The Coronavirus Disease 2019 (COVID-19) pandemic can be considered a stressful and uncontrollable public health crisis. Due to its ease of transmission and potential ability to cause death in the elderly, this disease can increase the risk of mental health problems or aggravate the symptoms of existing mental disorders; accordingly, by reducing mental health in the elderly, it can potentially affect their mental wellbeing [1]. Therefore, maintaining and improving the psychological wellbeing of the elderly is important as a positive socioeconomic and cultural measure. This study aimed to evaluate the psychological wellbeing of the elderly and its related factors during the COVID-19 pandemic in Mashhad City, Iran. In this study, the relationship between some factors affecting mental wellbeing in the elderly, such as family structure, chronic illnesses, staying at home, and physical activity, and the mental wellbeing of the elderly was investigated.

In this cross-sectional study, 400 individuals aged >60 years were studied from April 16, 2020, to June 31, 2020, in Mashhad City, Iran. Sampling was performed in several stages. First, 5 healthcare networks in Mashhad were considered as 5 clusters. Next, among the comprehensive healthcare centers covered by each of these clusters, a comprehensive healthcare center was randomly selected and considered as a cluster. Then, to reach the desired number of samples from each of the 5 comprehensive centers of healthcare, 80 samples were randomly selected and entered into the study. Due to the COVID-19 pandemic and the lack of face-to-face visits of the elderly to healthcare centers, the researcher, after obtaining permission to enter the comprehensive centers of healthcare services from the Vice Chancellor for Research of Mashhad University of Medical Sciences, referred to the healthcare services; after obtaining permission from the center officials, the researcher collected the telephone numbers of the elderly from their records. Subsequently, the demographic information and questionnaire used in the study were completed by telephone. The questionnaires were completed in June 2020 and 20 elderly were examined daily; thus, except for the 10 days off in June, the questionnaires were completed in the remaining 20 days of this month.
In this study, the Persian version of the Mental Welfare Index was used [2]. A score of ≥50 indicates adequate mental wellbeing and a score <50 reflects insufficient mental wellbeing [3]. The obtained data were analyzed in SPSS using descriptive and analytical statistics at a significance level of 0.05. The relevant code of ethics was obtained for this study (Code: IR.MUMS.REC.1399.158).

The Mean±SD age of the study participants was 66.7±5.8 years. Among all study participants, 224(56%) were females and 176(44%) were males. Most of the research subjects had high school education (61.5%), lived alone (49%), and had at least one chronic illness (73.8%). Moreover, most of the study participants were completely quarantined at home (91%) and had no physical activity (93.8%) during the study period.
Furthermore, the Mean±SD score of psychological wellbeing in the explored elderly was 44.8±24.7. According to the collected results, the psychological wellbeing score in 285(71.2%) subjects was below 50. Therefore, considering that a score of 50 and above indicates adequate mental wellbeing and a score less than 50 reflects insufficient mental wellbeing, most examined elderly had insufficient mental wellbeing. There was a significant relationship between family structure (P<0.001), chronic illness (P<0.001), staying at home (P<0.001), and physical activity (P<0.001), and psychological wellbeing in the study subjects. To determine the effects of the contextual variables on the psychological wellbeing of the tested elderly, a multiple logistic regression model was used. The relevant results demonstrated that having at least one chronic disease was the most effective variable for inadequate mental wellbeing in the elderly.
Thus, the elderly with chronic diseases presented a 23.77 times higher odds of inadequate mental wellbeing than those without the chronic disease (OR=23.7, 95%CI: 42.08-13.42) (P<0.001). Moreover, among the factors affecting the psychological wellbeing of the elderly in the COVID-19 pandemic, loneliness was the second most important characteristic after chronic disease. In other words, the elderly who lived alone presented an 8.28 times higher odds of inadequate mental wellbeing, compared to those who did not live alone (OR=8.28, 95%CI: 4.79-14.31) (P<0.001).
Furthermore, living with a spouse had a protective effect and prevented a decrease in psychological wellbeing in the examined elderly (OR=0.107, 95%CI: 0.065-0.175) (P<0.001); thus, living with a spouse reduced the odds of declined mental wellbeing in the tested elderly. The elderly who stayed at home during the study period had an 8.03-fold lower chance of poor mental wellbeing than others (OR=8.03, 95%CI: 3.72-17.30) (P<0.001).
Finally, the elderly who had no physical activity during the study period had a 7.37 times higher chance of inadequate mental wellbeing than the other elderly (OR=7.37, 95%CI: 2.98-18.18) (P<0.001).

According to the current research results, most of the studied elderly had inadequate mental wellbeing. The elderly have a vulnerable immune system and often suffer from chronic diseases; thus, infectious diseases are more severe and more dangerous than other populations in them. Consequently, the elderly are more prone to death, especially those with chronic illnesses. Therefore, encountering situations, such as the COVID-19 pandemic crisis can increase fear and stress among the elderly. During the COVID-19 pandemic, older people not only have to cope with the potential side effects of a weakened immune system but also have to overcome numerous problems caused by the psychological aspects of such a crisis. Therefore, it seems necessary to pay attention to the mental health of the elderly and adopt adaptive strategies to maintain and improve the mental wellbeing of the elderly in crises, like the COVID-19 pandemic.

Compliance with ethical guidelines
This study was approved by the Ethics Committee of the University of Mashhad University of Medical Sciences (Code: IR.MUMS.REC.1399.158).

This research was supported by by the Mashhad University of Medical Sciences.

Drafting, introduction and methodology: Nooshin Peyman; Editing and finalizing the article,analysing and writing finding, discussion and conclusion: Samira Olyani.

The authors declared no conflict of interest.

Authors appreciate from Vice-Chancellor of Mashhad University of Medical Sciences.
 

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