Introduction
Aging is an inevitable process during which the functioning of various body organs gradually declines and the elderly person is exposed to many injuries [1]. In recent years, studies have shown great interest in psychological well-being, especially in the elderly. The psychological well-being in old age has a significant positive relationship with short-term and long-term health outcomes and quality of life (QoL) [2]. It is important to identify the factors affecting psychological well-being. One of the important variables that can be considered a serious threat to psychological well-being is cognitive impairment [3]. Studies show that cognitive deficits, especially dementia, are among the main causes of disability and decline in QoL among the elderly, and it is expected that with the increasing growth of the elderly population, they will be among the most serious challenges in health care [4]. Emotions can be among other factors affecting psychological well-being. Research shows that negative emotions cause a decrease in life satisfaction and psychological well-being [5]. Coping self-efficacy is another factor that can play an important role in improving the psychological well-being of the elderly by strengthening or maintaining their independence [6]. Social support is another effective factor that has attracted the attention of many researchers. Many studies have confirmed its positive and significant effects on psychological well-being, especially in the elderly [7]. Cognitive deficits and negative emotions have negative effects on coping self-efficacy and social support, and lead to a significant decline in psychological well-being of the elderly [8-11]. In the present study, an attempt was made to investigate the effects of cognitive deficits and negative emotions on psychological well-being with the mediation of coping self-efficacy and social support. In this regard, we aim to answer the question: Is it possible to predict psychological well-being in the elderly based on cognitive deficits and negative emotions mediated by coping self-efficacy and social support?

Methods
In this study, participants were 450 older adults, including 247 men (54.9%) and 203 women (45.1%), aged 60-80 years who were selected by a convenience sampling method. Entry criterion was no any acute physical or psychiatric disease. The data collection tools were Ryff’s Psychological Well-Being Scale, Positive and Negative Affect Scale, Mini-Mental State Examination, Coping Self-Efficacy Scale, and the Social Provisions Scale. Due to the limitations caused by the COVID-19 pandemic, the questionnaires were administered via WhatsApp or Skype. The questionnaires were completed in two stages (to avoid the possible fatigue of the elderly). The collected data were analyzed in SPSS version 23 and LISREL version 8.80 software using descriptive statistics (Mean±SD and No.) and inferential statistics (Pearson’s correlation test, structural equation modeling, and Bootstrap method).

Results
The mean age of male participants was 66.34±5.34 years and the mean age of female participants was 65.57±6.08 years. The correlation matrix showed that psychological well-being had a significant negative relationship with cognitive impairment (r=-0.662) and negative emotions (r=-0.627) and a significant positive relationship with coping self-efficacy (r=0.764) and social support (r=0.835). The assumptions of structural equation modeling including univariate normality, multivariate normality, multiple collinearity and outliers were examined and confirmed. Moreover, before selecting the indicators, using the confirmatory factor analysis method, their ability to measure the latent variables was evaluated. The results of the structural equation modelling indicated a good fit of the model (NFI=0.95, IFI=0.96, RFI=0.94, TLI=0.95, CFI=0.96, SRMR=0.07). The results of the bootstrap test showed that all four mediating paths were significant. Cognitive impairment with standard coefficients of -0.57, -0.60, and -0.27 had an impact on social support, coping self-efficacy, and psychological well-being, respectively. Negative emotions also had an effect on social support, coping self-efficacy and psychological well-being with coefficients of -0.28, -0.34 and -0.11, respectively. The effect of coping self-efficacy on psychological well-being had a standard coefficient of 0.15, and the effect of social support on psychological well-being had a standard coefficient of 0.57. The final study model is presented in Figure 1.



Discussion
The variables of cognitive impairment and negative emotions had a significant effect on the psychological well-being of the elderly when were mediated by coping self-efficacy and social support. The direct effects of cognitive impairment and negative emotions on psychological well-being were less than their indirect effects. This confirms the importance of the role of mediating variables. It seems that the study model has a good theoretical coherence and can partially compensate for the previous theoretical gaps. From a practical point of view, the results of this study can be helpful in the field of geriatric health and in the design of educational packages and treatment protocols for the elderly. In overall, the results of this study highlighted the importance of coping self-efficacy and social support in promoting psychological well-being and subsequently preventing the occurrence of adverse consequences caused by cognitive deficits in the elderly. In this regard, it is recommended to develop comprehensive and practical strategies to strengthen the internal and external resources of the elderly and improve their health.

Ethical Considerations

Compliance with ethical guidelines
This study was approved by the ethics committee of Kharazmi University. After explaining the study objectives to the participants and assuring them of the confidentiality of their information, informed consent was obtained from them.

Funding
This study did not receive any financial support from government, private and non-profit organizations.

Authors' contributions
The authors had equal contribution to the preparation of this article.

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgements
The authors would like to thank all seniors participated in the study for their cooperation.
 

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