Study limitations
cognitive and emotional impairments, depression, cognitive impairment
Several limitations of this study are acknowledged. Firstly, we excluded individuals with major clinical depression, and severe sensory or cognitive impairment. This was essential for the practical application of the mindfulness-based interventions, but it potentially narrows the generalizability of our results to different institutional settings serving a broader population. Future research could examine the effectiveness of MBEC for individuals with varying degrees of cognitive and emotional impairments and explore potential adaptations of the mindfulness program. Secondly, although the IG was taken to the consulting room for the MBEC sessions during the institution's regular activity hours, the possibility of contamination between the two groups may not have been completely eliminated. Further studies are suggested using a cluster-randomized controlled study design to select subjects in the two groups. Thirdly, although the research team specifically requested that all participating institutions prevented from providing spiritual care interventions during our trial, existing institutional discrepancies, including routine activities of standard arrangement and resources, may still have created various degrees of biases to MBEC effects, aside from the intervention itself. Future studies may need to document all group activities from each institution while the types, numbers and frequencies of group activities could be treated as covariates in the LMM analysis.