Balance of Promoting Optimism in Older Patients

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Authors

I really appreciate Your manuscript: combine "necessity" and "hope" often ends with misleading effects. To support olders in extremely difficult conditions with optimism, on my opinion, is Art, and you have properly describe it...I think that Your suggestions will be taken in mind, if are not already, by geriatricians.

I think that the main object of this review is consistent with how necessary is to be positive with older patients, so called otpimism. This psychological asset is difficult to obtain and not infrequently yeald to undesired effects: one of these is loss of confidence in Physicians. So far "necessity" and "hope" often ends with misleading effects. Authors, using extensive and updated references,  described the correct approach to "optimism in olders "  providing as well as the correct approach to olders, possible hints to focus out, and the right balance with which each Physicians dwelling with olders should take in consideration.

Author Response

Dear Reviewer,

We would like to sincerely thank you and the reviewers for the time and effort dedicated to evaluating our manuscript. We greatly appreciate the insightful and constructive comments, which have helped us improve the quality and clarity of our work.

We have carefully revised the manuscript in accordance with the suggestions provided and have addressed all the points raised. 

We hope that the revised version meets your expectations and that our work will be considered suitable for publication.

Thank you again for your consideration.

Kind regards,

The Authors

Reviewer 2 Report

Comments and Suggestions for Authors

This manuscript presents an entry on optimism in older patients, focusing on its clinical relevance and ethical implications. It highlights both benefits (e.g., improved adherence and well-being) and risks (e.g., unrealistic expectations, “toxic positivity”), and argues for a balanced, context-sensitive use of optimism in geriatric care.

The manuscript addresses a relevant and timely topic and fits well within the scope of Encyclopedia. It provides a broad and well-referenced overview of the concept and integrates clinical, ethical, and cultural perspectives.

Scientific Quality

The manuscript is scientifically sound, well-referenced, and based on established knowledge. No major concerns regarding validity or relevance of the cited literature.

Overall Recommendation - Accept

The manuscript is of high quality and clearly within scope. 

• What is the main question addressed by the research?
The manuscript addresses the question of how optimism should be understood and applied in the care of older patients, particularly in light of its potential ethical implications. It focuses on identifying both benefits and risks, and on defining an appropriate balance between optimism and realism in clinical practice.

• Are the conclusions consistent with the evidence and arguments presented and do they address the main question posed? Please also explain why this is/is not the case.
Yes, overall the conclusions are consistent with the arguments and literature presented.
The manuscript logically develops from evidence suggesting beneficial associations of optimism TO a critical discussion of risks such as unrealistic expectations and impaired autonomy
The conclusion, that optimism should be applied in a balanced, context-sensitive, and ethically grounded way is well supported.
However, the manuscript could be slightly strengthened by (but this is not a mandatory revision): more clearly distinguishing between types and strength of evidence (e.g., observational vs. interventional findings)

• Are the references appropriate?
Yes, the references are appropriate, relevant, and generally up to date.
The manuscript draws on: empirical studies; systematic reviews; and conceptual and ethical literature

• Any additional comments on the tables and figures.
There are currently no tables or figures included. While not mandatory for an entry, the manuscript could benefit from: a simple conceptual figure or summary model (e.g., illustrating the balance between realistic optimism, unrealistic optimism, and ethical considerations)
This could improve accessibility, especially for non-specialist readers.

• advise if the authors should expand the manuscript
Despite this, the topic is covered in a reasonably comprehensive manner, and the manuscript captures the key dimensions of the subject.
However, to better meet journal expectations, the authors could consider modest expansion, for example by: further elaborating key concepts (e.g., types of optimism);  slightly expanding the clinical applications; providing a more structured overview of influencing factors (e.g., culture, health literacy)
That said, expansion should be focused rather than extensive, avoiding unnecessary repetition.

Author Response

Dear Reviewer,

We would like to sincerely thank you and the reviewers for the time and effort dedicated to evaluating our manuscript. We greatly appreciate the insightful and constructive comments, which have helped us improve the quality and clarity of our work.

We have carefully revised the manuscript in accordance with the suggestions provided and have addressed all the points raised. 

We hope that the revised version meets your expectations and that our work will be considered suitable for publication.

Thank you again for your consideration.

Kind regards,

The Authors

Reviewer 2

This manuscript presents an entry on optimism in older patients, focusing on its clinical relevance and ethical implications. It highlights both benefits (e.g., improved adherence and well-being) and risks (e.g., unrealistic expectations, “toxic positivity”), and argues for a balanced, context-sensitive use of optimism in geriatric care.

The manuscript addresses a relevant and timely topic and fits well within the scope of Encyclopedia. It provides a broad and well-referenced overview of the concept and integrates clinical, ethical, and cultural perspectives.

Scientific Quality

The manuscript is scientifically sound, well-referenced, and based on established knowledge. No major concerns regarding validity or relevance of the cited literature.

Overall Recommendation - Accept

The manuscript is of high quality and clearly within scope. 

• What is the main question addressed by the research?
  The manuscript addresses the question of how optimism should be understood and applied in the care of older patients, particularly in light of its potential ethical implications. It focuses on identifying both benefits and risks, and on defining an appropriate balance between optimism and realism in clinical practice.
• Are the conclusions consistent with the evidence and arguments presented and do they address the main question posed? Please also explain why this is/is not the case.
  Yes, overall the conclusions are consistent with the arguments and literature presented.
  The manuscript logically develops from evidence suggesting beneficial associations of optimism TO a critical discussion of risks such as unrealistic expectations and impaired autonomy
  The conclusion, that optimism should be applied in a balanced, context-sensitive, and ethically grounded way is well supported.
  However, the manuscript could be slightly strengthened by (but this is not a mandatory revision): more clearly distinguishing between types and strength of evidence (e.g., observational vs. interventional findings).

Response: Some changes have been made to the text to improve this aspect.

• Are the references appropriate?
  Yes, the references are appropriate, relevant, and generally up to date.
  The manuscript draws on: empirical studies; systematic reviews; and conceptual and ethical literature
• Any additional comments on the tables and figures.
  There are currently no tables or figures included. While not mandatory for an entry, the manuscript could benefit from: a simple conceptual figure or summary model (e.g., illustrating the balance between realistic optimism, unrealistic optimism, and ethical considerations)
  This could improve accessibility, especially for non-specialist readers.

Response: We agree with this valuable comment and have created the requested table (see Table 1 in the manuscript) to facilitate readability.

• Advise if the authors should expand the manuscript
  Despite this, the topic is covered in a reasonably comprehensive manner, and the manuscript captures the key dimensions of the subject.
  However, to better meet journal expectations, the authors could consider modest expansion, for example by: further elaborating key concepts (e.g., types of optimism);  slightly expanding the clinical applications; providing a more structured overview of influencing factors (e.g., culture, health literacy)
  That said, expansion should be focused rather than extensive, avoiding unnecessary repetition.

Response: We hope we have clarified the requested aspects in Table 1.

Reviewer 3 Report

Comments and Suggestions for Authors

_{Optimism in older Patients: Looking for the right balance}

_{Dear Authors, thank for giving me the chance to review this study. I wish my feedback is helpful for you to enhance the study. This manuscript addresses a relevant and ethically important topic in geriatric care. It is also well structured around practical domains such as family context, health literacy, culture, religion, and end-of-life decision-making. However, in its current form, the manuscript remains more narrative commentary than as a rigorous scholarly contribution. The main weaknesses concern conceptual precision, methodological framing, critical integration of evidence.}

_Comments:

_{-Some statements seems to be provided by other reviewers and were copied and pasted without understanding their meanings. For instance, “Expanding the analysis to include global cultural perspectives and contemporary 215 empirical evidence strengthens the ethical framework and enhances the manuscript’s 216 contribution to geriatric clinical practice”}

_{-Put the clear article type in the title of the study. The paper reads as a narrative or conceptual overview. It must be addressed whether it is a narrative overview OR an editoral paper…etc.}

_{-The conceptual distinctions require sharpening. The manuscript refers to optimism, realistic optimism, unrealistic optimism, hope, positivity, and toxic positivity, but these concepts are not conceptually OR operationally defined with enough precision at the outset.}

_{-The synthesis is not sufficient. There were many reasonable and clinically arguments, but the paper often moves from cited literature to broad implications without enough critical qualification. For example, the manuscript draws on evidence from general optimism research, serious illness, palliative care, communication studies, and cross-cultural literature, yet do not always clarify how directly these sources apply to older adults specifically. My advice is just to focus on studies that cite older adults (stick with the title of the study).}

_{-Some references are duplicated. The reference list contains at least one duplication, with the same Kwak and Haley citation appearing twice (reference 17 & 25).}

 

Author Response

Reviewer 3

Optimism in older Patients: Looking for the right balance

Dear Authors, thank for giving me the chance to review this study. I wish my feedback is helpful for you to enhance the study. This manuscript addresses a relevant and ethically important topic in geriatric care. It is also well structured around practical domains such as family context, health literacy, culture, religion, and end-of-life decision-making. However, in its current form, the manuscript remains more narrative commentary than as a rigorous scholarly contribution. The main weaknesses concern conceptual precision, methodological framing, critical integration of evidence.

Dear Reviewer,

We would like to sincerely thank you and the reviewers for the time and effort dedicated to evaluating our manuscript. We greatly appreciate the insightful and constructive comments, which have helped us improve the quality and clarity of our work.

We have carefully revised the manuscript in accordance with the suggestions provided and have addressed all the points raised. 

We hope that the revised version meets your expectations and that our work will be considered suitable for publication.

Thank you again for your consideration.

Kind regards,

The Authors

 

Comments:

• -Some statements seems to be provided by other reviewers and were copied and pasted without understanding their meanings. For instance, “Expanding the analysis to include global cultural perspectives and contemporary 215 empirical evidence strengthens the ethical framework and enhances the manuscript’s 216 contribution to geriatric clinical practice”

Response: The text indicated has been modified and reworked more explicitly, as follows: “Integrating cross-cultural variability in perceptions of hope and optimism, together with recent empirical findings on their clinical and ethical implications, provides a more robust ethical framework and increases the relevance of this discussion for contemporary geriatric practice.” We hope this version will better clarify the content previously discussed and reduce the risk of interpretive ambiguity.

• -Put the clear article type in the title of the study. The paper reads as a narrative or conceptual overview. It must be addressed whether it is a narrative overview OR an editoral paper…etc.

Response: The manuscript was edited as an Entry. Entries are short, factual articles on various scientific topics that describe established knowledge and serve as references. The title has also been changed to: “Balance of Promoting Optimism in Older Patients”.

• -The conceptual distinctions require sharpening. The manuscript refers to optimism, realistic optimism, unrealistic optimism, hope, positivity, and toxic positivity, but these concepts are not conceptually OR operationally defined with enough precision at the outset.

Response: Table 1 has been created and inserted into the text to clarify the required aspects.

• -The synthesis is not sufficient. There were many reasonable and clinically arguments, but the paper often moves from cited literature to broad implications without enough critical qualification. For example, the manuscript draws on evidence from general optimism research, serious illness, palliative care, communication studies, and cross-cultural literature, yet do not always clarify how directly these sources apply to older adults specifically. My advice is just to focus on studies that cite older adults (stick with the title of the study).

Response: We thank the reviewer for this insightful and constructive comment. We agree that the manuscript, in its original version, occasionally moved from broader empirical literature to geriatric-specific implications without always explicitly qualifying the degree of applicability to older adult populations. We have added clarifying statements throughout the text to explicitly distinguish between evidence derived from general adult populations and studies specifically involving older adults. Where appropriate, we now indicate when findings are likely transferable to geriatric populations based on shared psychological and clinical mechanisms (e.g., coping, self-efficacy, risk perception), while acknowledging the limits of direct generalization. We have further emphasized and prioritized studies involving older adults when available, particularly in sections addressing optimism, adherence, communication, and end-of-life decision-making. However, given the interdisciplinary nature of the topic, we retained selected broader literature (e.g., communication science and palliative care research) because these domains provide essential conceptual mechanisms that are directly relevant to geriatric practice, even when not exclusively derived from older adult samples. We believe that these revisions improve methodological transparency and strengthen the validity of the synthesis while preserving the conceptual breadth necessary for an ethical discussion of optimism in geriatric care.

• -Some references are duplicated. The reference list contains at least one duplication, with the same Kwak and Haley citation appearing twice (reference 17 & 25).

Response: Reference 25 has been removed as it was effectively a repetition of reference 17. The bibliography and text have been updated to reflect this change.