Extended Abstract
1. Introduction
The main psychological problems of the elderly are feelings of loneliness, boredom, anger, feelings of emptiness, apprehension, insomnia and anxiety [1-3]. Entering a nursing home also has psychological consequences. Living in a nursing home is associated with a lack of close and meaningful relationships with family members, loneliness, feelings of rejection, inadequacy and worthlessness, lack of control over life and reduced motivation. This makes the elderly feel passive and incapacitated [4-7]. As a result, these feelings lead to negative emotions such as sadness, low self-esteem and social isolation in the elderly and depression is an important and serious consequence of such emotions [8]. The aim of this study was to investigate the relationship between place of residence and having stress, anxiety and depression in the elderly. The main question was, “Is there a difference in stress, anxiety, and depression between the elderly living in nursing homes and home-dwelling elderly?”
2. Materials & Methods
This is descriptive comparative study with cross-sectional design. Study population consists of all older people living in nursing homes and those living at home in Tehran in 2017. The sample size was calculated 218 using Cochran’s formula. Using a convenience sampling method, 218 residents of nursing homes and 218 home-dwelling ones matched for age and gender were recruited. Inclusion criteria were: Age 60-80 years, ability to speak, willingness to participate in the study. Exclusion criteria were: Severe physical and motor disabilities, severe mental and cerebral problems such as Parkinson’s disease and dementia, and inability to perform personal activities that necessitate a permanent nurse. In order to ensure the absence of cognitive problems, Persian version of Abbreviated Mental Test was used [10].
Data collection tools were a demographic form (surveying age, gender, education, and accommodation) and 21-item Depression Anxiety Stress Scales (DASS-21) which has 7 items and the subject should rate the severity of symptoms that s/he has experienced during the last week on a 4-point scale (from 0 to 3). The abbreviated form of this scale was performed on a non-clinical sample of 1070 people to evaluate its psychometric properties. The reliability of this scale by using Cronbach’s alpha was acceptable (0.77 for depression, 0.79 for anxiety and 0.78 for stress) [11]. Data were analyzed in SPSS V. 20 software by using descriptive statistics (frequency, mean and standard deviation) and inferential statistics (independent t-test).
3. Results
Participants were 436 elderly people aged 60-80 years, 218 home-dwelling elderly people with a mean age of 68.6 years and 218 residents of nursing homes with a mean age of 72.1 years. 75.5%, 48.4%, and 39.7% had normal stress, anxiety and depression; 20%, 17.2%, and 26.6% had mild stress, anxiety and depression; 4.1%, 27.1%, and 24.1% moderate stress, anxiety and depression; and 0.5%, 7.4%, and 9.6% had severe stress, anxiety and severe depression, respectively. In Table 1, as can be seen, the mean and standard deviation of stress, anxiety and depression in the elderly living in a nursing home was 37.75±11.34, and in the home-dwelling elderly as 26.68±5.64. There was a significant difference between home-dwelling elderly people and nursing home residents in terms of stress, anxiety and depression (t=12.89, sig<0.05) (Sig=0.000, P<0.05).
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4. Conclusion
The results indicated that stress, anxiety and depression of elderly people living in nursing homes are more than in the elderly people living at home. Obviously, being away from home and family leads to the loss of effective relationships with friends and relatives, and as a result, reduces intimate relationships and material and psychological support of the elderly, and makes them more vulnerable to psychological problems. Elderly people living at home have better conditions due to the sense of belonging and acceptance, the feeling of being useful and supported, and having positive and useful social role in the family. In order to prevent the transfer of the elderly to nursing homes and increase their satisfaction with life and old age, it is necessary for policymakers to consider various community-based care models such as day care centers, home care services, economic and social support for family caregivers.
Ethical Considerations
Compliance with ethical guidelines
The Ethic Commitee of University of Social Welfare and Rehabilitation Sciences (Code: IR.USWR.REC.1396.369) approval this study.
Funding
This research is the result of a research project approved by the Student Research Committee of the University of Social Welfare and Rehabilitation Sciences (Code: 1834).
Authors' contributions
All authors contributed equally in preparing all parts of the research.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
We hereby thank the Deputy of the Tehran Welfare Organization in issuing the necessary permits, the nursing homes for their great assistance in accessing the samples, and all the elderly participated in this study.
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