Sandplay-Act. Older: Structured Sandplay Activity for Older Individuals

Old age is a period of life characterized by intense cognitive, physical, psychological, and social changes, where an individual's functionality may decrease and their psychosocial needs increase (Polat and Kahraman, 2013; Artan et al., 2017; Demir, 2022). The increasing elderly population worldwide and in Türkiye (WHO, 2015; TÜİK, 2023) increases the need for effective interventions to protect the mental health of older individuals. During the aging process, factors such as chronic diseases, loss of physical function, retirement, loss of loved ones, loneliness, and reduced social roles can negatively affect individuals' psychological well-being, emotions, and sense of meaning in life (Gothe et al., 2020; Enssle & Kabisch, 2020; Bahar & Başıbüyük, 2019). In addition, increased social isolation and the thought of approaching the end of life make the process of questioning the meaning of life more pronounced in older individuals (Weiss & Bass, 2002; Read, Westerhof & Dittmann-Kohli, 2005). Current studies show that loneliness and decreased social participation negatively affect psychological well-being; conversely, meaningful social relationships and psychological resilience support life satisfaction and meaning in life (Santini et al., 2020; WHO, 2021; Greenblatt-Kimron, Kagan & Zychlinski, 2022).

Meaning in life is a fundamental psychological resource that enables individuals to perceive their lives as purposeful, valuable, and holistic, and it is an important protective factor supporting mental health and successful aging in old age (Frankl, 1972; Wong, 1998). Research shows that individuals with a high level of meaning in life have higher psychological well-being, life satisfaction, and positive affect; Studies show that depression, loneliness, and psychological distress are lower in this group (Pinquart, 2002; Krause, 2007; Boyle et al., 2010; Cohen, Bavishi & Rozanski, 2016; Czekierda et al., 2017; van Selm & Dittmann-Kohli, 1998; Westerhof et al., 2006). Jung's analytical psychology theory describes the second half of life as a crucial developmental period in which individuals re-evaluate their lives, integrate past experiences, and intensify their search for meaning in life (Jung, 1933/2001; Fordham, 1958; Samuels, 2005; Leigh & Varghese, 2001; Patton, 2006). However, age discrimination, negative perceptions of aging, and unmet psychosocial needs can negatively impact this process; therefore, Neuroscience and expressive arts-based approaches demonstrate that nonverbal expression processes support emotional processing, the restructuring of life experiences, and psychological well-being (Schore, 2009; Nan & Ho, 2014; Nan et al., 2018; Nun et al., 2020). Meaning-focused interventions such as life assessment and expressive writing have been reported to increase meaning in life, reduce depressive symptoms, and support emotional well-being in older individuals (Butler, 1963; Erikson, 1982; Bohlmeijer, Smit & Cuijpers, 2003; Pennebaker & Beall, 1986; Frattaroli, 2006; Park et al., 2021; Ziemer & Kearney, 2020; Sloan & Marx, 2022). However, the number of experimental psychosocial interventions that address both meaning in life and positive-negative affect is limited. Sandplay is a creative psychosocial intervention that allows individuals to externalize, reinterpret, and express their inner experiences in a safe environment through symbols, addressing emotions, thoughts, and life experiences that they have difficulty expressing verbally (Kalff, 1980; Homeyer & Sweeney, 2017; Malchiodi, 2020). While it is stated that sandplay can support the restructuring of life experiences and the strengthening of meaning in life in older individuals, most studies in this area are limited to case reports or qualitative research (Homeyer & Sweeney, 2017; Kim, 2021). The lack of randomized controlled trials evaluating the effect of sandplay on meaning in life and positive and negative affect in older individuals constitutes a significant knowledge gap. Furthermore, in psychiatric nursing, it is necessary to address the individual's psychological, social, and existential needs holistically, not just their physical needs; It is recommended that creative interventions supporting therapeutic communication and emotional expression be integrated into the care process (Watson, 2008; Townsend & Morgan, 2018). In this context, evaluating the impact of structured sandplay activities on meaning in life and positive and negative affect in older adults will contribute to the development of evidence-based psychiatric nursing practices and the creation of alternative psychosocial interventions for older adults.holistic psychosocial interventions aimed at strengthening meaning in life are needed (Corbett, 2014; Nelson, 2016; Singh & Misra, 2009; Wong, 1998; Wijk & Grimby, 2008; Chan, 2015; Nun et al., 2020).

Inclusion criteria

• Voluntary participation in the study
• No specific condition that would cause learning difficulties (auditory or visual perception disorders, etc.)
• Being between 65-80 years of age
• No acute psychiatric disorder or severe cognitive impairment

Exclusion criteria

• Having a mental or physical disability that prevents communication and attendance at sessions (inability to speak, diagnosis of severe dementia, etc.)