Determinants of Quality of Life Among Older Adults in a Social Care Center: Emphasis on Sleep

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This study aimed to identify the determinants of quality of life among older adults living in a social care center in West Jakarta. Method This quantitative study employed a descriptive cross-sectional design involving 288 participants from a social care center. Data were collected using structured questionnaires measuring sleep behavior, medication adherence, nutritional intake, infection prevention, physical activity, and quality of life. Results The results indicated that sleep behavior was significantly associated with QoL (p = 0.005), whereas no statistically significant associations were found between QoL and other variables, including medication adherence, nutritional intake, infection prevention, and physical activity. Conclusion Sleep behaviour was identified as a significant association of QoL among institutionalized individuals. These findings suggest that a sleep-focused approach should be prioritized in care strategies to improve the quality of life of older adults in long-term care. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/14-1217", "name": "Determinants of Quality of Life Among Older Adults in a Social Care..." } } ] } Home Browse Determinants of Quality of Life Among Older Adults in a Social Care... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Yuliati Y, Wihardja H and Pambudi A. Determinants of Quality of Life Among Older Adults in a Social Care Center: Emphasis on Sleep [version 4; peer review: 1 approved, 1 not approved] . F1000Research 2026, 14 :1217 ( https://doi.org/10.12688/f1000research.171903.4 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Revised Determinants of Quality of Life Among Older Adults in a Social Care Center: Emphasis on Sleep [version 4; peer review: 1 approved, 1 not approved] Previously titled: "Determinants of Quality of Life Among Elderly in a Social Care Center: Emphasis on Sleep" Yuliati Yuliati 1,2 , Hany Wihardja https://orcid.org/0000-0001-8272-371X 3 , Ari Pambudi 4 Yuliati Yuliati 1,2 , Hany Wihardja https://orcid.org/0000-0001-8272-371X 3 , Ari Pambudi 4 PUBLISHED 23 Mar 2026 Author details Author details 1 Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Sabah, 88400, Malaysia 2 Department of Nursing Program,, Universitas Esa Unggul, West Jakarta, Jakarta, Indonesia 3 Department of Nursing Program, Sekolah Tinggi Ilmu Kesehatan Mayapada, Jakarta, Indonesia 4 Department of Computer Program, Universitas Esa Unggul, West Jakarta, Jakarta, 11510, Indonesia Yuliati Yuliati Roles: Conceptualization, Data Curation, Funding Acquisition, Writing – Original Draft Preparation Hany Wihardja Roles: Data Curation, Formal Analysis, Methodology, Software, Writing – Original Draft Preparation, Writing – Review & Editing Ari Pambudi Roles: Software, Validation, Visualization, Writing – Original Draft Preparation OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Dignity in Aging collection. Abstract Background The global aging population worldwide has led to increased attention toward ensuring a good quality of life (QoL) among older adults, particularly those residing in long-term care facilities. This study aimed to identify the determinants of quality of life among older adults living in a social care center in West Jakarta. Method This quantitative study employed a descriptive cross-sectional design involving 288 participants from a social care center. Data were collected using structured questionnaires measuring sleep behavior, medication adherence, nutritional intake, infection prevention, physical activity, and quality of life. Results The results indicated that sleep behavior was significantly associated with QoL ( p = 0.005), whereas no statistically significant associations were found between QoL and other variables, including medication adherence, nutritional intake, infection prevention, and physical activity. Conclusion Sleep behaviour was identified as a significant association of QoL among institutionalized individuals. These findings suggest that a sleep-focused approach should be prioritized in care strategies to improve the quality of life of older adults in long-term care. READ ALL READ LESS Keywords Determinants, Elderly, Nursing Home, Quality of Life, Sleep Behavior Corresponding Author(s) Yuliati Yuliati ( [email protected] ) Close Corresponding author: Yuliati Yuliati Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2026 Yuliati Y et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Yuliati Y, Wihardja H and Pambudi A. Determinants of Quality of Life Among Older Adults in a Social Care Center: Emphasis on Sleep [version 4; peer review: 1 approved, 1 not approved] . F1000Research 2026, 14 :1217 ( https://doi.org/10.12688/f1000research.171903.4 ) First published: 06 Nov 2025, 14 :1217 ( https://doi.org/10.12688/f1000research.171903.1 ) Latest published: 23 Mar 2026, 14 :1217 ( https://doi.org/10.12688/f1000research.171903.4 ) Revised Amendments from Version 3 In this revised version, several improvements have been made in response to reviewers’ comments. The Introduction has been revised to remove references to social support to ensure consistency with the variables analyzed in the study. Additional details have been added to the Methods section to clarify how health-related behaviors, including medication adherence, sleep patterns, nutritional intake, disease prevention practices, and physical exercise, were assessed using structured interview questions. Table III has been corrected to ensure consistency with the data presented in Table II and the bivariate analysis results. The Results and Discussion sections have also been revised to ensure accurate interpretation of the findings and consistency with the statistical outputs. Minor language edits have been made throughout the manuscript to improve clarity and readability. In this revised version, several improvements have been made in response to reviewers’ comments. The Introduction has been revised to remove references to social support to ensure consistency with the variables analyzed in the study. Additional details have been added to the Methods section to clarify how health-related behaviors, including medication adherence, sleep patterns, nutritional intake, disease prevention practices, and physical exercise, were assessed using structured interview questions. Table III has been corrected to ensure consistency with the data presented in Table II and the bivariate analysis results. The Results and Discussion sections have also been revised to ensure accurate interpretation of the findings and consistency with the statistical outputs. Minor language edits have been made throughout the manuscript to improve clarity and readability. See the authors' detailed response to the review by Zoe Menczel Schrire READ REVIEWER RESPONSES Introduction Aging is a natural and inevitable phase in human development, marked by progressive physical, psychological, and social changes that often result in gradual decline. According to the World Health Organization, 1 individuals aged 60 years and above are classified as elderly. This phase of life presents challenges such as reduced adaptability to stress, decreased biological and cognitive function, and diminished social interaction, all of which may significantly affect an individual’s quality of life (QoL). 2 However, aging should not be viewed solely as a period of decline. With adequate health care, meaningful daily activities, and supportive living environments, many older adults are able to maintain independence, resilience, and a sense of well-being. Thus, understanding the multidimensional impact of aging is essential for developing strategies that promote active aging and improve QoL among the elderly population. In Indonesia, caring for the elderly has traditionally been considered a familial responsibility, deeply rooted in cultural values of parental respect and intergenerational support. However, changes in family dynamics, rapid urbanization, and increasing work demands have shifted this paradigm, resulting in a growing number of elderlies being placed in nursing homes or social care centers. 3 While these institutions provide essential health and social services, the transition to institutional living often comes at a psychosocial cost. Many elderly residents report feelings of loneliness, abandonment, and diminished self-worth, particularly when the decision to institutionalize is made without their full consent or participation. 4 Such experiences not only affect emotional well-being but can also significantly lower overall quality of life, underscoring the need for more person-centered and family-inclusive approaches in elderly care. Quality of life among institutionalized elderly is influenced by multiple factors, including physical health, mental well-being, and social connectedness. Living in residential care facilities can shape how older adults experience daily life, particularly in relation to autonomy, participation in activities, and engagement with others within the institution. 5 A lack of meaningful interaction can lead to isolation, depression, and poor QoL among residents in social care facilities. 6 Studies have suggested that positive social environments and meaningful engagement can buffer the negative impact of institutionalization. When elderly individuals experience regular interaction with family, peers, and the broader community, their sense of purpose and emotional resilience improves. Moreover, opportunities for interaction, recreation, and companionship, together with healthy daily habits, can significantly enhance their perception of life satisfaction and reduce psychological distress. 7 A preliminary exploration at Tresna Werdha Budi Mulia 2 Social Care Center in Jakarta revealed that residents often felt bored, lonely, and disconnected due to the limited variety of daily activities and minimal opportunities for meaningful interaction. These psychosocial challenges illustrate how institutional living can restrict autonomy and reduce the sense of purpose among the elderly, which in turn may negatively influence their overall quality of life. Motivated by these observations, the present study seeks to explore factors related to the well-being of older adult individuals residing in social care centers. In this context, the research is directed toward understanding whether, and to what extent, health-related factors such as treatment adherence, nutritional status, sleep pattern, and physical activity can enhance different dimensions of quality of life, including physical health, psychological well-being, and social connectedness. By examining various health-related factors, the study aims to provide a clearer understanding of determinants that contribute to the lived experiences and overall well-being of older adults residing in social care facilities. Methods This study employed a cross-sectional design using a non-probability purposive sampling technique to recruit older adults individuals residing in Tresna Werdha Budi Mulia 2 Social Care Center, West Jakarta. Participants were selected based on specific inclusion and exclusion criteria to ensure the appropriateness of the sample for the research objectives. Data collection was conducted in August 2022 at Tresna Werdha Budi Mulia 2 Social Care Center, Cengkareng, West Jakarta. The inclusion criteria were as follows: (a) participants who had been residing in the care center for more than one month, (b) aged 46 years or older, and (c) not experiencing severe illness, dementia, severe hearing impairment, major psychological disorders, or impaired consciousness. The exclusion criteria included: (a) individuals with communication disorders that could hinder participations, and (b) residents who were unwilling to participate. The World Health Organization defines older adults as individuals aged 60 years and above, this study included participants aged 46 years and older to capture early ageing stages. For analytical purposes, participants were categorized into middle-to-older age group (46 – 55 years) and older age group (56 – 65 years). Participants demonstrated mild to moderate levels of dependency but were able to perform basic activities of daily living independently. Data collection utilized two main instruments. First, demographic data were collected using a standardized questionnaire from the World Health Organization. Second, quality of life was assesed using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire, which measures four domains: physical, psychological, social, and environmental. Quality of life scores were categorized into three levels: low (<33), moderate (≥33 and <67), and high (≥67). Additionally, the Quality-of-Life Index: Generic Version-III was used to support and compare WHOQOL-BREF findings. Health-related behaviours were assessed using structured interview questions administered by the research team. Five domains were evaluated: medication adherence, sleep patterns, nutritional intake, disease prevention practices, and physical exercise. Each domain consisted of four subjective questions related to participant’s daily health practices. Responses were recorded based on participant’s self-reported experiences and were subsequently categorized into two levels (fair and good) according to predefined criteria for analysis. Additional health-related behaviors, including sleep quality, nutritional intake, and disease prevention activities, were assessed descriptively using structured self-reported items to provide contextual information supporting QoL interpretation. These variables were not intended as primary outcome measures but served as complementary indicators of daily functioning. Data analysis consisted of univariate and bivariate methods. Univariate analysis was conducted to describe demographic variables such as age, gender, education, marital status, and employment. Bivariate analysis was conducted using Fisher’s Exact Test to examine the associations between categorical variables, including health-related factors and overall quality of life, as several contingency table cells had small expected counts. The Participant Information Sheet (PIS) and informed consent were verbally administered by the research team, as most participants were older adults and some had visual impairments. Following a detailed verbal explanation and confirmation of comprehension, participants who voluntarily agreed to take part provided their written signatures on the consent form. This procedure was reviewed and approved by the institutional ethics committee to ensure inclusivity, accessibility, and full understanding among all participants. Results Demographic data of participants This study involved 288 older adult residents of the Tresna Werdha Budi Mulia 2 Social Care Center in Cengkareng, West Jakarta ( Table I ). The majority (91.3%) were categorized as middle-to-older age group; 54.9% were male; and 45.1% were female. Most participants (66.7%) had a senior high school education background; 71.2% were employed prior to institutionalization; and 62.8% were married. Table I. Characteristics of participants (n = 288). Characteristic n (%) Age (years) Middle-to-older age group (46–55 years) 263 (91.3) Older age group (56–65 years) 25 (8.7) Gender Male 158 (54.9) Female 130 (45.1) Education Level No Formal Education 5 (1.7) Elementary School 25 (8.7) Junior High School 52 (18.1) Senior High School 192 (66.7) Higher Education 14 (4.9) Employment Status Not Working 83 (28.8) Working 205 (71.2) Marital Status Single 87 (30.2) Married 181 (62.8) Divorced 20 (6.9) The quality of life among 288 residents of the Tresna Werdha Budi Mulia 2 Social Care Center indicated that the majority of respondents (96.9%) had a good quality of life, while only 3.1% experienced a less-than-optimal quality of life ( Table II ). Table II. Distribution of Quality of Life (n = 288). Quality of Life (QoL) n (%) Good 279 (96.9) Poor 9 (3.1) Table II presents the association between several health behavior factors and the quality of life among 288 older adults. The data showed that the majority of respondents had good QoL across all categories. For medication adherence, most respondents with good QoL were found among non-adherent individuals (186; 66.7%), followed by adherent individuals (93; 33.3%) ( p = 0.491). In the nutritional intake category, most respondents with good QoL had fair nutritional intake (214; 76.7%), while 65 respondents (23.3%) with good nutritional intake were also categorized as having good QoL ( p = 0.445). Similar patterns were found in infection prevention ( p = 1.000) and physical exercise ( p = 0.280), with a high proportion of respondents in each category reporting good QoL. Table III. Association between health behavior factors and Quality of Life among older adult residents (n = 288). Variable Good QoL n (%) Poor QoL n (%) Total (n) p- value Medication Adherence Non-adherent 186 (66.7%) 5 (55.6%) 191 (66.3%) 0.491 Adherent 93 (33.3%) 4 (44.4%) 97 (33.7%) Nutritional Intake Fair 214 (76.7%) 6 (66.7%) 220 (76.4%) 0.445 Good 65 (23.3%) 3 (33.3%) 68 (23.6%) Sleep Pattern Fair 197 (70.6%) 2 (22.2%) 199 (69.1%) 0.005 * Good 82 (29.4%) 7 (77.8%) 89 (30.9%) Infection Prevention Fair 181 (64.9%) 6 (66.7%) 187 (64.9%) 1.000 Good 98 (35.1%) 3 (33.3%) 101 (35.1%) Physical Exercise Fair 188 (67.4%) 8 (88.9%) 196 (68.1%) 0.280 Good 91 (32.6%) 1 (11.1%) 92 (31.9%) * Levels of statistical significance: p-value ≤ 0.05. Overall, the analysis on Table III shows statistically significant association between sleep patterns and QoL ( p = 0.005). Among respondents with good sleep patterns, 82 (29.4%) were categorized as having good QoL, compared with 197 (70.6%) among those with fair sleep patterns. The other health behavior factors included in the analysis did not demonstrate statistically significant correlations with QoL in this sample of institutionalized older adult residents. Discussion Quality of life is defined as an individual’s perception of their position in life, in the context of their goals, expectations, and social and cultural values. 2 It is a broad, multidimensional concept that includes subjective evaluations of both positive and negative aspects of life. 5 Among the older adults, QoL is influenced by several interrelated factors, such as physical health, psychological well-being, social support, and environmental conditions. In addition, the World Health Organization emphasizes that QoL is not only merely related to the absence of disease but also reflects overall well-being, independence, social relationships, and spiritual aspects. QoL is a dynamic construct that can change over time in response to shifts in health status, life roles, or socioeconomic circumstances. As such, measuring QoL provides a comprehensive indicator of an individual’s overall health and serves as an essential outcome in evaluating the effectiveness of healthcare interventions and social policies. In this study, the majority of older adult residents in the social care center were married, had an adequate nutritional intake, and were actively engaged in disease prevention activities. The result also showed that most participants were categorized as having good QoL. Nevertheless, variations in perceived well-being may still occur among instutionalized older adults despite favourable health-related behavior. Previous research has reported that 68.4% of older adults in their study had poor QoL. 5 This suggests that objective indicators do not necessarily guarantee subjective well-being. Factors such as loneliness, declining physical capacity, loss of independence, or unmet emotional needs may influence how older adults perceive their quality of life. 8 Therefore, QoL assessment should adopt a holistic perspective, intergrating both behavioral measures and individual perceptions to capture the true well-being of the older adults. 9 One notable finding in this study was that sleep behavior showed a significant association with quality of life ( p = 0.005). Poor sleep has long been associated with diminished cognitive function, mood disorders, and lower life satisfaction among older adults. Although approximately 70% of the participants reported “fair” sleep quality, differences in sleep patterns were still associated with variations in QoL among participants. This suggests that even minor disturbances in sleep may be associated with meaningful reductions in perceived well-being. Tucker et al emphasized through a systematic review and meta-analysis that poor nutritional status and poor sleep were both linked with reduced QoL in institutionalized older adults, reinforcing the role of fundamental daily behaviors in shaping long-term well-being. 10 Similarly, Tatineny et al underscored that sleep architecture changed with age and was often accompanied by insomnia, fragmented sleep, and increased sleep latency, all of which contributed to daytime dysfunction. 11 These disruptions can lead to irritability, fatigue, cognitive decline, and social withdrawal, thus deteriorating QoL. Furthermore, Gothe et al found that sleep quality was closely linked with physical activity and psychosocial well-being. 12 Their findings suggest that better sleep is associated with more consistent physical activity, fewer depressive symptoms, and stronger social support factors that, collectively, predicted higher QoL in community-dwelling older adults. Contrary to expectations, this study found no significant association between medication adherence and QoL ( p = 0.491), although a substantial proportion of participants were categorized as non-adherence to medication. One possible explanation is the structured nature of medication administration in institutional settings, where the standardized delivery of prescribed drugs reduces the variability typically caused by individual adherence behaviors. This finding also underscores the multifactorial complexity of chronic illness management among older adults, suggesting that pharmacological treatment alone may not be sufficient to enhance overall well-being. Psychosocial aspects, environmental support, and the burden of comorbidities may play a more prominent role in shaping QoL than adherence in isolation. Therefore, interventions aimed at improving QoL among older adults should adopt a holistic approach that integrates medical, psychological, and social dimensions rather than focusing solely on medication compliance. Nutritional intake also did not show a significant relationship with QoL ( p = 0.445), despite the majority of participants reporting adequate food intake. While nutrition remains essential for physical health, Tucker et al found that its effects on QoL may have been moderated by the emotional context of mealtimes and individual autonomy in food choices. 10 In institutional settings where food provision is standardized, limited choice and reduced emotional engagement with meals may attenuate the impact on subjective well-being. Sleep quality again emerged as a significant factor associated of QoL among older adults. A study by Almondes et al comparing pre-pandemic and pandemic sleep patterns among older adults reported that disruptions in sleep habits were associated with increased anxiety and reduced social interaction, which were linked to lower QoL scores. 13 These findings reinforce the notion that psychological and environmental stability play a critical role in maintaining sleep quality and, by extension, life satisfaction in later adulthood. In contrast, disease prevention behavior and physical activity were also not significantly associated with QoL in this study, possibly due to age-related functional limitations and fear of injury. Physical activity among the older adults often declines as a result of mobility limitations or chronic pain, which may prevent it from translating into perceived improvements in life quality unless accompanied by a sense of autonomy and psychological well-being. 14 In addition, a cross-sectional study found that poor sleep quality was significantly associated with reduced QoL in retired older adults, particularly in domains related to emotional role functioning and general health perception. 15 Other findings highlight the critical role of sleep as a determinant of both physical and psychological well-being in later life. 16 Sleep disturbances may contribute to fatigue and impaired cognitive function but may also be associated with heightened anxiety, depressive symptoms, and social withdrawal, all of which negatively affect QoL. These findings suggests that interventions targeting sleep quality, such as sleep hygiene education, relaxation techniques, or supportive environmental modifications may indirectly enhance broader aspects of life satisfaction and health-related outcomes among older adults. Given the demonstrated relationship between sleep and QoL, improving sleep behavior may represent an important consideration in geriatric care planning. Simple, non-pharmacological interventions such as sleep hygiene education, optimizing light and noise levels in care environments, and the establishment of individualized bedtime routines have been shown to be associated with improvements in sleep outcomes in institutional settings. 17 Beyond their potential clinical benefits, such approaches are cost-effective and minimally invasive, making them particularly suitable for implementation in resource-limited social care institutions. Incorporating sleep-focused programs into routine geriatric care not only addresses sleep disturbances directly but also has the potential to indirectly enhance emotional well-being, cognitive function, and overall QoL in older adults. This study further highlights the need for a paradigm shift in evaluation and promotion of quality of life in institutionalized older populations. Moving beyond traditional health metrics, a more holistic approach should integrate psychological comfort and environmental tranquillity, in which sleep quality may acts as a important mediator. Future studies may explore how sleep-focused interventions interact with other domains such as emotional well-being, daily functioning, and cognitive functioning to enhance QoL in later life. Several limitations of this study should be acknowledged. First, the cross-sectional design precludes causal inference, and the observed associations should be interpreted with caution. Second, although quality of life was measured using a validated instrument, several health-related behaviors, including sleep quality, nutritional intake, and disease prevention activities were assessed using self-reported descriptive measures, which may be subject to reporting bias. Third, the highly imbalanced distribution of QoL categories may have limited statistical power and affected the robustness of the bivariate analyses. Finally, as the study was conducted in a single social care center among institutionalized older adults with mild to moderate dependency, the findings may not be generalizable to community-dwelling older adults or to other sociocultural contexts. Ethical considerations Ethical principles were upheld throughout the study. Ethical approval was obtained from the Research Ethics Committee of Universitas Esa Unggul (No. 0923-10.010/DPKE-KEP/FINAL-EA/UEU/X/2023). All participants provided informed consent prior to participation. The study design, including the use of validated instruments and structured methodology, ensured the protection of participants’ rights and the integrity of the research process. Findings contribute to understanding key determinants of quality of life among older adults and support evidence-based interventions in social care settings. Conclusion This study identified sleep behavior as the only statistically significant associated with quality of life among older adults residing in a social care center. Although the majority of participants demonstrated adequate medication adherence, nutritional intake, disease prevention behavior, and physical activity, these factors were not significantly associated with overall QoL. This finding suggests that subjective dimensions particularly those related to rest and psychological well-being, may play a more prominent role in shaping perceived quality of life in late adulthood than objective health behaviors alone. The findings are consistent with international evidence, including a meta-analysis by Sella et al. (2023), which highlighted sleep quality as an important factors associated with emotional, psychological, and functional well-being among older adults. In institutional settings, where autonomy and environmental control may be limited, suboptimal sleep quality sleep may further intensity fatigue, emotional distress, and reduced life satisfaction. From a practical perspective, the result suggest that integrate sleep-focused strategies, such as sleep hygiene education, optimization of night time environments, and individualized bedtime schedules. Future studies employing longitudinal or interventional design are needed to further examine how improvements in sleep quality interact with psychological and functional domains to enhance QoL. Overall, addressing sleep quality may represent a feasible and cost-effective approach to supporting well-being among aging populations, particularly those living in intuitional care settings. Data availability The datasets generated and analyzed during the current study are available in the Zenodo repository, https://doi.org/10.5281/zenodo.17309312 , 18 under the Creative Commons Attribution 4.0 International (CC-BY 4.0) licence. Acknowledgement The authors would like to express their sincere gratitude to all participants for their valuable contributions to this study. The authors also acknowledge the institutional support provided by the Research and Community Service Institute of Universitas Esa Unggul, Indonesia, for facilitating the publication of this article. References 1. Michel JP, Leonardi M, Martin M, et al. : Development of a common scale for measuring healthy ageing across the world: Results from the ATHLOS consortium. International Journal of Epidemiology. 2021 Jun.; 50 . Geneva: Oxford University Press. 2. Rodríguez-Martínez A, De-la-Fuente-Robles YM, Martín-Cano M d C, et al. : Quality of life and well-being of Older adults in nursing homes: Systematic review. Social Sciences. Multidisciplinary Digital Publishing Institute (MDPI); 2023; vol. 12 . . 3. Bakerjian D: Quality of care for older adults in nursing homes: It begins with registered nurses but does not end there!. J. Am. Geriatr. Soc. 2024; 72 : 2292–2295. California: John Wiley and Sons Inc. Publisher Full Text 4. Baeriswyl M, Oris M: Social participation and life satisfaction among older adults: diversity of practices and social inequality in Switzerland. Ageing Soc. 2023 Jun 30; 43 (6): 1259–1283. Publisher Full Text 5. Susanti SM: The correlation of social support with the quality of life of the elderly. International Journal Of Health Science. 2025 Jul 7; 5 (2): 148–154. Publisher Full Text Reference Source 6. Marzo RR, Khanal P, Ahmad A, et al. : Quality of life of the elderly during the COVID-19 pandemic in asian countries: A cross-sectional study across six countries. Life. 2022 Mar 1; 12 (3): 1–11. Publisher Full Text 7. Cudjoe TKM, Roth DL, Szanton SL, et al. : The epidemiology of social isolation: National health and aging trends study. J. Gerontol. B Psychol. Sci. Soc. Sci. 2020 Jan 1; 75 (1): 107–113. PubMed Abstract | Publisher Full Text | Free Full Text 8. Rodrigues F, Monteiro AM, Forte P, et al. : Effects of muscle strength, agility, and fear of falling on risk of falling in older adults. Int. J. Environ. Res. Public Health. 2023 Mar 1; 20 (6): 1–8. Publisher Full Text 9. Hidayati AR, Gondodiputro S, Rahmiati L: Elderly Profile of Quality of Life Using WHOQOL-BREF Indonesian Version: A Community-Dwelling. Althea Medical Journal. 2018 Jun; 5 (2): 105–110. Publisher Full Text 10. Tucker E, Luscombe-Marsh N, Ambrosi C, et al. : Nutritional status and quality-of-life of older adults in aged care: A systematic review and meta-analysis. Exp. Gerontol. 2022 Jun 1; 162 : 111764–111768. Publisher Full Text 11. Tatineny P, Shafi F, Gohar A, et al. : Sleep in the Elderly. Missouri: 2020 Sep [cited 2025 Sep 16]. Reference Source 12. Gothe NP, Ehlers DK, Salerno EA, et al. : Physical activity, sleep and quality of life in older adults: Influence of physical, mental and social well-being. Behav. Sleep Med. 2020 Nov 1; 18 (6): 797–808. PubMed Abstract | Publisher Full Text | Free Full Text 13. de Almondes KM , Castro E d AS, Paiva T: Sleep habits, quality of life and psychosocial aspects in the older age: Before and during COVID-19. Front. Neurosci. 2022 Mar 24; 16 (March): 1–10. Publisher Full Text 14. 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Wihardja H: Dataset of “Determinants of Quality of Life Among Elderly in a Social Care Center: Emphasis on Sleep Behavior”. [Data set]. Determinants of Quality of Life Among Elderly in a Social Care Center: Emphasis on Sleep Behavior. Zenodo. 2025. Publisher Full Text Comments on this article Comments (1) Version 4 VERSION 4 PUBLISHED 23 Mar 2026 Revised Comment ADD YOUR COMMENT Version 2 VERSION 2 PUBLISHED 05 Dec 2025 Revised Discussion is closed on this version, please comment on the latest version above. Reader Comment 10 Jan 2026 Iago Giné-Vázquez , Instituto de Investigacion Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain 10 Jan 2026 Reader Comment The first reference seems a mixture of two references, on one hand (by authors and date) Michel JP, Leonardi M, Martin M, Prina M. WHO’s report for the decade ... Continue reading The first reference seems a mixture of two references, on one hand (by authors and date) Michel JP, Leonardi M, Martin M, Prina M. WHO’s report for the decade of healthy ageing 2021–30 sets the stage for globally comparable data on healthy ageing. The Lancet Healthy Longevity. 2021 Mar;2(3):e121–2. and on the other hand (by title and journal) Sanchez-Niubo A, Forero CG, Wu YT, Giné-Vázquez I, Prina M, Fuente JDL, et al. Development of a common scale for measuring healthy ageing across the world: results from the ATHLOS consortium. International Journal of Epidemiology. 2020 Dec;dyaa236. By the content, it seems authors meant the first one. The first reference seems a mixture of two references, on one hand (by authors and date) Michel JP, Leonardi M, Martin M, Prina M. WHO’s report for the decade of healthy ageing 2021–30 sets the stage for globally comparable data on healthy ageing. The Lancet Healthy Longevity. 2021 Mar;2(3):e121–2. and on the other hand (by title and journal) Sanchez-Niubo A, Forero CG, Wu YT, Giné-Vázquez I, Prina M, Fuente JDL, et al. Development of a common scale for measuring healthy ageing across the world: results from the ATHLOS consortium. International Journal of Epidemiology. 2020 Dec;dyaa236. By the content, it seems authors meant the first one. Competing Interests: No competing interests were disclosed. Close Report a concern Discussion is closed on this version, please comment on the latest version above. Author details Author details 1 Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Sabah, 88400, Malaysia 2 Department of Nursing Program,, Universitas Esa Unggul, West Jakarta, Jakarta, Indonesia 3 Department of Nursing Program, Sekolah Tinggi Ilmu Kesehatan Mayapada, Jakarta, Indonesia 4 Department of Computer Program, Universitas Esa Unggul, West Jakarta, Jakarta, 11510, Indonesia Yuliati Yuliati Roles: Conceptualization, Data Curation, Funding Acquisition, Writing – Original Draft Preparation Hany Wihardja Roles: Data Curation, Formal Analysis, Methodology, Software, Writing – Original Draft Preparation, Writing – Review & Editing Ari Pambudi Roles: Software, Validation, Visualization, Writing – Original Draft Preparation Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (4) version 4 Revised Published: 23 Mar 2026, 14:1217 https://doi.org/10.12688/f1000research.171903.4 version 3 Revised Published: 18 Feb 2026, 14:1217 https://doi.org/10.12688/f1000research.171903.3 version 2 Revised Published: 05 Dec 2025, 14:1217 https://doi.org/10.12688/f1000research.171903.2 version 1 Published: 06 Nov 2025, 14:1217 https://doi.org/10.12688/f1000research.171903.1 Copyright © 2026 Yuliati Y et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Yuliati Y, Wihardja H and Pambudi A. Determinants of Quality of Life Among Older Adults in a Social Care Center: Emphasis on Sleep [version 4; peer review: 1 approved, 1 not approved] . F1000Research 2026, 14 :1217 ( https://doi.org/10.12688/f1000research.171903.4 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 3 VERSION 3 PUBLISHED 18 Feb 2026 Revised Views 0 Cite How to cite this report: Schrire ZM. Reviewer Report For: Determinants of Quality of Life Among Older Adults in a Social Care Center: Emphasis on Sleep [version 4; peer review: 1 approved, 1 not approved] . F1000Research 2026, 14 :1217 ( https://doi.org/10.5256/f1000research.196011.r459636 ) The direct URL for this report is: https://f1000research.com/articles/14-1217/v3#referee-response-459636 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 23 Feb 2026 Zoe Menczel Schrire , University of Sydney, Sydney, New South Wales, Australia Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.196011.r459636 1. I appreciate the authors’ efforts to incorporate several of the previous comments, including clarifying the rationale for the age inclusion criteria, reducing causal language, and revising the statistical approach. However, although the chi‑square test has been substituted, the cell sizes ... Continue reading READ ALL 1. I appreciate the authors’ efforts to incorporate several of the previous comments, including clarifying the rationale for the age inclusion criteria, reducing causal language, and revising the statistical approach. However, although the chi‑square test has been substituted, the cell sizes remain too small for this test to be valid. As a result, the subsequent discussion interpreting the null findings remains difficult to support. An alternative statistical test more appropriate for sparse data may be needed. 2. In the response to my earlier review, the authors indicated that all references to social support had been removed. However, social support continues to appear throughout the introduction, including the final sentence, which states: “By positioning social support as a central variable.” This discrepancy should be addressed for clarity and consistency. 3. There still appears to be a discrepancy between Table 2 and Table 3. In Table 3, a substantially larger number of participants are categorised as having poor QoL, whereas Table 2 reports only nine participants in this category. This inconsistency suggests that headings or classifications may still be misaligned and would benefit from verification. 4. The methods section continues to lack detail on how health‑related behaviors, such as sleep quality, nutritional intake, and disease‑prevention activities, were assessed. It would be helpful to specify the structured self‑report items or instruments used to collect these variables. Competing Interests: No competing interests were disclosed. Reviewer Expertise: older adults and dementia, sleep and circadian rhythms I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Schrire ZM. Reviewer Report For: Determinants of Quality of Life Among Older Adults in a Social Care Center: Emphasis on Sleep [version 4; peer review: 1 approved, 1 not approved] . F1000Research 2026, 14 :1217 ( https://doi.org/10.5256/f1000research.196011.r459636 ) The direct URL for this report is: https://f1000research.com/articles/14-1217/v3#referee-response-459636 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 23 Mar 2026 Yuliati Yuliati , Department of Nursing Program, Sekolah Tinggi Ilmu Kesehatan Mayapada, Jakarta, Indonesia 23 Mar 2026 Author Response Hi Zoe, Greetings from Indonesia, and thank you for your time and thoughtful effort in reviewing our manuscript. We greatly appreciate your constructive comments and suggestions, which have been ... Continue reading Hi Zoe, Greetings from Indonesia, and thank you for your time and thoughtful effort in reviewing our manuscript. We greatly appreciate your constructive comments and suggestions, which have been very helpful in improving the clarity and quality of our paper. We have carefully revised the manuscript and addressed each of your comments to the best of our ability. Below we provide a detailed response to your feedback. 1. I appreciate the authors’ efforts to incorporate several of the previous comments, including clarifying the rationale for the age inclusion criteria, reducing causal language, and revising the statistical approach. However, although the chi‑square test has been substituted, the cell sizes remain too small for this test to be valid. As a result, the subsequent discussion interpreting the null findings remains difficult to support. An alternative statistical test more appropriate for sparse data may be needed. Response: Thank you for this important comment. We agree that when contingency table cell counts are small, the chi-square test may not be appropriate. We would like to clarify that the bivariate analysis in this study was actually conducted using Fisher’s exact test , which is more suitable for contingency tables with small expected cell counts. However, due to an oversight during manuscript preparation, the statistical method was incorrectly described in the Methods section. We have now revised the Methods section to clearly state that Fisher’s exact test was used to examine the associations between categorical variables. The p-values reported in the Results section were derived from Fisher’s exact test. To ensure transparency, the corresponding SPSS output indicating Fisher’s exact test results has been attached. The manuscript has been revised accordingly to ensure that the statistical methods are accurately described. 2. In the response to my earlier review, the authors indicated that all references to social support had been removed. However, social support continues to appear throughout the introduction, including the final sentence, which states: “By positioning social support as a central variable.” This discrepancy should be addressed for clarity and consistency. Response: Thank you for highlighting this inconsistency. We apologize for the oversight in the previous version of the manuscript. In response to this comment, we have carefully revised the entire Introduction and removed the remaining references to social support to ensure clarity and consistency with the focus of the study. The final sentence of the Introduction has also been revised to reflect that the study examines health-related factors associated with quality of life, rather than positioning social support as a central variable. The Introduction section has been updated accordingly. 3. There still appears to be a discrepancy between Table 2 and Table 3. In Table 3, a substantially larger number of participants are categorised as having poor QoL, whereas Table 2 reports only nine participants in this category. This inconsistency suggests that headings or classifications may still be misaligned and would benefit from verification. Response: Thank you for carefully pointing out this discrepancy. We apologize for the error in the previous version of Table III. The inconsistency occurred due to an incorrect entry during the table preparation process. We have now corrected Table III so that the QoL categorization is consistent with the data presented in Table II. The revised table now accurately reflects the distribution of participants, with nine respondents categorized as having poor QoL, consistent with the bivariate analysis results. For transparency, the corrected Table III has been updated in the manuscript and corresponds with the bivariate analysis output provided in response to Comment 1. 4. The methods section continues to lack detail on how health‑related behaviors, such as sleep quality, nutritional intake, and disease‑prevention activities, were assessed. It would be helpful to specify the structured self‑report items or instruments used to collect these variables. Response: Thank you for this helpful comment. We agree that additional clarification regarding the assessment of health-related behaviors is important. The Methods section has now been revised to provide a clearer description of how these variables were measured. Specifically, sleep quality, nutritional intake, disease prevention activities, medication adherence, and physical exercise were assessed using structured self-report items administered to participants. The revised manuscript now includes a detailed explanation of the assessment approach and the categorization of responses. SPSS Output Proof Thank you again for your valuable input. Hi Zoe, Greetings from Indonesia, and thank you for your time and thoughtful effort in reviewing our manuscript. We greatly appreciate your constructive comments and suggestions, which have been very helpful in improving the clarity and quality of our paper. We have carefully revised the manuscript and addressed each of your comments to the best of our ability. Below we provide a detailed response to your feedback. 1. I appreciate the authors’ efforts to incorporate several of the previous comments, including clarifying the rationale for the age inclusion criteria, reducing causal language, and revising the statistical approach. However, although the chi‑square test has been substituted, the cell sizes remain too small for this test to be valid. As a result, the subsequent discussion interpreting the null findings remains difficult to support. An alternative statistical test more appropriate for sparse data may be needed. Response: Thank you for this important comment. We agree that when contingency table cell counts are small, the chi-square test may not be appropriate. We would like to clarify that the bivariate analysis in this study was actually conducted using Fisher’s exact test , which is more suitable for contingency tables with small expected cell counts. However, due to an oversight during manuscript preparation, the statistical method was incorrectly described in the Methods section. We have now revised the Methods section to clearly state that Fisher’s exact test was used to examine the associations between categorical variables. The p-values reported in the Results section were derived from Fisher’s exact test. To ensure transparency, the corresponding SPSS output indicating Fisher’s exact test results has been attached. The manuscript has been revised accordingly to ensure that the statistical methods are accurately described. 2. In the response to my earlier review, the authors indicated that all references to social support had been removed. However, social support continues to appear throughout the introduction, including the final sentence, which states: “By positioning social support as a central variable.” This discrepancy should be addressed for clarity and consistency. Response: Thank you for highlighting this inconsistency. We apologize for the oversight in the previous version of the manuscript. In response to this comment, we have carefully revised the entire Introduction and removed the remaining references to social support to ensure clarity and consistency with the focus of the study. The final sentence of the Introduction has also been revised to reflect that the study examines health-related factors associated with quality of life, rather than positioning social support as a central variable. The Introduction section has been updated accordingly. 3. There still appears to be a discrepancy between Table 2 and Table 3. In Table 3, a substantially larger number of participants are categorised as having poor QoL, whereas Table 2 reports only nine participants in this category. This inconsistency suggests that headings or classifications may still be misaligned and would benefit from verification. Response: Thank you for carefully pointing out this discrepancy. We apologize for the error in the previous version of Table III. The inconsistency occurred due to an incorrect entry during the table preparation process. We have now corrected Table III so that the QoL categorization is consistent with the data presented in Table II. The revised table now accurately reflects the distribution of participants, with nine respondents categorized as having poor QoL, consistent with the bivariate analysis results. For transparency, the corrected Table III has been updated in the manuscript and corresponds with the bivariate analysis output provided in response to Comment 1. 4. The methods section continues to lack detail on how health‑related behaviors, such as sleep quality, nutritional intake, and disease‑prevention activities, were assessed. It would be helpful to specify the structured self‑report items or instruments used to collect these variables. Response: Thank you for this helpful comment. We agree that additional clarification regarding the assessment of health-related behaviors is important. The Methods section has now been revised to provide a clearer description of how these variables were measured. Specifically, sleep quality, nutritional intake, disease prevention activities, medication adherence, and physical exercise were assessed using structured self-report items administered to participants. The revised manuscript now includes a detailed explanation of the assessment approach and the categorization of responses. SPSS Output Proof Thank you again for your valuable input. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 23 Mar 2026 Yuliati Yuliati , Department of Nursing Program, Sekolah Tinggi Ilmu Kesehatan Mayapada, Jakarta, Indonesia 23 Mar 2026 Author Response Hi Zoe, Greetings from Indonesia, and thank you for your time and thoughtful effort in reviewing our manuscript. We greatly appreciate your constructive comments and suggestions, which have been ... Continue reading Hi Zoe, Greetings from Indonesia, and thank you for your time and thoughtful effort in reviewing our manuscript. We greatly appreciate your constructive comments and suggestions, which have been very helpful in improving the clarity and quality of our paper. We have carefully revised the manuscript and addressed each of your comments to the best of our ability. Below we provide a detailed response to your feedback. 1. I appreciate the authors’ efforts to incorporate several of the previous comments, including clarifying the rationale for the age inclusion criteria, reducing causal language, and revising the statistical approach. However, although the chi‑square test has been substituted, the cell sizes remain too small for this test to be valid. As a result, the subsequent discussion interpreting the null findings remains difficult to support. An alternative statistical test more appropriate for sparse data may be needed. Response: Thank you for this important comment. We agree that when contingency table cell counts are small, the chi-square test may not be appropriate. We would like to clarify that the bivariate analysis in this study was actually conducted using Fisher’s exact test , which is more suitable for contingency tables with small expected cell counts. However, due to an oversight during manuscript preparation, the statistical method was incorrectly described in the Methods section. We have now revised the Methods section to clearly state that Fisher’s exact test was used to examine the associations between categorical variables. The p-values reported in the Results section were derived from Fisher’s exact test. To ensure transparency, the corresponding SPSS output indicating Fisher’s exact test results has been attached. The manuscript has been revised accordingly to ensure that the statistical methods are accurately described. 2. In the response to my earlier review, the authors indicated that all references to social support had been removed. However, social support continues to appear throughout the introduction, including the final sentence, which states: “By positioning social support as a central variable.” This discrepancy should be addressed for clarity and consistency. Response: Thank you for highlighting this inconsistency. We apologize for the oversight in the previous version of the manuscript. In response to this comment, we have carefully revised the entire Introduction and removed the remaining references to social support to ensure clarity and consistency with the focus of the study. The final sentence of the Introduction has also been revised to reflect that the study examines health-related factors associated with quality of life, rather than positioning social support as a central variable. The Introduction section has been updated accordingly. 3. There still appears to be a discrepancy between Table 2 and Table 3. In Table 3, a substantially larger number of participants are categorised as having poor QoL, whereas Table 2 reports only nine participants in this category. This inconsistency suggests that headings or classifications may still be misaligned and would benefit from verification. Response: Thank you for carefully pointing out this discrepancy. We apologize for the error in the previous version of Table III. The inconsistency occurred due to an incorrect entry during the table preparation process. We have now corrected Table III so that the QoL categorization is consistent with the data presented in Table II. The revised table now accurately reflects the distribution of participants, with nine respondents categorized as having poor QoL, consistent with the bivariate analysis results. For transparency, the corrected Table III has been updated in the manuscript and corresponds with the bivariate analysis output provided in response to Comment 1. 4. The methods section continues to lack detail on how health‑related behaviors, such as sleep quality, nutritional intake, and disease‑prevention activities, were assessed. It would be helpful to specify the structured self‑report items or instruments used to collect these variables. Response: Thank you for this helpful comment. We agree that additional clarification regarding the assessment of health-related behaviors is important. The Methods section has now been revised to provide a clearer description of how these variables were measured. Specifically, sleep quality, nutritional intake, disease prevention activities, medication adherence, and physical exercise were assessed using structured self-report items administered to participants. The revised manuscript now includes a detailed explanation of the assessment approach and the categorization of responses. SPSS Output Proof Thank you again for your valuable input. Hi Zoe, Greetings from Indonesia, and thank you for your time and thoughtful effort in reviewing our manuscript. We greatly appreciate your constructive comments and suggestions, which have been very helpful in improving the clarity and quality of our paper. We have carefully revised the manuscript and addressed each of your comments to the best of our ability. Below we provide a detailed response to your feedback. 1. I appreciate the authors’ efforts to incorporate several of the previous comments, including clarifying the rationale for the age inclusion criteria, reducing causal language, and revising the statistical approach. However, although the chi‑square test has been substituted, the cell sizes remain too small for this test to be valid. As a result, the subsequent discussion interpreting the null findings remains difficult to support. An alternative statistical test more appropriate for sparse data may be needed. Response: Thank you for this important comment. We agree that when contingency table cell counts are small, the chi-square test may not be appropriate. We would like to clarify that the bivariate analysis in this study was actually conducted using Fisher’s exact test , which is more suitable for contingency tables with small expected cell counts. However, due to an oversight during manuscript preparation, the statistical method was incorrectly described in the Methods section. We have now revised the Methods section to clearly state that Fisher’s exact test was used to examine the associations between categorical variables. The p-values reported in the Results section were derived from Fisher’s exact test. To ensure transparency, the corresponding SPSS output indicating Fisher’s exact test results has been attached. The manuscript has been revised accordingly to ensure that the statistical methods are accurately described. 2. In the response to my earlier review, the authors indicated that all references to social support had been removed. However, social support continues to appear throughout the introduction, including the final sentence, which states: “By positioning social support as a central variable.” This discrepancy should be addressed for clarity and consistency. Response: Thank you for highlighting this inconsistency. We apologize for the oversight in the previous version of the manuscript. In response to this comment, we have carefully revised the entire Introduction and removed the remaining references to social support to ensure clarity and consistency with the focus of the study. The final sentence of the Introduction has also been revised to reflect that the study examines health-related factors associated with quality of life, rather than positioning social support as a central variable. The Introduction section has been updated accordingly. 3. There still appears to be a discrepancy between Table 2 and Table 3. In Table 3, a substantially larger number of participants are categorised as having poor QoL, whereas Table 2 reports only nine participants in this category. This inconsistency suggests that headings or classifications may still be misaligned and would benefit from verification. Response: Thank you for carefully pointing out this discrepancy. We apologize for the error in the previous version of Table III. The inconsistency occurred due to an incorrect entry during the table preparation process. We have now corrected Table III so that the QoL categorization is consistent with the data presented in Table II. The revised table now accurately reflects the distribution of participants, with nine respondents categorized as having poor QoL, consistent with the bivariate analysis results. For transparency, the corrected Table III has been updated in the manuscript and corresponds with the bivariate analysis output provided in response to Comment 1. 4. The methods section continues to lack detail on how health‑related behaviors, such as sleep quality, nutritional intake, and disease‑prevention activities, were assessed. It would be helpful to specify the structured self‑report items or instruments used to collect these variables. Response: Thank you for this helpful comment. We agree that additional clarification regarding the assessment of health-related behaviors is important. The Methods section has now been revised to provide a clearer description of how these variables were measured. Specifically, sleep quality, nutritional intake, disease prevention activities, medication adherence, and physical exercise were assessed using structured self-report items administered to participants. The revised manuscript now includes a detailed explanation of the assessment approach and the categorization of responses. SPSS Output Proof Thank you again for your valuable input. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Version 2 VERSION 2 PUBLISHED 05 Dec 2025 Revised Views 0 Cite How to cite this report: Schrire ZM. Reviewer Report For: Determinants of Quality of Life Among Older Adults in a Social Care Center: Emphasis on Sleep [version 4; peer review: 1 approved, 1 not approved] . F1000Research 2026, 14 :1217 ( https://doi.org/10.5256/f1000research.192434.r451079 ) The direct URL for this report is: https://f1000research.com/articles/14-1217/v2#referee-response-451079 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 29 Jan 2026 Zoe Menczel Schrire , University of Sydney, Sydney, New South Wales, Australia Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.192434.r451079 This manuscript explores factors related to quality of life (QoL) in an adult population and addresses a topic of clear relevance. However, several conceptual and methodological issues need to be addressed to strengthen the clarity, coherence, and interpretability of the ... Continue reading READ ALL This manuscript explores factors related to quality of life (QoL) in an adult population and addresses a topic of clear relevance. However, several conceptual and methodological issues need to be addressed to strengthen the clarity, coherence, and interpretability of the findings. One key issue concerns the alignment between the stated research question and the measures used in the study. The authors indicate that the aim is 'to understand whether, and to what extent, the presence, quality, and consistency of social support enhance different dimensions of quality of life'. Despite this, social support is not clearly defined, measured, or reported in the methods or results. Clarifying how social support was operationalised or revising the research question to better reflect the measured variables, would substantially improve the coherence of the manuscript. Greater conceptual clarity is also needed. A clear definition of QoL should be provided earlier in the manuscript, rather than appearing primarily in the discussion. In addition, the manuscript at times uses language that implies causality. Given the observational nature of the study, it would be important to consistently frame the findings as associations and to explicitly acknowledge limitations related to directionality. The study population and inclusion criteria would benefit from further justification. The age threshold of 46 years appears inconsistent with the manuscript’s definition of older adults as those aged 60 years and above. Moreover, most participants were under 55 years of age and employed, suggesting relatively high levels of social engagement. Additional explanation is needed to justify the focus on social support in this sample, along with clearer description of the “social care centre” context and the level of participant independence. Several methodological details require clarification. Key variables such as sleep quality, infection prevention, and medication adherence are insufficiently described, with limited information on how these constructs were measured or whether validated tools were used. In particular, the assessment of sleep relies on subjective categories without reference to established or objective measures, which should be acknowledged as a limitation. A major methodological concern relates to the extreme imbalance in outcome and predictor group sizes. For example, QoL is overwhelmingly classified as “good” (279 participants) compared with “poor” (9 participants). When one category dominates to this extent, statistical comparisons and regression estimates become unstable and may be unreliable. Such imbalance substantially limits statistical power to detect true associations and increases the risk of misleading or non-generalisable results. Similar issues appear in other variables, where most groups exceed 90% in a single category. These distributions call into question whether the chosen analytical approach is appropriate for the data. Concerns regarding imbalance are further highlighted in Table 3, where some cell counts do not appear to align logically with reported totals, suggesting possible mislabelling or analytical inconsistencies. If variables were analysed categorically, this approach is problematic given the small cell sizes in some groups. The methods section would benefit from explicit clarification of how variables were entered into the regression models (categorical vs continuous) and whether assumptions for these analyses were met. In the discussion, the findings are occasionally overstated given the uneven group distributions and limited power. A more cautious interpretation, alongside acknowledgment that the study was conducted in Indonesia and may not generalise to other cultural contexts, would strengthen the manuscript. Finally, the inclusion of a dedicated limitations section is recommended, as several important methodological and interpretive constraints warrant explicit discussion. Overall, the study addresses a meaningful topic, and with clearer alignment between aims and measures, improved methodological transparency, and more careful interpretation of findings, the manuscript could be substantially strengthened. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? No Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? No Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? No Competing Interests: No competing interests were disclosed. Reviewer Expertise: older adults and dementia, sleep and circadian rhythms I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Schrire ZM. Reviewer Report For: Determinants of Quality of Life Among Older Adults in a Social Care Center: Emphasis on Sleep [version 4; peer review: 1 approved, 1 not approved] . F1000Research 2026, 14 :1217 ( https://doi.org/10.5256/f1000research.192434.r451079 ) The direct URL for this report is: https://f1000research.com/articles/14-1217/v2#referee-response-451079 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 30 Jan 2026 Yuliati Yuliati , Department of Nursing Program, Sekolah Tinggi Ilmu Kesehatan Mayapada, Jakarta, Indonesia 30 Jan 2026 Author Response Hi Zoe, Thank you for your valuable suggestions. We greatly appreciate your feedback and will revise the manuscript carefully in line with your comments. Competing Interests: No competing interests were disclosed. Hi Zoe, Thank you for your valuable suggestions. We greatly appreciate your feedback and will revise the manuscript carefully in line with your comments. Hi Zoe, Thank you for your valuable suggestions. We greatly appreciate your feedback and will revise the manuscript carefully in line with your comments. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 30 Jan 2026 Yuliati Yuliati , Department of Nursing Program, Sekolah Tinggi Ilmu Kesehatan Mayapada, Jakarta, Indonesia 30 Jan 2026 Author Response Hi Zoe, Thank you for your valuable suggestions. We greatly appreciate your feedback and will revise the manuscript carefully in line with your comments. Competing Interests: No competing interests were disclosed. Hi Zoe, Thank you for your valuable suggestions. We greatly appreciate your feedback and will revise the manuscript carefully in line with your comments. Hi Zoe, Thank you for your valuable suggestions. We greatly appreciate your feedback and will revise the manuscript carefully in line with your comments. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: PRIMA A. Reviewer Report For: Determinants of Quality of Life Among Older Adults in a Social Care Center: Emphasis on Sleep [version 4; peer review: 1 approved, 1 not approved] . F1000Research 2026, 14 :1217 ( https://doi.org/10.5256/f1000research.192434.r439087 ) The direct URL for this report is: https://f1000research.com/articles/14-1217/v2#referee-response-439087 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 29 Dec 2025 ASHAR PRIMA , Department Of Medical-Surgical Nursing, Universitas Bani Saleh, Margahayu, West Java, Indonesia Approved VIEWS 0 https://doi.org/10.5256/f1000research.192434.r439087 The authors have addressed the minor issues identified in the previous review. The correction of the first author’s affiliation has improved the accuracy of the authorship information. Additionally, the revision of the narrative description related to Table II, specifically ... Continue reading READ ALL The authors have addressed the minor issues identified in the previous review. The correction of the first author’s affiliation has improved the accuracy of the authorship information. Additionally, the revision of the narrative description related to Table II, specifically the clarification that good Quality of Life (QoL) is the dominant category is appropriate and now accurately reflects the presented data. These revisions enhance the clarity and consistency of the manuscript. No further concerns regarding findings or interpretations. The manuscript is acceptable in its current form. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Gerontology, Geriatric Palliative Care I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT PRIMA A. Reviewer Report For: Determinants of Quality of Life Among Older Adults in a Social Care Center: Emphasis on Sleep [version 4; peer review: 1 approved, 1 not approved] . F1000Research 2026, 14 :1217 ( https://doi.org/10.5256/f1000research.192434.r439087 ) The direct URL for this report is: https://f1000research.com/articles/14-1217/v2#referee-response-439087 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 06 Nov 2025 Views 0 Cite How to cite this report: PRIMA A. Reviewer Report For: Determinants of Quality of Life Among Older Adults in a Social Care Center: Emphasis on Sleep [version 4; peer review: 1 approved, 1 not approved] . F1000Research 2026, 14 :1217 ( https://doi.org/10.5256/f1000research.189568.r430711 ) The direct URL for this report is: https://f1000research.com/articles/14-1217/v1#referee-response-430711 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 21 Nov 2025 ASHAR PRIMA , Department Of Medical-Surgical Nursing, Universitas Bani Saleh, Margahayu, West Java, Indonesia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.189568.r430711 1. Presentation clarity and data consistency The manuscript contains several internal inconsistencies that must be corrected before the results can be indexed as scientifically credible. Table II reports that 96.9% of respondents have good QoL, ... Continue reading READ ALL 1. Presentation clarity and data consistency The manuscript contains several internal inconsistencies that must be corrected before the results can be indexed as scientifically credible. Table II reports that 96.9% of respondents have good QoL, and 3.1% have poor QoL. However, the narrative text and Table III state that the majority have poor QoL. These contradictions indicate either a data labeling error, misclassification, or table misplacement. This must be corrected urgently because it affects the interpretation of the entire study. 2. Definition of “elderly” is inconsistent The introduction references WHO standards (≥ 60 years), but: The inclusion criteria list ≥ 50 years A category “Early Elderly 46–55 years” appears in the results This is inconsistent and scientifically problematic. A clear, single definition of the target population is needed, with justification if the study deviates from WHO cut-offs. 3. Instruments and operational definitions are insufficiently described The authors state that a “researcher-developed” social support questionnaire was used but do not provide: item structure scoring system cut-off definitions validity statistics reliability coefficients (e.g., Cronbach’s alpha) Similarly, the operationalization of “sleep behavior,” “medication adherence,” “nutritional intake,” “infection prevention,” and “physical activity” is not described. Without this, the study is not reproducible . Authors must provide the full questionnaire and scoring rules as supplementary material. 4. Statistical analysis is insufficient and partly inappropriate The manuscript reports p-values, but the type of statistical tests used are not clearly stated. Moreover: If QoL is categorical (good vs poor), linear regression is inappropriate . No multivariable analysis was performed to control for confounders (age, gender, education, comorbidity, length of stay). No effect sizes or confidence intervals are reported. Given the nature of the variables, multivariable logistic regression would be appropriate if QoL is dichotomized. If QoL domain scores are continuous, then multiple linear regression can be used — but assumptions must be tested and reported. At minimum: report odds ratios / β coefficients 95% confidence intervals specify exact statistical tests used provide justification for model selection 5. Conclusions are overstated The manuscript frequently uses causal language (“determinants”). With a cross-sectional design and no multivariable model, causal inference is not justified. The conclusions should be toned down to “associated with.” Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Gerontology, Geriatric Palliative Care I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT PRIMA A. Reviewer Report For: Determinants of Quality of Life Among Older Adults in a Social Care Center: Emphasis on Sleep [version 4; peer review: 1 approved, 1 not approved] . F1000Research 2026, 14 :1217 ( https://doi.org/10.5256/f1000research.189568.r430711 ) The direct URL for this report is: https://f1000research.com/articles/14-1217/v1#referee-response-430711 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (1) Version 4 VERSION 4 PUBLISHED 23 Mar 2026 Revised Comment ADD YOUR COMMENT Version 2 VERSION 2 PUBLISHED 05 Dec 2025 Revised Discussion is closed on this version, please comment on the latest version above. Reader Comment 10 Jan 2026 Iago Giné-Vázquez , Instituto de Investigacion Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain 10 Jan 2026 Reader Comment The first reference seems a mixture of two references, on one hand (by authors and date) Michel JP, Leonardi M, Martin M, Prina M. WHO’s report for the decade ... Continue reading The first reference seems a mixture of two references, on one hand (by authors and date) Michel JP, Leonardi M, Martin M, Prina M. WHO’s report for the decade of healthy ageing 2021–30 sets the stage for globally comparable data on healthy ageing. The Lancet Healthy Longevity. 2021 Mar;2(3):e121–2. and on the other hand (by title and journal) Sanchez-Niubo A, Forero CG, Wu YT, Giné-Vázquez I, Prina M, Fuente JDL, et al. Development of a common scale for measuring healthy ageing across the world: results from the ATHLOS consortium. International Journal of Epidemiology. 2020 Dec;dyaa236. By the content, it seems authors meant the first one. The first reference seems a mixture of two references, on one hand (by authors and date) Michel JP, Leonardi M, Martin M, Prina M. WHO’s report for the decade of healthy ageing 2021–30 sets the stage for globally comparable data on healthy ageing. The Lancet Healthy Longevity. 2021 Mar;2(3):e121–2. and on the other hand (by title and journal) Sanchez-Niubo A, Forero CG, Wu YT, Giné-Vázquez I, Prina M, Fuente JDL, et al. Development of a common scale for measuring healthy ageing across the world: results from the ATHLOS consortium. International Journal of Epidemiology. 2020 Dec;dyaa236. By the content, it seems authors meant the first one. Competing Interests: No competing interests were disclosed. Close Report a concern Discussion is closed on this version, please comment on the latest version above. keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 4 (revision) 23 Mar 26 Version 3 (revision) 18 Feb 26 read Version 2 (revision) 05 Dec 25 read read Version 1 06 Nov 25 read ASHAR PRIMA , Universitas Bani Saleh, Margahayu, Indonesia Zoe Menczel Schrire , University of Sydney, Sydney, Australia Comments on this article All Comments (1) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Schrire Z. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 23 Feb 2026 | for Version 3 Zoe Menczel Schrire , University of Sydney, Sydney, New South Wales, Australia 0 Views copyright © 2026 Schrire Z. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions 1. I appreciate the authors’ efforts to incorporate several of the previous comments, including clarifying the rationale for the age inclusion criteria, reducing causal language, and revising the statistical approach. However, although the chi‑square test has been substituted, the cell sizes remain too small for this test to be valid. As a result, the subsequent discussion interpreting the null findings remains difficult to support. An alternative statistical test more appropriate for sparse data may be needed. 2. In the response to my earlier review, the authors indicated that all references to social support had been removed. However, social support continues to appear throughout the introduction, including the final sentence, which states: “By positioning social support as a central variable.” This discrepancy should be addressed for clarity and consistency. 3. There still appears to be a discrepancy between Table 2 and Table 3. In Table 3, a substantially larger number of participants are categorised as having poor QoL, whereas Table 2 reports only nine participants in this category. This inconsistency suggests that headings or classifications may still be misaligned and would benefit from verification. 4. The methods section continues to lack detail on how health‑related behaviors, such as sleep quality, nutritional intake, and disease‑prevention activities, were assessed. It would be helpful to specify the structured self‑report items or instruments used to collect these variables. Competing Interests No competing interests were disclosed. Reviewer Expertise older adults and dementia, sleep and circadian rhythms I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (1) Author Response 23 Mar 2026 Yuliati Yuliati, Department of Nursing Program, Sekolah Tinggi Ilmu Kesehatan Mayapada, Jakarta, Indonesia Hi Zoe, Greetings from Indonesia, and thank you for your time and thoughtful effort in reviewing our manuscript. We greatly appreciate your constructive comments and suggestions, which have been very helpful in improving the clarity and quality of our paper. We have carefully revised the manuscript and addressed each of your comments to the best of our ability. Below we provide a detailed response to your feedback. 1. I appreciate the authors’ efforts to incorporate several of the previous comments, including clarifying the rationale for the age inclusion criteria, reducing causal language, and revising the statistical approach. However, although the chi‑square test has been substituted, the cell sizes remain too small for this test to be valid. As a result, the subsequent discussion interpreting the null findings remains difficult to support. An alternative statistical test more appropriate for sparse data may be needed. Response: Thank you for this important comment. We agree that when contingency table cell counts are small, the chi-square test may not be appropriate. We would like to clarify that the bivariate analysis in this study was actually conducted using Fisher’s exact test , which is more suitable for contingency tables with small expected cell counts. However, due to an oversight during manuscript preparation, the statistical method was incorrectly described in the Methods section. We have now revised the Methods section to clearly state that Fisher’s exact test was used to examine the associations between categorical variables. The p-values reported in the Results section were derived from Fisher’s exact test. To ensure transparency, the corresponding SPSS output indicating Fisher’s exact test results has been attached. The manuscript has been revised accordingly to ensure that the statistical methods are accurately described. 2. In the response to my earlier review, the authors indicated that all references to social support had been removed. However, social support continues to appear throughout the introduction, including the final sentence, which states: “By positioning social support as a central variable.” This discrepancy should be addressed for clarity and consistency. Response: Thank you for highlighting this inconsistency. We apologize for the oversight in the previous version of the manuscript. In response to this comment, we have carefully revised the entire Introduction and removed the remaining references to social support to ensure clarity and consistency with the focus of the study. The final sentence of the Introduction has also been revised to reflect that the study examines health-related factors associated with quality of life, rather than positioning social support as a central variable. The Introduction section has been updated accordingly. 3. There still appears to be a discrepancy between Table 2 and Table 3. In Table 3, a substantially larger number of participants are categorised as having poor QoL, whereas Table 2 reports only nine participants in this category. This inconsistency suggests that headings or classifications may still be misaligned and would benefit from verification. Response: Thank you for carefully pointing out this discrepancy. We apologize for the error in the previous version of Table III. The inconsistency occurred due to an incorrect entry during the table preparation process. We have now corrected Table III so that the QoL categorization is consistent with the data presented in Table II. The revised table now accurately reflects the distribution of participants, with nine respondents categorized as having poor QoL, consistent with the bivariate analysis results. For transparency, the corrected Table III has been updated in the manuscript and corresponds with the bivariate analysis output provided in response to Comment 1. 4. The methods section continues to lack detail on how health‑related behaviors, such as sleep quality, nutritional intake, and disease‑prevention activities, were assessed. It would be helpful to specify the structured self‑report items or instruments used to collect these variables. Response: Thank you for this helpful comment. We agree that additional clarification regarding the assessment of health-related behaviors is important. The Methods section has now been revised to provide a clearer description of how these variables were measured. Specifically, sleep quality, nutritional intake, disease prevention activities, medication adherence, and physical exercise were assessed using structured self-report items administered to participants. The revised manuscript now includes a detailed explanation of the assessment approach and the categorization of responses. SPSS Output Proof Thank you again for your valuable input. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Schrire ZM. Peer Review Report For: Determinants of Quality of Life Among Older Adults in a Social Care Center: Emphasis on Sleep [version 4; peer review: 1 approved, 1 not approved] . F1000Research 2026, 14 :1217 ( https://doi.org/10.5256/f1000research.196011.r459636) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-1217/v3#referee-response-459636 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Schrire Z. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 29 Jan 2026 | for Version 2 Zoe Menczel Schrire , University of Sydney, Sydney, New South Wales, Australia 0 Views copyright © 2026 Schrire Z. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This manuscript explores factors related to quality of life (QoL) in an adult population and addresses a topic of clear relevance. However, several conceptual and methodological issues need to be addressed to strengthen the clarity, coherence, and interpretability of the findings. One key issue concerns the alignment between the stated research question and the measures used in the study. The authors indicate that the aim is 'to understand whether, and to what extent, the presence, quality, and consistency of social support enhance different dimensions of quality of life'. Despite this, social support is not clearly defined, measured, or reported in the methods or results. Clarifying how social support was operationalised or revising the research question to better reflect the measured variables, would substantially improve the coherence of the manuscript. Greater conceptual clarity is also needed. A clear definition of QoL should be provided earlier in the manuscript, rather than appearing primarily in the discussion. In addition, the manuscript at times uses language that implies causality. Given the observational nature of the study, it would be important to consistently frame the findings as associations and to explicitly acknowledge limitations related to directionality. The study population and inclusion criteria would benefit from further justification. The age threshold of 46 years appears inconsistent with the manuscript’s definition of older adults as those aged 60 years and above. Moreover, most participants were under 55 years of age and employed, suggesting relatively high levels of social engagement. Additional explanation is needed to justify the focus on social support in this sample, along with clearer description of the “social care centre” context and the level of participant independence. Several methodological details require clarification. Key variables such as sleep quality, infection prevention, and medication adherence are insufficiently described, with limited information on how these constructs were measured or whether validated tools were used. In particular, the assessment of sleep relies on subjective categories without reference to established or objective measures, which should be acknowledged as a limitation. A major methodological concern relates to the extreme imbalance in outcome and predictor group sizes. For example, QoL is overwhelmingly classified as “good” (279 participants) compared with “poor” (9 participants). When one category dominates to this extent, statistical comparisons and regression estimates become unstable and may be unreliable. Such imbalance substantially limits statistical power to detect true associations and increases the risk of misleading or non-generalisable results. Similar issues appear in other variables, where most groups exceed 90% in a single category. These distributions call into question whether the chosen analytical approach is appropriate for the data. Concerns regarding imbalance are further highlighted in Table 3, where some cell counts do not appear to align logically with reported totals, suggesting possible mislabelling or analytical inconsistencies. If variables were analysed categorically, this approach is problematic given the small cell sizes in some groups. The methods section would benefit from explicit clarification of how variables were entered into the regression models (categorical vs continuous) and whether assumptions for these analyses were met. In the discussion, the findings are occasionally overstated given the uneven group distributions and limited power. A more cautious interpretation, alongside acknowledgment that the study was conducted in Indonesia and may not generalise to other cultural contexts, would strengthen the manuscript. Finally, the inclusion of a dedicated limitations section is recommended, as several important methodological and interpretive constraints warrant explicit discussion. Overall, the study addresses a meaningful topic, and with clearer alignment between aims and measures, improved methodological transparency, and more careful interpretation of findings, the manuscript could be substantially strengthened. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? No Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? No Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? No Competing Interests No competing interests were disclosed. Reviewer Expertise older adults and dementia, sleep and circadian rhythms I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (1) Author Response 30 Jan 2026 Yuliati Yuliati, Department of Nursing Program, Sekolah Tinggi Ilmu Kesehatan Mayapada, Jakarta, Indonesia Hi Zoe, Thank you for your valuable suggestions. We greatly appreciate your feedback and will revise the manuscript carefully in line with your comments. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Schrire ZM. Peer Review Report For: Determinants of Quality of Life Among Older Adults in a Social Care Center: Emphasis on Sleep [version 4; peer review: 1 approved, 1 not approved] . F1000Research 2026, 14 :1217 ( https://doi.org/10.5256/f1000research.192434.r451079) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-1217/v2#referee-response-451079 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 PRIMA A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 29 Dec 2025 | for Version 2 ASHAR PRIMA , Department Of Medical-Surgical Nursing, Universitas Bani Saleh, Margahayu, West Java, Indonesia 0 Views copyright © 2026 PRIMA A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The authors have addressed the minor issues identified in the previous review. The correction of the first author’s affiliation has improved the accuracy of the authorship information. Additionally, the revision of the narrative description related to Table II, specifically the clarification that good Quality of Life (QoL) is the dominant category is appropriate and now accurately reflects the presented data. These revisions enhance the clarity and consistency of the manuscript. No further concerns regarding findings or interpretations. The manuscript is acceptable in its current form. Competing Interests No competing interests were disclosed. Reviewer Expertise Gerontology, Geriatric Palliative Care I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) PRIMA A. Peer Review Report For: Determinants of Quality of Life Among Older Adults in a Social Care Center: Emphasis on Sleep [version 4; peer review: 1 approved, 1 not approved] . F1000Research 2026, 14 :1217 ( https://doi.org/10.5256/f1000research.192434.r439087) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-1217/v2#referee-response-439087 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 PRIMA A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The author(s) is/are employees of the US Government and therefore domestic copyright protection in USA does not apply to this work. The work may be protected under the copyright laws of other jurisdictions when used in those jurisdictions. 21 Nov 2025 | for Version 1 ASHAR PRIMA , Department Of Medical-Surgical Nursing, Universitas Bani Saleh, Margahayu, West Java, Indonesia 0 Views copyright © 2025 PRIMA A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The author(s) is/are employees of the US Government and therefore domestic copyright protection in USA does not apply to this work. The work may be protected under the copyright laws of other jurisdictions when used in those jurisdictions. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions 1. Presentation clarity and data consistency The manuscript contains several internal inconsistencies that must be corrected before the results can be indexed as scientifically credible. Table II reports that 96.9% of respondents have good QoL, and 3.1% have poor QoL. However, the narrative text and Table III state that the majority have poor QoL. These contradictions indicate either a data labeling error, misclassification, or table misplacement. This must be corrected urgently because it affects the interpretation of the entire study. 2. Definition of “elderly” is inconsistent The introduction references WHO standards (≥ 60 years), but: The inclusion criteria list ≥ 50 years A category “Early Elderly 46–55 years” appears in the results This is inconsistent and scientifically problematic. A clear, single definition of the target population is needed, with justification if the study deviates from WHO cut-offs. 3. Instruments and operational definitions are insufficiently described The authors state that a “researcher-developed” social support questionnaire was used but do not provide: item structure scoring system cut-off definitions validity statistics reliability coefficients (e.g., Cronbach’s alpha) Similarly, the operationalization of “sleep behavior,” “medication adherence,” “nutritional intake,” “infection prevention,” and “physical activity” is not described. Without this, the study is not reproducible . Authors must provide the full questionnaire and scoring rules as supplementary material. 4. Statistical analysis is insufficient and partly inappropriate The manuscript reports p-values, but the type of statistical tests used are not clearly stated. Moreover: If QoL is categorical (good vs poor), linear regression is inappropriate . No multivariable analysis was performed to control for confounders (age, gender, education, comorbidity, length of stay). No effect sizes or confidence intervals are reported. Given the nature of the variables, multivariable logistic regression would be appropriate if QoL is dichotomized. If QoL domain scores are continuous, then multiple linear regression can be used — but assumptions must be tested and reported. At minimum: report odds ratios / β coefficients 95% confidence intervals specify exact statistical tests used provide justification for model selection 5. Conclusions are overstated The manuscript frequently uses causal language (“determinants”). With a cross-sectional design and no multivariable model, causal inference is not justified. The conclusions should be toned down to “associated with.” Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Gerontology, Geriatric Palliative Care I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) PRIMA A. Peer Review Report For: Determinants of Quality of Life Among Older Adults in a Social Care Center: Emphasis on Sleep [version 4; peer review: 1 approved, 1 not approved] . F1000Research 2026, 14 :1217 ( https://doi.org/10.5256/f1000research.189568.r430711) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-1217/v1#referee-response-430711 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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Register $(document).ready(function () { signIn.createSignInAsRow($("#sign-in-form-gfb-popup")); $(".target-field").each(function () { var uris = $(this).val().split("/"); if (uris.pop() === "login") { $(this).val(uris.toString().replace(",","/")); } }); });