Effects of the Color Narrative Preventive Intervention Using Occupational Storytelling: A Randomized Controlled Trial

Abstract

Importance:

Enhancing purpose in life is vital in cognitive interventions for older adults, yet its application in occupational therapy remains limited.

Objective:

To evaluate the effectiveness of the occupation-focused Color Narrative program compared with common Japanese community-based preventive care.

Design:

Randomized controlled trial.

Setting:

Community centers.

Participants:

Community-dwelling older adults (N = 44).

Intervention:

The Color Narrative program included group-based storytelling using 100 color cards as prompts (90 min), independent engagement in meaningful occupations (3 mo), and group reflection (90 min). Control participants attended health education and group recreational activities (90 min each).

Outcomes and Measures:

Primary outcomes included cognitive function (Mini-Mental State Examination– Japanese version [MMSE–J]) and purpose in life (Life Engagement Test [LET]). Secondary outcomes included domain-specific cognitive functions (Digit Span, Tapping Span, Symbol Search, Wisconsin Card Sorting Test), meaning in life (Meaning in Life Questionnaire–Short Form), functional status (FRAIL Scale, Frenchay Activities Index, 12-item Short-Form Health Survey).

Results:

A two-way analysis of variance showed significant interactions for MMSE–J, F(1.76, 73.89) = 4.531, p = .017, η²_p= .097, and LET, F(1.56, 58.78) = 8.743, p = .001, η²_p= .172. Post hoc tests revealed declined and stable MMSE–J scores in the control and intervention groups, respectively (corrected p = .031, Cohen’s d = 0.80). LET scores increased in the intervention group (corrected p = .041, Cohen’s d = 0.78).

Conclusions and Relevance:

The Color Narrative program enhanced purpose and prevented cognitive decline, highlighting the significance of occupational therapy in preventive care.

Plain-Language Summary

This study investigated the impact of the Color Narrative program on improving cognitive health and a sense of purpose in life among older adults. The program included group-based storytelling using 100 color cards as visual prompts, personalized goal setting, and independent engagement in meaningful occupations over 3 mo, followed by a group reflection session. Compared with individuals who participated in a standard community-based health education and recreation program, the participants in this program maintained cognitive function and reported an increased sense of purpose. The findings revealed the significance of maintaining cognitive function and purpose in life in improving older adults’ overall well-being. These findings highlight the unique role of occupational therapy, especially the Color Narrative program, in promoting preventive care and supporting healthy aging within communities.

This study investigated the impact of the Color Narrative program on improving cognitive health and a sense of purpose in life among older adults.

Dementia is a significant public health challenge, particularly with the global increase in the aging population (Sutin, Luchetti, & Terracciano, 2021). Prevention is crucial in managing dementia, considering the limited treatment options (Livingston et al., 2020). A sense of purpose in life is garnering attention as a promising target for interventions to promote cognitive health among older adults (Sutin et al., 2023). A stronger sense of purpose is associated with enhanced cognitive function (Kim et al., 2019; Lewis et al., 2017; Oliveira et al., 2024) and reduced risk of dementia or mild cognitive impairment (Boyle et al., 2010; Boyle et al., 2022; Sutin et al., 2023). Despite its significance, research on interventions to enhance a sense of purpose is lacking.

Sense of purpose in life, a future-oriented and goal-directed component of well-being, refers to finding meaning in life experiences and pursuing valued goals (Boyle et al., 2012; Sutin et al., 2023). As a modifiable psychological factor, it is a promising target for supporting cognitive health (Alimujiang et al., 2019; Boyle et al., 2010; Sutin, Luchetti, Stephan, & Terracciano, 2021). Interventions such as structured life review, narrative-based reflection, and goal clarification can improve well-being among older adults (Kim et al., 2019; Lewis et al., 2017; Shin et al., 2022). Although occupational therapy has long incorporated meaningful occupations for health promotion, the role of purpose in life remains underexplored in the field (Radomski et al., 2024).

To address this gap, Takashima et al. (2022) developed the Color Narrative program, an occupation-centered intervention for cognitive decline prevention among community-dwelling older adults. This program incorporates occupational storytelling and story-making (Clark, 1993; Clark et al., 1996), enabling participants to reflect on meaningful occupations and structured self-narratives. A pilot study suggested potential improvements or maintenance in cognitive function and health-related quality of life (Takashima et al., 2022). However, the underlying mechanisms remain unclear, and enhancing a sense of purpose is hypothesized as a key factor.

The Color Narrative program uses color cards as prompts for storytelling, followed by reflection to support agency and coherence. These narrative processes are thought to foster cognitive resilience. Building on this foundation, this study aimed to evaluate the effectiveness of the Color Narrative program—a piloted, occupation-focused preventive intervention—for improving cognitive function and a sense of purpose in life among community-dwelling older adults, compared with that of community-based preventive care commonly offered in Japan.

Method

Study Design

This single-blind, parallel-group randomized controlled trial was conducted by blinded outcome assessors (Daisuke Sawamura, Yuko Yoshida, Shan Yun, and Mari Sakaue, along with trained research assistants), following the 2010 Consolidated Standards of Reporting Trials statement (Schulz et al., 2010). Its protocol was registered in the UMIN Clinical Trials Registry (UMIN000043604).

Participants

Participants were recruited from community-based senior gatherings through municipal health and welfare agencies in northern Japan. These agencies introduced participant groups for recruitment. These gatherings, part of Japan’s preventive care services, required prior registration and were open to adults age 65 yr and older. Inclusion criteria were regular participation in community-based senior gatherings, independent commuting to the venue, and sufficient Japanese language proficiency. Exclusion criteria included hospitalization or residence in a care facility and prior dementia diagnosis. Baseline Mini-Mental State Examination–Japanese version (MMSE–J) scores ≥24 confirmed absence of significant cognitive impairment.

A pilot study of the Color Narrative program (Takashima et al., 2022) reported an improvement in the MMSE–J score from a mean of 26.5 (SD = 2.6) to 28.3 (SD = 1.4). These preliminary findings informed the sample size estimation for the present trial. By using G*Power 3.1, the required sample size was 38 (α = .05, power = 90%), with an anticipated 20% dropout rate, setting the target enrollment at 46 (23 per group). Participants were randomly assigned to the intervention (n = 31; 27 women) or control (n = 31; 28 women) group by using a computer-generated randomization list stratified by age, sex, and MMSE–J scores. The randomization was performed by the second author (Daisuke Sawamura), ensuring allocation concealment.

All outcome assessments were conducted by trained research staff or coauthors with healthcare qualifications who were not involved in the intervention delivery. The assessors were blinded to participants’ group assignments to minimize assessment bias.

Intervention Group: Color Narrative Intervention

The Color Narrative program (Takashima et al., 2022) is an occupation-centered intervention based on occupational storytelling and story-making (Clark, 1993; Clark et al., 1996). It aims to strengthen occupational identity and foster a sense of purpose and agency by encouraging reflection on meaningful past occupations and the creation of future-oriented narratives. Because purpose in life is linked to cognitive health, the program was designed to enhance cognition through personalized, goal-directed occupational engagement. The intervention was delivered in four phases between August 2021 and March 2022.

Phase 1: Building a Communal Horizon of Understanding

The first author (Risa Takashima), an occupational therapist, attended community-based senior gatherings once or twice monthly to build trust with participants and align perspectives by becoming familiar with the group’s shared values, interests, and communication styles (Clark et al., 1996).

Phase 2: Color-Mediated Occupational Storytelling and Goal Setting

Participants (four to six per group) engaged in 90-min color-mediated storytelling and goal-setting sessions. After familiarizing themselves with color cards (8.5 × 11.5 cm; 100 solid colors), they responded to the following key prompts: “Recall a time when you felt at your brightest. What were you doing?” and “What activities make you feel most like yourself?” Each participant selected a color card representing their experiences and shared their choice with the group. After storytelling, participants completed a program-specific worksheet listing occupations they wished to continue, resume, or challenge, followed by a 30-min goal-setting session to establish personalized occupational goals. The occupational therapist facilitated reflection and helped align goals with each participant’s values and life context by using Takashima et al.’s (2022) method.

Phase 3: Independent Occupational Story-Making

Over 3 mo, participants independently engaged in their selected occupations without direct occupational therapy support. Occupational story-making involves creating future occupational narratives through actual occupational engagement (Clark, 1993).

Phase 4: Group Reflection on Phase 3 and Updating Occupational Goals

Participants reconvened in their Phase 2 groups to reflect on their Phase 3 experiences, sharing achievements and challenges (90 min). Subsequently, they set new goals (30 min) to enhance occupational engagement.

Control Group

The control group participated in two sessions comprising a 30-min health education lecture and subsequent 90-min recreational activities, conducted at the same time points as Phases 2 and 4 of the intervention. These sessions aligned with standard community-based care prevention programs.

Outcome Variables and Measures

Questionnaires and neuropsychological assessments were used to obtain demographic data (sex, living arrangement, education, and community participation) and evaluate primary and secondary outcomes.

Primary Outcome Measures

Cognitive function (MMSE–J) and sense of purpose in life (Life Engagement Test; LET) were selected as primary outcomes based on the intervention’s theoretical framework.

MMSE–J.

The MMSE–J is a common validated tool for screening cognitive impairments among older adults (Sugishita et al., 2018). It evaluates orientation, memory, attention, and constructional skills, with scores ranging from 0 to 30; a score of ≤23 indicates dementia.

LET.

The LET was selected as the primary outcome measure owing to its conceptual alignment with the intervention’s emphasis on goal-directed and meaningful occupational engagement. The LET measures engagement in personally valued activities and was originally developed to assess purpose in life based on behavior (Scheier et al., 2006). It includes six items rated on a 5-point Likert scale, with total scores ranging from 6 to 30; higher scores indicate a stronger sense of purpose. The Japanese version of LET demonstrated strong internal consistency (α = .82–.86) and test–retest reliability (r = .76; Sumi, 2018).

Secondary Outcome Measures

To explore domain-specific or complementary effects, we conducted additional cognitive assessments, namely the Digit Span and Tapping Span (attention and working memory), Symbol Search (processing speed), and Wisconsin Card Sorting Test (executive function). We used the Japanese version of the Meaning in Life Questionnaire–Short Form (MLQ–SF–J) as a secondary measure to assess broader aspects of life meaning and psychological well-being. Functional status and quality of life were assessed by using the FRAIL Scale, Frenchay Activities Index (FAI–J), and 12-item Short-Form Health Survey (SF–12).

Digit Span and Tapping Span.

The Digit Span and Tapping Span, subcomponents of the Cognitive Assessment Test (Japan Society for Higher Brain Dysfunction, 2006), evaluate attention and working memory. The Digit Span test involves repeating number sequences, whereas the Tapping Span test requires tapping blocks in a specific order to replicate visual patterns.

Symbol Search.

The Symbol Search subtest from the Wechsler Adult Intelligence Scale (Wechsler, 2018) measures processing speed. Participants identified whether a target symbol matched a given set within a time limit, with raw scores calculated based on accuracy.

Wisconsin Card Sorting Test.

The Wisconsin Card Sorting Test (Heaton et al., 1993) assesses cognitive flexibility and executive function. Participants sorted cards based on changing rules, requiring adaptive problem-solving and concept formation.

MLQ–SF–J.

The MLQ–SF–J measures the sense of meaning in life by using three modified items from the original 10-item MLQ (Steger et al., 2006). Items are rated on a 4-point scale, with total scores ranging from 3 to 12. Higher scores indicate a greater sense of meaning and are associated with psychological well-being. The MLQ–SF–J has been validated for large-scale studies in Japan (Sumi, 2019).

FRAIL Scale.

The FRAIL Scale evaluates functional status through five components: Fatigue, Resistance, Ambulation, Illness, and Loss of weight (Morley et al., 2012). The scores range from 0 to 5, categorizing individuals as robust (0), prefrail (1–2), or frail (3–5). The Japanese version, validated through back-translation and expert review, ensures consistency (Yamada & Yamada, 2016).

FAI–J.

The FAI–J measures instrumental activities of daily living across 15 items, including meal preparation, shopping, gardening, and social activities (Holbrook & Skilbeck, 1983). Scores range from 0 to 45, with higher scores indicating greater activity levels. FAI–J validity has been established among community-dwelling older adults in Japan (Han et al., 2006).

SF–12.

We assessed health-related quality of life by using the SF–12, Japanese version (Fukuhara & Suzugamo, 2009). The scale evaluates eight quality of life domains: physical functioning, pain, role physical, general health, vitality, social functioning, role emotional, and mental health (Ware et al., 1996). Scores for each domain were converted into numerical values (0 to 100); summary scores for physical and mental components were calculated, with higher scores reflecting better perceived health.

Statistical Analyses

We compared baseline characteristics and all primary and secondary outcome measures by using chi-square test, t test, and Mann–Whitney U test. A 2 × 3 mixed-design analysis of variance (ANOVA) was applied to outcome assessments, with group (intervention vs. control) as the between-participants variable and time (preevaluation: October 2021; postevaluation: March– April 2022; 6-mo follow-up: October–November 2022) as the within-participant variable. Effect sizes were calculated as partial η squared (η² _p). We applied the Greenhouse–Geisser correction to the ANOVA for violations of the sphericity assumption and used the Bonferroni correction for multiple comparisons in each measure. We conducted all statistical analyses by using IBM SPSS Statistics for Windows (Version 25.0), with alpha level set at .05.

Ethics Approval

This study followed the 2008 revision of the Helsinki Declaration and was approved by the Ethics Committee of the Faculty of Health Sciences, Hokkaido University (Approval No. 20–72-1). Participants provided written informed consent after receiving oral and written explanations regarding anonymity, confidentiality, voluntary participation, and result publication.

Results

Sixty-five individuals were assessed for eligibility, and 62 were enrolled (Figure 1). Three participants were excluded (one did not meet the inclusion criteria, and two declined participation). Both groups comprised 31 individuals each, with dropouts at various stages. Data from 44 participants were assessed in the final analysis. There were no significant between-group differences in baseline demographic characteristics (Table 1).

Figure 1.

Flow diagram of participant selection.

Table 1.

Participants’ Characteristics

Characteristic	n		p
Characteristic	Intervention Group (n = 22)	Control Group (n = 22)	p
Age, years, M (SD), range	76.5 (7.3), 70–89	76.9 (4.8), 65–93	.85
Years of education, M (SD)	12.0 (2.0)	12.0 (1.1)	1.00
Sex			.68
Men	3	4
Women	19	18
Living arrangement			.69
Alone	4	6
Living with a partner	11	11
Others	7	5
Participation duration in the community group			.82
≤1 yr	2	2
≥1 and <3 yr	7	5
≥3 and <5 yr	9	12
≥5 yr	4	3

A 2 × 3 mixed-design ANOVA for the MMSE–J revealed a significant main effect of time, F(1.76, 73.89) = 3.902, p = .029, η² _p= 0.085, and Group × Time interaction, F(1.76, 73.89) = 4.531, p = .017, η² _p= 0.097 (Table 2 and Figure 2A). A post hoc t test for time showed scores that were lower at the 6-mo follow-up than at postevaluation in the control group, t(21) = −3.309, corrected p = .010, without significant differences observed among other time points in either group. Furthermore, a post hoc t test for group showed higher 6-mo follow-up scores in the intervention group than in the control group, t(42) = 2.675, corrected p = .031, Cohen’s d = 0.80.

Table 2.

Descriptive Statistics of Pre- and Postevaluation and 6-Mo Follow-Up and Analysis of Variance for All Outcome Measures

Measure	M (SD)						Time × Group			Main Effect
	Intervention Group (n = 22)			Control Group (n = 22)						Main Effect
	Intervention Group (n = 22)			Control Group (n = 22)						Time			Group
	Preeval	Posteval	6-Mo Follow-Up	Preeval	Posteval	6-Mo Follow-Up	F	df	p	F	df	p	F	df	p
MMSE–J	27.82 (2.24)	28.68 (1.39)	28.50 (1.37)	28.36 (1.56)	28.68 (1.49)	27.41 (1.33)	4.531	1.76, 73.89	.017	3.902	1.759, 73.89	.029	2.000	1, 42	.616
Digit Span Forward	5.18 (0.96)	5.50 (0.67)	5.50 (0.60)	5.59 (0.91)	5.73 (0.94)	5.64 (1.00)	0.473	2, 84	.625	1.420	2, 84	.247	1.660	1, 42	.205
Digit Span Backward	3.82 (0.96)	4.00 (0.93)	4.14 (0.71)	3.82 (1.14)	4.05 (1.21)	4.00 (1.23)	0.202	2, 84	.817	1.602	2, 84	.208	0.013	1, 42	.909
Tapping Span Forward	5.36 (1.33)	5.27 (0.89)	5.09 (1.15)	5.55 (1.14)	5.27 (0.70)	5.14 (0.83)	0.183	2, 84	.833	2.377	2, 84	.099	0.082	1, 42	.775
Tapping Span Backward	4.27 (0.94)	4.41 (0.96)	4.50 (0.86)	4.55 (1.34)	4.32 (1.00)	4.36 (0.97)	1.246	2, 84	.293	0.101	2, 84	.904	0.094	1, 42	.761
Symbol Search	24.59 (6.93)	26.77 (6.72)	28.00 (7.04)	25.86 (5.60)	27.64 (6.79)	28.41 (6.67)	0.250	2, 84	.779	12.311	2, 84	<.001	0.205	1, 42	.653
Wisconsin Card Sorting Test	3.77 (1.74)	4.23 (1.27)	4.95 (1.09)	3.55 (1.77)	4.05 (1.65)	3.82 (1.76)	2.430	2, 84	.094	4.576	2, 84	.013	1.82	1, 42	.042
Life Engagement Test	23.27 (4.54)	25.18 (3.14)	26.00 (2.58)	25.05 (3.74)	24.09 (3.28)	23.82 (3.02)	8.743	1.56, 65.58	.001	1.208	1.561, 65.579	.297	0.330	1, 42	.569
Meaning in Life Questionnaire–Short Form	8.95 (1.36)	9.68 (1.67)	9.64 (1.59)	9.77 (1.51)	9.59 (1.22)	9.41 (1.59)	1.776	2, 84	.176	1.247	2, 84	.292	0.415	1, 42	.523
FRAIL Scale	0.68 (0.78)	0.73 (0.77)	0.73 (1.24)	0.55 (0.67)	0.68 (1.00)	0.50 (0.86)	0.196	2, 84	.822	0.262	2, 84	.770	0.41	1, 42	.530
Frenchay Activities Index	44.27 (6.64)	44.64 (6.91)	44.68 (7.24)	46.23 (7.57)	45.50 (6.85)	46.95 (6.21)	0.451	1.68, 70.45	.604	0.506	1.677, 70.452	.573	0.813	1, 42	.372
SF–12v2
3PCS	41.27 (16.10)	43.22 (14.41)	48.29 (12.17)	45.27 (12.34)	43.20 (11.30)	43.52 (12.99)	3.203	1.7, 71.17	.055	1.566	1.695, 71.173	.218	0.006	1, 42	.941
3MCS	52.66 (7.99)	52.50 (6.99)	54.40 (8.06)	55.80 (5.55)	54.48 (8.62)	54.51 (8.01)	0.965	2, 84	.385	0.425	2, 84	.655	0.828	1, 42	.368
3RCS	44.53 (11.86)	50.00 (9.07)	49.73 (10.82)	45.92 (7.73)	49.17 (7.33)	48.58 (8.61)	0.331	2, 84	.719	3.980	2, 84	.022	0.010	1, 42	.923
2PCS–J	39.04 (12.62)	44.00 (10.50)	44.48 (8.89)	42.94 (11.55)	43.51 (9.31)	44.03 (9.20)	1.749	2, 84	.180	3.391	2, 84	.038	0.130	1, 42	.721
2MCS–J	51.70 (7.74)	52.63 (6.68)	53.59 (7.14)	54.93 (5.82)	54.30 (8.55)	58.30 (6.11)	1.192	2, 84	.308	4.523	2, 84	.014	3.156	1, 42	.083

Note. MMSE–J = Japanese version of the Mini-Mental State Examination; preeval = preevaluation; posteval = postevaluation; SF–12v2 = Japanese version of the Medical Outcome Study 12-Item Short Form Survey Version 2; 3PCS = Physical Component Summary–Version 3; 3MCS = Mental Component Summary–Version 3; 3RCS = Role Component Summary–Version 3; 2PCS–J = Physical Component Summary–Japanese Version 2; 2MCS–J = Mental Component Summary–Japanese Version 2. df1, numerator degrees of freedom; df2, denominator degrees of freedom.

Figure 2.

Significant intervention effects on the Japanese version of the (A) Mini-Mental State Examination (MMSE–J) and (B) the Life Engagement Test.

For the LET, a 2 × 3 mixed-design ANOVA revealed a significant Group × Time interaction, F(1.56, 58.78) = 8.743, p = .001, η² _p= 0.172, but no significant main effects for group or time, F(1, 42) = 0.330, p = .569, η² _p= 0.008 and F(1.56, 65.58) = 1.208, p = .297, η² _p= 0.028, respectively (Table 2 and Figure 2B). A post hoc t test for time showed a significantly higher 6-mo follow-up score than that of the preevaluation in the intervention group, t(21) = 2.793, corrected p = .033, without significant differences among other time points in either group. Furthermore, a post hoc t test for group showed a significant difference at the 6-mo follow-up, t(42) = 2.577, corrected p = .041, Cohen’s d = 0.78. No significant effects or interactions were observed for other outcomes (Table 2).

Discussion

This study showed that the Color Narrative program significantly enhanced participants’ sense of purpose in life (LET scores) and preserved cognitive function (MMSE–J scores). Although the control group’s scores declined by −1.27 points, this was below the 2- to 4-point threshold for meaningful cognitive change (Hensel et al., 2007) and may reflect typical variability. In contrast, the intervention group maintained stable MMSE–J scores, resulting in a significant Group × Time interaction. These findings suggest that the Color Narrative program was effective in preserving cognitive function compared with standard preventive care.

A sense of purpose in life involves pursuing personally valued goals that guide behavior (Boyle et al., 2012; Sutin et al., 2023). The results highlight the potential of psychological and social approaches, including the Color Narrative program, in maintaining cognitive function by enhancing a sense of purpose. This aligns with Fang et al.’s (2024) meta-analysis, highlighting the significance of a sense of purpose in life for well-being. Given that a sense of purpose declines with age (Springer et al., 2011), reinforcing it may support older adults’ cognitive health.

Our findings align with those of the “Living Legends” program by Chippendale and Boltz (2015), suggesting that sharing occupational stories enhances a sense of purpose and supports cognitive function. Whereas the Living Legends program focused on life history, the Color Narrative program emphasized future-oriented goal setting through occupational storytelling. In particular, the structured processes in Phases 2 and 3 may have played a central role. In these phases, participants first identified personally meaningful goals through color-mediated storytelling (Phase 2) and then enacted those goals in daily life (Phase 3). These experiences likely reinforced a future-oriented sense of direction and agency. The behavioral focus of the LET, which measures engagement in personally valued goals (Scheier et al., 2006), aligns closely with this process. Thus, narrative reflection and the act of enacting future-oriented goals might have contributed to enhanced purpose and cognitive resilience.

Occupation, central to identity and decision- making, offers a more personal connection than generic purposeful activities (Latham, 2021; Radomski et al., 2024). In our study, occupational storytelling (Phase 2) helped participants reflect on their occupational identity, whereas occupational story-making (Phase 3) encouraged engagement in meaningful occupations rather than simply performing goal-directed tasks. This approach may have contributed to a substantial and sustained enhancement of a sense of purpose in life.

Whereas the control group engaged in generic cognitive and social activities, the intervention group engaged in activities rooted in their personal values and life context. Engaging in occupations rather than generic activities was likely crucial in reinforcing purpose and preventing cognitive decline. These findings suggest that occupational therapy provides a unique, client-centered contribution to dementia preventive interventions.

Limitations and Further Research Directions

This study had some limitations. Although the study met the estimated sample size, the relatively small sample limits generalizability. Cognitive decline in the control group may have influenced between-groups differences; therefore, the observed effectiveness of the intervention should be interpreted cautiously. Although intervention effects were evaluated 6 mo postintervention, the follow-up period was relatively short, necessitating further research on long-term effects. Self-reported measures introduced potential reporting bias. Future studies should incorporate objective assessments.

The specific contributions of each phase of the Color Narrative program remain unclear, because the independent impacts of occupational storytelling (Phase 2) and occupational story-making (Phase 3) were jointly analyzed. Therefore, a more detailed investigation isolating these components would improve the understanding of the program’s mechanisms. Further research should explore how each phase contributes to enhancing a sense of purpose and preventing cognitive decline.

Implications for Occupational Therapy Practice

This study has the following implications for occupational therapy practice:

▪ The Color Narrative program helps maintain cognitive function and enhances a sense of purpose in life among community-dwelling older adults, supporting psychological well-being and cognitive health through occupational storytelling and story-making.

▪ Tailoring interventions through individualized storytelling and value-based goal setting fosters deeper engagement in meaningful occupations and strengthens occupational identity, emphasizing the role of occupational therapy in well-being promotion and dementia prevention.

Conclusion

This randomized controlled trial demonstrated that the Color Narrative program significantly preserved cognitive function and a sense of purpose in life among community-dwelling older adults. The findings underscore the potential of occupation-centered, narrative-based interventions in preventive occupational therapy. Future studies should investigate the long-term effects and underlying mechanisms.

Footnotes

Acknowledgments

We thank all study participants and collaborators. This study was supported by the Japan Society for the Promotion of Science KAKENHI (Grant 19K19862).

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