Extended Abstract
1. Objectives
The increasing number of elderly and changes in the socio-economic and personal and family lifestyles have increased the number of elderly care institutions [24]. 
Joining a nursery home imposes the most significant level of stress and fear on the elderly [22]. One of the issues the elderly face is death and its associated anxiety [23]. Some consider death as a stage of life, and others end up life. Those who believe in the first view do not require much concern; however, the reality is that, in general, the followers of both viewpoints are anxious [5]. In general, the fear of death is more prominent in the middle-age and late-life stages [11].
Furthermore, the influence of religious beliefs on death anxiety has long been discussed by numerous and sometimes different debates. Some scholars reported a significant relationship between the inner and outer religious orientation and death anxiety. In addition, some studies have revealed a negative relationship between Islam and death anxiety [11]. Coping with death anxiety is closely related to the unusual and great fear of death in terms of mental development and personality formation [22].
Exploring the relationship between the fear of death and religious beliefs and mental disorders in the elderly has been overlooked in Iran. Moreover, the fear of death plays an important role in the mental health of the elderly. Therefore, the present study investigated the relationship between fear of death and religious beliefs and mental disorders in the elderly living in the seniors’ homes in Karaj. The findings can be beneficial for families, senior citizens’ homes, well-being, specialist psychology clinics, and policymaking department of the mental health office of the Ministry of Health and Medical Education.
2. Methods and Materials
This was a descriptive correlational study. This study was conducted in the form of a dissertation. A total of 100 of the 887 elderly living in a nursing home in Karaj City were voluntarily and randomly selected to participate in the study in 2014. Despite obtaining a sampling permit from the Alborz Province’s Welfare Office and Karaj Provincial Welfare Organization, 11 nursing homes in the 12 areas of Karaj agreed to participate in the study and 8 centers were eventually enrolled to the research.
In addition, the inclusion criteria (based on the limitations of the Symptom Checklist-90-R (SCL-90-R) questionnaire) were no psychotic disorders, no intellectual disabilities, no brain lesions, and reading skills up to grade 6 to answer the questions. Most of the elderlies suffered from Alzheimer’s disease. The exclusion criteria were discontinuing participation in the study, high anxiety in the elderly while answering the questionnaires, as well as their general and psychosocial deterioration according to the diagnosis of physicians and psychologists, as well as providing incomplete questionnaires.
Research tools
The SCL-90-R neuropsychiatric, mental and emotional disorders questionnaire is among the most widely used psychiatric instruments to assess psychological disturbances based on a self-assessment method. This test has 90 questions and 9 scales in terms of physical impairment, obsession, interpersonal relationships, depression, anxiety, hostility, anxiety, paranoid, and psychosis [32]. The reliability coefficient of this test has been reported with a test-retest of between 0.77 and 0.90. The validity of the test was examined by conducting surveys on psychiatric patients, physical patients, and those with high-stress levels [21]. The reliability and validity of this test have been reported to be acceptable in Iran [21]. 
Templer’s Death Anxiety Scale (DAS, 1970): This self-report questionnaire consists of 15 yes/ no questions; 9 items are scores one point for correct answers and 6 items are scored one point for wrong answers. The answer is a sign of anxiety in the individual. Scores range from zero to 15, and a high score (higher than the average score of 8) represents a high degree of death anxiety. Death anxiety levels are categorized in three levels, as follows: mild (0-6), moderate (7-9), and severe (10-15). In the primary culture, the reliability coefficient of the resurfacing scale of 0.83, the coincidence of validity was reported by its correlation with the apparent anxiety of 0.27 and with a depression scale of 0.40 (Templer, 1970). This questionnaire was translated into Persian by Rajabi and Krishani (2000), using factor analysis and they validated it. Rajabi et al. examined it on 138 students in Ahwaz and reported an internal consistency of 0.73 for it. Masoudzadeh, Star Mohammadpour and Kurdie (2008) also reported the correlation coefficient of Temple death anxiety to be 0.95 [29].
The Golriz-Brahhani (1974) religious attitude questionnaire was designed to measure the religious attitude of individuals, based on an understanding of the Allport orientation theory. The questionnaire consists of 25 questions. The respondents should determine their opinion regarding each of the phrases. The reliability of this test was obtained by the correlation coefficient using the Allport, Vernon, and Lindsey test as 0.8. The validity of this questionnaire was also investigated through known groups method. The difference between the two groups was statistically significant. In other words, this questionnaire can differentiate between the two groups [26]. This questionnaire was reassessed in recent years, and its reliability was calculated as 0.63 using the Sphrman-Brown method. In Khosroshahi’s research (2010), the reliability of this questionnaire was obtained by the Cronbach’s alpha coefficient of 0.86.
To determine the reliability of these questionnaires, Cronbach’s alpha coefficient has been used in this study. For this purpose, the questionnaires completed by 30 elderly were analyzed, coded, and entered into SPSS. Based on this, Cronbach’s alpha coefficient for the questions of religious beliefs, the fear of death, and mental disorders were 0.56, 0.76, and 84, respectively. 
3. Results
The minimum and maximum age of the studied subjects were 55 and 49 years, respectively. Moreover, (40%) of the subjects aged 65-74 years. In total, (27%), (24%), and  (9%) of the study participants aged 55-64, 75-84, and 85-94 years, respectively. We studied 100 elderly, of whom, 61 were women, and 39 were men. Moreover, (51%) of the elderly were married, and (49%) of them were single. Paranoia, depression, and self-medication, weighing 1.61, 1.60, and 1.29, respectively, were the most significant dimensions of mental disorders among the elderly. Additionally, phobia, aggression, and psychotic disorder with a weighted average of 0.87, 0.81, and 0.95, respectively, were the weakest dimensions of mental disorders. To assess total psychiatric disorders, 90 questions have been used. The minimum and maximum obtained scores for mental disorders in the elderly were 5 and 291, respectively. The Mean±SD scores of the fear of death, religious beliefs, and mental disorders in the elderly were 3.12±6.30, 4.88±16.04, and 57.96±99.51, respectively.
Hypothesis 1. There is a relationship between the fear of death and mental disorders in the elderly: Based on the study findings, the Pearson’s correlation coefficient between “the fear of death” and “total psychiatric disorders” has a positive correlation of 0.49.
Considering that the significance level of correlation is less than 0.01 (P<0.01, r=0.499), the relationship is statistically significant; thus, the higher the “fear of death” in the elderly, the worse their psychiatric condition will be.
There was a direct and significant relationship between the fear of death and all mental disorders. The significance level of correlation values in all cases was P>0.01. Therefore, the higher the fear of death in the elderly, the higher the level of depression, anxiety, self-immobility, obsession, interpersonal sensitivity, aggression, paranoia, phobias, and psychosis will be.
Furthermore, the fear of death had the strongest correlation with “phobia” (P<0.01, r=517.0), psychotic disorder (P<0.01, r=0.508), “interpersonal sensitivity” (P<0.01, r=481.0), “anxiety” (r=-0.477), and “aggression” (P<0.01, r=427.0).
Hypothesis 2. There is a relationship between the fear of death and religious beliefs in the elderly: Based on the research findings, the Pearson’s correlation coefficient between “religious beliefs” and “the fear of death” is a very weak correlation and about 0.03. Considering that the significance level of correlation was higher than 0.05 (r=0.027, r=0.027), the obtained relationship is not significant; thus, religious beliefs and the fear of death were not significantly correlated.
4. Conclusion
The obtained results indicated a significant relationship between the fear of death and religious beliefs and mental disorders in the elderly. Therefore, based on the research findings, it is possible to determine the risk of developing mental disorders in the elderly with death anxiety. Consequently, it is possible to reduce the risk of mental disorders by developing proper plans and providing useful solutions to reduce the death anxiety in the elderly. It is also recommended to elaborate targeted educational programs to improve coping behaviors to prevent mental disorders in the elderly.
The lack of domestic and international research on the subject, of the small sample size, the unequal number of elderly women (61) and male (39), uncontrolled variables and the interference of them, the simultaneous use of three questionnaires (too many questions to be answered), disregarding the evaluation of patients, and in some cases, the negative impact of some SCL90 questions on the elderly realized by the researcher, were the limitations of this study. The use of Death Anxiety Questionnaire in this research was among the major and perhaps the most important constraint. Maybe the managers and psychologists of nursing homes were concerned about negative symptoms in the elderly after asking these questions. Additionally, some centers disagreed with permitting conducting research due to not having consent from the elderlies’ families. 
Death anxiety could be controlled in the elderly by providing psychological interventions in terms of preventing mental illnesses. Thus, health system managers in all sectors, by assessing and seeking other relevant organs, should take effective steps to reduce the fear of death among the elderly.
It is also necessary to provide more specialized training in the field of aging for physicians paramedics, and psychologists. It is recommended to conduct further research in this area on a larger sample size to obtain more reliable results. It is also suggested to determine the level of moral development in the elderly by the Kelberg test. Consequently, it could be determined which degree of moral development leads to mental disorders, and what stage of moral development improves the health of elderly.
Ethical Considerations
Compliance with ethical guidelines
The present research was conducted to observe ethical issues in the research council of Islamic Azad University, Hamedan, in 2015. For the implementation of ethical interventions, ethical codes proposed by the Islamic Republic of Iran Psychology and counseling system have been considered. Accordingly, the following components were observed for all patients participating in the research (at each stage of the research): The principle of respect for human dignity and freedom, the principle of conscientiousness and responsibility, the principle of utility and non-harm, the principle of non-discrimination, the principle of consideration To the welfare of others in such a way that they can be excluded at any time, the principle of paying attention to the system of community values. Accepted licenses were also obtained from the participants in the research, written consent and from the elderly.
Funding
The present paper was extracted from the MSc. thesis of the first Author, Roghaye Sadat Hosseini in Department of Psychology, Faculty of Humanities, Hamedan Branch, Islamic Azad University. 
Authors' contributions 
Conceptualization: Mohammad Esmaeel Ebrahimi,  Narges Zamani; Methodology: Roghaye Sadat Hosseini, Vahid Khalkhali; Validation: Mohammad Esmaeil Ebrahimi, Vahid Khalkhali; Research, drafting and financing: Roghaye Sadat Hosseini; Analysis, sources, editorial and finalization: Narges Zamani; Visualization, supervision and project management: Mohammad Esmaeil Ebrahimi; Funding: Roghaye Sadat Hosseini.
Conflicts of interest
The authors declared no conflict of interest.