The Effectiveness of Behavioral Activation Intervention on Increasing Self-Care Behaviors and Life Expectancy in the Elderly

Abstract
The process of aging seems inevitable to all living creatures, including humans. Self-care and life expectancy are two main concepts in aging and have good results in providing, maintaining and promoting elderly health. The present study aimed to investigate the effectiveness of behavioral activation intervention in increasing self-care behaviors and life expectancy in the elderly. A quasi-experimental research method with pretest, posttest and control group with a 3-month follow-up was used in this study. The statistical population of the study included all elderly people over 60 in Tehran. The participants included 24 individuals and were selected through purposive method according to the inclusion criteria. They were randomly assigned into two experimental and control groups (n=12). The experimental group received 8 sessions of behavioral activation intervention and the control group did not receive any intervention. Hemmati Maslak Pak's questionnaire on the self-care ability of the elderly and Schneider's life expectancy questionnaire were used to collect the required data. Finally, the collected data were analyzed by SPSS version 22 software in two levels of descriptive (mean and standard deviation) and inferential statistics (univariate analysis of covariance). Statistical results showed the significant effectiveness of behavioral activation intervention on increasing the life expectancy of the elderly and increasing their self-care behaviors; these results were consistent after a 3-month follow-up (p < 0.05). According to the findings of the study, behavioral activation intervention can be considered as one of the effective psychological interventions in increasing self-care behaviors and life expectancy in the elderly.

References
Abbasi, M., Ghadampour, A., Hojati, M. (2017). The Role of Self-care, Resilience and Despair on depression in the elderly with Heart Diseases. Aging Psychology, 3(3), 181-188. [Persian]
Afshari, A., Hashemi, Z. (2019). The Relationship Between Religious Exposure and Psychological Well-being with Loneliness in the Elderly. Aging Psychology, 1(5), 65-75. [Persian]
Bahari, F. (2014). The Essentials of Hope and Hope Therapy: A Manual for Hope Rising. Danjeh Publications. [Persian]
Bergman, Y. S., & Bodner, E. (2018). The connection between subjective nearness-to-death and depressive symptoms: The mediating role of meaning in life. Psychiatry Research, 261, 269-273.
Bonita, A. G. (2013). Computerized Behavioral Activation Treatment for Major Depressive Disorder and the Effects on Sexual Desire (Doctoral dissertation). Western Michigan University, USA.
Borhaninejad, V., Mansouri, T., Hoseyni, R., Kojaie bidgoli, A., & Fadayevatan, R. (2017). The relationship between diabetic knowledge and self-care among the Elderly with diabetes Type 2 in Kerman-2016. Journal of Gerontology, 1(3), 1-10. [Persian]
Caboral, M. F., Evangelista, L. S., & Whetsell, M. V. (2012). Hope in elderly adults with chronic heart failure. Concept analysis. Investigacion y Educacion en Enfermeria, 30(3), 406-411.
Chartier, I. S., & Provencher, M. D. (2013). Behavioural activation for depression: Efficacy, effectiveness and dissemination. Journal of Affective Disorders, 145(3), 292-299.
Chiang, K. J., Chu, H., Chang, H. J., Chung, M. H., Chen, C. H., Chiou, H. Y., & Chou, K. R. (2010). The effects of reminiscence therapy on psychological well‐being, depression, and loneliness among the  
     institutionalized aged. International Journal of Geriatric Psychiatry: A Journal of the Psychiatry of Late Life and Allied Sciences, 25(4), 380-388.
Chu, B. C., Colognori, D., Weissman, A. S., & Bannon, K. (2009). An initial description and pilot of group behavioral activation therapy for anxious and depressed youth. Cognitive and Behavioral Practice, 16(4), 408-419.
Davies, N. (2011). Promoting healthy ageing: the importance of lifestyle. Nursing Standard, 25(19), 43-51.
Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. E., ... & Atkins, D. C. (2006). Randomized Trial of Behavioral Activation, Cognitive Therapy, and Antidepressant Medication in the Acute Treatment of Adults With Major Depression. Journal of Consulting and Clinical Psychology, 74(4), 658-670.
Do Valle, C. R., Valle, E., Valle, L., & Fior, C. A. (2013). Quality of life and sleep disorders in elderly. Sleep Medicine, 14(1), 291-305.
Feist, J., Feist, G. J., & Roberts, T. A. (2009). Theories of Personality (Y. Seyyed Mohammadi, Trans.). Ravan Publications. [Persian]
Feldman, D. B. & Snyder, C. R. (2005). Hope and the meaningful life: Theoretical and empirical associations between goal–directed thinking and life meaning. Journal of Social and Clinical Psychology, 24(3), 401-421.
Griffin, B., Loh, V., & Hesketh, B. (2013). A mental model of factors associated with subjective life expectancy. Social Science & Medicine, 82, 79-86.
Hasson-Ohayon, I., Kravetz, S., Meir, T., & Rozencwaig, S. (2009). Insight into severe mental illness, hope, and quality of life of persons with schizophrenia and schizoaffective disorders. Psychiatry Research, 167(3), 231-238.
Hemmati Maslak Pak, & M., Hashemlo, L. (2015). Design and Psychometric Properties of a Self-Care Questionnaire for the Elderly. Salmand: Iranian Journal of Ageing, 10(3), 120-131. [Persian]
Hoseinikhah, M., Manshaee, G., & Ebrahimi, A. (2014). Prediction of Self-care behavior based on Hardiness, Hope and Dysfunction Attitude among patients with Type 2 Diabetes. Research in Behavioral Sciences, 12(2), 217-225. [Persian]
Jaarsma, T., Cameron, J., Riegel, B., & Stromberg, A. (2017). Factors related to self-care in heart failure patients according to the middle-range theory of self-care of chronic illness: a literature update. Current Heart Failure Reports, 14(2), 71-77.
Kanter, J. W., Busch, A. M. & Rusch, L. C. (2009). Behavioral Activation: Distinctive Features (M. Mirzaei & S. Fereydouni, Trans.). Arjmand Publications. [Persian]
Kao, Y. C., Liu, Y. P., Chou, M. K., & Cheng, T. H. (2011). Subjective quality of life in patients with chronic schizophrenia: relationships between psychosocial and clinical characteristics. Comprehensive Psychiatry, 52(2), 171-180.
Kermani, Z., Khodapanahi, M., & Heidari, M. (2011). Psychometric properties of the Snyder Hope Scale. Quarterly of Applied Psychology, 3(19), 7-23. [Persian]
Kim, G., Shim, R., Ford, K. L., & Baker, T. A. (2015). The relation between diabetes self-efficacy and psychological distress among older adults: do racial and ethnic differences exist? Journal of Aging and Health, 27(2), 320-333.
Knight, B. G. (2004). Psychotherapy with older adults. California: SAGE Publications.
Latifi, Z., Kiani, M., & Yousefi, Z. (2019). The Structural Equation Modeling of the Older People’s Life Expectancy Based on the Anxiety Sensitivity, Social Support, and Pain Perception. Salmand: Iranian Journal of Ageing, 14(2), 188-199. [Persian]
Leahy, R. L., Holland, S. J., & McGinn, L. K. (2012). Treatment Plans and Interventions for Depression and Anxiety Disorders, 2e. Guilford Press.
Lee, K. S., Lennie, T. A., Yoon, J. Y., Wu, J. R., & Moser, D. K. (2017). Living Arrangements Modify the Relationship Between Depressive Symptoms and Self-care in Patients With Heart Failure. The Journal of Cardiovascular Nursing, 32(2), 171-179.
Lejuez, C. W., Hopko, D. R., Acierno, R., Daughters, S. B., & Pagoto, S. L. (2011). Ten years revision of the brief behavioral activation treatment for depression: revised treatment manual. Behavior Modification, 35(2), 111-161.
Ly, K. H., Janni, E., Wrede, R., Sedem, M., Donker, T., Carlbring, P., & Andersson, G. (2015). Experiences of a guided smartphone-based behavioral activation therapy for depression: a qualitative study. Internet Interventions, 2(1), 60-68.
Mansano-Schlosser, T. C., Ceolim, M. F., & Valerio, T. D. (2017). Poor sleep quality, depression and hope before breast cancer surgery. Applied Nursing Research, 34, 7-11.
Martell, C. R., Dimidjian, S., & Herman-Dunn, R. (2010). Behavioral Activation for Depression: A Clinician's Guide. Guilford Press.
Mazzucchelli, T. G. (2010). Behavioural activation interventions for depression and well-being (Doctoral dissertation). Curtin University, Australia.
Moshier, S. J., & Otto, M. W. (2017). Behavioral activation treatment for major depression: A randomized trial of the efficacy of augmentation with cognitive control training. Journal of Affective Disorders, 210, 265-268.
Ong, A. D., Edwards, L. M., & Bergeman, C. S. (2006). Hope as a source of resilience in later adulthood. Personality and Individual Differences, 41(7), 1263-1273.
Oraki, M., Mehdizadeh, A., & Dortaj, A. (2019). The Effectiveness of Self-care Empowerment Training on Life Expectancy, Happiness and Quality of Life of the Elderly in Iranian Elderly Care Centers in Dubai. Salmand: Iranian Journal of Ageing, 14(3), 320-331. [Persian]
Orem, D. E. (1997). Views of human beings specific to nursing. Nursing Science Quarterly, 10(1), 26-31.
Parhoon, H., Moradi, A., Hatami, M., & Moshirpanahi, S. (2014). Effectiveness of Brief Behavioral Activation Treatment in Reducing Depression Symptoms and Improving Quality of Life in Patients with Major Depression. Clinical Psychology Studies, 4(14), 41-62. [Persian]
Pascariu, M. D., Canudas-Romo, V., & Vaupel, J. W. (2018). The double-gap life expectancy forecasting model. Insurance: Mathematics and Economics, 78, 339-350.
Ryba, M. M., Lejuez, C. W., & Hopko, D. R. (2013). Behavioral activation for depressed breast cancer patients: the impact of therapeutic compliance and quantity of activities completed on symptom reduction. Journal of Consulting and Clinical Psychology, 82(2), 325-335.
Sachdev, P. S., Brodaty, H., Reppermund, S., Kochan, N. A., Trollor, J. N., Draper, B., ... & Mather, K. A. (2010). The Sydney Memory and Ageing Study (MAS): methodology and baseline medical and neuropsychiatric characteristics of an elderly epidemiological non-demented cohort of Australians aged 70–90 years. International Psychogeriatrics, 22(8), 1248-1264.
Shareh, H. (2016). Effectiveness of behavioral activation group therapy on attributional styles, depression, and quality of life in women with breast cancer. Journal of Fundamentals of Mental Health, 18(4), 179-188. [Persian]
Simmons, L. (2009). Dorthea Orem's self-care theory as related to nursing practice in hemodialysis. Nephrology Nursing Journal, 36(4), 419-422.
Snyder, C. R., Harris, C., Anderson, J. R., Holleran, S. A., & Irving, L. M. (1991). The Will and the Ways: Development and Validation of an Individual-Differences Measure of Hope. Journal of Personality and Social Psychology, 60(4), 570-585.
Stewart, W. (2005). An A-Z of Counseling Theory and Practice (H. Keshavarz Afshar, A. Boostanipoor, M. Goodarzi, & M. B. Daneshjoo, Trans.). Elm Publications. [Persian]
Szramka-Pawlak, B., Hornowska, E., Walkowiak, H., & Żaba, R. (2014). Hope as a psychological factor affecting quality of life in patients with psoriasis. Applied Research in Quality of Life, 9(2), 273-283.
Teimoorpoor, S., Akbari, M., & Hasani, J. (2019). The evaluation of mechanism of Effectiveness of Behavioral Activation Therapy (BA) through Cognitive Flexibility and Emotional Flexibility on Symptoms of Women with Major Depressive Disorders. Journal of Cognitive Psychology, 6(4), 1-13. [Persian]
Zahmatkeshan, N., Bagherzadeh, R., Akaberian, S., Yazdankhah, M. R., Mirzaei, K., Yazdanpanah, S., Khoramroodi, R., Gharibi, T., Kamali, F., & Jamand, T. (2012). Assessing Quality Of Life and related factors in Bushehr's elders – 1387-8. Journal of Fasa University of Medical Sciences, 2(1), 53-58. [Persian]