | 1 | 382.349 | 34.931 | 0.107 | 0.972 | 0.357 |
| Time | 37.960 | 1 | 37.960 | 3.468 | 0.314 | 0.776 | 0.118 | |
| group×Time | 10.946 | 1 | 10.946 | 0.687 | 0.409 | 0.005 | 0.131 | |
| Presence of Meaning | group | 312.927 | 1 | 312.927 | 147.190 | 0.052 | 0.993 | 0.659 |
| Time | 250.455 | 1 | 250.455 | 117.805 | 0.058 | 0.992 | 0.606 | |
| group×Time | 2.126 | 1 | 2.126 | 0.137 | 0.712 | 0.001 | 0.066 |
Discussion
The results of this study showed that holding group poetry reading sessions can promote meaning in life, especially in the domain of “searching for meaning” among the elderly. But results showed no significant difference between the two groups’ Subjective Vitality mean scores after the intervention.
Based on the study findings, the mean score of Meaning in Life in the intervention group increased significantly after the intervention compared to baseline. Although the control group also exhibited an increase in the mean score of meaning in life following the intervention, the between-group comparison of post‐intervention scores indicated that the intervention group maintained a higher meaning score. These results are consistent with Li and colleagues’ findings on the impact of art therapy on life meaning [49] and with Visrekarami et al.’s report that painting therapy enhances meaning in lifeand mental health [50] Similarly, Hosseini and co-workers found that artistic activities, including music, positively affected meaning in life among older adults at an aging center in Iran [51, 52]. It can be inferred that life’s meaning may be derived from engaging in valuable activities, experiencing noble values, or enduring adversity. Researchers propose that mindfulness‐based art therapy fosters well-being and meaning in lifein older adults [52, 53]. Poetry, one of the most impactful forms of art and literature, is pivotal in strengthening life’s meaning. Some studies have shown that poems with hopeful, meaningful, inspirational, and resilient themes can reduce stress, increase perceived life control, bolster resilience, and heighten personal motivation[54–56]. A review of the literature indicates that poetry and literature significantly contribute to meaning-centered therapies, anxiety reduction, self-awareness enhancement, and improved life satisfaction [30, 57, 58].
Analysis of the subscales of Meaning in Life, namely “Search for Meaning” and “Presence of Meaning”, revealed that participation in the poetry-reading sessions significantly improved the Search for Meaning subscale among participants. Regarding the Presence of Meaning subscale, the intervention and control groups demonstrated increased scores after the intervention compared to baseline; however, no statistically significant difference was observed between the groups following the intervention [59].
Heyman Mahmoudfekheh found a significant positive association between the Search for Meaning in Life and students’ subjective well-being. These findings suggest that individuals with a greater inclination to search for meaning tend to experience higher levels of subjective well-being [60]. Moreover, Yekeh and colleagues examined the relationship between meaning in Life—both its presence and search dimensions—and health anxiety. Their results demonstrated that individuals with higher levels of both Presence and Search for Meaning experienced lower levels of health-related anxiety, implying that meaning-oriented individuals may be more resilient to anxiety symptoms [61, 62].
In interpreting these findings, it can be noted that in psychological literature, the search for meaning reflects an active striving for purpose, whereas the presence of meaning denotes the extent to which individuals currently perceive their lives as meaningful [45]. Activities like poetry reading primarily stimulate introspection, existential questioning, and engagement with metaphorical themes. These factors are well-suited to trigger the search for meaning, enhancing exploratory motivation, rather than immediately bolstering an already stable sense of meaningfulness. The presence of meaning tends to be more trait-like or slower to change. Short-term interventions may not be sufficient to significantly alter this dimension, which often requires deeper, integrative processes over time. The findings align with the search-to-presence model of meaning-making, where the act of searching can—over time—facilitate the development of a deeper sense of presence [63]. These findings suggest that short-term interventions primarily catalyze meaning-seeking, positioning participants along the initial phase of the meaning-making trajectory.
As the study findings suggest, the results of the statistical test did not show a significant difference between the mean vitality scores of the two groups after the intervention. This suggests that although subjective vitality improved in the intervention group following the sessions, a similar increase in the control group implies that the observed change may not be solely attributable to the intervention itself. “Other factors—such as participation in non-intervention activities at the elderly care center and broader socio-economic changes that promote greater social participation—may have influenced the results. In fact, these broader changes and higher levels of social participation appear to have a larger impact on the conclusion, since both the intervention and control groups were allowed to attend unrelated center activities and were similar in this regard.” Social connectedness is one of the most powerful predictors of mental vitality in older aged adults. Involvement in family life, community activities, volunteering, and peer support programs increase cognitive stimulation, sense of purpose, and emotional support, which improves mental vitality in the elderly [64–67]. Regarding the study findings, research by Hannigan et al. demonstrated that engaging in drawing activities improved subjective vitality [68]. Holmqvist and colleagues also reported that art therapy interventions contributed to increased levels of subjective vitality [69]. Cumulative evidence indicates that creative interventions—including poetry reading, painting, music therapy, and other art-based therapy—can positively influence subjective vitality and reduce stress [70, 71]. In light of previous findings and the nature of the present intervention, it can be postulated that the use of poems with themes of hope, motivation, and positive life values, such as purposefulness, personal worth, and future orientation, might have functioned similarly to hope-based therapy. Sharifi and colleagues, in their study on elderly women, reported that hope-based interventions enhanced both life satisfaction and subjective vitality [72]. Sherwin and colleagues also observed that a structured hope-based therapy process focusing on goal-directed thinking resulted in higher meaning in life, self-esteem, and subjective vitality [73]. Thus, by stimulating constructive thinking, evoking positive emotions, and creating a clear mental vision of the future, the selected poems may have activated internal psychological resources, contributing to enhanced subjective vitality among participants.
In general, it can be said, this study extends previous research by exploring the effects of group poetry reading as a community-based, culturally sensitive intervention for older adults. Unlike prior studies focusing on individualized poetry therapy, this study highlights the collective and participatory dimensions of poetry reading and its potential to enhance meaning-seeking and well-being in aging populations.”
Strong points and limitations
One of the strengths of this study is the simplicity and cost-effectiveness of the poetry reading intervention, which can be implemented easily in various settings. Another notable advantage is its non-invasive nature, allowing geriatric nurses to apply this method to enhance meaning in life and subjective vitality among older adults. However, the study also had some limitations. First, sampling was restricted to a single elderly care center, which may limit the generalizability of the findings. Second, the relatively high baseline levels of vitality and hope among participants in the control group—likely influenced by their involvement in other activities offered by the center—might have affected the outcomes. Third, the scarcity of comparable studies in this area limits researchers in drawing direct comparisons. Fourth, all data collection was performed by research staff, with no blinding during the study. A further limitation is the failure to consider the duration of the presence (activity) of the elderly in the daycare center. The length of the study due to consecutive sampling (temporal bias) is also an issue that should be considered in other studies. Moreover, given the likely temporal lag between search for meaning and presence of meaning, future interventions could include follow-up measures to capture gradual shifts in life meaningfulness that emerge after the initial exploration phase.
Conclusion
The results of this study showed that holding group poetry reading sessions can promote meaning in life, especially in the domain of “searching for meaning” among the elderly. But results showed no significant difference between the two groups’ Subjective Vitality mean scores after the intervention. Therefore, holding such classes in elderly day care centers or nursing homes are recommended to improve meaningful life in the elderly. Considering its demonstrated effectiveness in promoting a sense of purpose and meaning, along with practical advantages such as ease of implementation, low cost, and fewer side effects compared to specific pharmacological treatments, this technique may be recommended for broader use in geriatric care settings. These findings may be of particular interest to long-term care facilities, families, and those involved in elderly care, highlighting the importance of addressing this population’s psychological and existential needs. Nonetheless, further comprehensive and large-scale research is warranted to confirm and expand upon these results.
Acknowledgements
This study was extracted from Mohammad Reza Dehghani's master’s thesis. The authors would like to express their sincere gratitude to Dr. Majid Eskandari for his valuable collaboration and support in organizing the poetry reading sessions. They also thank Mrs. Tahereh Sokout, administrator of the Soroush Adult Daycare Center in Shiraz, for her assistance in coordinating the study, and all the participants for their valuable cooperation.
Abbreviations
- ANCOVA
Analysis of covariance
- MLQ
Meaning in life questionnaire
- SVS
Subjective vitality scale
Authors’ contributions
MRD and FSh contributed to the study design. FSh and SJ provided overall supervision and guidance throughout the study. MRD was responsible for conducting the research. He processed the data, performed the analyses, and drafted the initial version of the manuscript. All authors discussed the results, contributed to the interpretation, provided critical feedback, and approved the final version of the manuscript.
Funding
Shiraz University of Medical Sciences financially supported this research (Project No. 29338).
Data availability
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
The present study was approved by the Ethics Committee of Shiraz University of Medical Sciences (IR.SUMS.NUMIMG.REC.1402.140). It was also registered in the Iranian Registry of Clinical Trials (IRCT) with registration number IRCT20190727044347N7 on 2024-04-12. All necessary permissions for conducting the research were obtained from the relevant administrators, and all methods were performed following the relevant guidelines and regulations. Furthermore, a session was held after the selection of participants to explain the study objectives and procedures. Written informed consent forms were also obtained from all participants.
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.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.