Self-defining future projections (SDFPs) are vivid, emotionally salient projections of personally meaningful events that anchor identity and guide motivation. While past self-defining memories ground the self in remembered experiences, SDFPs extend this function into the future, offering a forward-looking perspective on identity and well-being. In Alzheimer's disease (AD), cognitive decline threatens autonomy, memory, and self-continuity, yet little is known about how SDFPs are affected. The present study examined SDFPs in 37 individuals with mild AD and 40 cognitively healthy older adults. Participants generated SDFPs, which were evaluated for specificity, integrative meaning, importance, and emotional valence. Compared to controls, patients with AD produced less specific, less integrated, and less important future events, while emotional intensity remained comparable across groups. In AD patients, better cognitive functioning predicted greater specificity, whereas higher depression and anxiety were associated with reduced specificity, integration, and importance, as well as higher negative emotions. These findings highlight that AD compromises the structural and identity-related features of future self-projections, but preserves emotional engagement, suggesting a potential pathway for interventions to support motivation, self-continuity, and well-being.
Background As populations age, home care is becoming increasingly important. Demanding working conditions in this strained sector may contribute to burnout; however, little is known about whether burnout in home care organisations is associated with care recipients’ outcomes. Objectives The study investigated the association between personal, work-related, and client-related burnout levels in organisations providing home care and the progression of depressive symptoms, pain, and health-related quality of life among older adult care recipients after six months. It also examined the moderating role of care recipients’ level of dependency. Methods The sample included 2284 care recipients and 1056 staff members from 22 home care organisations across six European countries. Burnout was assessed via the Copenhagen Burnout Inventory. Care recipient outcomes were measured using the Depression Rating Scale, 4-Point Pain Scale, Health Utility Index Mark 3, and Activities of Daily Living Long Form. Regression analyses were conducted at the organisational level. Results Analysis revealed no association between burnout levels in home care organisations and care recipients’ trajectories of depressive symptoms, pain, or health-related quality of life. Recipients’ dependency levels did not moderate these associations. Conclusions Findings suggest that burnout levels of home care staff were not associated with the progression of depressive symptoms, pain, or health-related quality of life among care recipients. A limitation is that, by using aggregated level data, dyadic associations between caregiver burnout and recipients’ care outcomes may have been missed. Future research should examine caregiver well-being and care recipient outcomes at the dyadic level.
Self-defining future projections (SDFPs) are vivid, emotionally salient projections of personally meaningful events that anchor identity and guide motivation. While past self-defining memories ground the self in remembered experiences, SDFPs extend this function into the future, offering a forward-looking perspective on identity and well-being. In Alzheimer’s disease (AD), cognitive decline threatens autonomy, memory, and self-continuity, yet little is known about how SDFPs are affected. The present study examined SDFPs in 37 individuals with mild AD and 40 cognitively healthy older adults. Participants generated SDFPs, which were evaluated for specificity, integrative meaning, importance, and emotional valence. Compared to controls, patients with AD produced less specific, less integrated, and less important future events, while emotional intensity remained comparable across groups. In AD patients, better cognitive functioning predicted greater specificity, whereas higher depression and anxiety were associated with reduced specificity, integration, and importance, as well as higher negative emotions. These findings highlight that AD compromises the structural and identity-related features of future self-projections, but preserves emotional engagement, suggesting a potential pathway for interventions to support motivation, self-continuity, and well-being.
BACKGROUND AND AIM:Family caregivers of patients receiving palliative care often experience substantial physical, emotional, and social burden, while spirituality has been associated with caregivers' coping experiences and perceived burden. The aim of this study was to evaluate the relationship between caregiver burden and spiritual well-being among individuals providing care to palliative care patients. METHODS:This descriptive and correlational study was conducted with 85 family caregivers of patients receiving palliative care at a university hospital in southeastern Türkiye between April and July 2025. Data collection tools included a caregiver descriptive information form, the Zarit Burden Interview, and the Spirituality Scale. Data were gathered through face-to-face interviews. RESULTS:The mean spirituality score was 25.82 ± 4.12, and the mean caregiver burden score was 46.56 ± 14.44. Married caregivers had significantly higher caregiver burden scores than unmarried caregivers (t = 2.764, p = 0.007). A statistically significant moderate negative correlation was found between caregiver burden and spirituality scores (r = -0.391, p < 0.001). CONCLUSION:Higher spirituality levels were associated with lower perceived caregiver burden among family caregivers of patients receiving palliative care. Nurses should routinely assess caregiver burden and spiritual needs and provide or coordinate individualized and culturally sensitive psychosocial and spiritual support.
BACKGROUND:Frailty is a significant risk factor for death and disability in older adults with diabetes. Early identification of frailty in this population is crucial for implementing timely interventions. METHODS:We analyzed national longitudinal data from the China Health and Retirement Longitudinal Study. Frailty status was defined using a modified Frailty Phenotype, and candidate predictors were selected based on published systematic reviews and meta-analyses. Six machine learning models were developed, including logistic regression, support vector machine, random forest, adaptive boosting, gradient boosting decision tree, and gradient boosting. Hyperparameters were tuned using grid search, and model validation was conducted via leave-one-out cross-validation and temporal validation. Model performance was evaluated using the area under the receiver operating characteristic curve, specificity, recall, precision, negative predictive value, accuracy, F1 score, decision curve analysis, calibration curve, and Brier score. The model's decision-making mechanism was interpreted using SHapley Additive exPlanations. RESULTS:A total of 2366 older adults with diabetes were included in the analysis, of whom 1613 were assigned to the training set and 753 to the test set. The random forest model performed best in estimating probability of frailty (training set: AUC = 0.988, 95% CI: 0.983-0.991; test set: AUC = 0.987, 95% CI: 0.982-0.993). Model interpretation identified depression as the most influential predictor. The model has been deployed on a web-based platform (https://ff.magvel.top/). CONCLUSIONS:This study developed and validated a machine learning-based diagnostic prediction model to estimate the probability of frailty in older adults with diabetes. The random forest model demonstrated promising performance, with good accuracy and potential clinical utility.
BACKGROUND:The complex and diverse needs of older adults have necessitated specialized and holistic nursing interventions. This study aimed to explore the experiences of registered nurses providing care to elderly individuals at the general medical wards, emergency unit, and outpatient department of a tertiary hospital in Cape Coast. METHOD:An exploratory qualitative study was conducted using purposive sampling of sixteen experienced registered nurses. Thematic analysis was applied to identify main themes and sub-themes within the data. RESULTS:Most participating registered nurses (RNs) reported at least ten years of experience caring for older adults. Two overarching themes emerged: positive and negative experiences in older-adult care. Positive experiences centered on feelings of reward, compassion, trust, respect, and the ability to provide nurturing, person-centered care. In contrast, negative experiences involved emotional strain, time pressure, interpersonal conflict, episodes of neglect or abuse, stressful care environments, and physical fatigue. CONCLUSION:The findings highlight the dual nature of older-adult care, deeply fulfilling yet demanding. Supporting nurses through improved staffing, emotional resources, and training may help enhance the positive aspects while reducing the challenges they face. This study underscores the importance of tailored support for nurses, enhanced patient-centered practices, and targeted policy improvements to optimize care for older adults.
BACKGROUND:Older adults represent a rapidly growing segment of the U.S. population and often experience limited access to timely, high-quality care. Nurse practitioners (NPs), particularly in states granting Full Practice Authority (FPA)-which allows NPs to practice without mandated physician oversight-may play a critical role in addressing these gaps. Evidence remains limited on whether FPA improves outcomes specifically for older adults. The purpose of this secondary data analysis was to evaluate the impact of NP FPA on access, functional status, medication use, and cancer detection among adults aged 65-84 years. METHOD:We analyzed restricted Medical Expenditure Panel Survey (MEPS) data from 2010 to 2019. A difference-in-differences design compared states that implemented FPA to states without FPA during the study period. Outcomes included emergency department utilization, instrumental activities of daily living (IADLs), medication patterns, and detection of six cancer types. Models estimated adjusted incidence rate ratios and regression coefficients, accounting for rurality and clustering at the county-state level. RESULTS:Implementation of FPA was associated with fewer diagnostic ED visits and a greater share of emergency-related visits, indicating improved appropriateness of ED use. Older adults in FPA states reported better IADL functioning post-policy, with particularly strong improvements in rural areas. Medication-related findings were mixed, and several cancer types showed modest increases in detection following FPA adoption. CONCLUSIONS:NP FPA may improve access and care quality for older adults, particularly in functional outcomes and patterns of ED utilization. Continued evaluation is needed to determine long-term clinical implications.
BACKGROUND:With nearly 19% of Canadians aged 65 and older, the aging population is increasingly multicultural. Despite this diversity, research on aging among racialized populations remains limited. This study examines healthcare-seeking behavior, lived experiences, and challenges faced by older adults (≥65 years) from minority backgrounds in Ontario. METHODS:This qualitative exploratory study employed descriptive phenomenology with 24 participants from Ontario's two largest metropolitan areas, the Greater Toronto Area and Ottawa. The sample included Asian, Black, Arab, and francophone minority older adults. Data were collected through recorded interviews and analyzed thematically using Braun and Clarke's approach. RESULTS:The participants' mean age was 69.3 years (19 females, 5 males), including 3 Arab, 1 Asian, 13 Black older adults, and 7 White Francophones. Most (¾) had a family doctor. The majority were born outside Canada, with residence durations (years) of 6-9 (n = 2), 10-19 years (n = 4), and ≥20 (n = 11). Three major themes and a subtheme emerged from the analysis: 1. Dearth of francophone services and induced advantage for bilinguals; 2. Discrimination and racism experienced in seeking care, 2-1 Health Professionals' Attitudes and Interactions With Racialized Older Care Seekers; 3. Two-system perception of the healthcare system from an outsider. Older adults from racialized communities and francophone minorities continue to face substantial challenges, particularly due to racism and language barriers. Those with a family doctor reported greater confidence navigating healthcare. Limited access to care underscores the urgent need to improve accommodations for these populations and strengthen the essential primary healthcare model.
BACKGROUND:Frailty is common geriatric syndrome associated with disability, hospitalization, and mortality, but could be preventable. Digital access and digital literacy are increasingly relevant to healthy aging, yet pathways linking digital access to frailty risk remain unclear. OBJECTIVES:This study examined whether digital literacy mediates the association between digital access and frailty risk and whether domain-specific social support moderates this indirect association. METHODS:Nationally representative data from 6625 community-dwelling older adults aged ≥65 years were analyzed. Digital access was categorized as no personal device access, device access without home internet connectivity, and connected device access. Digital literacy was assessed using 13 task-based items, and social support was measured as the availability of supporters providing emotional, practical, and financial assistance. Frailty risk was defined as prefrail/frail status based on the FRAIL scale. Covariate-adjusted mediation and moderated mediation analyses were conducted using generalized structural equation modeling, accounting for the complex sampling design. RESULTS:Connected device access was associated with lower frailty risk than no personal device access and device access without home internet connectivity. Digital literacy mediated the associations between digital access and frailty risk. Only practical support significantly moderated the indirect association of connected device access with frailty risk through digital literacy, strengthening the pathway from connected device access to digital literacy. CONCLUSIONS:Digital inclusion strategies should move beyond material access alone and incorporate age-friendly digital skills training and practical support. Nurses can help reduce digital disparities by assessing digital literacy, identifying barriers to digital engagement, and facilitating tailored support.
BACKGROUND:In the coming years, the elderly population is expected to grow, and with it, the need for nursing assistants in eldercare. The work of nursing assistants is physically and emotionally arduous: they face emotional demands and are often forced to engage in emotional labor. AIM:This scoping study investigated peer-reviewed journal publications on the emotional labor of nursing assistants or nurses' aides in eldercare. METHOD:Five academic databases were searched using the PCC and PRISMA-ScR protocols to find empirical articles in peer-reviewed journals on nurses' emotional labor in eldercare. RESULTS:688 articles were found using the search strategy. A final sample of 13 empirical articles remained following a three-stage process of screening and elimination. Nurses' aides' emotional labor was shown to be influenced by institutional hierarchies, workplace culture, patient needs, and family expectations, often requiring nursing assistants to manage their own emotions while dealing with those of others to maintain professionalism, therapeutic presence, and care quality. CONCLUSION:To understand the intricate emotional dynamics that exist in eldercare nursing work, more research focusing on nurses' aides' emotional labor is needed.
BACKGROUND:Persistent pain and emotional distress often challenge recovery among injured older adults, reducing health-related quality of life (HRQoL). Pain is a known determinant of poor HRQoL, and depressive symptoms may further exacerbate this burden. Limited research has examined whether depressive symptoms mediate the pain-HRQoL relationship during this period. OBJECTIVE:To examine whether depressive symptoms mediate the relationship between pain intensity and HRQoL in older adults recovering from traumatic injury. METHODS:A cross-sectional study of 80 older adults (aged 60-74) hospitalised for traumatic injury at a medical centre in southern Taiwan measured pain intensity, depressive symptoms, and HRQoL 14 days after discharge. Mediation analysis used the PROCESS macro (Model 4) with 10,000 bootstrap resamples, controlling for injury severity. RESULTS:Pain intensity was significantly associated with depressive symptoms (B = 1.83, 95% CI [1.29, 2.38]) and had a significant total effect on HRQoL (B = -5.86, 95% CI [-7.23, -4.50]). Depressive symptoms were also associated with HRQoL (B = -1.29, 95% CI [-1.78, -0.79]). Pain retained a significant direct effect on HRQoL after accounting for depressive symptoms (B = -3.50, 95% CI [-4.99, -2.02]); the indirect effect through depressive symptoms was also significant (B = -2.36, 95% BCI [-3.45, -1.40]), accounting for approximately 40% of the total effect. CONCLUSION:Pain directly affects HRQoL, partly through depressive symptoms. Care strategies for injured older adults should address psychological alongside physical recovery. Given the cross-sectional design, findings reflect a statistical association rather than confirmed causal mediation; longitudinal studies are needed to verify temporal sequence.
BACKGROUND:This study aimed to investigate the independent and joint associations of sleep and 24-hour rest-activity rhythms with reduced kidney function among older adults in rural China. METHODS:Data from 1493 participants in the baseline survey of the Rural Physical Activity Behavior and Healthy Aging Cohort were analyzed. Sleep and 24-hour rest-activity rhythm parameters, including total sleep time (TST), wakefulness after sleep onset (WASO), interdaily stability (IS), intradaily variability (IV), Least active 5 h span (L5), Most active 10 h span (M10), and relative amplitude (RA). Multivariable logistic regression models were employed to examine the independent and joint associations of sleep and 24-hour rest-activity rhythms with reduced kidney function. RESULTS:Independent analyses revealed that IS, L5, and M10 were significantly inversely associated with reduced kidney function (IS: OR = 0.13, 95% CI: 0.04-0.49; L5: OR = 0.89, 95% CI: 0.82-0.97; M10: OR = 0.97, 95% CI: 0.96-0.99), whereas IV and TST were significantly positively associated with reduced kidney function (IV: OR = 2.90, 95% CI: 1.37-6.15; TST: OR = 1.35, 95% CI: 1.15-1.57). Joint analyses demonstrated that compared with the long sleep group, the moderate and short sleep groups exhibited significantly lower ORs. Regardless of sleep duration, the stable rest-activity rhythm group showed significantly lower ORs than the unstable group. CONCLUSION:These findings suggest that maintaining stability in rest-activity rhythms should be emphasized in older rural Chinese populations, as it may play an important role in the early prevention and management of reduced kidney function.
PURPOSE:The purpose of this study is to provide a decision-making basis for skin care of older hospitalized patients through a penalized statistical prevalence association model. DESIGN:We reviewed nine eligible institutions as multi-center research centers in China. SUBJECTS AND SETTING:We conducted a multicenter cross-sectional study on July 17, 2023, from which 4851 valid questionnaires were collected. METHODS:LASSO regression with 10‑fold cross‑validation was first used to select candidate variables. Variables with a selection frequency >0.8 after 1000 bootstrap resampling steps were retained as stable identify. To address rare‑events bias, Firth's penalized logistic regression was then applied. Model discrimination was assessed using the ROC curve, AUC, and C‑index with 95% CI via bootstrap. Calibration was evaluated by calibration plots, slope, intercept, and the Brier score. A leave-one-center-out generalizability assessment was performed to evaluate model applicability across centers. Clinical utility was examined using decision curve analysis (DCA). RESULTS:Seven variables (age, albumin, hemoglobin, diabetes, painkillers, antipsychotics, Braden score were identified. The model demonstrated excellent discrimination (AUC = 0.916, 95% CI [0.892,0.916]; C-index = 0.916 [0.890,0.939]; sensitivity 0.91, specificity 0.80) and good calibration (slope 1.035, intercept -0.001, Brier score 0.018). In the leave-one-center-out generalizability assessment, the model demonstrated a mean cross-center AUC of 0.905 [0.835-0.967]. Decision curve analysis confirmed clinical utility within the 0-15% threshold probability range. CONCLUSIONS:This large-sample multi-center prevalence association model based on penalization and resampling techniques provides an accurate, stable, and clinically applicable tool for individualized pressure injury risk assessment in hospitalized older patients.
OBJECTIVE:Develop an understanding of the challenges experienced by relatives of patients with chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF) in exploring and expressing their perspectives in triadic (provider-patient-relative) palliative care conversations (TPC conversations). METHOD:Qualitative, explorative study using purposive sampling to create diversity in demographic variables of relatives. Semi-structured interviews were performed using a topic list. All interviews were audio-recorded, transcribed verbatim, and thematically analysed. RESULTS:Ten relatives participated in this study. In TPC conversations they find it challenging to express 1) what living with the disease is like for their loved one, 2) what has changed for themselves, 3) what is on their mind, and 4) what they would like to get from or need in TPC conversations. Relatives experience these challenges when they feel unseen by healthcare professionals and/or when they experience or perceive their participation in these conversations is not desired or appropriate. CONCLUSION:Relatives find it challenging to express their own perspectives as well as those of their loved one.
BACKGROUND:Post-stroke individuals often experience balanced impairments and reduced fall-related self-efficacy, which increases their risk of falling. The IFSM framework emphasizes the active engagement of patients and their families in managing health challenges. OBJECTIVES:To evaluate the effect of the IFSM fall prevention program in enhancing balance ability and fall-related self-efficacy among post-stroke individuals. METHODS:Sixty post-stroke individuals and their primary family caregivers were randomly assigned to an experimental or a control group. The experimental group participated in a 10-week IFSM fall prevention program comprising an in-hospital phase followed by a post-discharge home phase. The program was grounded in the theory of Individual and Family Self-Management. Balance ability and fall-related self-efficacy were measured at baseline and Week 10. Analyses followed the intention-to-treat principle, using descriptive statistics, Chi-square or Fisher's exact test, t-tests, and non-parametric tests. RESULTS:Following ten weeks of intervention, patients in the experimental group showed significantly higher Short Fall Efficacy Scale-International scores and Berg Balance Scale scores relative to those in the control group. The completion rate of target exercise repetitions ranged from 87.38% to 95.75%, and 61.54% to 80.77% of patients fully achieved their exercise goals. Engagement with home environment renovation was 87.18%. There was no statistically significant difference in the number of falls between the patient groups. CONCLUSION:The program is an intervention that improves balance ability and fall-related self-efficacy in post-stroke individuals. It warrants further investigation in larger, multicenter trials with extended follow-up periods.
OBJECTIVE:To determine the moderating mediation of depression, education, and activities of daily living (ADL) between the variables of social capital and cognitive function among older adults in rural China. METHOD:A moderated mediation analysis was performed using the 2018 CHARLS data (N = 7,352, age ≥ 60) through the PROCESS macro. RESULT:The association was partly mediated by depression (indirect effect: B = 0.0211, 95% CI[0.1110,0.3190]; proportion mediated: 4.45%). ADL dampened the depression-cognition relationship (B = 0.030, 95% CI[0.0030,0.0565]), which neutralized the adverse impact of depression. Education also had a mediating influence on the direct social capital-cognition relationship (B = -0.0206, 95% CI[-0.039,-0.0022]), although with a significant effect in less-educated cohorts. CONCLUSIONS:Combinational nurse interventions with the strategy of promoting social capital, screening and managing depression, and assisting with the activities of daily living could be particularly effective at sustaining cognitive ability in rural older adults, and particularly among less educated individuals.
BACKGROUND/OBJECTIVES:Dementia is an escalating public health concern globally. This study evaluated the knowledge, attitudes, practices, and perceived barriers to dementia care among healthcare practitioners in Nigerian tertiary hospitals, aiming to identify practitioner-related sociodemographic predictors and systemic barriers affecting dementia care delivery. METHODS:We collected data from May 2024 to May 2025 for this cross-sectional study in 12 purposively selected tertiary hospitals across Nigeria's six geopolitical zones. Participants included physicians, nurses, pharmacists, and other professionals involved in geriatric psychiatric care. Using multistage and convenience sampling, 394 respondents were recruited (response rate: 99.5%). Data were collected via a validated Dementia Care Practice Questionnaire (Cronbach's α = 0.84) and analyzed with SPSS v22. Descriptive statistics, Chi-square tests, and odds ratios (ORs) identified associations (significance: p ≤ 0.05). RESULTS:Of 394 respondents, 51.5% were aged ≥40 years, and 54.8% were female. While 62.9% demonstrated adequate knowledge, negative perceptions (51.3%) and attitudes (56.9%) were common. Despite this, 71.3% reported engagement in dementia care, and 75.6% demonstrated appropriate professional help-seeking behaviour when confronted with dementia care challenges. Practitioner-reported barriers included limited training opportunities, geographical barriers affecting patient access to dementia services, and inadequate staffing. Predictors of desirable care practices among healthcare practitioners included age ≥40 years, female gender, Christian affiliation, and ≥5 years of professional experience. CONCLUSION:Although many healthcare practitioners are involved in dementia care, gaps in perceptions, attitudes, and structural support persist. Interventions should focus on targeted training, system strengthening, and policy reform to improve dementia care outcomes.
OBJECTIVE:To examine the mediating roles of psychological resilience (PR) and self-esteem (SE) in the relationship between social support (PSS) and self-perceived burden (SPB) in stroke patients. METHODS:A convenience sampling method was used to recruit stroke patients admitted to a tertiary hospital in Wuhu from November 2024 to April 2025. A total of 370 patients were enrolled. Participants completed questionnaires assessing general demographics, perceived social support (PSS), self-perceived burden (SPB), self-esteem (SE), and psychological resilience (PR). Pearson correlation analysis was conducted to examine the relationships among social support, psychological resilience, self-esteem, and self-perceived burden. The PROCESS macro (Model 6) in SPSS was employed to analyze the serial mediating effects of psychological resilience and self-esteem between social support and self-perceived burden. RESULTS:The mean scores for perceived social support, psychological resilience, self-esteem, and self-perceived burden were 52.25 ± 9.70, 18.48 ± 8.66, 26.69 ± 7.49, and 33.85 ± 7.85, respectively. Self-perceived burden was negatively correlated with social support, psychological resilience, and self-esteem (r = -0.415, -0.497, -0.508, all P < 0.01). The mediation model revealed that psychological resilience and self-esteem played a fully mediating role (effect size = -0.338) in the relationship between social support and self-perceived burden, with no significant direct effect. CONCLUSION:Stroke patients exhibited moderate levels of self-perceived burden. The serial mediation of psychological resilience and self-esteem in the association between social support and self-perceived burden was statistically significant. Future stroke care should extend beyond traditional social support models. We recommend that healthcare institutions collaborate with communities to establish a "social support-psychological service" integrated system, enhancing patients' psychological resilience and self-esteem to alleviate self-perceived burden and improve quality of life.
Purpose of research Cognitive Stimulation Therapy (CST) is an evidence-based and widely implemented cognitive therapy for dementia. The current study aimed to assess a novel measure of fidelity to CST through testing it in two contexts: virtual group CST (vCST) and individual CST (V-iCST). Research design and methods A subsample of participants from prior feasibility randomised controlled trials of vCST and V-iCST were included in the current fidelity analysis (12 from vCST and 9 from V-iCST trials). Facilitators completed a self-report version of the measure after each CST session. Trained independent observers rated a purposive sample of video-recorded V-iCST and vCST sessions. Fidelity scores were compared across raters, and inter-rater agreement was assessed using weighted kappa and percentage agreement to evaluate the fidelity measure. Results vCST and V-iCST interventions were delivered with moderate and high fidelity, respectively. The inter-rater agreement between facilitators and observers was moderate for V-iCST (weighted κ = 0.57, 65.5%) and vCST (weighted κ = 0.511, 60.7%). Discussion and implications The study found that the novel fidelity measure can be applied successfully to measure fidelity in a virtual CST setting. However, given the moderate inter-rater agreement, explicit conclusions regarding the reliability of self-report as a fidelity measure should be further investigated in larger trials. The findings highlight the importance of integrating a fidelity measurement to evaluate future implementations of CST. The self-report measure can be particularly useful in clinical practice, allowing for the monitoring of facilitation quality and as a training tool for clinicians delivering CST. Translational significance The study evaluated a novel fidelity measure for CST and supported its applicability to group and individual therapy settings. For clinical settings, our findings suggest the fidelity checklist and associated guidelines can be implemented as a training and self-evaluation tool for facilitators to assess service provision, and the self-reported version may be particularly advantageous as it reduces the need for observer assessment. In research settings, we have highlighted applicability of the measure to monitor the link between fidelity of CST delivery and treatment outcomes. We include the fidelity checklist and guidelines in the publication to share with researchers and clinicians.
Older adults in Canadian hospitals often experience prolonged stays, leading to high volumes of sedentary time and social isolation, both of which negatively impact recovery. This qualitative descriptive study explored how healthcare workers and hospital leadership perceive these challenges and the opportunities to address them. Semi-structured interviews were conducted with 18 participants (12 health care workers and 6 leaders) at a mid-sized Ontario hospital, using the Social Ecological Model to guide design and analysis. Thematic analysis revealed four interrelated themes: role-related ambiguity as a constraint to supporting active aging, competing demands that deprioritize active aging despite a shared vision, families and volunteers as critical actors, and unconscious ageism in care despite a desire to be age-friendly. Findings point to the need for a comprehensive, multi-component strategy that integrates individual, organizational, and policy-level actions. This study lays the groundwork for future efforts to support an age-friendly hospital strategy, including further research incorporating the perspectives of patients and caregivers.
