1015456

research-article2021
JAGXXX10.1177/07334648211015456Journal of Applied GerontologyRíos Rincon et al.

Systematic Reviews
Journal of Applied Gerontology

Digital Storytelling in Older Adults With 2022, Vol. 41(3) 8 67­–880

© The Author(s) 2021

Typical Aging, and With Mild Cognitive Article reuse guidelines:

Impairment or Dementia: A Systematic

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Literature Review

Adriana Maria Rios Rincon1 , Antonio Miguel Cruz1,2,3,

Christine Daum1,3, Noelannah Neubauer3 ,
Aidan Comeau1 , and Lili Liu3

Abstract
The rates of dementia are on the rise as populations age. Storytelling is commonly used in therapies for persons living with
dementia and can be in the form of life review, and reminiscence therapy. A systematic literature review was conducted
to examine the range and extent of the use of digital technologies for facilitating storytelling in older adults and their care
partners, and to identify the processes and methods, the technologies used and their readiness levels, the evidence, and
the associated outcomes. Eight electronic databases were searched: Medline, EMBASE, PsycINFO, CINAHL, Abstracts in
Social Gerontology, ERIC, Web of Science, and Scopus. We included 34 studies. Mild cognitive impairment or dementia
represented over half of medical conditions reported in the studies. Overall, our findings indicate that the most common use
of digital storytelling was to support older adults’ memory, reminiscence, identity, and self-confidence; however, the level of
evidence of its effectiveness was low.

Keywords
older adults, digital storytelling, review, technology

Introduction housebound) to major biographical events of a person’s life.

Thus, digital storytelling can be a powerful tool that has been
The rates of dementia are on the rise as populations age. In used with older adults to foster social interaction (Chonody &
2019, 50 million people were living with dementia globally Wang, 2013), stimulate autobiographical memory and com-
and this number is expected to increase to 82 million in the munication with family members (Smith et al., 2009), and
next 11 years (World Health Organization [WHO], 2019). facilitate self-expression and identity (Manchester & Facer,
Challenges experienced by persons living with dementia 2015). Potential benefits of digital storytelling for persons liv-
include memory loss, difficulties with communication, and ing with dementia, in particular, include increased confidence,
losing a sense of their identity (Alm et al., 2007). Storytelling connection with others, sense of purpose, communication, and
is commonly used in therapies for dementia and can be in the improved well-being (Alm et al., 2007; Massimi et al., 2008).
form of reminiscence, life review, and reminiscence therapy
(Damianakis et al., 2010).
Manuscript received: December 9, 2020; final revision received:
When digital technology is used to create and tell stories, it April 12, 2021; accepted: April 17, 2021.
is called digital storytelling. A digital story can be defined as a
1
University of Alberta, Edmonton, Canada
3- to 5-min short clip with sequences of still images and pho- 2
Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
tos, music, video clips, narration, or written text, selected and 3
University of Waterloo, Ontario, Canada
woven together to impart messages to various audiences such
Corresponding Author:
as family, friends, care providers, community members, and
Adriana Maria Rios Rincon, Assistant Professor, Department of
the general public (Stenhouse et al., 2013; Waycott et al., Occupational Therapy, Faculty of Rehabilitation Medicine, University of
2017). These messages and topics can range from personal Alberta, 2-64 Corbett Hall, Edmonton, Alberta, Canada T6G 2G4.
experiences of a condition (e.g., illness, caregiving, being Email: [email protected]
2868 41(3)
Journal of Applied Gerontology 00(0)

Despite an increased interest in utilizing digital storytell- (b) Technology (ies) implemented or deployed at
ing among older adults, including those living with mild cog- least in pilot form: Technology Readiness Level
nitive impairment or dementia, scholarly literature on this (TRL) 5 (Department of Energy [DOE], 2009),
topic remains limited, and the level of evidence as well as the with one older adult at a minimum.
procedures and technologies used for the creation of the sto- (c) Digital media production to create narrative forms
ries are unknown. Thus, for this literature review, we posed of telling a story using nonphysical media such as
the question, “How has digital storytelling been used with video (with and without sound), animation, pic-
older adults with typical aging, and with mild cognitive tures, or audio and/or methods that employ any
impairment, or dementia?” This can inform how digital sto- kind of data mining and artificial intelligence to
rytelling can be applied in practice and identify future create these narrative forms of telling a story.
research directions. To address the research question, the 2. Papers published between January 1, 2005, and June
objectives of this systematic review were to (a) describe the 4, 2019.
purpose of digital storytelling studies; (b) identify the pro- 3. Studies published in any language and available in
cesses and methods utilized in the studies and development full-text in peer-reviewed journals or conference
of the stories; (c) identify technologies used in digital story- proceedings.
telling and describe their readiness levels, that is, stages of 4. Papers that used any type of study design or method-
precommercial development of a technology; (d) summarize ology, with positive or negative results.
the outcomes of using digital storytelling among persons
with typical aging, and living with mild cognitive impair- Exclusion criteria
ment or dementia; and (e) identify the clinical evidence of 1. Studies published in books, book chapters, doctoral,
the digital storytelling interventions used. or master’s theses.
2. Conference lecture notes, seminal or theoretical
Method papers, news, protocols, and any type of literature
reviews.
Design 3. Studies that used digital media only for gathering
In this systematic literature review, we (a) formulated the research data without producing a digital media story.
research questions based on the PICOS guidelines (Population, 4. A complete book of conference proceedings.
Intervention, Comparison, Outcome, Study type; Portney & 5. Full papers that were not available.
Watkins, 2015), (b) identified relevant studies, (c) selected the 6. Abstracts or papers that translation software was
studies based on inclusion and exclusion criteria, (d) charted unable to translate.
the data, and (e) collated, summarized, and reported the results. 7. Papers that did not provide enough information to
categorize it (e.g., description of participants, tech-
nology readiness).
Data Sources and Search Strategy
A health sciences librarian supervised and validated the Studies Selection Process
search strategy. Our search was conducted in eight electronic
databases: Medline, EMBASE, PsycINFO, CINAHL, Two members of the research team (C.D. and N.N.) exported
Abstracts in Social Gerontology, ERIC, Web of Science, and identified studies into the reference manager (RefWorks) and
Scopus. All databases were searched using the following removed duplicates. The team (A.M.R.R., C.D., N.N.,
MesH1 terms identified in the title, abstract, or key words: A.M.C., L.L.) evaluated the titles and abstracts and com-
(dementia OR Alzheimer OR “cognitive impairment”) OR pared them with the inclusion and exclusion criteria. Two
(elderly OR “older adults” OR aging) AND (reminiscence pairs of researchers (Pair 1: C.D. and A.R.; Pair 2: N.N. and
OR memories OR storytelling) AND (digital OR ICT OR A.M.C.) evaluated the full texts of the selected studies. Any
“artificial intelligence” OR online OR media OR mobile) differences between the two pairs of the independent
(see Table A.1 in Online Appendix A). researchers were reviewed by a third reviewer (L.L.) to make
the final decision.
Inclusion criteria
1. Papers that report the use of digital storytelling that
Data Extraction Process
included:
(a) People age 50 years and older, including those Two pairs of reviewers (Pair 1: A.R. and A.C.; Pair 2: C.D.
with typical aging or living with mild cognitive and A.M.C.) extracted data in the included papers. Each pair
impairment or dementia. This cutoff point allowed met to reconcile any differences through discussion. For more
us to include papers from diverse countries where details on the operationalization of each variable extracted
the life expectancy is shorter (WHO, 2001). from the studies, see Table B.1 in Online Appendix B.
Ríos Rincon et al. 8693

Figure 1. Scholarly literature search results.

Data Analysis and Synthesis extracted information from both outcomes and on how they
were measured, which allowed us to reduce bias of overesti-
One member of the team (A.C.) conducted the data analysis mated conclusions in the analyzed papers.
under the supervision of the experienced authors who met To control for bias in individual studies, for randomized
with him in a weekly basis to guide and review data analysis. controlled trial (RCT) studies, the risk of bias was measured
The studies were categorized into nine groups according to using the Physiotherapy Evidence Database (PEDro) Scale
the main purpose of the story. All studies were analyzed in (Portney & Watkins, 2015). We assessed the strength of the
terms of population characteristics, study designs, processes, evidence using an adaptation of the modified Sackett criteria
and methods for creating the digital storytelling, and the new (Teasell et al., 2020) in which evidence is assessed on levels
technologies that have been used and its readiness levels. We ranging from conflicting evidence to Level 1a (the highest
used descriptive statistics to characterize the studies included level; Online Appendix B, Table B.2). We assessed the qual-
in our literature review. In some cases, we allowed data such ity of qualitative studies using the clinical appraisal assess-
as diagnoses to be counted manifold. ment tools (Critical Appraisal Skills Programme [CASP]
Checklist; CASP, 2018).
Risk of Bias (Quality) Assessment
By including a variety of source, databases were able to Results
achieve greater levels of sensitivity to avoid reducing source
Study Selection
publication bias and to guarantee a more thorough search.
The inclusion of papers with positive and negative results Figure 1 shows the results of the review process. We identified
reduced the possibility of publication bias. The inclusion of 4,548 studies; after removing duplicates, a total of 3,890 (85.5%,
papers registered in electronic abstract systems was the first 3,890/4,548) studies remained for the title and abstract screen-
“quality filter,” thus ensuring a certain scientific level of con- ing phase. In total, we included 34 studies for data extraction.
ceptual and methodological rigor. The inclusion of non-Eng-
lish papers also avoided the Tower of Babel bias. For reducing
Population
rater bias, we included two pairs of raters during the selection
process for relevant articles (i.e., abstract and full paper read- Older adults involved in digital storytelling studies. Overall, the
ing) and a third reviewer in the case of disagreement. We studies included 510 participants in total. The majority or
4870 41(3)
Journal of Applied Gerontology 00(0)

70.2% of participants were female. Participants were older (67%, 23/34). Other topics included the experience of having
adults with a mean age of 72.90 (SD = 6.74) years. Mild a health condition or caring for someone with a health condi-
cognitive impairment or dementia represented over half tion (dementia, cancer; 9%, 3/34), and health information
(52%, 13/25) of medical conditions; less common conditions (screening, health promotion, disease management; 9%,
each account for 4% to 8%, including diabetes, chronic con- 3/34).
ditions, cancer or at risk of getting cancer, visual impairment,
depression, intellectual disability, Parkinson’s, and commu-
Digital Storytelling Processes
nication problems (see Table 1 for a detailed characterization
of the population). The processes used to create digital storytelling are shown in
Tables 2 and 4. The most common approach to create digital
People involved in digital storytelling studies. In some studies, stories was one-on-one, that is, not in a group format (45.9%,
the process of creating and delivering digital storytelling 17/37), and the stories were mostly co-created (72.9%,
involved people other than the older adults. Table 2 shows 27/37) between older adults and the other people involved in
the characteristics of these individuals. Overall, their roles the digital storytelling studies. Nearly 65% of the digital sto-
were characterized as (a) helping with the nontechnical ries were stored as film, movie, video, or motion picture.
development of the digital stories, (b) providing technical Participants’ homes (24.3%, 9/37) and community centers
support to the older adult participants (e.g., in the digital (16.2, 6/37) were the most common settings. It took on aver-
story production process), and (c) receiving or observing the age of 4.5 weeks, ranging from 1.62 to 4.57 weeks, to create
stories. In the first group, family members were the most a digital story and just over 8 months to assess the impact of
commonly involved (25%, 11/44), followed by research digital stories.
team members who conducted the study, and formal care
partners each accounted for 11.3% to 13.6%. In the second
group, the research team members were the most commonly
Digital Storytelling Technologies
involved (36.4%, 12/33), followed by the participants them- Technologies used to create digital storytelling employed an
selves and media/digital storytelling specialists each amalgamation of commercial off-the-shelf 2 traditional
accounted for 9.1% to 15.2%. In the third group, family video-editing tools (44.1%, 15/34) with new technologies for
members were the most commonly recipients of the digital editing video tools (23.5%, 8/34). In the first group, the soft-
stories (26.2%, 17/65), followed by the general public, for- ware used was Final Cut Pro (first developed by Macromedia
mal carers, and friends each accounted for 7.7% to 16.9%. Inc. and later Apple Inc), WeVideo (WeVideo, Inc.), Windows
Movie Maker (Microsoft), iMovie (Apple Inc.), Sony Movie
Studio (Sony Creative Software), and Adobe Premiere
Digital Storytelling: The Purpose of Stories and (Adobe Inc.). Table 5 shows the new technologies that have
the Study Designs been developed to create digital stories, including the name
Table 3 shows the purpose of digital stories and study of technology, the aim, the role, and the level of technology
designs. We found nine different categories of the purpose of readiness. Overall, the technology readiness level of the new
stories. With respect to study designs, qualitative and mixed technologies for editing video tools in digital storytelling
were the most common research designs used, accounting1 was 5.75 (0.46), meaning these technologies are at the
for 81% (30/37). Case study (20.6%, 7/37) was the most “Technology Development” level (DOE, 2009, p. 9). In other
common strategies of inquiry of quantitative design. We words, the new technologies that have been used to create
found no RCT so we did not assess any study with the PEDro digital storytelling are at the laboratory scale.
Scale. Most of the qualitative studies seemed to use generic
qualitative description (64.8%, 24/37), although not clearly Outcomes of Digital Storytelling and Level of
stated in the manuscripts. Overall, the qualitative papers met
9.6% of the CASP criteria (ranging between 0% and 37.5%).
Evidence
Twelve studies were clinical oriented (32.4%, 12/37) and 13 Twelve studies reported clinical research (e.g., using digital
aimed to determine the usability (35.1%, 13/37) of the tech- storytelling as an intervention); only five of these studies
nology used to create the digital stories. reported outcome variables:
Digital stories created were predominantly related to past
event (64%) although a few also focused on current (28%) 1. Bertera’s (2014) study evaluated a health education
and future events (2%). Regarding life events recalled, sto- intervention using storytelling slide shows designed to
ries were related to personal experiences, general content, or impact diabetes and hypertension knowledge, attitudes,
era/time in a person’s life; the majority were about personal and practices among African American older adults.
experiences (79%). Most common topics were life biogra- The Eating Decisions, the Diabetes Self-Efficacy Index,
phy, important life moments, or events related to history and the High Blood Pressure Self-Efficacy Index were
 Ríos Rincon et al.

Table 1. Population Characteristics: Older Adults Involved in Digital Storytelling Intervention.

Total sample of
How the DST was applied/purpose No. of older adults Sex male: Diagnosis/condition (no. of Type & severity of cognitive
of the story studies (%) n (%) M age (SD) Female studies) impairment (no. of studies) Study ID

Student or service provider learning/ 6 (17.6) 57 (11.2) 76.75 (NR) 7:11 Cognitive impairment (n = 1) Dementia early (n = 1) Brand et al. (2016), Hewson et al. (2015), Loe (2013),
development McGovern (2019), Sehrawat et al. (2017), and
Stenhouse et al. (2013)
Communication and social 6 (17.6) 81 (15.9) 72.84 (9.69) 20:39 Cognitive impairment (n = 5) Mild cognitive impairment (n = 4) Bentley et al. (2011), Chonody and Wang (2013), Crete-
connection (with family and Visual impairment (n = 1) Alzheimer disease Early to Nishihata et al. (2012), Damianakis et al. (2010), H.
friends) Housebound due to chronic advanced (n = 2) Davis et al. (2015), and Smith et al. (2009)
condition (n = 1) Early (n = 1)
Moderate (n = 1)
NR (n = 1)
Health education 5 (14.8) 44 (8.6) 65.1 (NR) 4:4 Cancer (n = 2) NA Bertera (2014), Briant et al. (2016), Cueva et al. (2013),
Diabetes (n = 2) Iredale et al. (2011), and Njeru et al. (2015)
Depression (n = 1)
Elevated cancer risk (n = 1)
Support older adult memory, 9 (26.5) 133 (26) 76.76 (6.09) 26:82 Cognitive impairment (n = 5) Dementia early (n = 1) Axtell and Munteanu (2017), Castro-Rojas (2018), B.
reminiscence, identity, and/or Intellectual disability (n = 1) Mild (n = 1) H. Davis and Shenk (2015), Hamilton and Atkinson
self-confidence Moderate (n = 1) (2009), Jaakola et al. (2015), Karlsson et al. (2014),
Mild to moderate (n = 1) Massimi et al. (2008), Pekkarinen, Melkas, et al. (2013),
Moderate to late (n = 1) and Subramaniam and Woods (2016)
Legacy 1 (2.9) 53 (10.4) 60.3 (NR) 3:0 NR NA Manchester and Facer (2015)
Stimulate social interaction with 2 (5.9) 80 (15.7) Unable to NR NR NA Hausknecht et al. (2016, 2017)
peers as a part of lifelong learning calculate (NR)
Communication and social 2 (5.9) 9 (1.8) 59.5 (NR) 1:2 Housebound due to chronic NA Waycott et al. (2017), Williams et al. (2017)
connection (with broader condition (n = 1)
community)
Communication to inform care 2 (5.9) 50 (9.8) 88 (5.1) 0:3 Cognitive impairment (n = 2) Dementia early (n = 1) Pekkarinen, Kuosmanen, et al. (2013), Webster and Fels
provision from service providers Parkinson’s (n = 1) Late (n = 1) (2013)
Communication Problems (n = 1)
Development of digital literacy skills 1 (2.9) 3 (0.6) 65 (NR) 0:3 NR NA Simsek and Erdener (2012)

Note. DST = Digital storytelling; NR = Not reported; NA = Not Applicable; DS = Digital Story.

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871
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872

Table 2. Population Characteristics: People Involved in Digital Storytelling Studies.

How the DST was applied/ No. of People involved in the nontechnical People who provided technical The recipients/observers of the Methods for sharing
purpose of the story studies (%) development of the digital stories support to the participants stories stories Study ID

Student or service 6 (17.6) University students (n = 2) University students (n = 4) Students (university or HCP) (n = 2) Public viewing (n = 4) Brand et al. (2016), Hewson et al. (2015), Loe
provider learning/ Formal care partner (n = 1) Research team (n = 2) General public (n = 2) Private viewing (n = 2) (2013), McGovern (2019), Sehrawat et al.
development NR (n = 3) Service providers (n = 1) Other participants (n = 2) Course (n = 1) (2017), and Stenhouse et al. (2013)
University alumnus (n = 1) Family (n = 2) Conferences/
Formal care partner (n = 1) presentations (n = 1)
HCP (n = 1)
Other participants (n = 1)
Others (nonspecific) (n = 1)
Communication and social 6 (17.6) Family (n = 5) Research team (n = 4) Family (n = 6) Private viewing (n = 6) Bentley et al. (2011), Chonody and Wang
connection (with family Community volunteers (n = 1) NA (n = 1) Other participants (n = 4) Online (n = 2) (2013), Crete-Nishihata et al. (2012),
and friends) Research team (n = 1) NR (n = 2) General public (n = 2) Public viewing (n = 1) Damianakis et al. (2010), H. Davis et al.
Formal care partner (n = 1) Friends (n = 1) (2015), and Smith et al. (2009)
NR (n = 1) Others (nonspecific) (n = 1)
Health education 5 (14.7) Formal care partner (n = 2) Research team (n = 2) Other participants (n = 3) Private viewing (n = 3) Bertera (2014), Briant et al. (2016), Cueva
Research team (n = 1) Participants (n = 2) General public (n = 2) Online (n = 3) et al. (2013), Iredale et al. (2011), and Njeru
Media/DST specialists (n = 1) Service providers (n = 1) Family (n = 1) Public viewing (n = 2) et al. (2015)
NR (n = 2) Media/DST specialists (n = 1) Friends (n = 1) Conferences/
Others (nonspecific) (n = 1) presentations (n = 1)
Support older adult 9 (26.6) Family (n = 4) Research team (n = 3) Family (n = 3) Private viewing (n = 5) Axtell and Munteanu (2017), Castro-Rojas
memory, reminiscence, Research team (n = 3) University students (n = 2) Other participants (n = 2) Online (n = 3) (2018), B. H. Davis and Shenk (2015),
identity, and/or self- University students (n = 1) Participants (n = 1) Not shared (n = 2) NR (n = 1) Hamilton and Atkinson (2009), Jaakola et al.
confidence Students (nonspecific) (n = 1) Formal care partner (n = 2) Formal care partners (n = 1) (2015), Karlsson et al. (2014), Massimi et al.
Formal care partner (n = 1) Family (n = 1) General public (n = 1) (2008), Pekkarinen, Melkas, et al. (2013),
NR (n = 3) NA (n = 2) NR (n = 2) and Subramaniam and Woods (2016)
Legacy 1 (2.9) NR (n = 2) Participants (n = 1) Family (n = 1) Public viewing (n = 2) Manchester and Facer (2015)
Community filmmakers (n = 1) General public (n = 1)
Stimulate social interaction 2 (5.9) NR (n = 2) Participants (n = 2) Family (n = 2) Public viewing (n = 2) Hausknecht et al. (2016, 2017)
with peers as a part of Friends (n = 2)
lifelong learning General public (n = 2)
Formal care partners (n = 1)
HCP (n = 1)
Communication and 2 (5.9) Family (n = 1) Research team (n = 2) Formal care partners (n = 2) Public viewing (n = 1) Waycott et al. (2017), Williams et al. (2017)
social connection (with Research team (n = 1) Media/DST specialists (n = 1) Family (n = 1) Online (n = 1)
broader community) Friends (n = 1)
General public (n = 1)
HCP (n = 1)
Students (university or HCP) (n = 1)
Communication to inform 2 (5.9) Family (n = 1) Research team (n = 1) Formal care partners (n = 2) Private viewing (n = 2) Pekkarinen, Kuosmanen, et al. (2013),
care provision from NR (n = 1) NR (n = 1) Family (n = 1) Webster and Fels (2013)
service providers
Development of digital 1 (2.9) NR (n = 1) Media/DST specialists (n = 1) NR (n = 1) NR (n = 1) Simsek and Erdener (2012)
literacy skills

Note. DST = Digital storytelling; NR = Not reported; NA = Not Applicable; HCP = Health Care Professional.
Journal of Applied Gerontology 41(3)
 Ríos Rincon et al.

Table 3. Digital Storytelling: The Purpose of Stories and the Study Designs.
Setting where the digital
How the DST was applied/ No. of Study design (no. of Type of study (no. of Design type storytelling is done (no. of
purpose of the story studies (%) studies) studies) Design type (quantitative) (qualitative) studies) Study ID

Student or service provider 6 (17.6) QUAN (n = 1) Clinical oriented (n Posttest (n = 1) Generic qualitative Public spaces (n = 1) Brand et al. (2016), Hewson et al. (2015), Loe
learning/development QUAL (n = 4) = 1) NA (n = 5) description (n = 3) Neighborhoods & communities (2013), McGovern (2019), Sehrawat et al.
Descriptive (n = 1) Usability (n = 2) PAR (n = 1) of older adults (n = 1) (2017), Stenhouse et al. (2013)
Descriptive (n = 3) NA (n = 2) NR (n = 4)
Communication and social 6 (17.6) QUAL (n = 4) Clinical Oriented (n Case study (n = 3) Generic qualitative Participants’ homes (n = 2) Bentley et al. (2011), Chonody and Wang
connection (with family and Mixed (n = 3) = 4) NA (n = 5) description (n = 6) Community centers (n = 1) (2013), Crete-Nishihata et al. (2012),
friends) Descriptive Usability (n = 1) Case Study (n = 1) NR (n = 5) Damianakis et al. (2010), H. Davis et al.
(n = 1) Descriptive (n = 3) NA (n = 1) (2015), and Smith et al. (2009)
Health education 5 (14.7) QUAL (n = 3) Clinical oriented (n Staggered pretest posttest Generic qualitative Participants’ homes (n = 2) Bertera (2014), Briant et al. (2016), Cueva
Mixed (n = 2) = 1) control group (n = 1) description (n = 4) Community centers (n = 1) et al. (2013), Iredale et al. (2011), Njeru et al.
Usability (n = 3) Pretest posttest & delayed PAR (n = 1) NR (n = 2) (2015)
Descriptive (n = 1) posttest (n = 1)
NA (n = 3)
Support older adult memory, 9 (26.6) QUAL (n = 3) Clinical Oriented (n Case study (n = 2) Generic qualitative Participants’ homes (n = 3) Axtell and Munteanu (2017), Castro-Rojas
reminiscence, identity, and/or Mixed (n = 5) = 6) Case series (n = 2) description (n = 6) Community centers (n = 2) (2018), B. H. Davis and Shenk (2015),
self-confidence Descriptive (n = 1) Usability (n = 1) Pretest posttest (n = 1) Case study (n = 1) Long-term care facility (n = 1) Hamilton and Atkinson (2009), Jaakola et al.
Descriptive (n = 2) NA (n = 4) Explorative multiple Memory care unit (n = 1) (2015), Karlsson et al. (2014), Massimi et al.
case study (n = 1) NR (n = 3) (2008), Pekkarinen, Melkas, et al. (2013), and
NA (n = 1) Subramaniam and Woods (2016)
Legacy 1 (2.9) Qualitative (n = 2) Descriptive (n = 2) NA (n = 2) Generic qualitative Community centers (n = 1) Manchester and Facer (2015)
description (n = 2) NR (n = 1)
Stimulate social interaction 2 (5.9) QUAN (n = 2) Usability (n = 1) Case study (n = 2) NA (n = 2) Public spaces (n = 1) Hausknecht et al. (2016, 2017)
with peers as a part of Descriptive (n = 1) NR (n = 1)
lifelong learning
Communication and social 2 (5.9) QUAL (n = 2) Usability (n = 2) NA (n = 2) Generic qualitative Participants’ homes (n = 1) Waycott et al. (2017) and Williams et al. (2017)
connection (with broader description (n = 2) Community centers (n = 1)
community)
Communication to inform 2 (5.9) QUAL (n = 2) Usability (n = 2) NA (n = 2) Generic qualitative Long-term care facility (n = 1) Pekkarinen, Kuosmanen, et al. (2013), Webster
care provision from service description (n = 1) NR (n = 1) and Fels (2013)
providers Case study (n = 1)
Development of digital literacy 1 (2.9) Descriptive (n = 1) Usability (n = 1) NA (n = 1) NA (n = 1) Participants’ homes (n = 1) Simsek and Erdener (2012)
skills Public spaces (n = 1)

Note. DST = Digital storytelling; NR = Not reported; NA = Not Applicable; PAR = Participatory Action Research; Descriptive = A study that describe a technology or initiative in DST; QUAN = Quantitative; QUAL =
Qualitative.

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Table 4. Digital Storytelling Processes.

How many weeks How many weeks to
Did the DST creation to create the digital assess the impact of
How the DST was applied/ No. of How were the digital process involve co- stories? the digital stories?
purpose of the story studies (%) Format/storage of the stories stories created? construction? Yes/no Discipline M (SD) M (SD) Study ID

Student or service 6 (17.6) Film/movie/video/motion picture Workshop (n = 3) Yes (n = 5) Education (n = 4) 4.25 (4.63) 37.33 (57.87) Brand et al. (2016), Hewson et al.
provider learning/ (n = 6) One-on-one (n = 2) No (n = 1) Social work (n = 3) (2015), Loe (2013), McGovern
development One-on-one/workshop Nursing (n = 2) (2019), Sehrawat et al. (2017),
mixed (n = 1) Medicine (n = 1) and Stenhouse et al. (2013)
Communication and social 6 (17.6) Film/movie/video/motion picture One-on-one (n = 7) Yes (n = 5) Computer science/ 4.57 (2.84) 19.2 (7.16) Bentley et al. (2011), Chonody
connection (with family (n = 4) Course/class (n = 1) No (n = 2) technology (n = 6) and Wang (2013), Crete-
and friends) Slide show of photographs and NR (n = 1) Psychology (n = 4) Nishihata et al. (2012),
other personal information Medicine (n = 4) Damianakis et al. (2010), H.
(n = 2) Social work (n = 2) Davis et al. (2015), and Smith
Blog/social media entry (n = 1) et al. (2009)
Film/movie/video/motion picture
that are linked to geographic
locations (n = 1)
Health education 5 (14.7) Film/movie/video/motion picture Workshop (n = 2) Yes (n = 5) Public/community 1.62 (2.26) 86 (75.26) Bertera (2014), Briant et al.
(n = 4) Course/class (n = 1) health (n = 3) (2016), Cueva et al. (2013),
Slide show of photographs and One-on-one (n = 1) Social work (n = 1) Iredale et al. (2011), Njeru
other personal information NR (n = 1) Medicine (n = 1) et al. (2015)
(n = 1)
Support older adult 9 (26.6) Film/movie/video/motion picture One-on-one (n = 4) Yes (n = 5) Computer science/ 4.57 (2.84) 6.75 (9.64) Axtell and Munteanu (2017),
memory, reminiscence, (n = 3) Course/class (n = 2) No (n = 3) technology (n = 3) Castro-Rojas (2018), B. H.
identity and/or self- Slide show of photographs and Other (n = 2) NR (n = 1) Education (n = 2) Davis and Shenk (2015),
confidence other personal information NA (n = 1) Humanities (n = 2) Hamilton and Atkinson (2009),
(n = 2) Psychology (n = 1) Jaakola et al. (2015), Karlsson
Memory stick (n = 1) Nursing (n = 1) et al. (2014), Massimi et al.
Blog/social media entry (n = 1) (2008), Pekkarinen, Melkas,
Not specified (n = 2) et al. (2013), and Subramaniam
and Woods (2016)
Legacy 1 (2.9) Film/movie/video/motion picture One-on-one (n = 1) Yes (n = 2) Education (n = 2) NR NR (NR) Manchester and Facer (2015)
(n = 2) Workshop (n = 1)
Stimulate social interaction 2 (5.9) Film/movie/video/motion picture Workshop (n = 2) Yes (n = 2) Education (n = 2) 7 (0) 0 (0) Hausknecht et al. (2016, 2017)
with peers as a part of (n = 2)
lifelong learning
Communication and 2 (5.9) Film/movie/video/motion picture One-on-one (n = 1) Yes (n = 2) Humanities (n = 1) 0.43 (NA) 0 (NA) Waycott et al. (2017), Williams
social connection (with (n = 2) Workshop (n = 1) Nursing (n = 1) et al. (2017)
broader community)
Communication to inform 2 (5.9) Memory stick (n = 1) One-on-one (n = 1) No (n = 1) Computer science/ 6 (NA) 104 (NA) Pekkarinen, Kuosmanen, et al.
care provision from Slide show of photographs and NR (n = 1) NR (n = 1) technology (n = 2) (2013), Webster and Fels
service providers other personal information Education (n = 1) (2013)
(n = 1) Humanities (n = 1)
Development of digital 1 (2.9) Film/movie/video/motion picture Workshop (n = 1) Yes (n = 1) Humanities (n = 1) 0.43 (NA) NR (NA) Simsek and Erdener (2012)
literacy skills (n = 1)

Note. DST = Digital storytelling; NR = Not reported; NA = Not Applicable.

Journal of Applied Gerontology 41(3)
 Ríos Rincon et al.

Table 5. Digital Storytelling: The New Technologies That Have Been Used and its Readiness Levels.

Role of novel Level of technology

Name of technology Aim of the technology or software technology readiness (TRL) Study ID
“SenseCam To simplify the selection and organization of SenseCam images using a simple user Story Creation 6 Crete-Nishihata
reexperience” & interface by automatically grouping them into event-based sequences. It “remixes” et al. (2012)
“SenseCam remix” the images, allows them to be pieced together, and facilitates the addition of
narration to give an edited version of images.
“Family Stories” (1) Record video stories using computer webcams using a website (called Story Creation 6 Bentley et al. (2011)
Website + Mobile Serendipitous Family Stories) and these are saved to a particular location on a map.
Application (2) Share these video stories with selected individuals using a mobile application. The
app facilitates downloading of the stories on a personal device and monitoring its
location. When the device location comes close to the location of the saved story,
it vibrates and the individual unlocks and views it.
“Biography Theatre” This ambient display (called Biography Theater) cycles through music, photographs, Story Creation 6 Massimi et al. (2008)
movies, and narratives from a person living with dementia’s life to encourage
reminiscence
“Frame of Mind” To facilitate the management of and interaction with digital pictures. It encourages Story Creation 6 Axtell and
natural reminiscence and storytelling, documenting stories with a simple audio and Munteanu (2017)
picture slideshow.
No Name Reported System to help persons living with dementia to remember their daily events and Story Creation 6 Karlsson et al.
stimulate conversation with family members about these events. (2014)
“Portrait System” This multimedia portrait (presented on a touch screen computer) helps care staff Story Creation 6 Webster and Fels
become familiar with their clients (persons living with dementia), including their (2013)
needs and habits as well as personal and social information (e.g., key life events,
family, preferences, hobbies, interests).
No Name Reported To facilitate interaction between digital story viewers and storytellers. Digital stories Story Sharing 5 Waycott et al.
were shown on a display (a television). Viewers scanned a QR code on the display (2017)
to select a story to view and responded to them by leaving comments which were Story Sharing 5 H. Davis et al.
moderated by the research team. Once approved, comments were added to the (2015)
story being displayed using running text at the bottom of the screen for subsequent
viewers and storytellers to see.

9
875
876
10 41(3)
Journal of Applied Gerontology 00(0)

outcome variables in this staggered pretest posttest con- Interview (AMI), the Mini-Mental State Exam
trol group study design. Findings suggest that when (MMSE), the Informant Questionnaire of Cognitive
digital storytelling was used through an education pro- Decline in the Elderly (IQCODE), and the Modified
gram designed for behavioral change, all outcome vari- Caregiver Strain Index (CSI) as outcome variables.
ables significantly improved, at postintervention (Level Based on this exploratory case study with a single par-
2 evidence). ticipant, the use of digital storytelling improved sense
2. Subramaniam and Woods’s (2016) study studied the of identity (SIP-AD), reduced apathy (GDS-30, GAS,
acceptability and efficacy of using multimedia digital AES-I), and changed the participant relationships and
life storybooks with people living with dementia in communication with the care partner (CSI; Level 5
care homes. Outcome measures included the Quality- evidence). No change in general cognition or autobio-
of-Life Alzheimer’s Disease (QOL-AD) Scale, the graphical memory was observed.
Autobiographical Memory Interview (AMI), the
Geriatric Depression Scale (Residential) (GDS-12R),
Discussion
and the Quality of the Caregiving Relationship
Questionnaire (QCPR). Based on the findings from Our systematic review addressed the question how has digi-
this pretest posttest study design (no control group), tal storytelling been used with older adults with typical
when digital storytelling was used with people living aging, and with mild cognitive impairment, or dementia? We
with dementia, the QOL-AD, AMI, GDS-12R, and examined the range and extent of the use of digital storytell-
the QCPR improved at postintervention (Level 4 ing in older adults and their care partners, described the pro-
evidence). cesses and technologies used and their readiness level, and
3. Karlsson et al.’s (2014) study explored the process of identified the evidence and the associated outcomes. We
acceptance and integration of a digital photograph included 34 studies, and overall, our findings indicate that
diary as a tool for remembering and conversing about there are nine purposes of digital storytelling, the most com-
daily life events among individuals living with mon of which was to support memory, reminiscence, iden-
dementia and their family members. The outcome tity, or self-confidence. The majority of stories focused on
variables were the Mini-Mental State Examination personal experiences that occurred in the past and were co-
(MMSE), Computer-Based Verbal Episodic Memory created on a one-on-one basis in participants’ homes. The
Test (two-word lists with random words), and the stories were mostly in the form of film, movie, video, or
Philadelphia Geriatric Center Morale Scale motion picture and were developed over approximately 4.5
(PGCMS). Based on the findings from this explor- weeks, and the technologies used to create digital stories
ative multiple case study design, the use of DPD has employed commercial off-the-shelf traditional video-editing
no effect on cognitive function, well-being, and tools and novel video-editing tools. Overall, the technology
memory function of older adults living with dementia readiness level of the novel technologies was medium-low.
(Level 4 evidence). The level of evidence for effectiveness was low for the use of
4. Davis and Shenk’s (2015) study explored digital sto- digital storytelling as intervention to support older adults and
rytelling to increase engagement and support the their care partners.
retention of identity in older adults living with
dementia. The outcome variable was engagement
Purpose of Digital Storytelling Studies
with the digital stories measured through physiologi-
cal data (e.g., heart rate), time spent viewing each There is a general interest in research exploring the use of
video, preferences between videos with personal or digital storytelling as a therapeutic means to improve cogni-
general content, and language patterns. Based on this tive, emotional, or affective skills in older adults living with
case study’s findings, participants were engaged in mild cognitive impairment or dementia, followed by its use
digital storytelling activities and that the videos with to facilitate conversation and social connection between
generic content elicited more diverse language in individuals living with dementia and their families. This is
participants than those with personal content (Level 5 aligned with the finding that the majority of the content was
evidence). Authors did not report how identity was personal (e.g., life biography, an important moment in life, or
measured nor results associated with this construct. events related to history) and related to past events in the
5. Massimi et al.’s (2008) study examined how the novel participants’ lives, which is commonly used in reminiscence
“off the desktop” technologies to aid in memory and therapy. Although the evidence was low, some findings sug-
conversation may help remediate identity. Authors gest avenues for future research. Damianakis and colleagues
used the Geriatric Depression Scale-30 (GDS-30), the (2010) found that the use of digital storytelling triggered
Goldberg Anxiety Scale (GAS), the Apathy Evaluation memories in older adults living with mild cognitive impair-
Scale–Informant (AES-I), the Self-Image Profile– ment or dementia, which provided the family with new
Adult (SIP-AD), the Autobiographical Memory insights about the participant’s life story, which in turn, eased
Ríos Rincon et al. 877
11

the interaction with the loved one living with dementia. co-creation process than the amount of time they spend
Participants living with mild cognitive impairment were less toward the overall product or the technical aspects of it.
likely view the triggers as early or lost memories than those
living with dementia. Davis and Shenk (2015) reported that
Technologies Used in Digital Storytelling
older adults living with dementia preferred to develop digital
stories in the form of videos with personal content rather Mainly commercial off-the-shelf technologies were used in
than with generic content. However, the videos with generic digital storytelling. Only seven papers reported novel tech-
content elicited more diverse language patterns than the per- nologies. All but one were developed to assist with story cre-
sonalized video. Crete-Nishihata and colleagues (2012) ation. Most are at a laboratory scale of technology readiness
found both positive and negative psychosocial outcomes (i.e., reported results are from test in a laboratory environ-
when SenseCam technology facilitated review of images of ment and technologies are not commercially available). Such
daily life events. Personal stories based on personal life notable technologies include software that automatically cre-
experiences may involve re-elicitation and consideration of ates an animated slideshow of the pictures older adults
sometimes painful memories (Lazar et al., 2014). Reminiscing selected while looking at their stored pictures on a mobile
can potentially cause emotional distress when older adults device synchronized with an older adult’s voice (Axtell &
living with dementia fail to recognize themselves, others, or Munteanu, 2017). Another example is an algorithm that uses
personal events in personal photographs (Gowans et al., recent first-person perspective photos automatically cap-
2004). On the contrary, when only generic material is used, tured using SenseCam (a lifelogging device) to create a digi-
older adults living with dementia preferred personal materi- tal story. This algorithm automatically selects 24 relevant
als to be used in reminiscence therapy (Alm et al., 2004). pictures, synchronizes them with the event’s narration by the
Thus, whether personal or generic content is more effective older adult’s partner, and thus holds promise not only for
for reminiscence therapy, including when digital technolo- digital storytelling but also for an autobiographical memory
gies are utilized, remains unknown. assistive technology for people with mild cognitive impair-
ment or dementia (Crete-Nishihata et al., 2012). Such tech-
nologies are promising as they may enable older adults with
Processes and Methods Utilized to Develop the cognitive or motor impairments to easily create a digital
Stories story, requiring less support from others with technical skills.
A co-creation approach was used when participants lived
with dementia or mild cognitive impairment (Crete-Nishihata Evidence and the Associated Outcomes of Digital
et al., 2012; Damianakis et al., 2010; Pekkarinen, Melkas,
et al., 2013; Smith et al., 2009; Stenhouse et al., 2013;
Storytelling
Subramaniam & Woods, 2016), other chronic diseases The level of evidence provided in the quantitative clinical
(Briant et al., 2016; H. Davis et al., 2015; Njeru et al., 2015; studies was low. Only five studies reported outcome vari-
Waycott et al., 2017), or an intellectual disability (Hamilton ables, among which only one study had a control condition.
& Atkinson, 2009). Co-creation is a “sophisticated, value- The low level of evidence seems to be associated with the
based, context-driven, collaborative effort to develop new research designs selected rather than to the technologies used
paradigms, products, and services to satisfy human wants” in the studies. Interestingly, the study providing the highest
(Akhilesh, 2017, p. 2). Co-creation was observed in several level of evidence (Hewson et al., 2015) used a prolonged
ways: (a) support given by facilitators to the older adults to amount of time to assess the impact of digital storytelling
create the digital story (Crete-Nishihata et al., 2012; H. Davis (i.e., 156 weeks or around 3 years). More rigorous research
et al., 2015; Hamilton & Atkinson, 2009; Pekkarinen, able to demonstrate effectiveness of using digital storytelling
Melkas, et al., 2013; Stenhouse et al., 2013); (b) participa- interventions on outcome variables in a shorter time span is
tory design (Damianakis et al., 2010; Njeru et al., 2015; also beneficial with older adults whose chronic conditions
Smith et al., 2009; Subramaniam & Woods, 2016); and (c) decline rapidly.
active engagement of older adults during the digital storytell- Qualitative studies are mainly devoted to exploring
ing process (Briant et al., 2016; Waycott et al., 2017). aspects of the use of digital storytelling such as (a) the topic
Stenhouse et al. (2013) proposed that digital storytelling is or content of the stories (Castro-Rojas, 2018; H. Davis et al.,
an arts-based method of representing experience of a person 2015), (b) strategies used by older adults to gather and choose
living with dementia. Waycott et al. (2017) suggested that data and the ethical issues related to dependence on others
co-creation is not so much about ensuring that participants for support in the processes of digital curation (Manchester
are involved in every aspect of the digital storytelling cre- & Facer,015), (c) whether of or not the stories were shared
ation process, but that participant find meaning in their par- (Cueva et al., 2013), (d) the experience with the process of
ticipation, regardless of the extent of their involvement. It is creating the stories (Williams et al., 2017), and (e) the role
more important how participants see themselves in the and functions of the technologies (Pekkarinen, Kuosmanen,
878
12 41(3)
Journal of Applied Gerontology 00(0)

et al., 2013). There was minimal detail on the methods used process. This would allow the therapist to focus in the com-
for collecting and analyzing the data; this compromises the munication and relationship with the client, which may be
credibility, dependability, confirmability, and transferability more useful for achieving therapeutic goals. Similarly, new
in most of the papers. Thus, results from these studies are technologies would support family and care partners in using
mainly anecdotal. digital storytelling to facilitate communication with older
Finally, although the literature has shown promise for sto- adults living with dementia.
rytelling activities as interventions for promoting positive psy-
chosocial outcomes in older adults living with dementia, little Acknowledgments
is known about the best format for using storytelling interven- We thank Maria Tan, Librarian at the John W. Scott Health Sciences
tions (e.g., paper-based or digital; Smith et al., 2009), and no Library at the University of Alberta for her guidance. We also thank
study in this literature review addressed such comparison. research assistants for their help in conducting this review.

Declaration of Conflicting Interests

Limitations
The authors declared no potential conflicts of interest with respect
Despite our efforts to conduct an exhaustive search of health to the research, authorship, and/or publication of this article.
databases, expand the timeframes of the published studies,
and be as inclusive as possible when selecting the target pop- Funding
ulation, we may have missed papers that were not published
The authors disclosed receipt of the following financial support for
nor indexed in these databases. the research, authorship, and/or publication of this article: This
study was funded by the Canadian Consortium on Neurodegeneration
Conclusions and Clinical Practice in Aging (CCNA).
Implications
ORCID iDs
The highest level of evidence for digital storytelling was as a Adriana Maria Rios Rincon https://orcid.org/0000-0002-9018
tool to improve knowledge, attitudes, and practices related to -9761
diabetes and high blood pressure in healthy older adults Noelannah Neubauer https://orcid.org/0000-0001-7040-2943
(Bertera, 2014). The positive results found in that study may Aidan Comeau https://orcid.org/0000-0003-2684-8897
be in part because the digital stories were produced using
only photos and recorded voices of community members that Ethical Approval
represent the target population, that is, low-income African Ethics approval was not required for conducting this literature
American older adults. Thus, digital storytelling may be a review.
way of creating materials for health education and behavioral
change to reach specific populations. The level of evidence is Supplemental Material
low for digital storytelling as a therapeutic means to improve
Supplemental material for this article is available online.
cognitive, emotional, or affective skills in older adults living
with mild cognitive impairment or dementia. Thus, clini-
cians need to consider this level of evidence if the goal is to Notes
improve certain abilities in clients living with dementia. 1. In some cases, studies contain a study with more than one dis-
Co-creation of digital stories emerged as a common strat- tinct substudies. These substudies were treated as standalone
egy that could be implemented in clinical practice. Digital and data were extracted for each.
2. Defined as a commercial item sold in substantial quantities in
storytelling can be used as a tangible way to uphold person-
the commercial marketplace and is offered to the Government,
hood among persons living with dementia (McKeown et al., under a contract or subcontract at any tier, without modifica-
2017). Communication and relational skills inherent in co- tion, in the same form in which it is sold in the commercial
creation approaches to digital storytelling can build a thera- marketplace.
peutic relationship, bond, rapport, comfort, and trust between
professionals and clients. More research would help support References
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