Introduction
Covid-19 is a new viral disease that was diagnosed on April 25, 2021, in 223 countries and has infected more than 146 million people in the world and caused the death of more than 3 million people [1]. The elderly due to decline in the function of body organs and suffering from various diseases and many sources of stress during the COVID-19 pandemic, including prolonged quarantine and social distancing, fear of infection, death of spouse or other relatives, and frequent exposure to news about the pandemic, are exposed to incompatible psychological reactions during this period [2]. In this regard and considering the existence of a relationship between activities of daily living (ADLs) and people’s mental health during the COVID-19 pandemic [3] and a 48% prevalence of depression in the elderly of Maneh and Samalghan county [4], the present study aims to determine the level of anxiety and obsession caused by the Covid-19 in the elderly and to investigate its relationship with their depression and ADLs.
Methods
This is a descriptive-analytical study with a cross-sectional design. The study population consists of all the elderly (≥60 years) refereed to health care centers in Maneh and Samalghan county located in North Khorasan province of Iran. Of these, 300 were selected using a simple random sampling method and based on the inclusion criteria which were age at least 60 years, living in Maneh and Samalghan county, no history of cognitive disorders according to the electronic health record, and consent to participate in the study. Questionnaires were completed both in person and by interview (through phone) between from November 30, 2020 to March 10, 2021.
Data collection tools were a demographic form surveying age, gender, number of people infected with the Covid-19, and history of deaths caused by the Covid-19 among family members and relatives; coronavirus anxiety scale (CAS) [5], obsession with COVID-19 scale (OCS) [6], geriatric depression scale (GDS), ADL scale, and Instrumental ADL scale [4].
The researchers assured the elderly that their information would remain confidential and that they could leave the study at any time. The collected data were analyzed in SPSS v. 18 software using Kolmogorov-Smirnov, Mann-Whitney U, Kruskal-Wallis, and Spearman correlation tests.
Results
The mean age of the participants was 67.1 ± 6.9 years, and 214 (71.2%) were under 70 years of age. Moreover, 206 (68.7%) were married and 80 (26.7%) were widow/widower; 64 (21.3%) were employed, 155 (51.6%) had high blood pressure, 67 (22.3%) had diabetes, 54 (18%) had heart disease, and 63 (21%) had no underlying diseases. Furthermore, 161 (51.7%) reported that at least one of their relatives was infected with the Covid-19, and 55 (18.3%) reported that at least one of their relatives had died due to the Covid-19. Other demographic characteristics are shown in Table 1.


The mean scores of the OCS and CAS were 1.9±2.4 and 1.2±2.3, respectively. The prevalence of obsession and anxiety caused by the Covid-19 in the elderly was 5.3% and 9%, respectively. Non-parametric Mann-Whitney U or Kruskal-Wallis tests were used to investigate the difference in the scores of OCS and CAS in terms of the independent variables. The results showed that the scores of OCS and CAS were not different in the elderly with different income level, marital status, and educational level (P>0.05). Other results are shown in Table 1.
The results showed that obsession and anxiety caused by the Covid-19 had a significant relationship with each other and with depression (P≤0.001), and there was a significant relationship between anxiety caused by the Covid-19 and ADLs (P=0.049).
Discussion
Due to the lack of information related to anxiety and obsession in the elderly before the covid-19 outbreak, it was not possible to compare the current prevalence of anxiety and obsession with that in the pre-pandemic period. However, by comparing the results of the present study with other studies conducted on different age groups, it can be concluded that the amount of obsession and anxiety caused by the covid-19 in the elderly is not different from that in other age groups. But, due to the vulnerability of the elderly, and the significant correlation of obsession and anxiety caused by the covid-19 with depression, and between anxiety caused by the covid-19 and ADLs, it seems necessary to pay attention to screening, referral and more detailed follow-up of services related to them in clinics and health care centers during the covid-19 pandemic. It is also recommended to conduct further studies in this field to better compare the results.

Ethical Considerations
Compliance with ethical guidelines
This project is approved by the Ethics Committee of the Research and Technology Vice-Chancellor of North Khorasan University of Medical Sciences with code IR.NKUMS.REC.1399.064.

Funding
This research was carried out with the financial support of the Research and Technology Vice-Chancellor of North Khorasan University of Medical Sciences.

Authors' contributions
Conceptualization: Vahid Rashidi and Marzieh Mohammadzadeh; Research and review and finalization of the article: all authors.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The researchers would like to express their appreciation and thanks to the esteemed Vice President of Research and Technology of North Khorasan University of Medical Sciences, who provided financial support for the project, to all the employees working in the health centers and health homes of the city, and to all the elderly who cooperated in conducting this research.


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