Aging is commonly regarded as transitioning from the middle age phase to a subsequent stage of life.1,2 In contemporary civilization, enhancing the healthcare system has resulted in a notable rise in the population of older adults.3 The issue of elderly health and well-being is continuously expanding due to the significant and rapid growth in older adults. In addition to a range of physical alterations, the aging process is accompanied by psychological changes, including but not limited to feelings of loneliness, anxiety, and depression.4

According to Skoog (2011), there is a prevalence of psychological problems in the aged population, which can be attributed to factors such as social isolation, diminished quality of life, dementia, worsened disability, and a higher incidence of physical ailments.5 Furthermore, the worsening reliance on others for daily tasks and the decline in social adaptability among older adults have been identified as significant contributors to various psychological disorders. These disorders not only impose additional healthcare costs and cause health problems but also drive individuals to experience feelings of hopelessness, despair, and depression, ultimately leading to a desire for death.6 Depression is among these disorders that is considered one of the leading causes of disability worldwide.7 It is also one of the most common psychiatric disorders among older adults and a significant risk factor for disability and mortality in this population.7, 8, 9, 10, 11 The prevalence of depressive symptoms varies widely across different societies.12 Studies in this field have shown that over a third of the world's older adults suffer from depression.7,12 In a systematic review and meta-analysis study by Bedaso et al. (2022), the pooled prevalence of depression among African older adults was reported to be 26.3 %.13 Similarly, in a systematic review and meta-analysis by Pilania et al. (2019), the estimated prevalence of depression in the population over 60 years of age in India was 34.4 %.14 This statistic highlights the importance of implementing effective preventive measures, regular screening, and timely interventions to address the high prevalence of this disorder in older adults.

According to cognitive theories, negative schemas and expectations in multiple aspects of life can lead to hopelessness, which in turn causes symptoms of depression.15 In addition, several studies have demonstrated a negative and significant relationship between depression and hope.16, 17, 18, 19 It can be said that low levels of hope or hopelessness potentially increase the risk of mental health problems such as anxiety, depression, and post-traumatic stress disorder (PTSD).20,21 On the other hand, physical and mental disorders in older adults are also considered a threat to hope, as they bring about the feeling of approaching the end of life.22,23 According to Snyder et al. (1991), hope can be conceptualized as a cognitive framework influenced by the perception of success derived from multiple sources and the formulation of strategies to attain goals.24 Individuals encounter varying levels of hope and utter despair throughout their lives and in the face of disease. Hope enables a person's attitude to transcend their current situation, empowering them to overcome pain and suffering.25 Moreover, hope increases the life contentment of older adults by fostering positive expectations for the present and future. The more hopeful older adults see other people as reliable sources of support. As a result, they adjust to any problems that may come along in their lives. Additionally, they are happier and more content with their lives.26 Cultivating a happy mental state is of significant importance as it has been found to influence individuals' ability to cope with stressful circumstances positively.25

It should be noted that there are numerous pharmacological and non-pharmacological treatments available to alleviate depression and enhance hope in older adults. However, considering the potential adverse effects of psychotropic drugs, it is advisable to prioritize non-pharmacological treatments such as health education, counseling, and psychotherapy as the primary choice.4,27,28 Reminiscence therapy (RT) is a type of psychotherapy4 that has been recognized as an effective planned intervention for older adults with various health conditions.29, 30, 31, 32, 33, 34 RT can be defined as the act of recalling past events, feelings, and thoughts in order to facilitate enjoyment, improve quality of life, and enhance adaptation to current circumstances.35,36

As shown in Table 1, RT is based on eight functions,37 which can be categorized based on three higher-order dimensions4,38: 1) Positive self-functions refer to maintaining or developing self-awareness, including reminiscing for identity, problem-solving, and preparation for death. 2) Negative self-functions are related to regretting the past and rumination and include reviving bitterness, reducing boredom, and maintaining intimacy. 3) Pro-social functions of reminiscence, such as conversation and Teaching/informing, also enabled communication with others.38 There are different types of reminiscence, including transmissive, integrative, instrumental, and spiritual. Transmissive reminiscence therapy involves sharing past life events from one generation to another.39Integrative reminiscence therapy focuses on reviewing past events, regardless of whether they were negative or positive, with the aim of creating positive self-esteem and establishing a connection between past and present memories. It also involves addressing and processing negative memories.40Instrumental reminiscence therapy examines how past events are resolved to enhance self-esteem.41Spiritual reminiscence therapy (SRT) is a review of life that encompasses people's efforts to find the meaning of life and their hopes for the future. It is also recognized as one of the treatment methods used for psychological disorders in clinical guidelines.42

In SRT, older adults find purpose in life by reflecting on past events and gaining insight into current challenges.42 SRT is a unique mode of communication that frames a person as a spiritual being and encourages rational and individual interaction to understand the meaning of life better.42,43 It is important to mention that words such as spirituality, religion, and faith are often used interchangeably, even though each term has its own distinct definition.44 Because this approach includes not only religious beliefs and practices but also entails comprehending one's connection with a higher power, societal interactions, artistic expressions, environmental considerations, and all intangible aspects of existence. Rather than solely recounting past events, individuals deeply review life's main problems, purpose, and intangible values.42,43Spirituality refers to an abstract and subjective concept that involves a connection with God, nature, others, and the world around us. It is often associated with the quality and meaning of life.44 In contrast, religion is linked to the traditional values and practices of a specific group or faith, influenced by tradition, laws, and culture. Religion can be understood as a personal set of religious attitudes, beliefs, and practices or as an institutionalized system of worship or service to God or the supernatural.44Faith is often associated with the two mentioned constructs. It is a more personal, subjective, and profound concept than religion, as it refers to one's relationship with God.44

Despite the differences between these concepts, researchers agree that both constructs (i.e., spirituality and religion) affect people's attitudes, behaviors, and well-being to some extent. Religious practices, whether social or individual, encourage spiritual growth in older adults. Additionally, spiritual beliefs play an essential role in a person's ability to cope with adversity, which ultimately has positive consequences for physical and mental health.45 Moreover, previous studies have found that faith is a powerful factor in strengthening hope46 and have mentioned religion as a facilitator of the feeling of hope for the future.47,48 The SRT is employed to examine, establish connections, and enhance the significance of older individuals' life history, cognitive processes, and future aspirations. This approach can potentially improve quality of life by influencing interpersonal relationships and individual behaviors.35,42 Syed Elias et al. (2019) described SRT as an effective program for reducing older adults’ feelings of loneliness, anxiety, and depression.49 According to the study conducted by Lök et al. (2019), SRT was found to have a significant impact on enhancing cognitive functioning, reducing depression, and increasing the overall quality of life among older individuals diagnosed with Alzheimer's disease.50

The distinguishing feature of this method, compared to other types of RT, is that participants in this approach, in addition to reminiscence meetings, also utilize spiritual and religious interactions as a means to express their emotions and feelings.51 In other words, this approach is particularly relevant for older populations influenced by spirituality and religious practices. This method involves reviewing events or life stories to find the meaning of life and one's hopes for the future. As a result, it may be more effective in fostering a sense of hope and reducing depression.51 As mentioned, it can be stated that non-pharmacological therapies, such as SRT, may potentially mitigate depression and enhance hope among older adults effectively. Additionally, SRT may facilitate their rehabilitation and adjustment to novel circumstances, leading to a more hopeful and meaningful existence, ultimately resulting in an augmented sense of hope.4 Unfortunately, in Iran, despite its unique culture and vast geography, and taking into account the religious and spiritual context of the Middle East, including Iran, no studies have been found on non-pharmacological treatments for reducing depression and increasing hope among older adults, specifically the use of SRT and there are significant research gaps in this field. Therefore, this study was designed and implemented to determine the impact of SRT on depression and hope among older adults living in Shahroud City, northeast of Iran.