Varoluşsal Anlamsızlık Ölçeğinin Türkçeye Uyarlanması: Üniversite Öğrencileri için Bir Ön Çalışma

Year 2023, Volume: 36 Issue: 3, 984 - 1012, 15.12.2023

Elif Harman Nagihan Oğuz Duran

https://doi.org/10.19171/uefad.1255425

Abstract

Bu çalışmada, Li vd. (2022) tarafından geliştirilen Varoluşsal Anlamsızlık Ölçeğinin (VAÖ) Türkçe formu oluşturularak toplam 349 üniversite öğrencisinden elde edilen verilere dayalı olarak geçerlik ve güvenirlik incelemeleri yapılmıştır. 18 maddeden oluşan 6’lı Likert tipindeki VAÖ, Varoluşsal Anlamsızlık Düşüncesi (VA-D) ve Varoluşsal Anlamsızlık Kaygısı (VA-K) olmak üzere iki boyutta değerlendirilebilmektedir. Her iki ölçek de Anlamlandıramama, Amaçsızlık ve Önemsizlik olmak üzere 3 faktörden oluşmaktadır. Çalışmada ölçeğin dil eşdeğerliği için İngilizce ve Türkçe formlar arasında güçlü ilişkiler hesaplanmıştır. Doğrulayıcı faktör analizi sonucu hesaplanan uyum indeksleri üç faktörlü modelin iyi düzeyde uyum sağladığını göstermiştir. VAÖ puanları için güçlü Cronbach alfa iç tutarlık değerleri hesaplanmış ve üç hafta arayla yapılan test-tekrar test ölçümü sonuçları arasında yüksek ilişki bulunmuştur. Bu sonuçlarla VAÖ’nün Türkçe formundan elde edilen puanların üniversite öğrencileri için geçerliğine ve güvenirliğine ilişkin kanıtlar toplanmıştır.

Keywords

Varoluşsal anlamsızlık, Anlamsızlık kaygısı, Yaşamda anlam, Ölçek uyarlama, Psikometrik özellikler

Adaptation of Existential Meaninglessness Scale to Turkish: A Preliminary Study for University Students

Abstract

In this study, the Turkish version of the Existential Meaninglessness Scale (EMS) developed by Li et al. (2022) was constructed, and its validity and reliability were analyzed based on data obtained from a total of 349 university students. The 6-point Likert-type EMS consists of 18 items and can be evaluated in two dimensions: Existential Meaninglessness Concern (EM-C) and Existential Meaninglessness Anxiety (EM-A). Both dimensions consist of three factors: Incomprehension, Purposelessness, and Insignificance. The study found strong relationships between the English and Turkish versions for language equivalence. The fit indices calculated from confirmatory factor analysis showed a good fit of the three-factor model. Strong Cronbach's alpha internal consistency values were calculated for EMS scores, and a high correlation was found between test-retest measurements performed at three-week intervals. These results provide evidence regarding the validity and reliability of the scores obtained from the Turkish version of the EMS for university students.

Keywords

Existential meaninglessness, Meaninglessness anxiety, Meaning in life, Scale adaptation, Psychometric properties

References

• Akın, A., & Taş, İ. (2015). Yaşam anlamı ölçeği: Geçerlik ve güvenirlik çalışması. International Periodical For The Languages, Literature and History of Turkish or Turkic, 10(3), 27-36. http://dx.doi.org/10.7827/TurkishStudies.7860
• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th.ed.). American Psychiatric Publishing.
• Arslan, I., & Bektaş, H. (2019). Üniversite öğrencilerinin yaşam doyumunun ölçülmesi. İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi, 8, 767-784. https://doi.org/10.38079/igusabder.587380
• Bailey, T. H., & Phillips, L. J. (2016). The influence of motivation and adaptation on students’ subjective well-being, meaning in life and academic performance. Higher Education Research & Development, 35(2), 201-216. https://doi.org/10.1080/07294360.2015.1087474
• Baumeister, R. F., Vohs, K. D. (2002). The pursuit of meaningfulness in life. In C. R. Snyder, & S. J. Lopez (Eds.), The handbook of positive psychology (pp. 608–618). Oxford University Press.
• Blair, R. G. (2004). Helping older adolescents search for meaning in depression. Journal of Mental Health Counseling, 26(4), 333-347.
• Brassai, L., Piko, B. F., & Steger, M. F. (2011). Meaning in life: is it a protective factor for adolescents’ psychological health? International Journal of Behavioral Medicine, 18, 44–51. https://doi.org/10.1007/s12529-010-9089-6
• Brassai, L., Piko, B. F., & Steger, M. F. (2012). Existential attitudes and Eastern European adolescents’ problem and health behaviors: highlighting the role of the search for meaning in life. The Psychological Record, 62, 719–734.
• Brassai, L., Piko, B. F., & Steger, M. F. (2013). Individual and parental factors related to meaning in life among Hungarian minority adolescents from Romania. International Journal of Psychology, 48(3), 308–315. http://dx.doi.org/10.1080/00207594.2011.645483
• Bruggen, V. V., Ten Klooster, P., Westerhof, G., Vos, J., de Kleine, E., Bohlmeijer, E., & Glas, G. (2017). The Existential Concerns Questionnaire (ECQ): Development and initial validation of a new existential anxiety scale in a nonclinical and clinical sample. Journal of Clinical Psychology, 73(12), 1692–1703.
• Büyüköztürk, Ş. (2002). Faktör analizi: Temel kavramlar ve ölçek gelistirmede kullanımı. Kuram ve Uygulamada Eğitim Yönetimi, 32, 470-483.
• Chen, Q., Wang, X., He, X., Ji, L., Liu, M., & Ye, B. (2021). The relationship between search for meaning in life and symptoms of depression and anxiety: Key roles of the presence of meaning in life and life events among Chinese adolescents. Journal of Affective Disorders 282, 545–553. https://doi.org/10.1016/j.jad.2020.12.156
• Csabonyi, M., & Phillips, L. J. (2020). Meaning in life and substance use. Journal of Humanistic Psychology, 60(1) 3–19. https://doi.org/10.1177/0022167816687674
• Çevik, C., Ciğerci, Y., Kılıç, İ., & Uyar, S. (2020). Relationship between smartphone addiction and meaning and purpose of life in students of health sciences. Perspectives in Psychiatric Care, 56, 705–711. https://doi.org/10.1111/ppc.12485
• Datu, J. A., & Mateo, N. J. (2015). Gratitude and life satisfaction among Filipino adolescents: the mediating role of meaning in life. International Journal for the Advancement of Counselling, 37, 198–206. https://doi.org/10.1007/s10447-015-9238-3
• De Vaus, D. (2002). Analyzing social science data. 50 key problems in data analysis. Sage.
• Demirbaş, N. (2010). Yaşamda anlam ve yılmazlık. (Yayın No. 265337) [Yüksek Lisans Tezi, Hacettepe Üniversitesi]. YÖK. .https://tez.yok.gov.tr
• Demirdağ, S., & Kalafat, S. (2015). Yaşamın anlamı ölçeği (YAÖ): Türkçeye uyarlama, geçerlik ve güvenirlik çalışması. İnönü Üniversitesi Eğitim Fakültesi Dergisi, 16(2), 83-95. https://doi.org/10.17679/iuefd.16250801
• Dezutter, J., Casalin, S., Wachholtz, A., Luyckx, K., Hekking, J. & Vandewiele, W. (2013). Meaning in Life: An important factor for the 102 psychological well-being of chronically ill patients. Rehabilitation Psychology, 58(4), 334-341.
• Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment, 49(1), 71-75.
• Dursun, P., Sala, B., & Üzer, A. (2021). Üniversite öğrencilerinden oluşan bir örneklemde internet ve akıllı telefon bağımlılıkları: Yaşamda anlam arayışının rolü. Anadolu Kliniği Tıp Bilimleri Dergisi, 26(3), 249-258. https://doi.org/10.21673/anadoluklin.860677
• Erikson, E. H. (1982). The life cycle completed. W.W. Norton.
• Eryılmaz, A. (2014). Meaning of life-setting life goals: comparison of substance abusers and non-abusers. Turkish Psychological Counseling and Guidance Journal, 5(42), 235-243.
• Frankl, V. E. (1969). The will to meaning. New American Library.
• Frankl, V. E. (1972). The feeling of meaninglessness: A challenge to psychotherapy. The American Journal of Psychoanalysis, 32(1), 85–89.
• Frankl, V. E. (1998). Duyulmayan anlam çığlığı (Çev. S. Budak). Öteki Yayınevi.
• Frankl, V. E. (2009). İnsanın anlam arayışı (3. baskı). Okuyan Us.
• George, L. S., & Park, C. L. (2016). Meaning in life as comprehension, purpose, and mattering: Toward integration and new research questions. Review of General Psychology, 20(3), 205–220. http://dx.doi.org/10.1037/gpr0000077
• George, L. S., & Park, C. L. (2017). The multidimensional existential meaning scale: A tripartite approach to measuring meaning in life. The Journal of Positive Psychology, 12(6), 613–627. https://doi.org/10.1080/17439760.2016.1209546
• Glaw, X., Kable, A., Hazelton, M., & Inder, K. (2017). Meaning in life and meaning in life in mental health care: An integrative literature review. Issues in Mental Health Nursing, 38, 243–252.
• Güven, P. (2015). Üniversite öğrencilerinde yaşamın amacı ve anlamı ile yaşam doyumu ve yakın ilişkiler (Yayın No. 395267) [Yüksek Lisans Tezi, Dokuz Eylül Üniversitesi]. YÖK. https://tez.yok.gov.tr
• Hill, C. E. (2018). Meaning in life: A therapists guide. American Psychological Association.
• Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55.
• Hurst, R., & Carson, J. (2021). Stressing the meaning: Examining meaning in life, depression and academic stress in psychology undergraduate students. International Journal of Existential Positive Psychology, 10(1).
• Kaiser, H. F. (1974). An index of factorial simplicity. Psychometrika, 39(1), 31–36. https://doi.org/10.1007/BF02291575
• Kalkan, M., & Vural Batık, M. (2019). Öğrenilmiş anlamsızlık ölçeği: Geçerlik ve güvenirlik çalışması. Elektronik Sosyal Bilimler Dergisi, 18(72).
• Kim, J., Seto, E., Davis, W. E., & Hicks, J. A. (2014). Positive and existential psychological approaches to the experience of meaning in life. In A. Batthyany & P. Russo-Netzer (Eds.), Meaning in positive and existential psychology (pp. 221– 233). Springer.
• Kim, T. H., Lee, S. M., Yu, K., Lee, S., & Puig, A. (2005). Hope and the meaning of life as influences on Korean adolescents' resilience: implications for counselors. Asia Pacific Education Review, 6(2), 143-152.
• King, L. A., & Hicks, J. A. (2020). The science of meaning in life. Annual Review of Psychology, 72, 561–584. https://doi.org/10.1146/annurev-psych-072420-122921
• Kleiman, E. M., & Beaver, J. K. (2013). A meaningful life is worth living: Meaning in life as a suicide resiliency factor. Psychiatry Research, 210, 934–939.
• Klein, N. (2017). Prosocial behavior increases perceptions of meaning in life. The Journal of Positive Psychology, 12(4), 354-361. https://doi.org/10.1080/17439760.2016.1209541
• Kline, P. (1994). An easy guide to factor analysis. Routledge.
• Köker, S. (1991). Normal ve sorunlu ergenlerin yaşam doyumu düzeyinin karşılaştırılması (Yayın No. 16802) [Yüksek Lisans Tezi, Ankara Üniversitesi]. YÖK. https://tez.yok.gov.tr
• Krok, D. (2018). When is meaning in life most beneficial to young people? Styles of meaning in life and well-being among late adolescents. Journal of Adult Development, 25, 96-106. https://doi.org/10.1007/s10804-017-9280-y
• Kunzendorf, R. G., Moran, C., & Gray, R. (1995). Personality traits and realitytesting abilities, controlling for vividness of imagery. Imagination, Cognition, and Personality, 15, 113–131.
• Lambert, N. M., Stillman, T. F., Baumeister, R. F., Fincham, F. D., Hicks, J. A., & Graham, S. M. (2010) Family as a salient source of meaning in young adulthood. The Journal of Positive Psychology, 5(5), 367-376. https://doi.org/10.1080/17439760.2010.516616
• Lent, R. W. (2004). Toward a unifying theoretical and practical perspective on well-being and psychosocial adjustment. Journal of Counseling Psychology, 51, 482–509.
• Leontiev, D. A. (2013). Personal meaning: A challenge for psychology. The Journal of Positive Psychology, 8(6), 459–470.
• Li, P. F. J., & Wong, Y. J. (2020). Beliefs in free will versus determinism: Search for meaning mediates the life scheme–depressive symptom link. Journal of Humanistic Psychology, 1–14. https://doi.org/10.1177/0022167820933719
• Li, P. F. J., Wong, Y. J., McCullough, K. M., Jin, L., & Wang, C. (2022). Existential meaninglessness scale: Scale development and psychometric properties. Journal of Humanistic Psychology, 1–35. https://doi.org/10.1177/00221678211072450
• Marco, J. H., Guillén, V., & Bottela, C. (2017). The buffer role of meaning in life in hopelessness in women with borderline personality disorders. Psychiatry Research, 247, 120–124.
• Markman, K. D., Proulx, T., & Lindberg, J. (2013). The psychology of meaning. .American psychological Association
• Martela, F., & Steger, M. F. (2016). The three meanings of meaning in life: Distinguishing coherence, purpose, and significance. The Journal of Positive Psychology, 11(5), 531–545. http://dx.doi.org/10.1080/17439760.2015.1137623
• Martela, F., & Steger, M. F. (2022). The role of significance relative to the other dimensions of meaning in life – an examination utilizing the three dimensional meaning in life scale (3DM). The Journal of Positive Psychology. https://doi.org/10.1080/17439760.2022.2070528
• May, R. (1977). The meaning of anxiety (Rev. ed.). Norton
• May, R. (2013). Kendini arayan insan. Okuyan Us.
• May, R., & Yalom, I. (1995). Existential psychotherapy. In R. J. Corsini & D. Wedding (Eds.), Current psychotherapies (5th ed.). Itasca: Peacock.
• McCullough, M. E., Emmons, R. A., & Tsang, J. (2002). The grateful disposition: A conceptual and empirical topography. Journal of Personality and Social Psychology, 82, 112-127.
• Nie, S., Huini, P., Qianqian, J., Qi, L., Cong, Z., Xiaowei, Q., & Yiqun, G. (2023). The relatiopnship between meaning in life and health behaviors in adults aged 55 years and over during the Covid-19 pandemic: the Mediating role of risk perception and the moderating role of powerful others health locus of control. International Journal of Behavioral Medicine, 30, 388-397. https://doi.org/10.1007/s12529-022-10100-x
• Park, C. L. (2010). Making sense of the meaning literature: An integrative review of meaning making and its effects on adjustment to stressful life events. Psychological Bulletin, 136(2), 257–301.
• Polacsek, M., Gayelene, H. B., & Terence, V. M. (2022). Self-identity and meaning in life as enablers for older adults to self-manage depression. Issues in Mental Health Nursing, 43(5), 409-417. https://doi.org/10.1080/01612840.2021.1998263
• Qiu, C., Liu, Q., Yu, C., Li, Z., & Nie, Y. (2022). The influence of meaning in life on children and adolescents’ problematic smartphone use: A three-wave multiple mediation model. Addictive Behaviors, 126, 107-199. https://doi.org/10.1016/j.addbeh.2021.107199
• Rathi, N., & Rastogi, R. (2007). Meaning in life and psychological well-being in pre-adolescents and adolescents. Journal of the Indian Academy of Applied Psychology, 33(1), 31-38.
• Reker, G. T. (1992). Manual of the Life Attitude Profile-Revised. Student Psychologists Press.
• Reker, G. T., Peacock, E. J., & Wong, P. T. P. (1987). Meaning and purpose in life and well-being: A life-span perspective. Journal of Gerontology, 42, 44–49.
• Roepke, A. M., Jayawickreme, E., & Riffle, O. M. (2014). Meaning and health: A systematic overview. Applied Research Quality Life, 9, 1055–1079.
• Ryan, R. M., & Deci, E. L. (2001). On happiness and human potentials: a review of research on hedonic and eudaimonic wellbeing. Annual Review of Psychology, 52, 141–166.
• Ryff, C. D., & Singer, B. (1998). The contours of positive human health. Psychological Inquiry, 9, 1–28.
• Sargent, G. A. (1981). Transference and countertransference in logotherapy. The International Forum for Logotherapy, 5(2), 115-118.
• Schermelleh-Engel, K., Moosbrugger, H., & Müller, H. (2003). Evaluating the fit of structural equation models: Tests of significance and descriptive goodness-of-fit measures. Methods of Psychological Research, 8(2), 23–74.
• Schneider, K. J., & Krug, O. T. (2015). Vaoluşçu-hümanistik terapi. (Çev. G. Akkaya). Okuyan Us.
• Schnell, T. (2009). The Sources of Meaning and Meaning in Life Questionnaire (SoMe): Relations to demographics and well-being. The Journal of Positive Psychology, 4(6), 483–499.
• Schreiber, A. (2015). Logotherapy in educational systems. Romanian Review of Social Sciences, 5(9).
• Seki-Öz, H., Ayhan, D., & Söyünmez, S. (2021). Sağlık bilimleri fakültesi son sınıf öğrencilerinin akademik yeterlikleri ile yaşamın anlamı arasındaki ilişki. Journal of Yasar University, 16(61), 264-277.
• Seligman, M., & Csikszentmihalyi, M. (2000). Positive psychology: An introduction. American Psychologist, 55(1), 5–14.
• Steger, M. (2012). Experiencing meaning in life: Optimal functioning at the nexus of well-being, psychopathology, and spirituality. In P. T. P. Wong (Ed.), The human quest for meaning: Theories, research, and applications. (2nd ed., pp. 165–184). Routledge.
• Steger, M., Fitch-Martin, A., Donnelly, J., & Rickard, K. (2015). Meaning in life and health: Proactive health orientation links meaning in life to health variables among American undergraduates. Jounal of Happiness Studies, 16, 583–597. https://doi.org/10.1007/s10902-014-9523-6
• Steger, M. F., Frazier, P., Oishi, S., & Kaler, M. (2006). The Meaning in Life Questionnaire: Assessing the presence of and search for meaning in life. Journal of Counseling Psychology, 53(1), 80–93.
• Steger, M. F., Kashdan, T. B., Sullivan, B. A., & Lorentz, D. (2008). Understanding the search for meaning in life: Personality, cognitive style, and the dynamic between seeking and experiencing meaning. Journal of Personality, 76(2), 199–228.
• Steger, M. F., Mann, J. R., Michels, P., & Cooper, T. C. (2009). Meaning inlife, anxiety, depression, and general health among smoking cessationpatients. Journal of Psychosomatic Research, 67, 353–358.
• Steger, M., Oishi, S., & Kashdan, T. (2009). Meaning in life across the life span: Levels and correlates of meaning in life from emerging adulthood to older adulthood. The Journal of Positive Psychology, 4(1), 43-52. https://doi.org/10.1080/17439760802303127
• Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics (6. baskı). Pearson.
• Thege, B. K., Bachner, Y. G., Martos, T., & Kushnir, T. (2009). Meaning in life: does it play a role in smoking? Substance Use & Misuse, 44(11), 1566-1577. https://doi.org/10.1080/10826080802495096
• Thorne, F. C. (1973). The existential study: A measure of existential status. Journal of Clinical Psychology, 29(4), 387–392.
• Tillich, P. (2014). Olmak cesareti. Okuyan Us.
• Van Tongeren, D. R., & Green, J. D. (2010). Combating meaninglessness: On the automatic defense of meaning. Personality and Social Psychology Bulletin, 36(10), 1372–1384.
• Van Tongeren, D. R., Green, J. D., Davis, D. E., Hook, J. N., & Hulsey, T. L. (2016). Prosociality enhances meaning in life. The Journal of Positive Psychology, 11(3), 225-236. https://doi.org/10.1080/17439760.2015.1048814
• Vanhooren, S., Dezutter, J., & Leijssen, M. (2015). Posttraumatic growth during incarceration: A case study from an experiential-existential perspective. Journal of Humanistic Psychology, 1–24. Advance online publication. https://doi:10.1177/0022167815621647
• Volkert, J., Schulz, H., Brütt, A. L., & Andreas, S. (2014). Meaning in life: Relationship to clinical diagnosis and psychotherapy outcome. Journal of Clinical Psychology, 70, 528–535.
• Vos, J. (2016). Working with meaning in life in chronic or life-threatening disease: A review of its relevance and the effectiveness of meaning-centred therapies. In P. Russo-Netzer, S. E. Schulenberg, & A. Batthyany (Eds.), Clinical perspectives on meaning: Positive and existential psychotherapy (pp. 171–200). Springer.
• Walt, C. (2019). The relationships between first‑year students’ sense of purpose and meaning in life, mental health and academic performance. Journal of Student Affairs in Africa, 7(2), 109‑121. https://doi.org/10.24085/jsaa.v7i2.3828
• Weems, C. F., Costa, N. M., Dehon, C., & Berman, S. L. (2004). Paul Tillich’s theory of existential anxiety: A preliminary conceptual and empirical examination. Anxiety, Stress & Coping, 17(4), 383–399.
• Wong, P. T. P. (1998). Meaning-centered counselling. In P. T. P. Wong & P. S. Fry (Eds.), The human quest for meaning: A handbook of psychological research and clinical applications (pp. 395–435). Lawrence Erlbaum Associates.
• Yalom, I. D. (1980). Existential psychotherapy. Basic Books.
• Yalom, I. D. (2018). Varoluşçu psikoterapi. (Çev. Z. Babayiğit). Pegasus Yayınları.
• Yavaş, H., & Oğuz-Duran, N. (2019). Turkish version of the revised sense of purpose scale 2 (SOPS-2): A preliminary study for validity and reliability. 2nd International Congress On New Horizons In Education And Social Sciences (ICES - 2019) Proceedings. https://doi.org/10.21733/ibad.581250
• Yetim, Ü. (1991). Kişisel projelerin organizasyonu ve örüntüsü açısından yaşam doyumu. (Yayın No. 16120) [Doktora Tezi, Ege üniversitesi]. YÖK. https://tez.yok.gov.tr
• Yıkılmaz, M. (2016). Üniversite öğrencilerinde varoluşsal kaygı: Erken dönem uyum bozucu şemalar, kontrol odağı ve travma sonrası gelişimin yordayıcılığı (Yayın No. 432441) [Doktora Tezi, Anadolu Üniversitesi]. YÖK. https://tez.yok.gov.tr
• Yuen, D., & Datu, J. A. D. (2021). Meaning in life, connectedness, academic self-efficacy, and personal self-efficacy: A winning combination. School Psychology International, 42(1), 79-99. https://doi.org/10.1177/0143034320973370
• Yuen, M., Chung, Y. B., Lee, Q. A. Y., Lau, P. S. Y., Chan, R. M. C., Gysbers, N. C., & Shea, P. M. K. (2020). Meaning in life and school guidance programs: Adolescents’ voices from Hong Kong. International Journal for Educational and Vocational Guidance, 20, 653–676. https://doi.org/10.1007/s10775-020-09423-6
• Yuen, M., Yau, J., Datu, J. A. D., Wong, S., Chan, R. T. H., Lau, P. S. Y., & Gysbers, N. C. (2021). Examining the influence of meaning in life and social connectedness on adolescents’ career self-efficacy. The Journal of Individual Psychology, 77(3), 335-361. https://doi.org/10.1353/jip.2021.0024
• Yüksel, A., & Oğuz Duran, N. (2012a). Turkish adaptation of the Gratitude Questionnaire. Eğitim Araştırmaları-Eurasian Journal of Educational Research, 46, 199-216.
• Yüksel, A., & Oğuz Duran, N., (2012b). Minnettarlık Ölçeği’nin Yetişkinlere Uyarlanması: Geçerlik ve Güvenirlik Çalışmaları. Çağdaş Eğitim Dergisi Akademik/Journal of Contemporary Education Academic, 1(1), 31-40.
• Zhang, J., Peng, J., Gao, P., Huang, H., Cao, Y., Zheng, L. Miao, D. (2019). Relationship between meaning in life and death anxiety in the elderly: self-esteem as a mediator. BMC Geriatrics, 19(308). https://doi.org/10.1186/s12877-019-1316-7