Journal of Ageing and Longevity

This study examined how resilience-based interventions enable rural older women living with HIV in Zimbabwe to confront stigma and sustain their quality of life. Guided by the 4S framework of resilience resources planning (social support, coping strategies, sagacity, and solution-seeking), the research explored how women apply these dimensions to navigate challenging life events. A purposive sample of 17 women (those not living with a spouse or in a socially sanctioned relationship), aged 40–65, all on antiretroviral therapy and drawn from rural Matabeleland South Province, participated through in-depth interviews. Using Interpretive Phenomenological Analysis, four themes emerged: (1) Social Support and Social Networks as Foundations of Resilience, (2) Self-Efficacy and Coping Strategies in Managing Emotional Distress, (3) Spirituality and Sagacity as Sources of Strength and Meaning, and (4) Sense of Purpose and Solution-Seeking Behaviours. The findings highlight that resilience is actively mobilised through family ties, peer groups, and community initiatives, enabling women to adapt to socio-economic hardship and health-related barriers. This study concludes that empowerment strategies, especially community-based programmes focused on skills development and economic opportunities, are essential for enhancing resilience, reducing vulnerability, and improving health outcomes. Strengthening these resources not only equips women to manage HIV-related challenges but also contributes to sustainable development within their communities. Full article

Sex steroid hormones play a pivotal role in maintaining systemic homeostasis throughout life. Their age-related decline is closely associated with the onset of frailty, including sarcopenia and dementia. Here, this article provides a narrative review of the existing literature about the multifaceted roles of sex steroid hormones, particularly estrogens and androgens, in aging and age-related diseases. Sex steroid action is mediated by nuclear receptors such as estrogen receptor alpha (ERα) and androgen receptor (AR). Transcriptional activation through these receptors is orchestrated by epigenetic mechanisms, including histone modifications and chromatin remodeling. Beyond their reproductive functions, sex hormones also influence systemic physiology, metabolism, immune responses, and neuroplasticity. Clinical studies on hormone-deprivation therapies for prostate and breast cancers, as well as animal models, have revealed the key contributions of AR and ER activity to muscle integrity, bone density, and cognitive function. The sexual dimorphism in cognitive decline, especially in postmenopausal women, suggests the therapeutic potential of hormone supplementation and receptor-targeted strategies. Thus, AR- and ER-associated genes are considered promising targets for preventing frailty, sarcopenia, osteoporosis, and dementia. This review summarizes the current knowledge on sex hormone signaling in aging, with an emphasis on translational implications and future research directions. Full article

The COVID-19 pandemic profoundly disrupted the lives of older adults, yet their experiences have remained underexplored. This paper draws on empirical evidence from a two-wave (W1 April–July 2020, W2 January–April 2021) qualitative study in the UK (n = 62) and a companion study in Colombia (n = 32), focusing on participants aged 60 and above. Data was analysed using constructivist grounded theory principles, leading to the development of an ecological theory of older adults’ well-being within the context of a health crisis at three interconnected levels: individual, community, and societal. Individual resources, such as adaptability and support systems, contributed to enhancing and maintaining their well-being. Community support and a sense of belonging were essential to meet the needs of people in later life, whilst necessary social health protection measures during the pandemic restricted social activities, further impacting well-being, mostly perceived as challenging. Cultural differences and societal support systems shaped participants’ experiences. The study emphasises the interdependence of the different levels in impacting older adults’ well-being, offers strategies for policy and practice, and advocates and contributes for the development of gerontological theories in the context of health crises. Full article

Reaction time (RT) is a key indicator of cognitive and motor processing speed, and its age-related decline has important implications for everyday activities such as driving. However, conventional Psychomotor Vigilance Tests (PVTs) assess hand responses and do not capture lower-limb reaction characteristics relevant to pedal operations. This study aimed to compare RT characteristics between younger and older adults using the foot-response version of the PVT (Foot PVT) and to examine factors associated with RT. Sleep-related variables, physical activity level (PAL), and height were analyzed, and RT distribution characteristics were evaluated. Twenty younger adults (24 ± 3 years, range: 22–29 years) and twenty-four older adults (73 ± 5 years, range: 66–84 years) performed a 10 min Foot PVT. Mean RT was significantly slower in older adults (818 ± 105 ms) than in younger adults (700 ± 73 ms) (p < 0.001), indicating an age-related delay of approximately 120 ms. Older adults showed lower skewness and kurtosis, suggesting more homogeneous and cautious responses. In younger adults, height was negatively correlated with RT (r = −0.593, p = 0.006), and multiple regression analysis identified height as a significant predictor (adjusted R² = 0.316). No significant predictors were found in older adults. In the combined sample, age and height jointly explained 37.2% of the variance in mean RT. These findings indicate that Foot PVT performance reflects both biomechanical characteristics and age-related declines in reaction speed, supporting its utility for assessing lower-limb reaction capabilities relevant to driving and aging. Full article

Population ageing has led to a rapid increase in the number of individuals aged 80 and above, yet empirical evidence on the determinants of quality of life among the oldest-old remains limited. This study investigates the socioeconomic, lifestyle, and care-related factors associated with functional independence at very advanced ages using harmonized cross-national data from the Survey of Health, Ageing and Retirement in Europe (SHARE). Focusing on individuals aged 80 and above, we estimate logistic regression models to examine the probability of experiencing limitations in activities of daily living (ADL). The results reveal a persistent socioeconomic gradient in functional health: educational attainment is significantly associated with lower odds of ADL limitations, even after controlling for age, gender, physical functioning, living arrangements, and country fixed effects. Preserved physical functioning, proxied by the absence of walking difficulties, emerges as a strong protective factor against functional dependency. By contrast, institutional residence does not exhibit an independent association with ADL limitations once individual characteristics are taken into account. These findings demonstrate that functional independence among the oldest-old reflects long-term life-course resources and lifestyle-related capacities rather than late-life care settings alone. Policies aimed at promoting successful ageing should therefore adopt a life-course perspective, emphasizing education, health literacy, and the maintenance of physical functioning to enhance quality of life at very advanced ages. Full article

Background/Objectives: This study aimed to describe changes in physical performance and nutritional status among frail adults at risk of falls receiving muscle-targeted oral nutritional supplementation (MT-ONS) as part of routine clinical care. Methods: A prospective, open-label, single-centre, uncontrolled, descriptive study was conducted in a real-world clinical setting. Patients ≥ 70 years attending an outpatient fall clinic were consecutively recruited and assessed at baseline and after at least 90 days of MT-ONS (100% whey protein enriched with leucine and vitamin D), provided as part of a comprehensive care plan including exercise recommendations, medication review, and home adaptation advice. Sociodemographic, physical performance [Short Physical Performance Battery (SPPB)], nutritional status [Mini Nutritional Assessment-Short Form, (MNA^®-SF)], walking ability [Functional Ambulation Categories (FACs)], number of falls, muscle strength (dynamometry), body composition (Tanita), health-related quality-of-life (SF-12), functional capacity (Barthel Index), and adherence data were collected. Statistics analyses were descriptive and exploratory. Results: Twenty-six participants were assessed (58% women, age: 82.1 ± 5.4 years). Mean SPPB score increased from 7.3 (±3.6) to 8.0 (±4.0) (p = 0.3). At baseline, 35% were malnourished, 42% at risk of malnutrition, and 23% well-nourished. After ≥90 days of MT-ONS, 4% were malnourished, 54% at risk, and 42% well-nourished. The number of falls decreased from 1.2 falls/month (±0.9) to 0.2 falls/month (±0.3, p < 0.0001). Favourable changes in physical performance were positively correlated with improvements in nutritional status (p = 0.03). Adherence was high (92%), largely attributed to pleasant taste (71%) and smell (58%) and positive health perceptions (58%). Conclusions: In routine clinical practice, frail adults at risk of falls who received MT-ONS, 100% whey protein enriched with leucine and vitamin D for ≥90 days, as part of a comprehensive care plan improved their physical performance and nutritional status and reduced the number of falls. These findings should be interpreted as preliminary. Full article

Ageing is a dynamic biological process involving interconnected physiological, psychological, and social changes, making the promotion of healthy ageing a global public health priority. The World Health Organization (WHO) defines healthy ageing as the process of developing and maintaining functional ability that enables well-being in older age. The WHO’s Decade of Healthy Aging (2021–2030) outlines four key action areas: changing attitudes toward ageing, creating age-friendly environments, delivering integrated and person-centred care, and ensuring access to long-term care. This Perspective examines yoga, a holistic mind–body practice integrating physical postures, breath regulation, and mindfulness, as a potentially safe, adaptable, and scalable intervention for older adults. Evidence suggests that yoga may improve flexibility, balance, mobility, and cardiovascular function, reduce pain, and support the management of chronic conditions commonly associated with ageing. Psychological and cognitive research further indicates reductions in stress, anxiety, and depressive symptoms, alongside potential benefits for attention, memory, and executive function. Improvements in health-related quality of life (HRQoL) have been reported across physical, psychological, and social domains, with benefits sustained through regular practice. Adaptations such as chair-based practices, restorative postures, and the use of props enhance accessibility and safety, allowing participation across diverse functional levels. Mindfulness and breath-focused components of yoga may additionally support emotional regulation, resilience, and psychological well-being, particularly among older adults experiencing stress or limited mobility. Yoga interventions are generally well tolerated, demonstrate high adherence, and can be delivered through in-person and digital formats, addressing common access barriers. Despite this growing evidence base, yoga remains underintegrated within health policy and care systems in the US, UK, and India. Strengthening its role may require coordinated efforts across research, policy, and implementation to support healthy ageing outcomes. Full article

Despite the increasing number of older Syrian refugees in Canada, little is known about how they manage their health care needs while contending with language barriers, cultural dissonance, and systemic inequities. This qualitative study explored how older Syrian refugees in the Greater Toronto Area (GTA) navigate healthcare across Canadian and transnational contexts. The study was guided by the transnational circulation of care framework and used an interpretive descriptive design. Following research ethics approval, 20 older Syrian refugees were interviewed by bilingual research assistants. In-depth individual interviews were conducted in Arabic and analyzed using reflexive thematic analysis. Four interrelated themes emerged: (1) Navigating a New System; (2) Living in Two Worlds; (3) Medication Portability, Herbal Practices, and Supplement Culture; and (4) Digital Health Across Borders. Findings demonstrate that older Syrian refugees actively construct hybrid care pathways that integrate biomedical, cultural, and transnational practices. These strategies reflect resilience and adaptability but also expose gaps in the healthcare system. The study underscores the need for culturally responsive and age-friendly healthcare practices that acknowledge transnational realities. By illuminating how care circulates across borders, this study provides actionable guidance for designing responsive health systems. Full article

This scoping review aims to synthesize peer-reviewed literature exploring quality of life (QoL) for individuals with age-related hearing loss (ARHL), age-related central auditory processing (ARCAP) deficits, and age-related cognitive decline. A growing body of research has identified ARHL as a risk factor for the development of dementia, highlighting the connection between the sensory and cognitive systems. As the aging population continues to grow, examining comorbid age-related hearing and cognitive decline is especially relevant. These conditions may have potential negative consequences on the daily functioning, social participation, mental health, and overall wellbeing of older adults. A systematic search of peer-reviewed literature was conducted across multiple databases, adhering to the PRISMA guidelines for scoping reviews. Studies that focused on the impact of ARHL, ARCAP deficits, and/or related cognitive deficits on QoL were included in the present review. Key data extracted included QoL measures categorized into the ICF framework, the effects of hearing loss intervention on QoL, and the impact of ARHL on QoL for aging individuals. This review summarizes the reported effects that ARHL, ARCAP, and/or cognitive decline have on older adults, and discusses the clinical and practical implications for managing clients with these conditions. In addition to preventative measures and deficit management, maintenance of life participation, social engagement, and overall wellbeing should be considered when caring for aging adults with hearing and/or cognitive impairment. Full article

Resting-state functional connectivity (rsFC) provides insight into the intrinsic organization of brain networks and is increasingly recognized as a sensitive marker of age-related neural changes. Functional near-infrared spectroscopy (fNIRS) offers a portable and cost-effective approach to measuring rsFC, including in naturalistic settings. However, its sensitivity to age-related alterations in network topology remains poorly characterized. Here, we applied graph-based analysis to resting-state fNIRS data from 57 healthy participants, including 26 young adults (YA, 18–30 years) and 31 older adults (OA, 50–77 years). We observed that older adults exhibited a marked attenuation of low-frequency oscillation (LFO) power across all hemoglobin contrasts, corresponding to a 5–6-fold reduction in spectral power. In addition, network analysis revealed altered topological organization under matched sparsity conditions, characterized by reduced degree heterogeneity and increased segregation in older adults, with the strongest differences observed in the default mode (DMN), auditory, and frontoparietal control (FPC) networks. Network visualizations further indicated a shift toward more right-lateralized and posterior hub organization in older adults. Together, the coexistence of reduced oscillatory power and increased connectivity suggests that fNIRS-derived rsFC reflects combined neural and non-neural hemodynamic influences, including increased coherence arising from age-related vascular and systemic physiological processes. Overall, our findings demonstrate that fNIRS is sensitive to age-related changes in large-scale hemodynamic network organization. At the same time, sensitivity to non-neural hemodynamics highlights the need for cautious interpretation, but it may provide complementary, clinically relevant signatures of aging-related changes. Full article

Cognitive reserve (CR) is widely recognized as a protective factor that supports cognitive functioning across the lifespan. Recent research suggests a reciprocal relationship between CR and creative thinking—particularly divergent thinking (DT)—with DT potentially contributing to and benefiting from CR and remaining relatively preserved in older adulthood. This cross-sectional study, conducted in Italy between April and July 2025 using convenience sampling, examined whether CR predicts verbal and conceptual creativity in healthy older adults. One hundred participants (aged 65–92 years; M = 68.45, SD = 8.12) completed the Cognitive Reserve Index questionnaire (CRIq), the Test di Intelligenza Breve (TIB; Short Intelligence Test), and two creativity tasks. Data were analyzed using IBM SPSS Statistics (version 25.0; IBM Corp., Armonk, NY, USA). Multiple regression analyses showed that overall CR significantly predicted all creativity outcomes, including verbal fluency (β = 0.316, p = 0.011) and flexibility (β = 0.336, p = 0.007), as well as conceptual fluency (β = 0.371, p = 0.003), flexibility (β = 0.381, p = 0.002), and originality (β = 0.338, p = 0.006). Education and leisure activities more strongly predicted verbal creativity, whereas occupational experience and leisure activities predominantly predicted conceptual creativity. These findings indicate that CR supports creative thinking in later life and highlight the importance of cognitively and socially enriched experiences across the lifespan. Full article

This study aims to characterise the B cell compartment in a cohort of Sicilian centenarians by analysing absolute CD3⁻CD19⁺ lymphocyte counts, in association with age, sex, cytomegalovirus (CMV) serostatus, related to immune ageing, and interleukin (IL)-6 levels, representative of inflamm-ageing. It also investigates age-related changes in the CD4⁺/CD19⁺ ratio as a marker of immune ageing, reflecting shifts in immune homeostasis. B cell counts were assessed by flow cytometry on 53 Sicilians aged 19–110 years: 20 Adults, 15 Older adults, 11 long-living individuals, and 7 oldest centenarians. A multiple negative binomial regression was applied to evaluate the effects of age, sex, CMV serostatus, and Il-6 levels on values of B cells. The results showed a non-significant trend toward age-related decline without sex-based differences. A significant reduction in B cell count was observed in individuals with high anti_CMV titres, while IL-6 levels showed a borderline inverse correlation. CD4⁺/CD19⁺ ratio values showed an age-related increase. Our findings suggest that the age-related decline in B cell numbers may be mostly related to CMV infection and IL-6 values, without sex contribution. The age-related increase in the CD4⁺/CD19⁺ ratio, most pronounced in oldest centenarians, may represent a compensatory adaptation promoting immune regulation and chronic inflammation control. Full article

Dementia is a progressive condition that affects cognition, communication, mobility, and independence, posing growing challenges for individuals, caregivers, and healthcare systems. While traditional care models often focus on symptom management in later stages, emerging artificial intelligence (AI) technologies offer new opportunities for proactive and personalized support across the dementia trajectory. This concept paper presents the Assistive Intelligence framework, which aligns AI-powered interventions with each stage of dementia: preclinical, mild, moderate, and severe. These are mapped across four core domains: cognition, mental health, physical health and independence, and caregiver support. We illustrate how AI applications, including generative AI, natural language processing, and sensor-based monitoring, can enable early detection, cognitive stimulation, emotional support, safe daily functioning, and reduced caregiver burden. The paper also addresses critical implementation considerations such as interoperability, usability, and scalability, and examines ethical challenges related to privacy, fairness, and explainability. We propose a research and innovation roadmap to guide the responsible development, validation, and dissemination of AI technologies that are adaptive, inclusive, and centered on individual well-being. By advancing this framework, we aim to promote equitable and person-centered dementia care that evolves with individuals’ changing needs. Full article

Background/Objectives: Mild Cognitive Impairment (MCI) is a transitional stage between normal aging and early dementia, affecting up to 20% of older adults. Sleep disturbances, particularly insomnia, affect around 60% of individuals with MCI, contributing to declines in cognitive and physical function. Although Cognitive Behavioral Therapy for Insomnia (CBT-I) is an evidence-based non-pharmacological treatment, few studies have adapted it for individuals with MCI. This pilot study developed and evaluated Slumber, a clinician-supported mobile CBT-I app tailored for older adults with MCI and insomnia. Methods: The study had three aims: (1) to develop the app for delivering CBT-I to individuals with MCI; (2) to evaluate its usability and refine smart messaging prompts; and (3) to assess the feasibility of outcome measurement while detecting exploratory signals of change through a 6-week pilot trial. N = 19 participants completed the trial. Results: A significant reduction in insomnia severity was observed (mean difference = −2.06; p = 0.0131), while changes in cognitive and physical functioning were not statistically significant. Participants reported high satisfaction with the app’s tracking features and motivational reminders, though some noted technical challenges with presenting and interpreting sleep analysis charts. Conclusions: Findings support the usability of the Slumber app and the feasibility of outcome measurement in this population. The observed improvement in sleep quality provides an initial signal of promise. Future studies should address user feedback, enhance technical features, and evaluate clinical effectiveness in a larger randomized trial. Full article

Background: Frailty is a geriatric syndrome of increased physiological vulnerability, decreasing an older adult’s ability to successfully cope with health stressors. Social determinants of health (SDOH), including rural residence, can amplify healthcare disparities for older adults due to less accessibility to resources and lead to worse health outcomes. While the impact of rurality on older adult health is well-established, little is known about how the interaction of SDOH and geographical residence impact frailty status in older adults. Methods: Older adults (65+ years) in the National Health and Aging Trend Study (2011–2021) were categorized using Fried’s frailty phenotype (robust, pre-frail, frail). Rurality was defined using the 2013 Rural–Urban Continuum Codes. Generalized estimation equations with generalized logit link function determined the relationship between SDOHs (healthcare access, community support, income, education) and frailty status. Results: Of n = 6082 participants (56.4% female), the mean age was 75.12 years (SE 0.10), 1133 (18.6%) lived in rural residence, and 2652 (53.0%) had pre-frailty. Although there was no relationship between geographical residence and frailty status (p = 0.73), we did observe lower associated odds of worse frailty status for those with Medigap insurance coverage (0.81, SE 0.08; p = 0.04) and inconsistent frailty status trends for those of divorced (1.12, SE 0.05; p = 0.007) and never married (0.20, SE 0.03; p < 0.001) status in urban areas. Conclusions: Our findings suggest that geographic residence may modify the relationship between SDOH and frailty status in older adults, providing novel insight into the complexity of these interactions. This work is important for identifying modifiable areas where additional support interventions may be important for mitigating frailty development and progression for older adults with efforts at both the individual and system levels. Full article

Introduction: The Mediterranean Diet is known for its protective effects against cardiovascular and metabolic diseases. Metabolic syndrome, characterized by multiple health risk factors, is increasingly concerning in older populations. Understanding dietary impacts on metabolic health is key for promoting healthy ageing. Objectives: This feasibility study aimed to explore the relationship between adherence to the Mediterranean Diet and metabolic risk factors in older adults participating in a community exercise program and to evaluate the feasibility of applying validated tools in this setting. Methods: A cross-sectional design was used. Adherence to the Mediterranean Diet was evaluated using the PREDIMED questionnaire, while Metabolic Syndrome was evaluated according to National Cholesterol Education Program criteria. Blood samples were taken following WHO guidelines. Results: Ten participants (mean age 73.1 years; 90% women) were included. 50% showed high adherence to the Mediterranean Diet, while 40% had moderate or low adherence. No participants met the full criteria for Metabolic Syndrome. Significant associations were found between Mediterranean Diet adherence and chronic disease (r = 0.869, p < 0.01), and an inverse correlation with the number of Metabolic Syndrome criteria (r = –0.707, p < 0.05). The Mediterranean Diet score was also inversely related to cholesterol (r = –0.740, p < 0.05). Conclusions: Higher adherence to the Mediterranean Diet was associated with better metabolic profiles, highlighting its potential protective role. The study demonstrates the feasibility of incorporating nutritional screening in community exercise programs for older adults. Future research should include larger and longitudinal samples and integrate inflammatory biomarkers. Full article

Nutrition risk is prevalent in community-dwelling older adults, and leads to increased morbidity and mortality. Understanding the factors associated with the development of high nutrition risk is crucial for the development of appropriate programs and policies to address this problem. Therefore, our objective was to identify the psychosocial factors correlated with the development of high nutrition risk, as assessed by SCREEN-8, among Canadian adults categorized by ten-year age groups (45–54, 55–64, 65–74, and 75+). We used data from 17,051 participants in the tracking cohort of the Canadian Longitudinal Study on Aging and employed multivariable binomial logistic regression to identify the social and demographic factors associated with the emergence of high nutrition risk at follow-up, three years after the baseline. Baseline data were gathered between 2011 and 2015. At baseline, 34.4% of participants across all age groups were at high nutrition risk, while 40.0% were at high risk at follow-up. Factors consistently associated with the development of high nutrition risk across all age groups included lower levels of social support, lower self-rated social standing, infrequent participation in sports or physical activities, infrequent participation in cultural or educational activities, and lower household incomes. Programs and policies addressing these factors may reduce the prevalence of high nutrition risk and the development of high nutrition risk. Full article

Purpose: Cross-sectional analysis using open data has revealed an association between the traditional Japanese diet score (TJDS) and healthy life expectancy (HALE). This study aimed to clarify the association of the TJDS with the HALE and average life expectancy (LE) via a longitudinal analysis. Methods: Data regarding the food supply and total energy were extracted from the database of the Food and Agriculture Organization of the United Nations, and data regarding HALE and LE were obtained from the Global Burden of Disease Study 2019. The supply of items consumed frequently (rice, fish, soybeans, vegetables, and eggs) and less frequently (wheat, milk, and red meat) in the Japanese diet were scored (total: −8 to 8 points) and stratified into tertiles by country. The gross domestic product, aging rates, years of education, smoking rate, physical activity, and obesity rate were used as covariates. Longitudinal analyses were conducted for 143 countries, using the HALE and LE for each country from 2010 to 2019 as dependent variables and the 2010 TJDS as an independent variable. Results: The fixed effects (standard errors) were HALE 0.424 (0.102) and LE 0.521 (0.119), indicating significance (p < 0.001). Conclusion: The nine-year longitudinal analysis using international data suggests that the traditional Japanese diet based on rice may prolong the HALE and LE. Full article

Background: In Canada, 30 percent of the older adult population is foreign-born. Immigrant older adults are more likely to experience significant social isolation due to a variety of factors. However, limited research exists on the influence of specific factors. The objective of this study is to understand the economic factors that contribute to social isolation among older immigrants in the Greater Toronto Area (GTA), Canada. Methods: A qualitative interpretive description method was used. Following research ethics boards’ approval, semi-structured individual interviews were conducted with a total of 47 Arabic, Mandarin, and Punjabi-speaking older immigrants in the GTA. The interviews were conducted in their preferred language, audio-recorded, and translated (when needed) into English and transcribed. Thematic analysis of the data was informed by an ecosystemic framework. Results: Six themes were identified: (1) barriers to finding employment; (2) living a “hand-to-mouth life” due to limited income/pension; (3) housing costs that eliminate choices and options; (4) costs (and availability) of transportation as a barrier to getting around; (5) lack of “essential” healthcare coverage; and (6) costs of community programs that prevent “getting out of the house.” These economic factors at micro, meso, and macro levels of society intersected to create desperate situations that contributed to social isolation among older immigrants in the GTA. Conclusions/Implications: Addressing these economic factors is critical to immigrant older adults’ aging in place. Service providers must advocate for accessible physical and financial resources and services including affordable housing and transportation, old age security, and comprehensive healthcare coverage for older immigrants. Future research should focus on economic challenges faced by older adults across other immigrant communities in the GTA as well as in other cities, provinces, and territories. Full article