The relationship between nurses’ caring behaviors with comfort and fear of hospitalization of hospitalized elderly patients

Abstract

Introduction

Understanding the perspectives of elderly patients regarding their care and outcomes is crucial, especially considering the unique role nurses play in delivering high-quality care. This study was conducted to assess the relationship between nurses’ caring behaviors with comfort and fear of hospitalization in elderly patients.

Methods

This research utilized a descriptive correlational cross-sectional design and involved a sample of 197 elderly patients who were hospitalized in the medical and surgical inpatient departments of four universal hospitals in Iran. Participants were selected through stratified proportional random sampling. Data collection occurred between September and November 2024 using a Demographic Information Questionnaire, the Caring Behaviors Inventory-16 (CBI-16), and the Fear of Hospitalization Scale. The collected data were analyzed using SPSS version 24.

Results

There was a correlation between the caring behaviors of nurses and the general comfort of elderly patients (r = 0.302, p < 0.001), as well as with their fear of hospitalization (r=-0.412, p < 0.001). Furthermore, a significant correlation was observed between general comfort and the fear of hospitalization (r=-0.404, p < 0.001). The findings from the regression analysis indicated that nurses’ caring behaviors accounted for 9.1% of the variance in patients’ comfort levels (β = 0.302, p < 0.001). Additionally, both caring behaviors (β=-0.319, p < 0.001) and general comfort (β=-0.307, p < 0.001) were found to negatively predict the fear of hospitalization (R² = 0.256).

Conclusion

This study emphasized the vital role of nursing care in promoting comfort and alleviating the fear of hospitalization in elderly patients. It is essential to enhance nurses’ caring behaviors, which should be a focus for hospital administrators and nursing managers in daily practice. Implementing structured training programs for nurses to enhance caring behaviors, as well as integrating elderly patients’ perspectives on fear and comfort into hospital quality metrics, is recommended.

Introduction

Advancements in medical science, lifestyle changes, preventive care, and improved control of infectious diseases have significantly increased human lifespan over the past few decades [1]. As a result, the global population is aging rapidly. According to data from international organizations, the number of people aged 65 and older reached 727 million in 2020 and is projected to exceed 1.5 billion by 2050 [2]. According to a census conducted by the Statistical Center of Iran, the percentage of the population aged 60 and older rose from 2.8% in 2011 to 2.9% in 2016 [3]. It is projected that by 2050, the elderly population in Iran will exceed 30% [4].

As individuals age, they become more vulnerable to various diseases and disabilities due to a decline in their physiological capacities. Consequently, elderly people represent a significant percentage of hospitalized patients, presenting numerous challenges for health systems [5, 6]. They often experience heightened vulnerability stemming from a loss of control over their circumstances, exacerbated by negative attitudes toward aging and elderly care among healthcare workers. Sadly, this may lead to incidents of violence and mistreatment during their care [7]. According to the findings of some studies, more than half of the nurses had an unfavorable attitude towards elder care [8–10]. Negative attitude can impact the quality of nurses’ performance [11]. Additionally, other research has indicated that elder abuse in hospitals is more prevalent among individuals with dementia [12, 13], low social support, or retired patients [12]. Nurses, as a vital part of the healthcare workforce in hospitals, play a crucial role in ensuring the quality of care, end-of-life care, safety, and satisfaction of elderly patients [14–16]. Caring behaviors are essential in nursing activities, which are defined as actions taken by nurses to promote the well-being and comfort of their patients. These behaviors include qualities such as sensitivity, calmness, empathetic listening, honesty, and non-judgmental acceptance [17]. Caring behaviors can be divided into two main components. The first is instrumental behaviors, which encompass technical and physical actions [14]. This includes task-oriented procedures, creating a suitable physical environment, providing education, giving advice, and problem-solving [18]. The second component is expressive behaviors, which involve psychological, social, and emotional actions. These behaviors include demonstrating loyalty, trust, hope and kindness [14], as well as building trust, offering emotional support, being sensitive to patients’ needs, and respecting their privacy [18]. Research indicates that caring behaviors can significantly reduce pain in elderly patients, prevent falls and pressure ulcers, lower medical costs, decrease readmission rates, and increase patient satisfaction [19].

Many elderly individuals are hospitalized due to chronic diseases that often require multiple medications, which can lead to cognitive and functional impairments. These factors increase the risk of adverse outcomes during hospitalization. Hospitalization is regarded as one of the most stressful experiences, primarily because of unfamiliar procedures, disruptions to daily routines, financial burdens, and the constant changes within a hospital environment [20]. For elderly patients, the fear of hospitalization and a decreased sense of comfort can lead to negative outcomes [21, 22]. This fear is a natural and complex emotion, stemming from various sources: poor communication with medical staff, concerns about their illness, fear of death, separation from family, lack of trust in healthcare providers, and a perceived loss of privacy and autonomy in decision-making [23, 24]. Additionally, factors such as education level, awareness of the disease, gender, and age can influence the intensity of this fear [25]. Fear and anxiety significantly impact patients’ sense of comfort; as these emotions increase, their sense of comfort tends to diminish [26]. One of the primary goals of nursing interventions is to enhance patient comfort, as nurses strive to facilitate the recovery process through supportive measures that positively influence both the physical and mental well-being of hospitalized patients [27, 28].

The study conducted by Semiarto (2020) aimed to identify the factors influencing patient comfort in hospitals. It found that nursing care behaviors, the hospital environment, and the quality of service provided have a positive and significant relationship with patient comfort [29]. A review of previous studies reveals that the majority of research focuses on measuring caring behaviors from the perspectives of nurses or hospitalized patients. However, the voices of older adults are often overlooked, highlighting a significant gap in research related to this demographic. Older individuals are particularly at risk of receiving substandard care from nurses due to various factors, including physical disabilities, complex care needs, dementia or cognitive impairments, higher levels of dependency, multiple therapeutic and diagnostic interventions, and increased vulnerability [30]. Research indicates that caring behaviors positively impact hospitalized patients’ feelings of safety [31] and trust [32]. Additionally, there is a correlation between fear and the level of comfort experienced by patients [33, 34]. Furthermore, studies highlight caring behaviors as a significant factor in improving patient comfort [35, 36]. However, there is a limited research focused specifically on the fear of hospitalization and comfort levels in elderly patients. This research aims to investigate how nurses’ caring behaviors relate to elderly patients’ fear of hospitalization and their sense of comfort, addressing the gap in studies from the elderly patients’ perspective.

Methods

Research design, setting and subjects

:This descriptive, correlational, and cross-sectional study was conducted in four university hospitals located in Hamedan city.

The study population comprised elderly patients who were hospitalized in the medical and surgical departments of these hospitals during the study period (from 2024 September to November). The sample included those patients who met the specific entry requirements.

Inclusion Criteria:

• - Patients aged 60 years or older.

• - At least three days since their current hospitalization.

• - Able to comprehend and have suitable physical, mental, and psychological conditions to complete the questionnaire.

• - Proficient in speaking Persian.

• - Absence of patients diagnosed with severe mental illness, blindness, deafness, cognitive disorders, or speech difficulties.

Exclusion Criteria:

• - Incomplete responses to the questionnaire.

• - Patients in a critical condition.

The stratified-proportional sampling method was utilized to determine the number of samples required from each hospital, based on the number of hospital beds and the internal and surgical wards. In this approach, the number of samples for each hospital was calculated in relation to the total number of samples and the number of hospital beds in that hospital. Within each hospital, the sample size for each department was estimated according to the ratio of the number of beds in that department to the total sample allocated to the hospital. Ultimately, sampling was carried out using a simple random method.

The sample size for this study was calculated based on a previous study [37] with a test power of 80%, α = 0.05 and a correlation coefficient of 0.25 by using the fallowing formula: N= [(Zα + Zβ)/C]2 + 3, where C = 0.5*ln[(1 + r)/(1 − r)]. After a non-response rate of 15% was considered, the minimum sample size was 200 elderly patients.

Data collection tools

Demographic information questionnaire

This questionnaire included demographic information of patients including age, gender, education level, marital status, occupation, and length of hospitalization.

The caring behaviors Inventory-16 (CBI-16)

The 16-item form of the Caring Behaviors Inventory (CBI-16) consists of four subscales: communicating respectfully (items 1, 2, 3, 4, 7, 8, and 10); ensuring human presence (item 11); communication & positive attitude (items 5, 6, 9, 12, and 15); professional knowledge and skill (items 13, 14, and 16). Responses to the questions are given on a 6-point scale, with total scores ranging from 16 to 96. In a study conducted by Ghafouri et al. (2021), the researchers aimed to translate and psychometrically evaluate the 16-item version of the Caring Behaviors Inventory (CBI). After the translation, they assessed face validity (qualitative), content validity (both quantitative and qualitative), and construct validity in a cross-sectional study involving 509 patients. A demographic questionnaire and the 16-item CBI were distributed to registered patients through online surveys. The reliability of the instrument was evaluated using internal consistency, measured by Cronbach’s alpha. The internal consistency was found to be good, with a Cronbach’s alpha of 0.89. The results indicated that the Persian version of the 16-item CBI demonstrates sufficient validity and reliability, making it a suitable tool for investigating nurses’ caring behaviors [38]. The Cronbach alpha value in the current study was 0.94.

Fear of hospitalization scale

The Fear of Hospitalization Scale was developed and psychometrically validated by Jankovic et al. in 2018. This questionnaire consists of 17 items and includes three subscales: fear of being injured, trust to medical staff and fear of losing privacy or autonomy. Responses are measured using a five-point Likert scale (strongly agree to strongly disagree), with scores ranging from 1 to 5. Notably, three items are scored in reverse order [39]. In a study conducted by Sharifnia et al. in 2023, the Persian version of the Fear of Hospitalization Scale was psychometrically evaluated among 612 patients who were hospitalized for emergency surgery. The findings from exploratory and confirmatory factor analyses supported a three-factor structure consisting of 15 items: fear of being injured (6 items), fear of losing privacy or autonomy (6 items), and trust in medical staff (3 items). Consequently, two items with factor loadings below 0.3 were removed from the Persian version. The reliability of the instrument, as measured by Cronbach’s alpha, has been reported to be over 0.70 across the three subscales [40]. In the present study, the Persian version of the Fear of Hospitalization Scale was used. The Cronbach alpha value was 0.91.

Shortened general comfort questionnaire (SGCQ)

To evaluate patients’ comfort levels, the Shortened General Comfort Questionnaire developed by Kolkaba et al. (2006) will be utilized. This questionnaire consists of 28 questions, and the individual’s score is determined by summing the selected options. It employs a six-option Likert scale, ranging from “strongly agree” to “strongly disagree,” scored from 1 to 6. Notably, 19 of the items are scored in reverse order, with a higher total score indicating a greater sense of comfort. The cumulative score for the questionnaire can range from a minimum of 28 to a maximum of 168 [41]. This instrument was first translated and adapted for use in Iran by Safavi Bayat et al. [42] The reliability of the questionnaire has been reported, with Cronbach’s alpha exceeding 0.70 in several studies [41–43]. The Cronbach alpha value in the current study was 0.92.

Data collection

The researcher collected data after visiting the internal surgical wards of the four universal hospitals. Prior to this, permission was obtained from the relevant authorities, and the purpose of the study was communicated. Informed consent was secured from elderly patients who met the inclusion criteria. The researcher personally provided the questionnaire to patients in the inpatient ward. Elderly patients were thoroughly informed about the voluntary nature of their participation in the study, their right to withdraw at any time, and the confidentiality of their information. The questionnaires were administered in two ways: through self-reporting and interviews. For literate elderly patients, the questionnaires were filled out independently, while the researcher was present to answer any questions. For illiterate elderly patients, the researcher read the questions and their potential answers aloud, recorded the responses directly on the questionnaire, and provided assistance throughout the process. Questionnaires were distributed to patients during times when no treatment or care was being administered. The sampling process continued until the predetermined sample size was achieved.

Data analysis

The data was analyzed using SPSS 24 statistical software. Descriptive statistics were employed to calculate and report measures of central tendency, measures of dispersion, as well as frequencies and percentages. Additionally, inferential statistics were conducted using Pearson’s correlation coefficient and linear regression analysis. The normality of the data distribution was assessed by examining skewness and kurtosis values within the ± 2 range. Multicollinearity was checked for the tolerance and variation inflation factors. As a general rule, tolerance values should not be less than 0.1, and variance inflation factor (VIF) values should not be greater than 10. In the current study, two regression models were developed. Model 1 measured the effect of caring behaviors on comfort, while Model 2 examined the influence of both caring behaviors and comfort on the fear of hospitalization in elderly patients. A significance level of p < 0.05 was used for the statistical tests.

Results

Out of the total, 197 questionnaires were analyzed, while 3 were excluded due to incomplete responses, resulting in a response rate of 98.5%. The study involved 197 hospitalized elderly patients (mean age = 69.61 ± 9.09 years). The majority of participants were male (67.51%), married (79.19%), and illiterate (61.42%). Most patients (61.93%) had at least one prior hospitalization, with an average hospitalization duration of 5.91 ± 6.92 (Table 1).

Table 1.

Personal characteristics of the study participants (n = 197)

Variable	Subscales	Frequency (n)	Percentage (%)
Gender	Male	133	67.51
	Female	64	32.49
Marital status	Widowed	41	20.81
	Married	156	79.19
Education level	Illiterate	121	61.42
	Under diploma	57	28.93
	Diploma and above	19	9.65
History of hospitalization	No	6	3.05
	Once	122	61.93
	Twice	37	18.78
	Three times or more	32	16.24
Variable		Mean	Standard Deviation
Age (year)		69.61 (9.09)	9.09
Number of days of hospitalization (day)		5.91 (6.92)	6.92

The mean total score of caring behaviors was 88.90 (SD = 12.17), which is 91% of the total score of the questionnaire, indicating that patients reported nurses’ caring behaviors at a high level. The mean score of general comfort was 117.27 (SD = 19.09), which accounted for 79.5% of the total score and may indicate that the general comfort of the patients is at a moderate to high level. The mean total score of fear of hospitalization was 32.43 (SD = 10.80), which accounted for 23.2% of the total score and indicates a low level of fear of hospitalization in elderly patients (Table 2).

Table 2.

Means, and standard deviations for study variables

Variables	Subscales	Mean (SD) based on the total score	Mean (SD) based on the Likert scale
Caring Behaviors	Communicating respectfully	38.15 (5.67)	5.45 (0.81)
	Ensuring human presence	5.60 (1.01)	5.60 (1.01)
	Communication & positive attitude	28.46 (3.46)	5.69 (0.69)
	Professional knowledge and skill	16.68 (2.69)	5.56 (0.89)
	Total	88.90 (12.17)	5.55 (0.76)
General Comfort		117.27 (19.09)	4.18 (0.68)
Fear of Hospitalization	Fear of being injured	13.65 (7.86)	2.27 (1.31)
	Fear of losing privacy or autonomy	14.70 (4.06)	2.45 (0.67)
	Trust in medical staff	4.08 (2.35)	1.36 (0.78)
	Total	32.43 (10.80)	2.16 (0.68)

Caring behaviors were positively correlated with general comfort (r = 0.302, p < 0.001) and negatively correlated with the fear of hospitalization (r =−0.412, p < 0.001). Additionally, general comfort demonstrated a negative correlation with the fear of hospitalization (r=−0.404, p < 0.001) (Table 3).

Table 3.

Correlations between caring behaviors, general comfort, and fear of hospitalization

Variables		Caring Behaviors	General Comfort	Fear of Hospitalization
				Fear of being injured	Fear of losing privacy or autonomy	Trust in medical staff	Total
Caring Behaviors		1
General Comfort		r = 0.302 p < 0.001	1
Fear of Hospitalization	Fear of being injured	r=−0.269 p < 0.001	r=−0.340 p < 0.001	1
	Fear of losing privacy or autonomy	r=−0.205 p = 0.004	r=−0.260 p < 0.001	r = 0.334 p < 0.001	1
	Trust in medical staff	r=−0.640 p < 0.001	r=−0.269 p < 0.001	r = 0.245 p = 0.001	r = 0.129 p = 0.070	1
	Total	r=−0.412 p < 0.001	r=−0.404 p < 0.001	r = 0.907 p < 0.001	r = 0.647 p < 0.001	r = 0.444 p < 0.001	1

The results from the regression model revealed that caring behaviors accounted for 9.1% of the variance in general comfort (β = 0.302, p < 0.001). Furthermore, both caring behaviors (β=−0.319, p < 0.001) and general comfort (β=−0.307, p < 0.001) negatively predicted the fear of hospitalization. In total, these factors accounted for 25.6% of the variance (Table 4).

Table 4.

Multiple linear regression results for predictors of general comfort, fear of hospitalization

Criterion variable	Predictor variable	B	SE	β	t	Sig.	95% Confidence Interval for B
							Lower Bound	Upper Bound
General Comfort	(Constant)	75.205	9.613		7.823	< 0.001	56.246	94.165
	Caring Behaviors	0.473	0.107	0.302	4.417	< 0.001	0.262	0.684
R2 = 0.091; AdjR2 = 0.086; F (Sig.) = 19.508 (< 0.001)
Fear of Hospitalization	(Constant)	78.043	5.658		13.794	< 0.001	66.885	89.202
	Caring Behaviors	−0.284	0.058	−0.319	−4.916	< 0.001	−0.397	−0.170
	General Comfort	−0.174	0.037	−0.307	−4.729	< 0.001	−0.246	−0.101
R2 = 0.256; AdjR2 = 0.248; F (Sig.) = 33.304 (< 0.001)

Discussion

The current study aimed to investigate the relationship between nurses’ caring behaviors and the levels of fear and comfort experienced by hospitalized elderly patients. The findings revealed that elderly patients reported a high level of nurses’ caring behaviors. Supporting these results, Asadi et al. (2023) evaluated the perceptions of elderly patients regarding nurses’ caring behaviors in intensive care units using a similar assessment tool. Their findings also indicated a high average score for this variable [44]. Additionally, in the study conducted by Herwan and Pribadi (2019), which employed a different assessment method, over 50% of hospitalized patients reported high levels of nurses’ caring behaviors [45].

The results of this study indicated that the average score for fear of hospitalization among the elderly was low. A thorough review of available sources and databases did not reveal any studies that specifically and independently assessed this issue in the elderly population. However, findings from a study by Mohammadi et al. (2022) suggested that the level of fear of hospitalization among the elderly is lower than that of other demographic groups [25].

The findings indicate that elderly individuals hospitalized in the studied educational and medical centers experienced a moderate level of comfort. Aligning with these results, Sirti et al. (2024) reported a similar moderate level of comfort among hospitalized elderly patients using a comparable assessment tool [46]. Additionally, Marques et al. (2024) also found an average comfort score at a reasonable level, though they employed a different instrument for their evaluation [47].

The results of this study indicate a direct and statistically significant relationship between nurses’ caring behaviors and the comfort of elderly patients in hospitals. This finding aligns with the research conducted by Roulin et al. (2020), which identified patient comfort as a crucial aspect of caring behaviors [48]. To enhance elderly patients’ sense of comfort, it is recommended that nurses strengthen the following caring behaviors: respectful communication, ensuring human presence, maintaining a positive attitude, and demonstrating professional knowledge and skills. A qualitative study by Borzou et al. (2020) explored patients’ perceptions and experiences of nurses’ care behaviors in providing comfort during hemodialysis. The study highlighted that factors such as the presence and monitoring of patients, establishing human relationships, demonstrating professional responsibility, and possessing knowledge, maturity, and agility in work are effective in enhancing patient comfort [35]. Furthermore, a review study by Tian (2023) aimed to determine the factors affecting the patient experience of comfort in hospitals. It concluded that both physical and social environmental factors play a significant role in fostering patient comfort. Compassionate care, empathy, effective pain management, strong communication with patients, and respect for privacy and confidentiality all contribute positively to patients’ experiences of comfort [36].

Another crucial aspect of our study examines the correlation between nurses’ caring behaviors and fear of hospitalization among the elderly patients. Our study’s findings indicated that nurses’ caring behaviors were significantly related to fear of hospitalization. The nurses’ caring behaviors play a crucial role in reducing elderly patients’ vulnerabilities, such as anxiety, fear, and loneliness [49]. In this regard, research conducted by Corless et al. (2023) demonstrates a direct relationship between nurses’ caring behaviors and the sense of security experienced by hospitalized patients [31]. Furthermore, Alshammari (2022) identified the fear of returning to the office or hospital as a negative consequence stemming from inadequate treatment of elderly patients in healthcare settings [50]. In this study, caring behaviors significantly enhanced patient trust in medical staff. Sedighi et al. (2025) found a significant link between nurses’ caring behaviors and patients’ trust, underscoring the vital role of nursing care in building this trust. Nurses build patient trust by being consistently available to address needs and ensure safety. Involving patients in care plans and empowering them fosters this trust. For those experiencing anxiety and stress, nurses should dedicate time to listen and address concerns. Establishing a warm relationship and actively meeting patient expectations are essential [32]. The current study’s findings indicate that enhancing caring behaviors for the elderly reduced their fear of being injured, as well as their fear of losing privacy or autonomy. Therefore, by helping to develop nurses’ caring behaviors, nursing managers can be effective in reducing fear of hospitalization in addition to creating elderly patient comfort. In this regard, Bahrami et al. (2018) highlighted that nurses must exhibit emotional competence when caring for elderly individuals. This includes fostering a positive attitude, spiritual maturity, maintaining emotional self-control, adhering to professional ethics, creativity in care, relationship management, and providing compassionate care in their practice [51]. Also, Purfarzad et al. (2021) defined geriatric nursing competence as encompassing five factors: care competence and patient/older adult and family empowerment, ethical and compassionate care competence, patient safety competence, continuous professional development and self-care competence, and collaborative and team care competence [52].

The current study reveals that the inverse correlation exists between comfort and fear of hospitalization among elderly patients. Comfort is a primary objective for patients and central to their experience. Therefore, maximizing comfort is a universal goal in healthcare. Comfort is the immediate experience of strength when one’s needs for relief, ease, and transcendence are met across four contexts: physical, psychospiritual, social, and environmental [53]. Considering the effect of feeling comfortable in reducing fear of hospitalization in elderly patients, it is necessary to identify caring behaviors to increase the comfort of elderly patients. In this regard, a qualitative study by Bahrami et al. (2018) found that elderly participants seek nurses who pay close attention and regularly monitor their well-being, which enhances their comfort. Trust in nurses’ knowledge and skills are crucial for their sense of security. Comfort for elderly patients also relies on suitable hospital facilities, timely responses to their care needs, and effective pain management. Therefore, a nurse’s ability to ensure comfort is a key aspect of competence in elder care [54]. In support of this, Kiliç & Mercan (2024) and Taylan & Çelik (2022) demonstrated in their research that there is a significant inverse relationship between fear of surgery and comfort in hospitalized patients [33, 34].

Our regression models explain a low percentage of variance: 9% for comfort and 25.6% for fear of hospitalization. This suggests that, although the predictors are statistically significant, many factors remain unexplained. Elements not included in our model—such as the hospital environment, family support, prior trauma, and resilience—likely play vital roles. Future research should include these variables to enhance our understanding of comfort and fear in elderly patients.

It should be noted that our study design, which incorporated both self-administered and interviewer-administered modes, is itself a limitation. This design exposes the study to the risk of information bias, particularly interviewer bias and differential reporting of sensitive information based on the mode. Although our interviewer received general guidelines, a formal, standardized training program to minimize interviewer bias was not implemented. For future research, we recommend implementing comprehensive interviewer training programs, along with regular monitoring and supervision, to ensure data collection consistency and mitigate this potential source of bias. Physical discomfort from existing illnesses, as well as increased weakness and fatigue commonly experienced by the elderly, can impact the accuracy and reliability of their responses. To reduce potential biases, future studies should consider using a combination of methods, such as direct observation or interviews. The cross-sectional design precludes any inference of causality between the variables examined. The use of self-reported measures for all data collection introduces the potential for self-report bias, including social desirability and recall bias. Furthermore, the reliance on Likert-type scales for all instruments raises the possibility of response style biases (e.g., acquiescence or extreme responding) and means that findings could be influenced by item framing. Finally, the generalizability of our findings is limited by the demographic characteristics of our sample, which was predominantly male and had a high rate of illiteracy, potentially not representing the broader population. Future research would benefit from a longitudinal design, a more demographically diverse sample, and the incorporation of behavioral or objective measures to complement self-reported data.

Conclusion

This study revealed that nurses exhibited high levels of caring behaviors, while the elderly patients’ fear of hospitalization was low, and their overall comfort level was average. Additionally, a significant inverse relationship was found between nurses’ caring behaviors and the fear of hospitalization among the elderly. Conversely, a significant direct relationship was observed between nurses’ caring behaviors and the comfort of hospitalized elderly patients. Lastly, a significant inverse relationship existed between the fear of hospitalization and the comfort level of the elderly. These findings underscore the crucial role that nurses play in caring for hospitalized elderly patients and highlight the importance of addressing the concerns of this vulnerable population. These findings carry significant implications for nursing practice and healthcare policy. On a practical level, it is essential to develop regular training workshops and communication skills programs for nurses, focusing on empathy, compassion, and patient-centered care models. On a policy level, we recommend that hospital quality assessment frameworks incorporate specific indicators related to ‘fear of hospitalization’ and ‘comfort levels of elderly patients.’ Furthermore, promoting care models that involve patients and their families in the care process can be an effective strategy to alleviate fear and enhance comfort for this vulnerable population.

Authors’ contributions

Study conception and design: N.S, Z.P, M.M.K, L.T, M.S; Data collection: M.M.K; Data analysis and interpretation: L.T, Z.P; Drafting of the article: N.S, Z.P. Critical review of the manuscript: M.M.K, L.T, M.S. All the authors have carefully reviewed the article and approved the final draft.

Funding

This article is derived from a component of an approved research project (NO: 140304193213) conducted at Hamadan University of Medical Sciences.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

The present study was conducted in terms of the principles of the revised Declaration of Helsinki. The study design was approved by the Ethics Committee of the Hamadan University of Medical Sciences (IR.UMSHA.REC.1403.228). Patients provided written and informed consent. Patients were informed of the research goals, and they could stop their participation in the survey at any time without giving any reason or consequences.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.