1. Introduction
Aging is a natural phenomenon, and many countries are experiencing an increase in the number of older people [1]. The World Health Organization has estimated that the world's aging population, currently 841 million, will increase to 2 billion by 2050 [2]. Aging is associated with high mortality rates, decreased psychological and physical functioning, and psychological disorders, such as depression and anxiety. Such consequences can affect one's Quality of Life (QOL); therefore, the QOL and mental well-being of the elderly have become a challenge to public health and identifying related risk and protective factors are among the areas of interest in geriatric psychology. Given the importance of this issue, the present study aimed at determining the role of irrational beliefs and attitudes toward death in predicting QOL in the elderly.
2. Materials and Methods
This research is a descriptive correlational study. The study population consisted of all people aged over 60 years living in Ardabil city, Iran, in 2014. Using a convenience sampling method, 150 individuals were selected for the study. Because in correlational studies the sample size required for each predictor variable is 5 to 40 people, and based on the existence of 10 subscales for each scale, 15 individuals were considered for each one. Thus, a total number of 150 people were the samples of the present study. The inclusion criteria were having reading and writing skills and living with wife or husband. Those with any physical or psychological diseases were excluded from the study.
After visiting the older people in different areas of the city, including parks and mosques, and explaining the aims of the research, their informed consent to participate in the research was obtained. Then, we collected the study data by the World Health Organization Quality of Life (WHOQOL)-BREF questionnaire with 26 items, Jones Irrational Beliefs Questionnaire with 40 items, and the Death Attitude Profile-Revised (DAP-R) instrument with 32 items. For analyzing the collected data, we used descriptive statistics (mean and standard deviation), as well as the Pearson correlation test and multiple regression analysis (enter method) in SPSS V. 16.
3. Results
Of 150 participants, 115 were men, and 35 were women with a Mean±SD age of 68.82±6.91 years. In terms of marital status, 5 were single, 141 were married, and 4 were divorced. In terms of education, 113 had less than high school education, 35 a high school diploma and bachelor's degree, and 2 a degree higher than a bachelor's degree. The results of the Pearson correlation test showed that the overall score of QOL had a significant negative association with the attitudes of fear of death (r=-0.36, P<0.001), death avoidance (r=-0.16, P<0.05), escape avoidance (r=-0.17, P<0.03), beliefs of helpless for change (r=-0.27, P<0.001), and emotional irresponsibility (r=-0.24, P<0.002). However, there was a significant positive association between the overall score of QOL and attitude dimension of approach acceptance (r=0.31, P=0.000). Before performing the regression analysis, the results of the Kolmogorov-Smirnov test confirmed the normal distribution of the data (P=0.09). The results of the regression analysis showed that irrational beliefs and attitudes towards death explained about 9% and 30% of the total variance in QOL, respectively. The beta values indicated that the irrational belief of emotional irresponsibility (β=-0.18), attitudes of fear of death (β=-0.25), neutral acceptance (β=-0.28), approach acceptance (β=0.35), and escape avoidance (β=-0.24) were the predictors of the QOL of older people. The linear regression coefficients revealed no possible linearity possible among these predictors.
4. Conclusion
The results of this study suggested that irrational beliefs and attitudes toward death could affect the QOL of the elderly. Older people, who have positive attitudes towards death, accept and see it as a way to achieve eternal happiness. They acknowledge that death is not the end of human life but a transition from one life to another, where human life continues in another form, so they are always hopeful and have a better QOL and mental well-being. Moreover, having the irrational belief of helplessness for change can hinder proper problem-solving techniques and harm their QOL. Emotional responsibility as an emotion control skill also induces one's emotional self-regulation and acts as a skill to deal with one's concerns. Therefore, believing that one is not responsible for their own experienced emotions can reduce emotional self-awareness and lead to emotional misalignment. These results suggest that cognitive intervention in these variables can improve the QOL in the elderly.
Ethical Considerations
Compliance with ethical guidelines
All ethical principles were met in this study. The participants were informed about the study purpose and method. They were also assured of  the confidentiality of their information and were free to leave the study at any time, and if desired, the results of the study would be available to them. This study was approved by the Research Ethics Committee of Ardabil University Of Medical Sciences. 


Funding
This study received  support from the Deputy of Technology Research and Technology of University of Mohaghegh Ardabili.
Authors' contributions
Study design by Sajjad Basharpoor; data collection and analysis by Seyede Tayebeh Hoseinikiasari and Esmaeil Soleymani; writing by Sajjad Basharpoor and Omid Massah.
Conflicts of interest
The authors have declared that they have no potential or competing conflicts of interest.

 

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