Effectiveness of psychological first aid on dignity-related distress, social frailty, and psychological resilience among institutionalized older adults: a randomized controlled trial

Objectives Previous studies highlighted the need for interventions addressing the psychological and social needs of older adults residing in institutional settings. To evaluate the effectiveness of PFA in reducing dignity-related distress, social frailty, and improving psychological resilience among institutionalized older adults.Method A randomized controlled trial (RCT) employing a two-arm, single-blind design was conducted among older adults residing in two assisted living facilities between December 2024 and March 2025. The required sample size was calculated using G*Power version 3.1.9.7, yielding a total of 80 participants. Participants were recruited from a pool of eligible residents through simple random sampling following eligibility screening and were subsequently allocated to either the intervention group (n = 40) or the control group (n = 40). Outcomes were assessed using the Makizako Social Frailty Index (SFI), the Resilience Evaluation Scale, and the Patient Dignity Inventory (PDI) at baseline (T0) and three months post-intervention (T1).Results At three months post-intervention, participants in the intervention group demonstrated significantly higher psychological resilience compared to the control group (Mdn = 28, IQR = 27–36 vs. Mdn = 8, IQR = 4.25–9) with a statistically significant difference (U = 149, Z = 6.302, p < 0.001, r = 0.70). Additionally, dignity inventory distress was significantly lower in the intervention group (Mdn = 40.50, IQR = 37–50) than in the control group (Mdn = 110.50, IQR = 104.25–114.00) with a statistically significant difference (U = 108, Z = 6.67, p < 0.001, r = 0.70). A significant difference was also observed in social frailty, with the intervention group reporting lower levels of frailty (Mdn = 0, IQR = 0–2) compared to the control group (Mdn = 4.00, IQR = 2.25–5.00), U = 179.00, Z = 6.12, p < 0.001, r = 0.68, indicating a large effect size.Conclusion Psychological First Aid demonstrated effectiveness in reducing dignity-related distress and social frailty while enhancing psychological resilience among institutionalized older adults, highlighting its potential as a comprehensive psychosocial intervention, although further research is required to establish its long-term effectiveness and cross-cultural applicability.