The Journal of Nursing Research h VOL. 26, NO.
2, APRIL 2018
A Systematic Review of Reminiscence
Therapy for Older Adults in Taiwan
Hsin-Yen Yen1 & Li-Jung Lin2*
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ABSTRACT
Background: Population aging is an increasing phenomenon in
many countries around the world. It has been estimated that
more than one quarter of all older adults experience a mental or
neurological disorder or disease such as dementia, depression,
anxiety, and substance abuse. Reminiscence is a popular
treatment for enhancing well-being in older adults. Previous
studies have shown that reminiscence therapy improves the
cognitive functions, behaviors, and other psychosocial out-
comes in older adult patients. The themes and materials that are
used in reminiscence treatments for the older adults in Taiwan
differ from those used in other countries because of Taiwan_s
unique historical background and culture.
Purpose: The main purpose of the current study was to review
systematically the application and outcomes of reminiscence
therapy in Taiwan.
Method: The terms Breminiscence,[ Bdementia,[ BAlzheimer_s
disease,[ and BTaiwan[ were used in an Integrated Resources
Search that was conducted at National Taiwan Normal Univer-
sity. Sixteen articles were systematically reviewed using a syn-
thesis of two matrices of experimental designs and intervention
designs.
Result: Reminiscence group sizes ranged between 7 and 12
participants, session frequencies were all once a week for pe-
riods lasting between 4 and 16 weeks, and session durations
ranged from 30 minutes to 2 hours. The memories of the
participants were stimulated using materials dating from their
youth such as Taiwanese folk songs, toys, photos, radio pro-
grams, newspapers, and food and drinks. In terms of research
methodology, most of the studies that were reviewed used
quasi-experimental designs without random assignment or
control group due to sample size. A minority of the reviewed
studies applied the randomized controlled treatment method.
Only a few of the studies evaluated indicators in pretest, post-
test, and follow-up periods. The results of these studies identi-
fied several benefits of reminiscence therapy in Taiwanese older
adults, including improvements in cognitive function, anxiety,
depressive symptoms, self-esteem, life satisfaction, and per-
sonal interaction.
Conclusions: Reminiscence is a good noninvasive treatment
for the prevention and treatment of mental diseases in Taiwanese
older adults. Furthermore, reminiscence promotes mental health
in older adults. Finally, this study provides recommendations for
further study and clinical application of reminiscence therapy in
Taiwan.
138
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KEY WORDS:
life review program, dementia, gerontology, psychiatry,
mental health.
Introduction
Healthy aging is an important issue globally. The number
of people aged 65 years and above worldwide has in-
creased from 524 million in 2010 to 1.5 billion in 2050.
The cost of healthcare for this older population has be-
come a huge social burden (World Health Organization,
2011). Thus, the health status and health promotion issues
of older adults are of critical concern. More than 26% of
older adults experience at least one mental or neurological
disorder or disability. The most common neuropsychiatric
disorders in older adults are dementia, depression, anxiety,
and substance abuse problems. Health, social services,
and long-term care play important roles in promoting mental
health in older adults (World Health Organization, 2015).
However, adults in the maturity stage of Erickson’s life
stage (9 65 years old) have undergone the ‘‘ego integrity vs.
despair’’ process. During this stage, older adults develop
integrity and cope with their feelings about life events
(Erikson, 1959). Social isolation and exclusion are also
common problems during this stage. Common objectives of
older adults include adapting to the social environment,
enjoying support, and being empowered to live and die
with dignity (World Health Organization, 2015). Reminis-
cence therapy may help older adults review their memories,
experiences, and accomplishments to age successfully and
to face death.
Reminiscence therapy is a popular intervention for older
people in dementia care, long-term care, and hospice care
(Cotelli, Manenti, & Zanetti, 2012). The reminiscence tech-
nique has been used extensively since the 1960s by profes-
sional practitioners such as psychologists, nursing staff, social
workers, and recreational therapists. Reminiscence therapy is
usually used as a treatment and an intervention for the older
adults because of its nonpharmacological nature. Reminiscence
1
MEd, RN, Doctoral Student, Graduate Institute of Sports,
Leisure, and Hospitality Management, National Taiwan Normal
University & 2PhD, CTRS, HTR, Associate Professor, Graduate
Institute of Sports, Leisure, and Hospitality Management,
National Taiwan Normal University.
Reminiscence Therapy in Taiwan
therapy has been shown to have a positive impact on older
patients with and without mental health problems (Syed
Elias, Neville, & Scott, 2015; Woods, Spector, Jones, Orrell,
& Davies, 2005).
Reminiscence is defined as an action or process of recall-
ing the past, which may occur in people of any age. Rem-
iniscence therapy may involve sharing in a group setting or in
the presence of one observer who listens quietly without
comment (Butler, 1963). Reminiscence is an internalized
behavior in which ‘‘there is often an interplay, a ‘dialectic,’
between an individual’s internal mental processes and
external manifestations of thought’’ (Parker, 1995). Al-
though not everything that is thought internally is ex-
pressed externally, people who review life events tend to
select stories that reflect their values. Therefore, the remi-
niscence process may be completed on two different levels:
intrapersonally (internally) or interpersonally (in a dyad or
group). When people talk about their past to others, they
not only ruminate or introspect about what they believe
and value in the relationships among self-relevant events
across time but also reconstruct an interpersonal context
by obtaining input from others and achieving reciprocity
or an exchange of ideas. This process contributes to deve-
loping, maintaining, or reconstructing personal identity
(Parker, 1995).
In general, three global functions may be used to ex-
amine reminiscence as a mechanism for continuity: self-focus
(coherence and meaning), guidance (knowledge based),
and social bonding (emotion management; Cappeliez,
Rivard, & Guindon, 2007). In addition, describing negative
feelings that were induced by a tragedy and then releasing
the related grief with support from others may provide
psychological relief for the individual. Although cognitive
capacity may decrease with age or disease, older adults
may enhance cognitive performance by exercising memory
systems and by improving plasticity via reminiscence.
Undoubtedly, individuals keep past memories stored in the
brain, even as particular areas are gradually impaired.
Reminiscence may be the key to unfolding memories and
to making ‘‘the past become a rich resource of living in the
present and anticipating the future’’ (Gibson & Burnside,
2005, p. 175).
Lin, Dai, and Hwang (2003) first proposed the frame-
work of reminiscence therapy. Reminiscence therapy is a
process that includes several stages: antecedent, assessment
setting the therapeutic purpose, choosing the therapy modal-
ity (simple reminiscence or life review), and outcome mea-
surement. Most of the previous studies examining the
effectiveness of reminiscence therapy have focused on the
improvement of depression and anxiety, interactions and
communications, positive affect, life satisfaction, self-esteem,
and cognitive functions (Cotelli et al., 2012; Pinquart &
Forstmeier, 2012; Song, Shen, Xu, & Sun, 2014).
The themes and materials that have been used in remi-
niscence therapy differ from country to country because of
cultural differences. This study was conducted in Taiwan,
Copyright © 2018 Taiwan Nurses Association. Unauthorized reproduction of this article is prohibited.
VOL. 26, NO. 2, APRIL 2018
subject to Japanese rule for 50 years, between 1895 and
1945. The Republic of China has governed Taiwan since
1945. Thus, Taiwan has a multicultural society that has
been influenced significantly in modern times by Chinese,
Japanese, and indigenous Malayo-Polynesian cultures.
Many of Taiwan’s older adults have experienced wars,
food shortages, resource shortages, poverty, and imposed
patriotism (Rubinstein, 2015). These life events were
important parts of the childhoods of these older adults.
Therefore, the themes and materials of reminiscence should
reflect the history, personal background and experiences,
and shared memories, and remembrance therapy should be
tailored to the context of older Taiwanese.
Few studies on the application of reminiscence approaches
in populations of frail older adults have been published in
gerontology or nursing care journals in Taiwan. The research
designs, reminiscence intervention designs, and outcomes all
differ significantly among previous studies. Therefore, the aim
of the current study was a systematic review of reminiscence
therapy interventions and outcomes in Taiwan, the experi-
mental and intervention designs that were used in previous
studies, and the distinctive contents of reminiscence programs
that are currently used for Taiwanese older adults. In addition,
this study attempted to identify the benefits and effectiveness
of reminiscence therapy in this population. The results may be
used to guide the design of reminiscence therapies for future
studies and clinical application.
Methods
A synthesis matrix was used to conduct the systematic re-
view. A synthesis matrix is a literature review method that
is widely applied in the health sciences. The matrix box is
composed of rows and columns, with the rows comprising
literature and the columns comprising topics and variables
of interest to the researchers. The abstracts, summary, and
points of articles are included in a synthesis matrix. A
synthesis matrix is also a critical analysis method that is
used to develop future research (Garrard, 2006).
This study used the search terms ‘‘reminiscence,’’ ‘‘de-
mentia,’’ ‘‘Alzheimer’s disease,’’ and ‘‘Taiwan’’ in an Inte-
grated Resources Search that was conducted through the
National Taiwan Normal University. The search covered sev-
eral databases, including Taylor and Francis, Ltd.; Springer
Science; Science Direct; Sage Publications, Inc.; and Elsevier,
Ltd., among others. The search focused on articles pub-
lished between 2004 and 2016. Two reviewers conducted
the systematic review. The first was a doctoral student in a
graduate institute of sport and leisure and a registered nurse
in Taiwan with psychiatric nurse experience. The second
was an associate professor in the same graduate institute
who held a doctorate in Parks, Recreation, and Leisure and
therapeutic recreation specialist and horticultural therapist
certifications from the United States. The two reviewers se-
lected, cross-compared, and discussed the articles together to
ensure accuracy.
139
The Journal of Nursing Research
To explore the implementation and effectiveness of
reminiscence therapy in Taiwan, several criteria were used
in the selection process. First, all selected articles used
evidence-based interventions and were not theoretical, in-
troductory, or review articles. Second, all experiments used
in the selected articles were conducted in Taiwan regions in
either institutional or noninstitutional settings such as older
adult care facilities, medical centers, nursing homes, and
community and other healthcare institutions. Third, remi-
niscence therapy was the intervention in all of the selected
articles. Studies that used music therapy and art therapy in
patients with dementia were excluded. Experimental,
nonexperimental, and qualitative studies were included.
Finally, participants in the selected studies were all 65 years
or older. Overall, 20 articles were identified by the Integrated
Resources Search. Four of these were excluded from the final
review; two addressed unrelated topics, and the remaining
two were literature reviews.
Results
Sixteen articles were reviewed using two different synthesis
matrices (intervention and experimental designs). Issues
discussed in the articles using experimental designs were
assessed with regard to type of reminiscence intervention
approach used, intervention frequency, group size, remi-
niscence topic/theme, evocative materials, and training
procedures (see Table 1).
Group Size
Most of the studies in the review implemented group rem-
iniscence therapy, whereas three studies adopted one-on-
one programs (Chao et al., 2008; Wang, 2004, 2005). The
most common group sizes ranged from 7 to 12 participants,
although Su et al. (2012) had the largest groups, with
25Y26 participants each. Group size was not recorded in two
of the studies (Chiang et al., 2008, 2010).
Frequency
Eight to 16 sessions were held over a 4- to 16-week period.
Reminiscence sessions were held once or twice a week. Most
of the interventions conducted eight sessions over 8 consec-
utive weeks, with a frequency of one session per week. The
duration of each reminiscence session was between 30 min-
utes and 2 hours. In most of the studies, reminiscence was
60 minutes per session. The most frequent session was ad-
ministered in 72 successive sessions at three times per week
over a 3-month period (Su et al., 2012).
The Content of Reminiscence
Structured, unstructured, and life review approaches were
used in the reviewed studies. Themes and topics focused
on childhood experiences, marriage, family life, and jobs.
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Hsin-Yen Yen et al.
Other themes focused on identifying meaning in life, future
goals, fears of death, and expressing personal feelings.
Unspecified discussions based on evocative materials
were prevalent. However, Huang et al. (2009) used cooking
lessons only to stimulate the senses of older adults to evoke
memories through food. Images and sounds were commonly
used as evocative materials and stimuli. Several studies asked
participants and their family members to collect old be-
longings to share with the group (Chao et al., 2008; Chiang
et al., 2008). Because of Taiwanese history, many evoca-
tive materials dated from the Japanese Colonial Period and
included folk items such as lullabies; traditional toys; folk
music tapes, records, and movies; and tea art. These made
it easier for the participants to recall memories of past
experiences.
Only two of the studies applied a life review interven-
tion (Chiang et al., 2008; Lin et al., 2011). Life review is a
spontaneous, universal mental process that involves the
evaluation and resynthesis of past experiences, in partic-
ular, unresolved conflicts. It is necessary for individuals to
reintegrate the experiences of life to adapt to old age; cope
with loss, guilt, conflict, or defeat; and help find meaning
in their accomplishments (Butler, 1963; Haber, 2006). On
the basis of Erikson’s theory, a professional using a struc-
tured program is able to systematically evoke the salient mem-
ories from each stage of the life cycle of an older person.
Facilitators
Two people are typically needed to conduct group sessions
(Chao et al., 2006, 2008; Wang, 2007; Wang et al., 2009).
The leader and co-leader of the program and the reminis-
cence facilitator were usually registered nurses, social work-
ers, recreation therapists, or healthcare providers with
experience in geriatric care. However, most of the studies
did not identify background or profession of the program
leader. Only five studies provided training for the program
leader (Hsu & Wang, 2009; Su et al., 2012; Wang, 2005,
2007; Wang et al., 2009).
Second is the result of a synthesis matrix of research
designs. Research design is a critical factor for developing
future, qualified studies. Several usable items of informa-
tion on reminiscence research designs were provided by
the reviewed studies. All articles were reviewed using the
following topics: participants and settings, study design,
outcome indicators, and findings (Table 2).
Participants and Setting
Two major groups were recruited for these studies, older
adults with dementia and older adults without dementia or
with no cognitive impairment, with each reflecting distinct
research purposes. Five studies focused on patients with
mild to moderate dementia (Huang et al., 2009; Lin et al.,
2011; Su et al., 2012; Wang et al., 2009; Wu & Koo, 2016),
and only one study expanded the intervention to include
Reminiscence Therapy in Taiwan
severe dementia (Wang, 2007). On the other hand, partici-
pants without dementia were identified using either the Mini
Mental State Examination (MMSE) or psychiatric diagnoses.
All of the studies recruited a sample of between 7 and
103 participants. Three studies had small sample sizes of
7Y10 participants (Chao et al., 2008; Huang et al., 2009;
Lin et al., 2011), two had 20Y30 participants (Chao et al.,
2006; Chueh & Chang, 2014), three had 45Y48 partici-
pants (Hsu & Wang, 2009; Wang, 2004, 2005), three had
75Y77 participants (Chiang et al., 2008; Wang et al., 2009;
Wu, 2011), and five had even larger sample sizes, from 92
to 103 participants (Chiang et al., 2010; Su et al., 2012;
Wang, 2007; Wang et al., 2005; Wu & Koo, 2016).
The studies targeted recruitment efforts in healthcare fa-
cilities, including the gerontology departments of medical
centers, long-term care facilities, nursing homes, and a san-
atorium. Most of the studies employed purposive sampling
in long-term care facilities. Nine of the studies recruited
participants from only one long-term care institution, and
seven recruited participants from two different healthcare
institutions. Three of the reviewed studies recruited veterans
exclusively (Chiang et al., 2008; Chueh & Chang, 2014;
Wu, 2011). Finally, Wang (2004) compared institutional-
ized and noninstitutionalized older adults.
Experimental Design
Randomized controlled trials (RCTs) have been recommended
as a strong research design for topics in patient care because
of the power and reliability of results (Begg et al., 1996).
However, few reminiscence studies have applied RCT
(Chiang et al., 2008; Wang, 2007; Wang et al., 2009; Wu
& Koo, 2016). Those that used RCT were mostly studies
with large sample sizes. All the remaining studies used quasi-
experimental designs. For example, only one experiment
group was used, or participants were not divided randomly
because of the small sample size. Furthermore, pretests and
posttests were commonly used in the reviewed studies.
Finally, three of the studies conducted a follow-up test 1Y3
months after the intervention (Chiang et al., 2008, 2010;
Chueh & Chang, 2014).
Outcome Indicators
Most of the studies collected quantitative data to examine the
effectiveness of reminiscence on daily functioning, cognition,
depression, mood status, self-esteem, and life satisfaction.
However, only one of the studies, in which a nurse was both
the investigator and the leader of reminiscence activity, used the
qualitative method of participant observation to clarify the
process and the meanings of reminiscence (Chao et al., 2008).
Most of the studies adopted subjective psychosocial
measurements, including the Geriatric Depression ScaleYShort
Form and Self-esteem, Life Satisfaction, and Health Percep-
tion Scales, or objective performance assessments (e.g., MMSE
and Activities of Daily Living [ADL]) to detect intervention-
Copyright © 2018 Taiwan Nurses Association. Unauthorized reproduction of this article is prohibited.
VOL. 26, NO. 2, APRIL 2018
related changes. Other common measurement instruments
that were not adopted included the Apparent Emotion Rating
Scale, Loneliness Scale, Behavioral Rating Scale, Medical
Outcomes Study, 36-Item Short Form Healthy Survey (MOS
SF-36), Clinical Dementia Rating Scale, Short Portable Mental
State Questionnaire, and Herth Hope Index. However, Huang
et al. (2009) examined differences in electroencephalography
(EEG) waves.
Findings
Reminiscence therapy has been shown to improve depres-
sive symptoms and mood status. Wang (2004, 2005) and
Wang et al. (2005) showed that reminiscence therapy had
significant, positive influences on self-health perception, de-
pressive symptoms, and mood status in institutionalized
older people. Wang (2007), Hsu and Wang (2009), and Wang
et al. (2009) identified significant improvements in cogni-
tion functions, mood and affection, social disturbance, and
depressive symptoms. However, no significant difference was
identified in terms of group effects on overall behavior com-
petence or ADL. Chueh and Chang (2014) and Su et al.
(2012) showed that the experimental group with reminis-
cence therapy significantly improved in terms of depres-
sive symptoms and geriatric depression in both the posttest
and follow-up test. However, no significant change was de-
tected in terms of cognitive status rating, MMSE, or Clinical
Dementia Rating Scale level.
Reminiscence therapy was found to influence self-esteem
and life satisfaction positively. Chao et al. (2008) showed a
significant improvement in self-esteem but insignificant
differences in depression and life satisfaction. Chiang et al.
(2010) and Wu (2011) found that experimental groups
improved significantly in terms of self-esteem, life satisfac-
tion, and depression.
Reminiscence therapy was shown to benefit the mental
health of older persons. Chiang et al. (2010) applied struc-
tured reminiscence and showed significant improvements in
depressed mood, psychological well-being, and feelings of
loneliness. Lin et al. (2011) found improved mental health,
including vitality, social functioning, emotional role, and phys-
ical role in physical health. Wu and Koo (2016) found that
all indicators had increased significantly in the experimental
group, including the Herth Hope Index, Life Satisfaction
Scale, Spirituality Index of Well-Being, and MMSE. Huang
et al. (2009) determined that reminiscence therapy significantly
improved the EEG slow and fast waves, personal interaction
scale, and feelings of participants, but there were only insig-
nificant improvements for MMSE scores and depression.
Chao et al. (2006) applied a group reminiscence inter-
vention in developing the framework of reminiscence therapy
using observation as their method of study. The information
collected included the personal characteristics of the resi-
dents, the content of the reminiscence, settings and triggers
or catalysts, the verbal and nonverbal reactions of residents,
and the thoughts and feelings of researchers. The result
141
The Journal of Nursing Research Hsin-Yen Yen et al.

TABLE 1.
Description of the Interventions Used in the Reviewed Studies
Frequency of Intervention
Study Modality Length Total Session Minute per Session Group Size (No. in Each Group)*

Wang, 2004 Individual (1:1) 4 months 16 (once a week) 45Y60 1

Wang, 2005 Individual (1:1) 4 months 16 (once a week) 35Y45 1

Wang, Hsu, & Cheng, Group 4 months 16 (once a week) 30Y120 N/A (unspecified in article)
2005
Chao et al., 2006 Group 9 weeks 9 (once a week) 60 12

Wang, 2007 Group 8 weeks 8 (once a week) 60 8Y10

Chao, Chen, Liu, & Individual 8 weeks 8 (once a week) 60 1

Clark, 2008

Chiang, Lu, Chu, Chang, Group 8 weeks 8 (once a week) 60Y90 N/A
& Chou, 2008

Hsu & Wang, 2009 Group 8 weeks 8 (once a week) 60 8Y10

Huang, Li, Yang, & Group 8 weeks 8 (once a week) 60 11

Chen, 2009

Wang, Yen, & OuYang, Group 8 weeks 8 (once a week) 60 8Y12

2009

Chiang et al., 2010 Group 8 weeks 8 (once a week) 90 N/A

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Reminiscence Therapy in Taiwan VOL. 26, NO. 2, APRIL 2018

Executor
Topic/Theme Evocative Material No. of Leader Pretraining

Unstructured reminiscence. Focus on past experiences or Old photos, recordings of old songs and 1 N/A
feelings, without specific topics but some events (i.e., radio programs, and other reminders of
childhood experiences, marriage, family life, the the past
hardships of war, and previous jobs)
Unstructured reminiscence. Focus on past events, e.g., Old photos, recordings of old songs and radio 1 Yes (2 months)
childhood experiences, marriage, family life, war, and jobs programs, and other reminders of the past
Unstructured reminiscence. Recall past events such as Old photos, recordings of old songs and radio 1 N/A
childhood experiences, marriage, family life, and jobs programs, and other reminders of the past
1.That_s how I grew up Photos, magazine articles, albums, news 2 N/A
2. The home I created clippings, tape recorder, incense holders,
posters, special holiday snacks
1. First meeting Photographs, household, and other familiar items 2 Yes (32 hours)
2. Childhood experiences from the past; old-time music; old-time food
3. Old flavor of food flavors
4. Old style music
5. Festivals
6. My family
7. Younger age
Unstructured reminiscence. Any past event related Old photos, magazine articles, albums, 2** N/A
to each individual new clippings

Life review program N/A 1 N/A

1. Childhood memories
2. Adolescence
3. The subject_s family
4. The subject_s job
5. The subject_s friends
6. The greatest thing the subject has accomplished in life
Unstructured reminiscence. Topics: first meeting, childhood Traditional festival food, photos, and 2 Yes (16 hours)
experiences, old-time flavor of food, old-time music, recordings of old songs
festival, my family, when I was young, and my awards
The summary of life reviews and the integration
of life events
Cooking lessons (remembered dishes) Stir-fried powder, wheat soup, fried 1 N/A
oysters, fried noodles, dumplings,
soup, and green onion pancakes

1. First meeting Photographs, foods, music, household, 2 Yes (32 hours)

2. Childhood experiences and other familiar items from the past
3. Old-time flavor of food
4. Old-time music
5. Festival
6. My family
7. When I was young
8. My awards

Structured reminiscence N/A 1 N/A

1. Memories and greeting
2. Express their feelings
3. Past to present relationships
4. Family history and life stories
5. Transition in life issues
6. Personal accomplishments
7. positive strengths and goals
8. Overall review
(continues)

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The Journal of Nursing Research Hsin-Yen Yen et al.

TABLE 1.
Description of the Interventions Used in the Reviewed Studies, Continued

Frequency of Intervention
Study Modality Length Total Session Minute per Session Group Size (No. in Each Group)*

Lin, Li, & Tabourne, Group 5 weeks 10 (twice a week) 60 7

2011

Wu, 2011 Group 12 weeks 12 (once a week) N/A 8Y10

Su, Wu, & Lin, 2012 Group 24 weeks 72 (thrice a week) 120 25Y26

Chueh & Chang, 2014 Group 4 weeks 8 (twice a week) 60 11

Wu & Koo, 2016 Group 6 weeks 6 (once a week) 60 3Y6

described the reminiscence process in four stages: entrée,
immersion, withdrawal, and closure. Triggers in initiation
included auditory and visual. The inducer and active
listeners played important roles during the entrée stage.
Several items of evidence from previous studies show the
psychological benefits of using reminiscence in older popula-
tions. First, significantly higher posttest MMSE scores
(Wang, 2007; Wu & Koo, 2016) and faster EEG waves
(Huang et al., 2009) indicate improvement in cognitive func-
tion. Second, depressive symptoms tended to decrease and
mood status tended to improve in the treatment groups
(Chueh & Chang, 2014; Hsu & Wang, 2009; Su et al.,
2012; Wang, 2005, 2007; Wang et al., 2005). Third, signi-
ficant improvements in personal interaction (Huang et al.,
2009) and self-esteem (Chao et al., 2006; Chiang et al.,
2008) were observed.
Discussion
Reminiscence therapy acts as a vehicle for older adults to
recall their experiences and specific life events and to
explore the meanings and influence on the future behavior
of individuals who have these memories (Gibson & Burnside,
2005; Parker, 1995). Careful examination and discussion
of reminiscence may help older adults reintegrate their life
strengths and accomplishments and apply them to the pres-
ent (Cappeliez et al., 2007). Several studies have confirmed
that reminiscence therapy influences cognition (Huang et al.,
2009; Wang, 2007; Wu & Koo, 2016), mood/emotions
(Chueh & Chang, 2014; Hsu & Wang, 2009; Su et al., 2012;
Wang, 2005, 2007; Wang et al., 2005), social interaction
(Huang et al., 2009), and psychological well-being in older
adults.
However, several improvements should be incorpo-
rated into research designs and processes. First, the benefits of
recruiting from a single institution include convenience for the
researchers and homogeneity among participants due to
shared institutional experiences and similar lifestyles (Lin
et al., 2011). However, studies with larger sample sizes
may recruit participants from multiple institutions. In fu-
ture studies, the recruiting process should be based on inter-
vention designs that are valid with larger and smaller group

144

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 Reminiscence Therapy in Taiwan
TABLE 1.
Description of the Interventions Used in the Reviewed Studies
Topic/Theme
Live review program
Focus on each Erikson_s life stages
Unstructured reminiscence.
A past photo I miss, a memorable trip and person, a proud
thing in life, present life, one thing I can do now, and hope
for the future
Unstructured reminiscence.
Theme: knowing each other, childhood and family, previous
employment and making a living, leprosy episode, social
isolation and stigmatization, lifestyle in the sanatorium, old
friends, child raising, physical illness and disability,
entertainment, old-style music, environmental change
after sanatorium
1. Memories related to the war
2. Past relationships
3. Life histories and life stories
4. Life transitions
5. Personal accomplishments
6. Personal goals
1. Meaning in life
2. Relationships, isolation, and connecting
3. Hopes, fears, and worries
4. Growing older and transcendence
5. Spiritual and religious beliefs
sizes. Furthermore, participant characteristics should be
considered in future studies. Most of the studies emphasized
the importance of recruiting a sufficiently large sample size
(Chiang et al., 2008; Lin et al., 2011; Wu & Koo, 2016).
Second, with regard to study design, RCTs are recom-
mended for all future studies on this topic. RCTs are usually
intended for use with larger sample sizes because of the
requirement of assigning sufficient numbers of participants to
experimental and control groups (Chiang et al., 2008; Wang,
2007; Wang et al., 2009; Wu & Koo, 2016). Most of the
studies did not randomize participant assignments to two
comparison groups. These studies not only measured the
effectiveness of the interventions using pretest and posttest
measures but also instituted follow-up measures after 1Y3
months. The objective of reminiscence therapy is sustained
improvement over the long term (Lin et al., 2011).
Third, the quantitative research method was a common
approach used in the reminiscence therapy studies that were
reviewed. Reliable and valid questionnaires and inventories
such as Geriatric Depression ScaleYShort Form; Self-
esteem, Life Satisfaction, and Health Perception Scales;
Copyright © 2018 Taiwan Nurses Association. Unauthorized reproduction of this article is prohibited.
VOL. 26, NO. 2, APRIL 2018
Executor
Evocative Material No. of Leader Pretraining
Taiwanese lullaby songs, draw lots, old-time 2Y3 N/A
toys, old-time Taiwanese record and movie,
garden activities, and tea art
Favorite songs, significant documents and 1 N/A
pictures
Old buildings, old trees and plants, old 4 Yes
furniture, photographs, diaries, old-time
music, and old-time food
N/A 1 N/A
Scrapbooks, handicraft, autobiographical 1 N/A
writing, observing the growth of plants,
storytelling, and singing
MMSE; and ADL were used as measurement tools and
outcome indicators (Chao et al., 2006; Su et al., 2012;
Wang et al., 2009; Wu, 2011; Wu & Koo, 2016). Suit-
able research instruments should be selected based on the
character of the participants and the purpose of the study.
In addition, the qualitative method may be adopted to
collect richer psychological information on participants
via in-depth interviews and observations (Chao et al.,
2008).
Other suggestions elicited from our review of previous
reminiscence therapy studies are as follows. A group size
of 7Y12 participants is common and considered ideal in
group reminiscence therapy. Group reminiscence therapy
is beneficial because Chinese older adults tend to be more
reluctant to interact in social groups (Wang, 2005). A small
group setting may allow the group leader to more readily
implement and control the reminiscence therapy process,
providing more opportunities to note reactions, perfor-
mances, feedback, and the safety of older subjects to ensure
that all have equal opportunity to participate. On the other
hand, individual reminiscence therapy was also used in
145
The Journal of Nursing Research Hsin-Yen Yen et al.

TABLE 2.
Summary Descriptions of the Reviewed Studies
Study Design
Study Participant Setting Approach Group Outcome Indicator Finding
Wang, 48 seniors without Recruited from a Quasi-experimental Two groups both had 1. Self-esteem No significant difference
2004 dementia (52 variety of design with RT intervention between institutionalized
2. Self-health perception
original, 4 community pretest and (one group is from and noninstitutionalized in
dropped) care facilities posttest institutions; the 3. Depression symptom self-esteem, self-health
and home care other one is from 4. Mood status perception, and depressive
agencies in home care) symptoms, but significant
south Taiwan difference in mood status.
Within time changes, no
significant differences in the
noninstitutionalized group,
but significant differences
in self-health perception,
depressive symptoms, and
mood status for the
institutionalized group
(exclude self-esteem).
Wang, 48 seniors without Selected from Quasi-experimental Experimental and 1. Depressive symptom Significant improvement in
2005 dementia (55 five long-term design with control groups the experimental group
2. Mood status
original, 7 care facilities in pretest and on depressive symptom
dropped) south Taiwan posttest and mood status, but
not in the control group.
High percentages of
depression in the pretest
and decrease after the
intervention.
Wang et al., 94 seniors without Recruited from Quasi-experimental Experimental (with 1. Geriatric Depression 1. All variables had no
2005 dementia five community design with IV) and control Scale-Short Form statistically significant
care facilities pretest and (without IV) (GDS-SF) differences in the
and three posttest groups pretest scores between
2. Apparent Emotion
home care two groups.
Rating Scale
agencies in 2. No significant difference
Southern 3. Health Perception Scale
was found in the four
Taiwan 4. Rosenberg_s variables between the
Self-esteem Scale pretest and posttest for
the control group.
3. The significant difference
was noted in depressive
symptoms between the
pretest and posttest for
the experimental group.
Chao et al., 24 seniors without Selected two Quasi-experimental One ward is 1. Depression (GDS-15) Significant improvement in
2006 dementia wards from design with assigned for the self-esteem in the
2. Self-esteem
one nursing pretest and control group; the treatment group, but the
home in north posttest other ward is for 3. Life satisfaction control group also
Taiwan the experimental showed insignificant
group improvement. Both
groups have insignificant
results in depression
and life satisfaction.
Wang, 102 seniors with Selected from Randomized Each facility has Cognition (MMSE) 1. Significant improving
2007 mild to severe five elderly controlled trial control (without RT) effects of cognition
dementia care facilities in (RCT) with and experimental (MMSE) and mood/
south Taiwan pretest and (with RT) groups affection (CSDD)
posttest between groups
Mood/affection (GDS-SF, 2. Insignificant differences
CSDD) in mood/affection
measured by GDS-SF
(continues)

146

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Reminiscence Therapy in Taiwan VOL. 26, NO. 2, APRIL 2018

TABLE 2.
Summary Descriptions of the Reviewed Studies, Continued
Study Design
Study Participant Setting Approach Group Outcome Indicator Finding

Chao et al., 10 seniors without Selected from Qualitative study Only one RT 1. Resident_s personal The process of reminiscence
2008 dementia one nursing design with intervention group characteristics exhibited four stages:
home in north participant 2. Time, setting, and triggers entrée, immersion,
Taiwan observation or catalysts used to withdrawal, and closure.
initiate reminiscence Triggers in initiation include
3. Content of the auditory and visual.
reminiscence Inducer and active listeners
4. Resident_s verbal and play important roles in
nonverbal reactions the entrée stage.
Chiang et al., 75 seniors without Selected from RCT with pretest, Experimental and Self-esteem In the posttest, the
2008 dementia one veterans_ posttest, and control groups experimental group has
Life satisfaction
home in north follow-up test significant improvement
Taiwan (1 month after) in self-esteem and life
satisfaction. In the
follow-up test, the
experimental group has
significant improvement
in self-esteem and life
satisfaction compared
with preintervention levels.
Hsu & 45 seniors without Selected from Quasi-experimental Experimental and 1. GDS-SF 1. The mean GDS score of
Wang, dementia four long-term design with control groups 2. Barthel_s Index of the experimental group
2009 care facilities pretest and Activities of Daily decreased significantly
posttest Living (ADLs) by a 2-point scale.
2. The intervention group
3. Behavioral Rating
significantly improved
Scale (BRS)
the BRS score.

Huang et al., 10 seniors with mild Selected from Case study with Only one RT 1. Feeling of participation 1. Significant improvement
2009 to moderate one elderly pretest and intervention (Personal Interaction in fast waves of EEG
dementia care facilities in posttest group Scale and Feeling of 2. Insignificant improvement
(12 original, 2 south Taiwan Participation Scale) in MMSE and depression
dropped) 2. Cognition (MMSE) 3. Significant improvement
3. Depression (GDS-30) in personal interaction
4. Fast and slow waves (i.e., feeling of happiness,
in EEG positive communication,
positive interaction,
participation, by order,
and activity preference)
and feeling of participation
(i.e., stress relief,
adaptation, impression)
Wang et al., 77 seniors Selected from RCT with pretest Each facility has 1. ADL 1. No significant difference
2009 (86 original, four official and posttest experimental and within group effects
2. Behavior competence:
9 dropped) with registered care control groups on overall behavior
mild to facilities in (1) Physical disability
competence or ADL but has
moderate south Taiwan (2) Apathy
a significant difference in the
dementia (3) Communication social disturbance
difficulties
2. No significant changes
(4) Social disturbance in overall behavior
competence and ADL
by stage of dementia

(continues)

147

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The Journal of Nursing Research Hsin-Yen Yen et al.

TABLE 2.
Summary Descriptions of the Reviewed Studies, Continued
Study Design
Study Participant Setting Approach Group Outcome Indicator Finding

Chiang et al., 92 seniors without Recruited from Quasi-experimental Experimental and 1. Psychological 1. Changing of the
2010 dementia one nursing design with control groups well-being depressed mood
home pretest, posttest, 2. Depression 2. Improvement in the
institution in and follow-up psychological
the Taipei area test 3. Loneliness
well-being
3. Improvement in the
feeling of loneliness
Lin et al., Seven seniors Selected from Preexperimental Only one RT 1. Quality of life (MOS 1. Mental health in the
2011 with dementia one day care design with intervention SF-36) posttest including vitality,
center in pretest and group social functioning,
south Taiwan posttest emotional role, mental
health, and physical role
in physical health were
higher than the pretest.
2. Persons with moderate
cognitive impairment may
benefit more from the LRP.
Wu, 2011 77 seniors without Selected from Quasi-experimental Experimental and 1. Self-esteem (SES) 1. The average SES score
dementia veterans_ design control groups in the reminiscence
2. Life satisfaction (LSI-A)
home in four group increased.
districts in 3. Depressive symptoms
(GDS-SF) 2. The difference of
central Taiwan
self-esteem in the posttest
differed significantly
between groups.
3. Life satisfaction and
GDS-SF score had
improved.
Su et al., 93 seniors with Selected Longitudinal Experimental and 1. GDS-SF 1. The experimental group
2012 dementia from one quasi- control groups 2. MMSE in the posttest exhibited
sanatorium experimental a significant decrease in
design with 3. Clinical Dementia the GDS-SF score, but there
pretest and Rating (CDR) Scale was no significant change in
posttest the cognitive status rating,
MMSE, or CDR level.
2. In the control group,
there was no significant
change in the posttest.
Chueh & 21 male veterans Selected from Quasi-experimental Experimental and 1. Short Portable Mental 1. The experimental group
Chang, without dementia one veterans_ design with control groups State Questionnaire significantly improved their
2014 (33 original, nursing home pretest, post- depressive symptoms and
2. Health status
12 dropped) in northern test, and 3- and geriatric depression.
Taiwan 6-month 3. Taiwan GDS 2. The follow-up tests
follow-up tests also showed reduction
in their depressive
symptoms.
Wu & Koo, 103 patients Selected from RCT with pretest Experimental and 1. Herth Hope Index The indicators all significantly
2016 with mild and one medical and posttest control groups increased in the
2. Life Satisfaction Scale
moderate center experimental group but
dementia 3. Spirituality Index of decreased in the control
Well-Being group The indicators were
4. MMSE all significantly different
between each group.

Note. MMSE = Mini Mental State Examination; CSDD = Cornell Scale for Depression in Dementia; RT = Reminiscence; EEG = Electroencephalography;
MOS SF-36 = Medical Outcomes Study, 36-Item Short Form Healthy Survey; LRP = Life Review Program; LSI-A = Life Satisfaction Index-A.

148

Copyright © 2018 Taiwan Nurses Association. Unauthorized reproduction of this article is prohibited.
Reminiscence Therapy in Taiwan
several studies (Chao et al., 2008; Wang, 2004, 2005). Al-
though this approach to therapy likely costs more in terms
of time and lacks interaction among group members, in-
dividual (one-on-one) reminiscence therapy may better facil-
itate the relationship between participants and the leader
(Wang, 2004, 2005).
The frequency of intervention sessions should be
considered for reminiscence therapy designs. The reviewed
studies typically conducted interventions once or twice a
week over a 3-month period. Each intervention session was
approximately 60 minutes long, depending on group size
and on the attention and interest of participants (Chao et al.,
2006; Chueh & Chang, 2014; Hsu & Wang, 2009; Wang,
2007).
Before instituting a reminiscence intervention, the condi-
tion of older adult participants, including mental health,
physical health, social interaction, and mood status, should
be considered. Two people are typically needed to conduct
the program in the group format. Training the facilitator
before leading a reminiscence intervention is advised to en-
sure sufficient levels of expertise in the techniques and to
manage the quality of the intervention program (Chao et al,
2006, 2008; Wang, 2007; Wang et al., 2009). During the
intervention program, the leader should pay special atten-
tion to participants with cognitive impairments or unstable
emotional conditions. Appointing healthcare providers as
group leaders or holding interventions at healthcare in-
stitutions should be considered.
Initially, it may be difficult to start the intervention pro-
gram smoothly because participants may not be familiar
with one another. The facilitator should lead older adults to
introduce themselves, and participants should be encour-
aged to share their thoughts, memories, and feelings in each
following session. Interactions among participants dur-
ing the intervention may improve their behaviors, accep-
tance, and the effectiveness of results. The intervention
should be conducted in an environment that is quiet and safe
and fosters an atmosphere of trust (Chao et al., 2008; Lin
et al., 2011).
The content of reminiscence therapy may be designed
differently based on participant characteristics such as age,
gender, life habits, hometown or home area, and so on.
The facilitators may use different materials evocative of
reminiscence that dovetail with the topics under discus-
sion. Specific reminiscence themes that were designed for
Taiwanese older adults in the reviewed studies included
the hardships of war (Wang, 2004); Taiwanese festivals,
Chinese traditional food, and old-style entertainments
(Chiang et al., 2010; Hsu & Wang, 2009; Wang, 2007;
Wang et al., 2009); and experience with leprosy (Su et al.,
2012). The Life Review Program for Taiwanese was
designed to help participants recall past events such as
childhood experiences, marriage, family life, and jobs, using
photos, recordings, and radio programs as the evocative
materials (Wang, 2004, 2005). On the other hand, Taiwanese
cultural facets such as Japanese and Taiwanese folk songs,
Copyright © 2018 Taiwan Nurses Association. Unauthorized reproduction of this article is prohibited.
VOL. 26, NO. 2, APRIL 2018
tapes, records, radio programs, and movies; firecrackers;
special snacks; traditional festival food; folk toys; tea art; and
cooking lessons should be incorporated as evocative mate-
rials used in reminiscence interventions (Chao et al., 2006;
Hsu & Wang, 2009; Wang, 2004; Wang et al., 2005).
It is important that both structured and unstructured
reminiscence interventions set a theme and a goal for
the intervention at the beginning of sessions (Lin et al., 2011).
Setting a goal makes the associated process more directive
and proactive and helps the leader to execute a program
more effectively. If the reminiscence therapy is effective in
the group setting, the duration may be prolonged to incor-
porate reminiscence into the regular routine of participants.
In conclusion, this systematic review looked at previous
studies about reminiscence interventions. These studies
showed that Taiwanese culture-specific reminiscence ther-
apies are able to improve the mental and physical health of
subjects in the realms of quality of life, cognitive functions,
and depressive status, although not every indicator in
every study improved significantly (Chao et al., 2006;
Huang et al., 2009; Su et al., 2012; Wang, 2004, 2007;
Wang et al., 2009). Further studies are necessary to
establish evidence-based protocols and systemic effective-
ness for interventions that use reminiscence. However, the
reviewed studies identified no negative postintervention im-
pacts on participants. The authors have no doubt that remi-
niscence therapy is an effective, side-effect-free approach for
promoting mental health in older adults. Reminiscence, cur-
rently widely used as a noninvasive intervention in the
treatment of mentally ill older adults in Taiwan, is thus also
recommended as a therapeutic treatment for older adults,
especially those living in institutions.
Accepted for publication: October 27, 2016
*Address correspondence to: Li-Jung Lin, No. 162, Sec. 1, Heping E. Rd.,
Taipei City 10610, Taiwan, ROC.
Tel: 886-2-77345410; Fax: 886-2-3393-8647;
E-mail: maru641220@ntnu.edu.tw
The authors declare no conflicts of interest.
Cite this article as:
Yen, H. Y., & Lin, L. J. (2018). A systematic review of reminiscence
therapy for older adults in Taiwan. The Journal of Nursing Research,
26(2), 138Y151. doi:10.1097/jnr.0000000000000233
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