Functional Interdependence: A Conceptual Construct for Healthy Ageing and Geriatric Care

Abstract

The World Health Organization defines Healthy Ageing as the process of developing and maintaining Functional Ability through the interaction between Intrinsic Capacity and the environment. However, this framework does not explicitly recognise the influence of primary informal caregivers on the Functional Ability of older adults who depend on assistance in everyday life. This paper proposes Functional Interdependence as a multidimensional relational construct that complements existing healthy ageing theory while preserving the principles of Person-Centred Care. Functional Interdependence is conceptualised as the dynamic and reciprocal interaction between the Functional Ability of the older adult and the Intrinsic Capacity, Functional Ability, and Caregiving Capacity of a primary informal caregiver within a shared biological, psychological, social, environmental, and healthcare context. The construct is conceptually delimited through its antecedents, defining attributes, and expected functional outcomes, and supported by a complementary conceptual framework for Caregiving Capacity. Functional Interdependence is proposed as a relational determinant that helps explain how Functional Ability is maintained when care depends on the interaction between two functional systems. This conceptual framework provides a theoretical foundation for future instrument development, empirical validation, and the design of interventions that strengthen caregiving relationships and promote healthy ageing.

Keywords:Healthy ageing, Functional Interdependence, Functional Ability, Intrinsic Capacity, Caregiving Capacity, Person-Centred Care, informal caregiver, older adults

Introduction

Population ageing has transformed the priorities of health systems worldwide, shifting the focus of geriatric care from the management of individual diseases towards the preservation of functional ability, independence, and quality of life [1-3]. The World Health Organization (WHO) defines healthy ageing as the process of developing and maintaining the functional ability that enables well-being in older age, positioning functional ability—not the absence of disease—as the principal outcome of health care for older adults [4]. This paradigm has been reinforced through the Integrated Care for Older People (ICOPE) framework, which promotes person-centred care aimed at maintaining intrinsic capacity and preventing or delaying functional decline through comprehensive, coordinated interventions across the continuum of care [4-6]. Functional ability is increasingly recognised as the result of a dynamic interaction between an individual’s intrinsic capacity and the physical, social, and environmental contexts in which they live [7-8]. Consequently, contemporary comprehensive geriatric assessment extends beyond the evaluation of medical conditions to include mobility, cognition, psychological well-being, nutrition, social resources, and environmental factors that collectively determine an older adult’s ability to function independently [9-10]. Nevertheless, despite this multidimensional approach, current conceptual frameworks continue to evaluate functional ability primarily as an attribute of the individual older adult, while the influence of those who provide day-to-day care remains largely considered an external contextual factor rather than an integral component of functional performance [4-6,11-14].

For many older adults living with frailty, multimorbidity, cognitive impairment, or functional limitations, maintaining functional ability depends not only on their own capacities but also on the abilities of a primary informal caregiver to provide physical assistance, emotional support, decision-making, medication management, and coordination of daily activities. Likewise, the caregiver’s own physical health, cognitive status, emotional well-being, and social resources are progressively shaped by the demands of caregiving, creating reciprocal interactions that influence the health trajectories of both individuals. A growing body of evidence has documented these bidirectional relationships through studies of caregiver burden, dyadic health science, dyadic illness management, and dyadic interventions across a range of chronic conditions [15-32]. Despite these advances, there remains no conceptual construct that explicitly describes the reciprocal dependence between the functional capacities of older adults and their primary informal caregivers as a shared determinant of health and functional outcomes. Existing concepts—including intrinsic capacity, functional ability, frailty, caregiver burden, and dyadic care—capture important dimensions of ageing and caregiving but do not fully explain how the functional trajectories of both individuals become dynamically interconnected over time. We propose that functional interdependence represents this missing conceptual link: a multidimensional construct describing the reciprocal interactions through which the capacities and resources of older adults and their primary informal caregivers influence one another, shaping their ability to maintain health, independence, autonomy, and social participation. Recognising this construct may provide a stronger theoretical foundation for future research, clinical assessment, and the development of more integrated approaches to healthy ageing and geriatric care.

Functional Interdependence: Definition and Conceptual Basis

Within the WHO framework, functional ability emerges from the interaction between an individual’s intrinsic capacity and the environments in which they live, enabling older adults to maintain independence, autonomy, social participation, and wellbeing [4-6]. This perspective has transformed geriatric care by shifting its focus from disease-centred management towards preserving what older adults are able to be and do throughout the ageing process. However, for many older adults living with frailty, multimorbidity, cognitive impairment, or functional dependence, functional ability cannot always be explained exclusively by individual intrinsic capacity and environmental characteristics. In daily clinical practice, the preservation of functional ability frequently depends upon the continuous support of a primary informal caregiver, whose own physical, cognitive, psychological, and social capacities directly influence the older adult’s ability to perform everyday activities and maintain independence. Likewise, the caregiver’s own health trajectory is progressively influenced by the physical and emotional demands associated with caregiving. Consequently, the functional trajectories of both individuals become dynamically interconnected over time.

We therefore propose functional interdependence as a conceptual construct that complements the current framework for healthy ageing. Functional interdependence is defined as a relational construct and determinant of functional ability describing the dynamic, multidimensional, and reciprocal interactions through which the intrinsic capacities, functional abilities, caregiving capacity, and shared contextual factors of an older adult and a primary informal caregiver mutually influence the older adult’s ability to maintain health, functional ability, independence, autonomy, social participation, and quality of life over time. Unlike concepts such as caregiver burden, caregiving experience, or dyadic interventions, functional interdependence does not primarily describe the caregiving relationship itself. It describes the functional relationship through the capacities of both individuals continuously influence the preservation or decline of the older adult’s functional ability. Consequently, functional interdependence should be understood as a relational determinant of functional ability whenever everyday functioning depends upon the support of a primary informal caregiver.

Biological Foundations

The biological basis of functional interdependence originates from the interaction between the intrinsic capacities of both individuals. Within the WHO healthy ageing framework, intrinsic capacity encompasses five interconnected domains: locomotion, cognition, psychological capacity, sensory capacity, and vitality [4- 6]. These domains remain the biological foundation of functional ability for both: the older adult and the caregiver [4-6]. Declines affecting any of these domains in either member of the caregiving relationship may influence the quality, safety, and sustainability of everyday care [33]. Reduced mobility may limit physical assistance; cognitive impairment may interfere with medication management or decision-making; sensory impairment may compromise communication and safety; psychological distress may affect motivation and adherence to treatment; and reduced vitality may diminish the capacity to sustain caregiving over time [34-47]. Conversely, the physical demands of caregiving may progressively modify the caregiver’s own intrinsic capacity through chronic stress, fatigue, musculoskeletal overload, sleep disturbance, or worsening chronic diseases [48-49]. Therefore, biological changes are not isolated events but reciprocal processes continuously reshaping the functional ability of both individuals.

Psychological Foundations

Psychological capacity represents a central mechanism through which functional interdependence develops and evolves. Emotional wellbeing, resilience, motivation, coping strategies, anxiety, depression, and cognitive-emotional adaptation influence not only individual health but also the effectiveness of the caregiving relationship itself [50-52]. The psychological state of the caregiver may determine treatment adherence, promotion of physical activity, participation in rehabilitation programmes, medication management, and healthcare utilisation [48-52]. Likewise, deterioration in the older adult’s physical or cognitive health frequently increases caregiver stress, emotional burden, uncertainty, and psychological exhaustion [47-48]. Consequently, psychological wellbeing becomes a bidirectional determinant that continuously strengthens or weakens functional interdependence over time.

Social and Environmental Foundations

Consistent with the WHO framework, functional ability develops within environmental contexts rather than in isolation [4-6]. Functional interdependence extends this principle by recognising that older adults and primary informal caregivers usually share the same or similar biological, social, economic, environmental, and healthcare context. Family relationships, housing conditions, architectural accessibility, financial resources, assistive technologies, social support networks, community services, healthcare systems, cultural values, and public policies simultaneously influence both individuals [49-51]. These shared determinants may either facilitate or hinder caregiving capacity, preservation of functional ability, and healthy ageing. Consequently, functional interdependence should be understood as emerging not only from reciprocal interactions between two individuals but also from the common context in which both live and receive care.

Conceptual Model of Functional Interdependence

The model preserves the conceptual foundations established by the WHO [4-6]. Both the older adult and the primary informal caregiver possess intrinsic capacity, which gives rise to functional ability. In the caregiver, functional ability additionally supports caregiving capacity, defined as the ability to provide safe, effective, appropriate, and sustainable care over time. Both individuals exist within a shared biological, psychological, social, environmental, and healthcare context, which simultaneously shapes their health trajectories and opportunities to maintain function. The continuous interaction between the older adult’s Functional Ability and the caregiver’s Functional Ability and Caregiving Capacity gives rise to Functional Interdependence. Rather than constituting a sixth domain of Intrinsic Capacity or replacing Functional Ability, Functional Interdependence is proposed as a multidimensional relational construct that emerges from the reciprocal interactions between both functional systems. Delimiting this construct requires distinguishing the conditions that enable its emergence, the characteristics that define its conceptual identity, and the outcomes through which it is expected to influence health and functioning. Accordingly, Functional Interdependence is characterised by a coherent set of antecedents, defining attributes, and expected functional outcomes (Figure 1).

Figure 1:Conceptual Delimitation of Functional Interdependence.

Source: Authors’ own elaboration based on the proposed Functional Interdependence conceptual framework. The figure illustrates the conceptual boundaries of functional interdependence through its antecedents, defining attributes, and expected functional outcomes. Antecedents represent the conditions required for the emergence of the construct, defining attributes describe its essential characteristics, and expected functional outcomes reflect its potential influence on healthy ageing, functional independence, autonomy, social participation, quality of life, sustainable caregiving, and overall health outcomes. This conceptual sequence follows the classical methodology for construct development, in which antecedents generate the phenomenon, defining attributes characterise its essential nature, and consequences represent the observable outcomes derived from the construct [52-54]. Accordingly, functional interdependence should be understood as a relational determinant operating between the functional systems of the older adult and the caregiver rather than as an individual characteristic of either person.

Importantly, this conceptual model does not challenge the principles of person-centred care. The older adult remains the principal recipient of care and the central focus of clinical decisionmaking. Instead, the model proposes that functional interdependence should be recognised as a relational determinant of functional ability whenever an older adult depends on a primary informal caregiver for everyday functioning. Under these circumstances, preserving Functional Ability requires not only assessing the older adult’s Intrinsic Capacity but also understanding and strengthening the reciprocal relationship that supports everyday functioning. Thus, Person-Centred Care is not replaced but enriched, while Functional Interdependence becomes an additional conceptual component that helps explain why Functional Ability cannot always be fully understood without considering the capacities of the primary informal caregiver and the shared caregiving environment. To better characterise this relational construct, it is necessary to recognise that the caregiving relationship is sustained by the capacities of both individuals. Whereas the older adult’s Functional Ability emerges from the interaction between Intrinsic Capacity and the surrounding environment, the caregiver contributes an additional component that has not been explicitly conceptualised within current healthy ageing frameworks: Caregiving Capacity. This component represents the caregiver’s ability to transform his or her own functional resources into effective support for another person’s Functional Ability and therefore constitutes one of the structural elements of Functional Interdependence.

Definition of Caregiving Capacity: Caregiving Capacity is defined as the caregiver’s ability to safely, effectively, appropriately, and sustainably provide physical, cognitive, emotional, social, and practical support to an older adult according to the individual’s functional needs [55]. Caregiving Capacity emerges from the interaction between the caregiver’s own Intrinsic Capacity, Functional Ability, knowledge, caregiving skills, health literacy, available resources, resilience, and the surrounding social and healthcare environment (Figure 2).

Figure 2:Conceptual framework of Caregiving Capacity.

Source: Authors’ own elaboration based on the proposed Functional Interdependence conceptual framework. Caregiving Capacity is conceptualised as a multidimensional construct comprising physical, cognitive, psychological, educational, social, environmental, and healthcare-related components that collectively determine a caregiver’s ability to provide safe, effective, appropriate, and sustainable support to an older adult. The framework illustrates the interdependence among these domains, their defining attributes, and their contribution to delivering physical, cognitive, emotional, social, and practical support according to the older adult’s functional needs within a shared caregiving context.

Unlike Functional Ability, which reflects an individual’s ability to perform basic and instrumental activities of diary live, Caregiving Capacity represents the caregiver’s ability to support another person’s Functional Ability while maintaining his or her own health and wellbeing. Consequently, Caregiving Capacity should be understood as a dynamic characteristic that may improve through education, rehabilitation, environmental adaptations, assistive technologies, multidisciplinary support, and community resources, or deteriorate as a consequence of physical decline, psychological distress, caregiver burden, social isolation, or inadequate support systems [55]. Recognising Caregiving Capacity as a distinct but related construct provides the theoretical basis for understanding how Functional Interdependence develops within caregiving relationships. Building upon these concepts, Figure 3 presents the proposed conceptual model of Functional Interdependence, illustrating how the intrinsic capacities and functional abilities of the older adult and the primary informal caregiver interact within a shared biological, psychological, social, environmental, and healthcare context. The model conceptualises Functional Interdependence as a multidimensional conceptual construct that acts as a relational determinant of the older adult’s Functional Ability while preserving the principles of Healthy Ageing and Person-Centred Care. Therefore, Functional Interdependence is a relational construct describing the dynamic, multidimensional, and reciprocal interactions through which the Intrinsic Capacity, Functional Ability, and Caregiving Capacity of a primary informal caregiver jointly influence the Functional Ability of an older adult within a shared biological, psychological, social, environmental, and healthcare context (Figure 3).

Figure 3:Conceptual framework of Functional Interdependence

Source: Authors’ own elaboration based on the proposed Functional Interdependence conceptual framework. Functional Interdependence is conceptualised as a multidimensional relational construct emerging from the dynamic interaction between the functional systems of an older adult and a primary informal caregiver within a shared biopsychosocial and healthcare context. The model illustrates how the caregiver’s Intrinsic Capacity, Functional Ability, and Caregiving Capacity jointly influence the older adult’s Functional Ability while preserving the principles of Person-Centred Care and contributing to shared functional outcomes.

Implications for Healthy Ageing and Geriatric Care

Recognising functional interdependence has important implications for research, comprehensive geriatric assessment, and integrated care. First, it provides a theoretical explanation for why interventions directed exclusively at the older adult may be insufficient when functional ability is strongly influenced by the caregiver’s own capacities. Second, it offers a conceptual basis for incorporating relational determinants into comprehensive geriatric assessment without modifying the principles of person-centred care. Finally, it establishes a theoretical foundation for future research aimed at operationalising, measuring, and validating functional interdependence as a clinically meaningful construct. Rather than replacing the current WHO framework, functional interdependence extends it by recognising that, whenever everyday functioning depends on a primary informal caregiver, preserving functional ability requires understanding not only the older adult’s capacities but also the dynamic interactions occurring within the caregiving relationship. This perspective may facilitate the development of more integrated strategies for promoting healthy ageing while maintaining the older adult as the central focus of care.

Conclusion

Functional Interdependence provides a novel conceptual framework for understanding how the reciprocal relationship between an older adult and a primary informal caregiver influences Functional Ability within a shared biopsychosocial and healthcare context. By integrating Intrinsic Capacity, Functional Ability, and the newly defined construct of Caregiving Capacity into a single relational model, this framework extends current healthy ageing theory while remaining fully consistent with the principles of Person-Centred Care. Rather than shifting the focus away from the older adult, Functional Interdependence recognises that maintaining Functional Ability frequently depends on the dynamic interaction between both members of a caregiving dyad.

Acknowledgements

The authors would like to thank Professor Susana Ortiz Vela, Master in translation, and express their gratitude to the Centro de Investigación y de Educación Continua S.C. for their support in translation.

Competing Interests.

Authors have declared that no competing interests exist.

Authors’ Contributions

All authors contributed to conceptualization (ideas, formulation, or development of research goals and objectives), analysis, writing - original draft (preparation, creation, and/or presentation of the published work, specifically writing the initial draft), writing - review and editing (preparation, creation, and/ or presentation of the published work by the research group, specifically critical review, commentary, or revisions, including pre- or post-publication stages), and visualization (preparation, creation, and/or presentation of the published work, specifically data visualization/presentation).

References

1. Bruyère O, Demonceau C, Kergoat MJ (2024) Navigating the health care landscape for an ageing population: An international survey of strategies and priorities. Journal of the American Medical Directors Association 25(9): 105155.
2. Rudnicka E, Napierała P, Podfigurna A, Męczekalski B, Smolarczyk R, et al. (2020) The World Health Organization (WHO) approach to healthy ageing. Maturitas 139: 6-11.
3. Vincenza Gianfredi, Daniele Nucci, Flavia Pennisi, Stefania Maggi, Nicola Veronese, et al. (2025) Aging, longevity, and healthy aging: The public health approach. Aging Clinical and Experimental Research 37(1): 125.
4. John R Beard, Alana Officer, Islene Araujo de Carvalho, Ritu Sadana, Anne Margriet Pot, et al. (2016) The World report on ageing and health: A policy framework for healthy ageing. The Lancet 387(10033): 2145-2154.
5. (2019) World Health Organization. Integrated care for older people (ICOPE): Guidance for person-centred assessment and pathways in primary care. World Health Organization.
6. Matteo Cesari, Islene Araujo de Carvalho, Jotheeswaran Amuthavalli Thiyagarajan, Cyrus Cooper, Finbarr C Martin, et al. (2018) Evidence for the domains supporting the construct of intrinsic capacity. The Journals of Gerontology: Series A 73(12): 1653-1660.
7. Jaro Govaerts, Zhao Yang, Marjolein Visser, Martijn Huisman, Vincent Francois Lavet, et al. (2026) The relationship between intrinsic capacity and functional ability: Identifying key environmental features to support healthy ageing. Experimental Gerontology 220: 113171.
8. John R Beard, Yafei Si, Zhixin Liu, Lynn Chenoweth, Katja Hanewald, et al. (2022) Intrinsic capacity: Validation of a new WHO concept for healthy aging in a longitudinal Chinese study. The Journals of Gerontology: Series A 77(1): 94-100.
9. Ioanna Dimitriadou, Aikaterini Toska, Sini Eloranta, Susanna Mört, Nina Korsström, et al. (2025) Comprehensive Geriatric Assessment: Addressing Unmet Healthcare Needs in Older Adults. Healthcare 13(21): 2715.
10. Jung Yeon Choi, Vasuki Rajaguru, Jaeyong Shin, Kwang-Il Kim (2023) Comprehensive geriatric assessment and multidisciplinary team interventions for hospitalized older adults: A scoping review. Archives of Gerontology and Geriatrics 104: 104831.
11. Antoine Gbessemehlan, Cécile Proust Lima, Luc Letenneur, Hélène Amieva, Karine Pérès, et al. (2025) Healthy aging: how does a multidimensional construct of functional ability predict objective and subjective outcomes?. BMC geriatrics 25(1): 727.
12. Almar A L Kok, Martijn Huisman, Erik J Giltay, Gabriela Lunansky (2025) Adopting a complex systems approach to functional ageing: Bridging the gap between gerontological theory and empirical research. The Lancet Healthy Longevity 6(3): 100673.
13. Andreea Alexandra Piriu, Maria Vittoria Bufali, Giulia Cappellaro, Amelia Compagni, Aleksandra Torbica, et al. (2025) Conceptualisation and measurement of healthy ageing: Insights from a systematic literature review. Social Science & Medicine 374: 117933.
14. Zhang W, Wang Ap (2025) Functional ability of older adults based on the World Health Organization framework of healthy ageing: a scoping review. J Public Health (Berl.) 33: 1513-1531.
15. Molly McHugh, Ellen Munsterman, Hannah Cho, Mary D Naylor (2025) Effective solutions for caregivers of older adults: A review of systematic reviews. Journal of Applied Gerontology 44(10): 1571-1583.
16. Ricardo Alejandro Sánchez Bárcenas, Daniel López Hernández, Leticia Brito Aranda, Brenda Berenice García Mantilla, María Del Rocío Thompson Bonilla, et al. (2024) Factors associated with caregiver burden in primary caregivers of older adults with type 2 diabetes. Atención Primaria 56(10): 102948.
17. Charlene C Quinn, Sheila Staub, Erik Barr, Ann Gruber Baldini (2019) Mobile support for older adults and their caregivers: Dyad usability study. JMIR Aging 2(1): e12276.
18. Teja Pristavec (2019) The caregiving dyad: Do caregivers' appraisals of caregiving matter for care recipients' health? Archives of Gerontology and Geriatrics 82: 50-60.
19. Judith Bom, Pieter Bakx, Frederik Schut, Eddy van Doorslaer (2019) The Impact of Informal Caregiving for Older Adults on the Health of Various Types of Caregivers: A Systematic Review. The Gerontologist 59(5): e629-e642.
20. Angel Muñoz Alicea, William Suarez Gomez (2025) Exploring mental health implications of informal caregiving for the older adult within the Hispanic community: an in-depth cross-cultural analysis of depression symptoms. Front. Public Health 13: 1610733.
21. Nova Mengxia Huang, Liang Ze Wong, Shirley S Ho, Bryan Timothy (2025) Understanding Challenges and Emotions of Informal Caregivers of General Older Adults and People with Alzheimer Disease and Related Dementia: Comparative Study. Journal of medical Internet research 27: e54847.
22. Karen S Lyons, Christopher S Lee (2018) The theory of dyadic illness management. Journal of Family Nursing 24(1): 8-28.
23. Giulia Ferraris, Srishti Dang, Joanne Woodford, Mariët Hagedoorn (2022) Dyadic interdependence in non-spousal caregiving dyads' wellbeing: A systematic review. Frontiers in Psychology 13: 882389.
24. Si Qi Yoong, Rachel Tan, Ying Jiang (2024) Dyadic relationships between informal caregivers and older adults with chronic heart failure: A systematic review and meta-synthesis. European Journal of Cardiovascular Nursing 23(8): 833-854.
25. Stacey Rand, Wenjing Zhang, Grace Collins, Barbora Silarova, Alisoun Milne, et al. (2022) Applying a dyadic outcomes approach to supporting older carers and care-recipients: A qualitative study of social care professionals in England. Health & social care in the community 30(6): e5001-e5009.
26. Charalambous A (2023) Caregiving and Caregivers: Concepts, Caregiving Models, and Systems. In: Charalambous, A. (eds) Informal Caregivers: From Hidden Heroes to Integral Part of Care. Springer Cham.
27. Riffin C A, Wolff JL (2021) Identifying, assessing, and supporting family caregivers in health and long-term care: Current progress and future opportunities. In J. E. Gaugler & R. L. Kane (Eds.), Bridging the family care gap 341-365.
28. William E Haley, Joanne Elayoubi (2024) Family caregiving as a global and lifespan public health issue. The Lancet Public Health 9(1): e2-e3.
29. Sarah M Bannon, Victoria A Grunberg, Heena R Manglani, Ethan G Lester, Christine Ritchie, et al. (2022) Together from the start: A transdiagnostic framework for early dyadic interventions for neurodegenerative diseases. Journal of the American Geriatrics Society 70(6): 1850-1862.
30. Stephanie J Wilson, Joshua R Novak, Jeremy B Yorgason, Lynn M Martire, Karen S Lyons, et al. (2024) New opportunities for advancing dyadic health science in gerontology. The Gerontologist 64(1): 187.
31. Zhiyao Xiong, Yizhen Yin, Jingping Zhang, Anni Wang (2022) Dyadic interventions in older people with chronic diseases: An integrative review. Geriatric Nursing 48: 327-349.
32. Wang M, He Y, Song J, Li H, Geng N, et al. (2026) Digital technology-based dyadic interventions in patients with mild cognitive impairment or dementia and their caregivers: A scoping review. Frontiers in Psychiatry 17: 1726605.
33. (2016) Families Caring for an Aging America. Committee on Family Caregiving for Older Adults; Board on Health Care Services; Health and Medicine Division; National Academies of Sciences, Engineering, and Medicine; Schulz R, Eden J, editors. Washington (DC): National Academies Press (US) 8: 3.
34. Petra Maresova, Ondrej Krejcar, Raihan Maskuriy, Nor Azlina Abu Bakar, Ali Selamat, et al. (2023) Challenges and opportunity in mobility among older adults - key determinant identification. BMC geriatrics 23(1): 447.
35. Takuji Adachi, Yuki Tsunekawa, Daisuke Tanimura (2025) Association between cognitive impairment and medication adherence score, including psychological aspects in older patients with cardiovascular disease. Geriatric Nursing 62(Part B): 229-235.
36. Bogen B, Gujord Tangen G, Mc Ardle R (2023) Editorial: Mobility in older adults with cognitive impairment. Frontiers in Aging Neuroscience 15: 1257605.
37. Yurun Cai, Qu Tian, Alden L Gross, Hang Wang, Jian Yu E, et al. (2022) Motor and physical function impairments as contributors to slow gait speed and mobility difficulty in middle-aged and older adults. The Journals of Gerontology: Series A 77(8): 1620-1628.
38. Moira E Dunsmore, Annmaree Watharow, Julie Schneider (2025) An invisible disability: Communication, patient safety and dual sensory impairment in older persons. Journal of Advanced Nursing 81(9): 5623-5626.
39. Inger Ekman, Karl Swedberg, Charles Taft, Anders Lindseth, Astrid Norberg, et al. (2011) Person-centered care—Ready for prime time. European Journal of Cardiovascular Nursing 10(4): 248-251.
40. Matthew E Growdon, Krista L Harrison, Michael A Steinman, Lauren J Hunt, Robyn I Stone, et al. (2026) Medication management among older adults living alone with cognitive impairment. JAMA Internal Medicine 186(7): 838-849.
41. Bryan W Heckman, Amanda R Mathew, Matthew J Carpenter (2015) Treatment burden and treatment fatigue as barriers to health. Current Opinion in Psychology 5: 31-36.
42. Nurul Alyaa Ibrahim, Yuet Yen Wong, Qi Ying Lean, Kalavathy Ramasamy, Siong Meng Lim, et al. (2024) Medication self-management among older adults with cognitive frailty. Research in Social and Administrative Pharmacy 20(2): 172-181.
43. Maud Ranchet, Laurence Paire Ficout, Hannes Devos (2022) Editorial: Cognition and mobility with aging or neurological conditions: Assessment and intervention strategies. Frontiers in Aging Neuroscience 13:1089584.
44. Richard Schulz, Paula R Sherwood (2008) Physical and mental health effects of family caregiving. The American Journal of Nursing 108(9 Suppl): 23-27.
45. Fernández Carro C, Faus Bertomeu A, Rodríguez Blázquez C (2025) The impact of caregiving on older caregivers' health: A scoping review. Ageing International 50: 34.
46. Stefan Sebastian Heinz, Anthony John O Brien, Cameron Walker, Michael O Sullivan, Paul Rouse et al. (2025) Mediating pathways between resilience, mental health and wellbeing: A scoping review of individual, social, and systemic factors. BMC Public Health 25(1): 3758.
47. Marques LM, Battistella LR (2025) Well-being as a core element of rehabilitation: Preventing mental health challenges in a global context. Global Health Journal 9(1): 1-5.
48. Ratchaneekorn Upasen, Weeraphol Saengpanya, Wanida Awae, Preedanan Prasitvej, Sudaporn Stithyudhakarn, et al. (2025) Understanding how older adults sustain mental well-being when facing challenging in later life. Acta Psychologica 259: 105293.
49. Shahmir H Ali (2025) Care beyond caregivers: A wider spectrum of social support for older adults. The Lancet Healthy Longevity 6(10): 100782.
50. Sánchez Coronel G, Soto Ávila V, Ramos Durán JD, Ruiz Domínguez AE, Ramírez Aquino A, et al. (2025) Association between family functionality and caregiver burden for older adults. Ciencia Latina Multidisciplinary Scientific Journal 9(1).
51. Wrede C, Sharma N, Heins P, Sturge J (2026) Interventions for informal caregivers of community-dwelling older adults: A scoping review and future research agenda. Journal of Aging and Health. Advance online publication.
52. Lewis B, Templeton GF, Byrd TA (2005) A methodology for construct development in MIS research. European Journal of Information Systems 14(4): 388-400.
53. Schurer Lambert L, Newman D A (2022) Construct development and validation in three practical steps: Recommendations for reviewers, editors, and authors. Organizational Research Methods. Advance online publication.
54. Dong Y, Dumas D (2025) Capturing developing constructs: Methodologies and validation practices of dynamic measurement. Methods in Psychology 13: 100217.
55. (2015) National Council for Standardization and Certification of Labor Competencies (CONOCER). EC0669: Basic care of older adults at home (Cuidado básico de la persona adulta mayor en domicilio) [Competency Standard; original in Spanish]. Government of Mexico.