DOI: 10.31038/PSYJ.2025741

Abstract

This paper reviews and synthesizes literature on the participation of older adults in Taiwan in art therapy and art-based group activities, with particular attention to their psychosocial development and experiences of life review and integration. Against the backdrop of Taiwan’s rapidly aging population, national policies have emphasized healthy, active, and successful aging. Art therapy and creative group engagement have been shown to enhance self- awareness, emotional regulation, interpersonal connectedness, and group cohesion—thereby fostering a sense of belonging and reducing loneliness. These interventions also facilitate life review, promote acceptance of past experiences, and activate personal potential. Drawing on Erikson’s (1968) theory of ego integrity and Cohen’s (2005) concept of creative aging, this paper examines how art therapy fosters psychological growth, existential reflection, and life integration. Practical recommendations are provided for policymakers and practitioners to integrate art therapy into elder care systems in Taiwan.

Keywords

Older adults, Art therapy, Life integration, Psychosocial development, Creative aging

Introduction

Population aging has emerged as a critical global challenge. In 2025, Taiwan’s population aged 65 and above exceeds 20%, placing the nation within the classification of a super-aged society (National Development Council, 2025). This demographic shift underscores the necessity for healthcare and mental health professionals to address not only the physical health needs of older adults but also their psychological and social well-being. In Taiwan, governmental policy has increasingly promoted the concepts of healthy aging and active aging, emphasizing the importance of maintaining physical and mental health, engaging in social activities, and sustaining overall life satisfaction in later years.Art therapy—whether through individual sessions or group-based creative activities—has demonstrated the capacity to enhance self-awareness, regulate emotions, foster personal growth, and strengthen interpersonal relationships among older adults. Such participation can contribute to life transformation and the integration of past experiences into a coherent sense of self [1,2]. This paper reviews the characteristics of Taiwan’s older adult population and synthesizes literature on the application of art therapy in this demographic, with a focus on its psychological and integrative benefits.

Literature of Older Adults in Taiwan

Taiwan’s older adult population has expanded rapidly, and the nation will soon be classified as a super-aged society. This demographic shift presents challenges including physiological decline, increased risk of mortality, and transformations in familial and social roles [3]. Common age-related conditions include hearing impairment, cataracts, osteoarthritis, diabetes, depression, and dementia. Aging entails progressive biological, psychological, and social changes. Many older adults strive to maintain autonomy despite physical decline [4] but often express concern about becoming a burden to others [5]. By 2026, approximately one in eight older adults in Taiwan is expected to experience functional disability [6].

Social transitions such as retirement, reduced authority, children leaving home, declining health, and widowhood may erode social networks and economic stability, increasing the risk of isolation and diminished self-esteem. Tseng et al. [7] explored the impact of social isolation, especially living alone and loneliness, on the short- term and long-term health-related quality of life of middle-aged and elderly people in Taiwan. They analyzed data from 5,644 respondents and found that 9% of the respondents lived alone, 10.3% said they felt lonely, and 2.5% both lived alone and felt lonely. Compared with those who lived with others, those who lived alone and felt lonely had significantly lower health-related quality of life in both the long and short term.

Research shows that living arrangements significantly affect life satisfaction among older adults in Taiwan. For example, those who live in preferred arrangements—particularly with their children— report higher life satisfaction [8]. While aging may bring emotional distress linked to loss, it can also foster wisdom and resilience through accumulated life experience. Furthermore, subjective perceptions of physical capability are strong predictors of depressive symptoms, sometimes outweighing objective health indicators [9]. Older adults often encounter disruptive life events, such as retirement, widowhood, the death of a loved one, children moving out or moving in with them, and chronic illness that may lead to disability. Such experiences increase the risk of loneliness and social isolation [10]. According to the Taiwan Ministry of Health and Welfare’s [11] Senior Citizens Survey, which asked individuals aged 65 and older, “Do you feel lonely?”, 3.27% of respondents reported feeling lonely “often,” while 17.14% indicated feeling lonely “sometimes.” Chen et al. [12] examined the relationship between loneliness and life satisfaction among 138 institutionalized older adults. Their findings indicated that greater loneliness was associated with lower life satisfaction, whereas higher levels of life adaptation corresponded to greater satisfaction.

The growing aging population has made elder care a pressing policy concern. Beyond medical care, complementary interventions that enhance social participation are increasingly recognized for their role in maintaining physical and mental health. Social engagement— particularly in leisure and recreational activities—has been shown to correlate with better psychological well-being [13]. Factors such as multigenerational living, strong social networks, close friendships, positive attitudes toward life, and lifelong learning contribute to active aging in Taiwan [14,15].

Existential Themes and Life Integration in Older Adulthood

The integration of life experiences in later life requires reflection on existential themes such as mortality, independence, self-worth, interpersonal relationships, and the meaning of one’s life journey [16]. As older adults approach the end of life, they often engage in a process of life review—seeking to reconcile past experiences, affirm life meaning, and achieve a sense of integrity, as described in Erikson’s developmental theory. This process aligns closely with the aims of art therapy, which can provide both a reflective and expressive medium for such integration.

Erikson [17] identified the primary psychosocial task of late adulthood as the attainment of ego integrity. Older adults achieve this by integrating and reflecting on their life experiences, thereby reducing the risk of despair. When individuals dwell exclusively on past mistakes or perceived shortcomings, they may become trapped in regret, which hinders acceptance of the present and diminishes their capacity to envision future possibilities. Conversely, accepting the inevitability of loss and the impermanence of life fosters resilience and facilitates the pursuit of ego integrity [18].

Life review serves as a process through which older adults recognize personal strengths, accept imperfections, and reconcile with the diverse events and consequences of their life journey. Acknowledging the finitude of existence enables more peaceful end- of-life planning and supports a deeper appreciation of life’s meaning and value, contributing to a more tranquil approach toward death. Cohen’s [19] notions of human potential in later life introduces a developmental structure characterized by wisdom and creativity. He posits that individuals retain an “inner drive” to pursue positive change at any age, continually adapting and reshaping cognitive abilities. This perspective challenges the assumption of inevitable cognitive decline. Through the concept of creative aging, Cohen emphasizes that aging can be additive and generative. While normal aging may involve some cognitive loss, continued learning can preserve identity, social status, and functional capacity [20].

In contrast, older adults who remain fixated on unresolved regrets and feel powerless to address them—especially due to age-related limitations—are more likely to experience despair. As physical and psychological functions decline, those who cultivate wisdom can approach aging and mortality with greater compassion for themselves and their life experiences. From a life-course perspective, theories of aging vary along a continuum from passive acceptance—viewing death as a natural endpoint—to active resistance, which emphasizes the capacity to counter functional decline. The successful aging paradigm integrates these perspectives, advocating for proactive engagement in life while acknowledging the natural processes of aging [21]. Yu outlines strategies for successful aging that include: (1) maintaining physical health to slow decline, (2) strengthening self-care skills and the capacity for solitude, (3) engaging in lifelong learning to promote healthy aging, (4) enhancing social participation and building community-based support networks, and (5) fostering a culture of regular physical activity.

Older adulthood thus remains a stage of plasticity, potential, and continued development. Creative engagement and the stimulation of latent abilities can promote life integration. Reflection and acceptance of past experiences constitute a key developmental task [22,23]. Even in advanced old age, individuals can pursue personal growth and deepen their understanding of life’s existential significance. Brown and Lowis [24] demonstrated that resolving late-life psychosocial crises is associated with higher life satisfaction. Older adults who cultivate wisdom, activate latent potential, and engage in reflective life review are more likely to achieve empowerment, appreciate their life narratives, and experience a sense of meaning and integration.

Art Therapy and Its Effectiveness

Art therapy combines creative expression with psychotherapeutic principles. Within a supportive therapeutic relationship, clients use art materials to produce visual imagery and symbolic representations that reflect aspects of their development, personality, interests, intentions, subconscious processes, and emotional states [25]. Through this process, individuals explore emotions, regulate affect, enhance self- understanding, improve social skills, reduce anxiety, and strengthen self-esteem. Art therapy provides opportunities for emotional expression, cognitive reframing, and the integration of fragmented personal experiences. It fosters problem-solving abilities, encourages personal growth, and supports the development of latent capacities. According to Chen [26], artistic creation is a symbolic, non-verbal medium in which artworks serve as auxiliary tools for therapist– client interaction. While visual imagery is central, verbal dialogue is also employed to promote insight, resolve conflicts, and encourage adaptive change. Beyond its therapeutic applications, the act of creating art itself has inherent benefits: it offers a channel for self- expression, enhances communication with others, and facilitates the integration of body, mind, and spirit.Empirical studies further support art therapy’s value for older adults. Castora-Binkley et al. [27] reported that participation in artistic activities reduced depressive symptoms, increased self-esteem, and enhanced feelings of control, comfort, and psychological well-being. Kim (2013) demonstrated that art therapy helps older adults reduce negative affect, increase self-worth, and alleviate anxiety, thereby supporting healthy aging. Hsu [28] noted that well-designed, age-appropriate art activities are particularly effective in promoting creative aging, underscoring the adaptability of art therapy interventions for diverse elder populations.

Participation of Older Adults in Art Therapy Groups in Taiwan

Art therapy groups for older adults in Taiwan employ diverse themes and media, enriching group dynamics and sustaining participants’ engagement. These groups offer opportunities for self- expression and emotional release [29]. Through artistic activities and creative processes, participants awaken inner strengths, cultivate a sense of accomplishment, and experience empowerment. The group setting fosters interpersonal communication and social connection; artistic creation further enhances self-awareness, facilitates emotional release, and supports internal integration [30,31]. Within these groups, older adults often develop interpersonal bonds and receive mutual support. Art therapy promotes increased social contact and interaction. For example, Chen examined the experiences of six older adults in an art activity group, finding that participants forged supportive relationships, revisited nostalgic memories, and regained a sense of vitality—illustrating art therapy’s positive psychosocial impact. Similarly, Teng, in facilitating an art therapy group for older adults, observed that participants shared creative experiences, expressed emotions, enhanced self-awareness, accepted differences, and formed emotional connections.

In institutional settings, Wen et al. [32] implemented art- based activities guiding older adults to express feelings through artwork creation and exhibition. Group sharing and feedback reduced depression and loneliness while enhancing confidence and achievement. Wen et al. [33] further reported that art therapy supported older adults with depressive tendencies in self-exploration and interpersonal engagement. Artistic creation generated joy, confidence, and accomplishment, improved social skills, alleviated depressive symptoms, and boosted self-esteem.Overall, existing studies suggest that art-related activities and therapy groups for older adults foster self-understanding, social engagement, vitality, and emotional well-being. They also promote interpersonal interaction and sustained vitality. For older adults with health conditions, art therapy offers stress relief, emotional expression, memory enhancement, and improved communication—contributing positively to physical health and overall quality of life.

Using Art Therapy to Facilitate Life Review and Integration

As older adults reflect on the meaning of life, they often seek closer relationships with family and society. Facing mortality with openness and living in the present can deepen appreciation of life’s significance and foster balance between ego integrity and despair. Life review enables older adults to articulate their physiological, psychological, and social experiences, revealing resilience alongside vulnerability, and reconstructing the meaning and value of their lives [34]. Older adults may have endured adversity, failure, or crises. By avoiding entrapment in victimhood and learning to process negative emotions, they can activate latent potential and demonstrate life resilience. Artistic creation can empower older adults, preserve cherished memories, and stimulate vitality and creativity.

Chen invited three elderly women, with an average age of 86, to narrate their life stories, focusing on significant events. The participants exhibited tranquility, independence, confidence, harmony, and active engagement with life. Their reflections on death preparation supported the idea that life story review and the identification of pivotal events foster ego integration, self-renewal, and transcendence.

Similarly, Hsu et al. involved ten older adults with mild to moderate disabilities in a health promotion group, where participants reviewed and compiled life storybooks and shared personal narratives. This process promoted physical and mental well-being, emotional relief, and attitudes of contentment, confidence, and hope. It also enhanced their sense of control, meaning, and efficacy, contributing to life integration.Chen examined expressive art therapy groups in which participants reviewed past experiences through nostalgic themes such as family life, memories of historical eras, personal achievements and health, and unfinished business. Participants reported coping strategies including “self-reflection and inner adjustment,” “cherishing life and pursuing health,” and “drawing strength from religious faith” to navigate aging and mortality. Many adopted a calm and accepting attitude toward aging and death, recognized life’s finitude, and focused on living meaningfully in the present. They viewed death as a natural transition and family as central to their legacy—preserving personal meaning and life value. By revisiting and reconstructing life narratives, older adults adapt to aging with greater psychological resilience and existential clarity, preparing for death with acceptance and a sustained sense of purpose.

Discussion

This page highlights the multifaceted benefits of art therapy for older adults, encompassing self-awareness, emotional regulation, social engagement, and meaning-making. Through creative expression, participants engaged kinesthetic, sensory, emotional, and cognitive dimensions, facilitating the processing of experiences that may be difficult to articulate verbally. By engaging with images and symbols, older adults externalized internal experiences, deepened self-understanding, and fostered psychological integration. Such processes support the enhancement of self-esteem, reduction of depressive symptoms, and development of resilience, consistent with previous findings. Through art therapy and group-based creative activities, older adults can foster successful aging by engaging in artistic creation, thereby promoting healthy aging, enhancing social participation, and strengthening community-based support networks, as highlighted by Yu. Within the framework of creative aging, older adults are characterized by wisdom and creativity, and aging is viewed as an additive and generative process. Moreover, continued learning plays a vital role in preserving older adults’ identity, social status, and functional capacity.

The benefits of art therapy extend beyond the individual, reaching into the social domain. Shared artistic creation fosters empathy, acceptance of differences, and mutual support, thereby strengthening emotional bonds and cultivating a sense of belonging. Participation in art therapy groups enhances social engagement, which has been shown to correlate with improved psychological well-being. Consistent with the observations of He and Lin and Liu, members of art therapy groups often develop strong social networks, close friendships, and positive attitudes toward life, with lifelong learning contributing to active aging. These group dynamics reduce loneliness, promote social connectedness, and create an affirming community for older adults— an especially valuable outcome in Taiwanese culture, where aging may be accompanied by social isolation as addressed by Liu. In this way, art therapy groups serve as social interventions that counter isolation and marginalization, while also deepening participants’ understanding of life’s existential significance.A further dimension of art therapy is its role in meaning-making. The reflective process inherent in creating and interpreting artwork enables older adults to revisit life narratives, integrate past experiences, and confront existential concerns, including mortality. This aligns with Eriksonian theories of psychosocial development in later life, in which the integration of life experiences is essential for achieving ego integrity. Art therapy for older adults contributes to the integration of past experiences into a coherent sense of self. Such creative engagement offers a pathway toward acceptance of life’s finitude while affirming one’s legacy [35].

Implications

Given its broad psychosocial impact, art therapy should be recognized as a vital component of gerontological care. At the policy level, governments and community organizations could incorporate art therapy into health promotion initiatives for older adults, ensuring that programs are accessible and culturally relevant. Sustainable implementation requires collaboration between trained art therapists, healthcare professionals, and community leaders.For facilitators, sensitivity to participants’ physical and cognitive capacities is essential. Adapting materials and techniques to accommodate varying abilities can ensure full participation and avoid frustration. Encouraging personal choice in themes and modes of expression supports autonomy and reinforces self-worth. Facilitators should also be prepared to respond to intense emotions that may surface during the creative process, providing appropriate support or referrals when necessary.Future research should explore long-term outcomes of art therapy, examine its applicability across diverse cultural settings, and investigate its integration with other therapeutic modalities. Such inquiry will deepen understanding of its mechanisms and support the development of best-practice models that maximize its benefits for aging populations.

Conclusion

Art therapy offers a uniquely integrative approach to promoting well-being in older adults, addressing emotional, social, and existential needs. By enabling expression beyond verbal language, fostering supportive relationships, and facilitating the construction of meaning, it counters the narrative of inevitable decline in later life. This review underscores the potential of art therapy not only as a psychosocial intervention but also as a medium for existential reconciliation, helping older adults to embrace life’s final stages with dignity and connection.

References

1. Kim SK (2013) A randomized, controlled study of the effects of art therapy on older Korean-Americans’ healthy aging. The Arts in Psychotherapy 40: 158-164.
2. Teng YC (2021) An inquiry on the experience of art therapists who work with elderly art therapy Chinese Culture University.
3. Liu LH, Chang RE (2022) Literature review of physical, cognitive, social, and multidimensional Taiwan Journal of Public Health 41: 374-382.
4. Huang FS (2009) Understanding and knowing the Journal of Healthcare Quality 3: 13-18.
5. Yao CT, Chen YC (2018) The effect of participation in art therapy reminiscence group on the community elderly’s life meaning and self-integrity. Feng Chia Journal of Humanities and Social Sciences 37: 37-67.
6. Ministry of Health and Welfare (2025) 2023 Taiwan longitudinal study on aging survey report.
7. Tseng HY, Lee CY, Wu CS, Wu IC, Chang HY, et (2024) Examining the role of living alone and loneliness in predicting health-related quality of life: results from the healthy aging longitudinal study in Taiwan (HALST) Quality Life Research 33: 1015-1028. [crossref]
8. Chen SM, Lin PS (2014) The Relationship between the living arrangement and life satisfaction of the elderly-A discussion of four regions in Journal of Architecture and Planning 15: 61-82.
9. Liu LF, Guo NW, Ho HT (2014) An investigation into the influencing factors for predicting depression in elderly people in Archives of Clinical Psychology 8: 47-48.
10. Liu CN (2021) Loneliness, social isolation and health among elderly people. Journal of Living Sciences 23: 1-25.
11. Ministry of Health and Welfare (2018) Survey on the status of the elderly in  2017.
12. Chen TZ, Lee PL, Huang CK, Kung YL (2015) The relationship between life adaptation, life satisfaction and loneliness of elderly. Journal of Crisis Management 12: 1-10.
13. Liou HC, Chen HK (2021) An empirical study on the impacts of types of social activity participation on mental health of the elders in Taiwan. Journal of Modern Social Work 11: 168-205.
14. He SY (2008) Under aging society, old person how to active aging in National Taipei University.
15. Lin CH, Liu SC (2013) Healthy life expectancy for successful aging and active aging elderly in Taiwan. Taiwan Journal of Public Health 32: 562-575.
16. Yang HC, Lee SF (2022) The phenomenological study of psychologically aging process for elderly Journal of Taiwan Counseling Psychology 10: 79-109.
17. Erikson E (1968) Identity: Youth and crisis. New York: W. Norton & Company.
18. Erikson E (1963) Childhood and society. New York: W. Norton & Company.
19. Cohen G (2005) The mature mind: the positive power of the aging brain. New York: Basic Books.
20. Lee CP (2011) Modern gerontology. Taipei: Hung Yeh Publishing Co, Ltd.
21. Yu HG (2010) How do baby boomers practice successful Aging? Community Development Journal 132: 325-339.
22. Chen LC (2017) Retrospection of life narrative inquiry of elderly self National Chi Nan International University.
23. Hong PH, Shih PW (2011) Life review for the elder clients with suicidal Counseling and Guidance 307: 17-19.
24. Brown C, Lowis MJ (2003) Psychosocial development in the elderly: An investigation into Erikson’s ninth Journal of Aging Studies 17: 415-426.
25. Taiwan Art Therapy Association (2025) Definition of art therapy.
26. Chen PC (2011) A study on integrity of life experience of the community-dwelling elderly in the expressive arts group National Taichung University of Education.
27. Castora-Binkley M, Meng H, Hyer K (2014) Predictors of long-term nursing home placement under competing risk: Evidence from the health and retirement Journal of the American Geriatrics Society 62: 913-918. [crossref]
28. Hsu SC (2022) Creative aging: A study on the teaching of senior art and picture book The International Journal of Arts Education 20: 162-178.
29. Hsu YJ, Chen HY, Lin HP (2017) The effect of making life story books in elderly group Journal of Taiwan Play Therapy 6: 79-97.
30. Li YW (2014) Beyond art: the art therapy group in life review with the elderly living University of Taipei.
31. Lu KT (2020) The effects of existential-based art therapy group with the elderly in the long-term care facility. University of Taipei.
32. Wen HS, Wu HL, Kang SY (2016) The applications of artistic activities in the institutions for the elderly. Taiwan Journal of Gerontological Health Research 12: 22-36.
33. Wen HN, Wu HL, Kuo CL, Liu WM (2015) The effects of using artistic activities on improving depression and self-esteem among older people in long-term care Journal of Nursing and Healthcare Research 11: 267-276.
34. Song HM, Chen DF (2016) A preliminary study on the resilience demonstrated by the elderly through life review. Journal of Gerontechnology and Service Management 4: 271-272.
35. National Development Council (2024) Aging.