Introduction
The increase in life expectancy and the decrease in the fertility rate have caused an increase in the number of elderly people in the world, such that aging has become one of the public health challenges in recent years. Due to the rapid growth of the elderly population, it is necessary to pay attention to this group. Empowerment is effective in the general health of the elderly. Self-efficacy, self-esteem and self-control are the main factors affecting empowerment. Sarai Mahallat (Neighborhood House) acts as the executive arm of the Iranian municipality in the neighborhoods. The Health House is one of the branches in Neighborhood House, and the Center for the Elderly is one of the branches in the Health Houses, which aims to improve the physical, mental and social health of the elderly. The purpose of this study is to determine the relationship between individual aspects of empowerment and general health in elderly people attending Sarai Mahallat in Tehran in 2020.
Methods
In this descriptive-analytical study with cross-sectional design, 320 elderly men and women over 60 years of age were selected by cluster sampling method. First, 22 districts of Tehran city were considered as clusters. Of these, 4 districts were selected from the North, South, East and West areas of Tehran. Then, 5 neighborhood houses from each district were randomly selected by drawing cards. If there was not enough samples in one neighborhood house, the drawing repeated to select another neighborhood house. For collecting data, a demographic form, the standard 28-item general health questionnaires (GHQ-28), 10-item general self-efficacy scale (GSE-10), Rosenberg self-esteem scale, and Tangney’s brief self-control scale. They were completed through interview. Due to the difficulty of completing all the questionnaires together for the elderly and to prevent its negative effect on the responses, the questionnaires were completed separately at different times appropriate for the elderly. They took about 10 minutes to complete. The data were described using mean and standard deviation and analyzed using chi-square test, Spearman correlation test, linear regression, and one-way analysis of variance in SPSS software version 22. The normality of the data distribution was checked using the Smirnov- Kolmogorov test which showed the non-normal distribution of the data related to study variables. Correlation coefficient <0.1 indicated low correlation; 0.1-0.3; weak correlation; 0.3-0.5, moderate correlation, and >0.5 strong correlation.
Results
The mean age of participants was 68.42±8.3; 54.4% were female and 45.6% were male. The level of education in 31.87% of them was diploma and most of them were married. The mean score of GHQ-28 was 21.95±13.4. The highest score was related to the dimension of social function (7.23) and the lowest score was related to the dimension of depression (2.71). The mean scores of general self-efficacy, self-esteem and self-control were 32.21±4.8, 20.4±79.4, and 47.76±0.8, respectively which were at the optimal level. Based on the results of Spearman correlation test, a significant negative correlation was found between general health, general self-efficacy, self-esteem, and self-control (P<0.001). A strong negative correlation between the two variables of general health and self-control was observed (r=-0.65). All four components of general health (somatization, anxiety/insomnia, social functioning and depression) had significant negative correlation with self-esteem, self-control and general self-efficacy (P<0.001). The general health had a significant relationship with educational level (P<0.001), years of employment (P=0.002) and housing status (P<0.001).
Using the linear regression at a significance level of 0.2, it was observed that among the independent variables, gender (P=0.117), housing status (P=0.156), self-esteem (P<0.001), self-control (P<0.001) and general self-efficacy (P>0.001) had a significant correlation with general health. These variables entered into the multiple regression model. Finally, using the forward method, self-control and self-esteem variables were fitted in the final model. By using confirmatory factor analysis, direct and indirect relationships between general health components and other variables were investigated, the results are shown in Figure 1. According to the final fitted model, one unit increase in self-control reduced general health by 0.99. The reduced amount for self-esteem was 0.422. Finally, the results of multivariate regression showed that the variables of housing status (P=0.156), self-esteem (P<0.001), self-control (P<0.001) and general self-efficacy (P<0.001) were significant predictors of general health in the elderly.
Discussion
Based on the results of this study, a significant correlation was observed between the general health and individual factors of empowerment (general self-efficacy, self-esteem, and self-control) in the elderly who attending neighborhood houses in Tehran. In addition, there was a significant relationship between the general health of the elderly and their education, years of employment, and housing status. Based on the results of multivariable regression, the variables of housing status, self-esteem, self-control and general self-efficacy were the predictors of general health in the elderly. Considering the increase in the number of elderly people in Iran and the need to pay attention to their physical and mental health, the results of this study can be useful for planning to increase the empowerment of the elderly at different levels. These factors should be considered in health promotion interventions for the elderly.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Iran University of Medical Sciences (Code: IR.IUMS.REC.1398.1061)

Funding
This study is the result of a research thesis approved by Iran University of Medical Sciences and has received the financial support of the Research and Technology Vice-Chancellor of this university.

Authors' contributions
Conceptualization: Mahnaz Solhi ,Fatemeh Gholami; Methodolgy, Mahnaz Solhi, Jamileh Abolghasemi, Fatemeh Gholami; Investigation, Fatemeh Gholami; Writing-Original Draft, Fatemeh Gholami, Mahnaz Solhi; Writing-Review & Editing, Fatemeh Gholami, Mahnaz Solhi; Supervision, Mahnaz Solhi

Conflicts of interest
The authors declared no conflict of interest.



References

1. Mohammadi F, Dabbaghi F, Nikravesh M. [Facilitator and barriers factors in family caregiving process of Iranian frail elderly: Qualitative study (Persian)]. Iran Journal of Nursing. 2008; 21(55):55-65. [Link]
2. Islam A, Tahir, MZ. Health sector reform in South Asia: New challenges and constraints. Health Policy. 2002; 60(2):151-69. [DOI:10.1016/S0168-8510(01)00211-1]
3. Momeni K, Karimi H. [The comparison of general health of the residents/ non residents in the elder house (Persian)]. Salmand: Iranian Journal of Ageing. 2010; 5(3):23-9. [Link]
4. Ghanbari Moghadam A, Mohammadi Shahbolaghi F, Dalvandi A, Hoseinzade S. [Relationship between lifestyle and general health among elderly people in Tehran (Persian)]. Salmand: Iranian Journal of Ageing. 2015; 10(3):90-9. [Link]
5. Joakar Z, et al. Effects of pulmonary rehabilitation home-based on quality of life in patients with chronic obstructive pulmonary disease [MSc thesis]. Tehran: Welfare and Rehabilitation University; 2012. [Link]
6. Anderson RM, Funnell MM, Butler PM, Arnold MS, Fitzgerald JT, Feste CC. Patient empowerment. Results of a randomized controlled trial. Diabetes Care. 1995; 18(7):943-9. [DOI:10.2337/diacare.18.7.943] [PMID]
7. Khezri R, Ravanipour M, Motamed N, Vahedparast H. [Effect of self-management empowering model on the quality of life in the elderly patients with hypertension (Persian)]. Salmand: Iranian Journal of Ageing. 2016; 10(4):68-79. [Link]
8. Singh B, Udainiya R. Self-efficacy and well-being of adolescents. Journal of the Indian Academy of Applied Psychology. 2009; 35(2):227–32. [Link]
9. Chang SH, Crogan NL, Wung SF. The self-care self-efficacy enhancement program for chinese nursing home elders. Geriatric Nursing. 2007; 28(1):31-6. [DOI:10.1016/j.gerinurse.2006.11.006] [PMID]
10. Hellström K, Lindmark B, Wahlberg B, Fugl-Meyer AR. Self-efficacy in relation to impairments and activities of daily living disability in elderly patients with stroke: A prospective investigation. Journal of Rehabilitation Medicine. 2003; 35(5):202-7. [DOI:10.1080/16501970310000836] [PMID]
11. Lev EL, Daley KM, Conner NE, Reith M, Fernandez C, Owen SV. An intervention to increase quality of life and self-care self-efficacy and decrease symptoms in breast cancer patients. Scholarly Inquiry for Nursing Practice. 2001; 15(3):277-94. [PMID]
12. D’Souza MS, Karkada SN, Parahoo K, Venkatesaperumal R, Achora S, Cayaban ARR. Self-efficacy and self-care behaviours among adults with type 2 diabetes. Applied Nursing Research. 2017; 36:25-32. [PMID]
13. Doba N, Tokuda Y, Saiki K, Kushiro T, Hirano M, Matsubara Y, et al. Assessment of self-efficacy and its relationship with frailty in the elderly. Internal Medicine. 2016; 55(19):2785-92. [PMID]
14. Smits MW, Kee CC. Correlates of self-care among the independent elderly: Self-concept affects well-being. Journal of Gerontological Nursing. 1992; 18(9):13-8. [DOI:10.3928/0098-9134-19920901-05] [PMID]
15. Hojjati H, Sharifnia H, Hassanalipour S, Akhonzadeh G, Asayesh H. [The effect of reminiscence on the amount of group self-esteem and life satisfaction of the elderly (Persian)]. Nursing and Midwifery Journal. 2011; 9(5):350-6. [Link]
16. Amani R. [Happiness in the elderly: The role of self-esteem (Persian)]. Aging Psychology. 2016; 2(1):73-80. [Link]
17. Ekrami M, Mirhaj A. [The comparison of general health and self-esteem status in the trained aged women in Iran Alzheimer’s Association and other (Persian)]. Journal of Health Psychology. 2015; 4(14):98-112. [Link]
18. Hagger MS, Wood C, Stiff C, Chatzisarantis NLD. Ego depletion and the strength model of self-control: A meta-analysis. Psychological Bulletin. 2010; 136(4):495-525. [DOI:10.1037/a0019486] [PMID]
19. Zahn D, Adams J, Krohn J, Wenzel M, Mann CG, Gomille LK, et al. Heart rate variability and self-control--A meta-analysis. Biological Psychology. 2016; 115:9-26. [PMID]
20. Tu Y, Yang Z. Self-control as mediator and moderator of the relationship between social support and subjective well-being among the Chinese elderly. Social Indicators Research. 2016; 126(2):813-28. [DOI:10.1007/s11205-015-0911-z]
21. Ghasemi S, Keshavarz Mohammadi N, Mohammadi Shahboulaghi F, Ramezankhani A, Mehrabi Y. [Physical Health status and frailty index in community dwelling older adults in Tehran (Persian)]. Salmand: Iranian Journal of Ageing. 2019; 13(5):652-65. [DOI:10.32598/SIJA.13.Special-Issue.652]
22. Dehmani Z, Hakami M, Kraskian Mojembari A. [Effects of horticultural therapy on self-esteem and general health status in elderly nursing home residents (Persian)]. Salmand: Iranian Journal of Ageing. 2015; 9(4):259-67. [Link]
23. Moeini B, Shafii F, Hidarnia A, Babaii GR, Birashk B, Allahverdipour H. Perceived stress, self-efficacy and its relations to psychological well-being status in Iranian male high school students. Social Behavior and Personality: An International Journal. 2008; 36(2):257-66. [DOI:10.2224/sbp.2008.36.2.257]
24. Rajabi. GR. [Reliability and validity of the general self-efficacy beliefs scale (gse-10) comparing the psychology students of Shahid Chamrin University and Azad University of Marvdasht (Persian)]. New Thoughts on Education. 2006; 2(2):11-22. [Link]
25. Hosseini M, Elias H, Krauss SE, Aishah S. A review study on spiritual intelligence, adolescence and spiritual intelligence, factors that may contribute to individual differences in spiritual intelligence and the related theories. Journal of Social Sciences. 2010; 6(3):429-38. [DOI:10.3844/jssp.2010.429.438]
26. Shahbazzadegan B, Farmanbar R, Ghanbari A, Atrkar Roshan Z, Adib M. [The effect of regular exercise on self-esteem in elderly residents in nursing homes (Persian)]. Journal of Ardabil University of Medical Sciences. 2008; 8(4):387-93. [Link]
27. Malekooti S K, Mirabzadeh A, Fathollahi P, Salavati M, Kahali S, Afkham Ebrahimi A, et al. [Reliability, validity and factor structure of the GHQ-28 in Iranian elderly (Persian)]. Salmand: Iranian Journal of Ageing. 2006; 1(1):11-21. [Link]
28. Kakabaraei K, Moazinejad M. [The relationship between finding meaning in life and demographic characteristics with death anxiety in the elderly (Persian)]. Journal of Aging Psychology. 2016; 2(1):37-47. [Link]
29. Barati M, Fathi Y, Soltanian A, Moini B. Mental health and health promoting behaviors in older people living in Iran, Hamadan. Iranian Journal of Nursing and Midwifery. 2012; 20(3):12-9. [Link]
30. Tanaka H, Sasazawa Y, Suzuki S, Nakazawa M, Koyama H. Health status and lifestyle factors as predictors of depression in middle-aged and elderly Japanese adults: A seven-year follow-up of the Komo-Ise cohort study. BMC Psychiatry. 2011; 11:20.        [DOI:10.1186/1471-244X-11-20] [PMID] [PMCID]
31. Zarei F, Mohammadi M, Aboozade Gatabi K, Ghanbari Moghaddam A. [General health and its related factors among elderly in Sabzevar 2016 (Persian)]. Journal of Gerontology. 2017; 2(3):26-33. [DOI:10.29252/joge.2.2.26]
32. Najafi B, Arzaghi M, Fakhrzadeh H, Sharifi F, Shoaei S, Alizadeh M, et al . [Mental health status and related factors in aged population: Urban health equity assessment and response tool (Urban- HEART) study in Tehran (Persian)]. Iranian Journal of Diabetes and Metabolism. 2014; 13(1):62-73. [Link]
33. Garshad A, Hashemi M, Hatame A, Hossienpour B, Ostade N, Hossienzadeh A, et al . [Examine the relationship between self-esteem and religious attitudes nursing students Bojnoord 2013 (Persian)]. Journal of North Khorasan University of Medical Sciences. 2017; 8(3):439-45. [DOI:10.18869/acadpub.jnkums.8.3.439]
34. Aliverdinia A, Yunesi E. [The effect of level of self-control on crime commitment; among university students (Persian)]. Culture Strategy.  2014; 7(26):93-118. [Link]
35. Rozbahani N, Khorsandi M, Fekrizadeh Z.  [Self-efficacy of self-care behaviors of elderly patients with hypertension (Persian)]. Journal of Sabzevar University of Medical Sciences. 2014; 21(5):753-60. [Link]
36. Shaabani J, Rahgoi A, Nourozi K, Rahgozar M, Shaabani M. [The Relationship between self-efficacy and quality of life among elderly people (Persian)]. Salmand: Iranian Journal of Ageing. 2017; 11(4):518-27. [DOI:10.21859/sija-1104518]
37. Hoseini M, Dakhteh Harooni M, Yaghmaei F,  Alavi MH. [Correlation of social support and health in an elderly population in Iran (Persian)]. Advances in Nursing and Midwifery. 2011; 21(73):25-30. [Link]
38. Khomarnia M, Baghbanian A. [Comparison of the old population’s health status and chronic diseases in the urban and rural areas of Zahedan, Iran in 2012 (Persian)]. Sadra Medical Journal. 2013; 1(3):139-48. [Link]
39. Keefe FJ, Ahles TA, Porter LS, Sutton LM, McBride CM, Pope MS, et al. The self-efficacy of family caregivers for helping cancer patients manage pain at end-of-life. PAIN. 2003; 103(1-2):157-62. [DOI:10.1016/S0304-3959(02)00448-7]
40. Ghadampour E, Heidaryani L, Radmehr F. [Investigating the relationship between the meaning of life and self-esteem with the quality of life of the elderly living in the home and living in the nursing home (Persian)]. Avicenna Journal of Nursing and Midwifery Care. 2018; 26(5):315-22. [DOI:10.30699/sjhnmf.26.a5.315]
41. Hemmati MM, Musavi M, Sheikhi S.  [The effect of reminiscence therapy on the self-esteem among residents of a nursing home in Uromie (Persian)]. Iranian Journal of Psychiatric Nursing. 2013; 1(2):30-7. [Link]
42. Khorramabadi R, Sepehri Z, Bigdeli I. [Structural model of executive function and extramarital relationship with mediating role of self-control (Persian)]. Journal of Cognitive Psychology. 2018; 6(1):46-57. [Link]

43. Solhi M, Kazemi SS, Haghni H. [Relationship between general health and self-efficacy in women referred to health center No.2 in Chaloos (2012) (Persian)]. Razi Journal of Medical Sciences. 2013; 20(110):63-70. [Link]
44. Afrooz GA, Motamedi F. [Self efficacy & mental health of gifted and normal students (Persian)]. Journal of Developmental Psychology. 2006; 2(6):89-99. [Link]
45. Narimani M, Atadokht A, Ahadi B, Abolghasemi A, Zahed A. [Effectiveness of stress management training on reduction of psychological symptoms and ZGlycemic control in Diabetics patients (Persian)].  Quarterly Journal of Health Psychology. 2013; 1(3):19-29. [Link]
46. Niko Ghoftar M, Taghi Sayeedi M. [Prediction of elderly’s general health by their wisdom (Persian)]. Health Psychology. 2014; 3(10):38-46. [Link]
47. Mousavomoghadam SRA, Nouri T, Khodadadi T, Ahmadi A, Ghiasi G. [Association of internet addiction and self-control with mental health among students of the University of Applied Sciences and Technology, Ilam city, Iran (Persian)]. Journal of School of Public Health and Institute of Public Health Research. 2017; 15(1):1-8. [Link]
48. Nastizadeh N. [The relationship between general health and internet addiction (Persian)]. Zahedan Journal of Research in Medical Sciences (Tabib-E-Shargh). 2010; 11(1):57-63. [Link]
49. Yen JY, Ko CH, Yen CF, Wu HY, Yang MJ. The comorbid psychiatric symptoms of Internet addiction: Attention Deficit and Hyperactivity Disorder (ADHD), depression, social phobia, and hostility. The Journal of Adolescent Health. 2007; 41(1):93-8. [DOI:10.1016/j.jadohealth.2007.02.002] [PMID]
50. Hacihasanoğlu R, Yildirim A, Karakurt P. Loneliness in elderly individuals, level of dependence in Activities of Daily Living (ADL) and influential factors. Archives of Gerontology and Geriatrics. 2012; 54(1):61-6. [DOI:10.1016/j.archger.2011.03.011] [PMID]
51. Masti E, Fakhrayi S. [The study of the relationship between women’s employment and their social health in Maragheh (Persian)]. Sociological Studies. 2014; 7(24):117-33. [Link]
52. Sharifian A, Rezai H. [Comparison of life satisfaction, general health and functionality of elderly residents in public and private nursing homes in Tehran (Persian)]. Journal of Social Work Research. 2016. 2(8):77-111. [Link]
53. Hemmati Alamdarlou G, Dehshiri G, Shojaie S, Hakimi Rad E. [Health and Loneliness Status of the Elderly Living in Nursing Homes Versus Those Living with Their Families (Persian)]. Salmand: Iranian Journal of Ageing 2008; 3(2):557-564. [Link]