The Relationship Between Mindfulness and Tolerance of Ambiguity with Death Anxiety and Improving Sleep Quality in the Elderly

Document Type : Original Article

Authors

1 Dept. of Psychology, Yadegar-e-Imam Khomeini (RAH) Shahre Rey Branch, Islamic Azad University, Tehran, Iran

2 Dept. of Psychology, Science and Research Branch, Islamic Azad University, Tehran, Iran

10.22126/jap.2023.8258.1649

Abstract

Conducting research in the field of the elderly, who will form the majority of the population of Iran in the coming years, and identifying the various dimensions of their problems and difficulties in order to perform more efficient interventions, are of particular importance. Due to the fact that the elderly considers their death close, the anxiety of death and its vagueness may unconsciously affect various aspects of their life, including the quality of their sleep. Therefore, the current research aims to predict death anxiety and sleep quality of the elderly based on the mindfulness and tolerance of ambiguity. This was a descriptive study, of correlational type. The statistical population included all people over 65 years of age living in the nursing homes of Tehran, Iran in 2022 (around 1120 people), among whom 200 people from Asman Niavaran (area 1) and Kahrizak (area 20) centers were selected using convenience sampling method. In order to collect data, Bauer et al.’s five-factor mindfulness, McLean’s tolerance of ambiguity, Cult-Lester’s death anxiety and Petersburg’s sleep quality questionnaires were used. Data was analyzed using Pearson’s correlation coefficient and multivariate regression analysis. The findings illustrated that mindfulness and tolerance of ambiguity were able to predict death anxiety and sleep quality in the elderly (P<0.05). Mindfulness was correlated to sleep quality and death anxiety. Besides, there was a significant negative relationship between tolerance of ambiguity with death anxiety and sleep quality. Based on the findings of the current study, trying to increase the mindfulness and tolerance of ambiguity as an intervention related to mental health is recommended to reduce death anxiety and increase the sleep quality of the elderly.
References
Apouey, B. H. (2018). Preparation for old age in France: The roles of preferences and expectations. The Journal of the Economics of Ageing, 12, 15-23. https://doi.org/10.1016/j.jeoa.2017.11.003  
Baharvandi, B., Kazemianmoghadam, K., & Haroon Rashidi, H. (2020). The Effectiveness of compassion-focused therapy on ambiguity tolerance and death anxiety in the elderly. Aging Psychology6(1), 13-26. https://jap.razi.ac.ir/article_1446.html?lang=en [Persian]
Barghi Irani, Z., Aliakbari, M., & Bagian Kulehmarz, M. J. (2015). The Effectiveness of cognitive-behavioral therapy on sleep and memory state in the elderly. Aging Psychology1(1), 19-30. https://jap.razi.ac.ir/article_286.html?lang=en [Persian]
Beh-Pajooh, A., & Solimani, S. (2017). The relationship between quality of sleep and the quality of life of the elderly in three districts of Tehran. Aging Psychology3(2), 107-114. https://jap.razi.ac.ir/article_747.html?lang=en [Persian]
Belmi, P., & Peffer, J. (2016). Power and death: Mortality salience increases power seeking while feeling powerful reduces death anxiety. Journal of Applied Psychology, 101(5), 702–720. https://doi.org/10.1037/apl0000076
Dorri, S., Hakimi, H., Rafii, F., Ashghali Farahani, M., & Mohammadi, H. (2019). Concept of active aging in diabetics: A qualitative article. Journal of Hayat, 25(3), 325-341. http://hayat.tums.ac.ir/article-1-3133-fa.html [Persian]
Fadayevatan, R., Bahrami, M., Mohamadzadeh, M., & Borhaninejad, V. (2020). Relationship of sleep quality with mental health and blood sugar control in elderly people with diabetes mellitus. Iranian Journal of Ageing, 14(4), 380-391. https://doi.org/10.32598/sija.13.10.120 [Persian]
Fernandez, L. A., Smith-Plaza, A. M., Barrea-Castillo, M., Prado-Suarez, J. P., Lopez-Garica, E., Rodriguez-Artalejo, F., & Alberto, L. (2021). Sleep patterns and physical function in older adults attending primary health care. Family practice, 38(2), 147-153. https://doi.org/10.1093/fampra/cmaa085 [Persian]
Gholmi, M., hafezi, F., Askari, P., & Naderi, F. (2016). The Comparison between the effectiveness of mindfulness and spiritual/religious coping skills on death anxiety and blood pressure of the elderly patients with hypertension. Aging Psychology2(2), 143-151. https://jap.razi.ac.ir/article_580.html?lang=en [Persian]
Ghadampour, E., moradizadeh, S., & Shahkarami, M. (2018). The Effectiveness of mindfulness training on increasing happiness and improving quality of life in elderly. Aging Psychology4(1), 27-38. https://jap.razi.ac.ir/article_900.html?lang=en [Persian]
Hajatnia, B., Tajeri, B., & Haji Alizadeh, K. (2021). The effectiveness of spiritual therapy on the quality of sleep, resilience, and death anxiety of the elderly, Journal of Preventive Medicine, 8(2), 17-26. http://dx.doi.org/10.52547/jpm.8.2.26 [Persian]
Hokett, E., Arunmozhi, A., Campbell, J., Verhaeghen, P., & Duarte, A. (2021). A systematic review and meta-analysis of individual differences in naturalistic sleep quality and episodic memory performance in young and older adults. Neuroscience and Biobehavioral Reviews, 127, 675-688. https://doi.org/10.1016/j.neubiorev.2021.05.010
Hoshi, N., Kjodabakhshi Kolaei, A., & Falsafinejad, M. (2020). The Effectiveness of mindfulness-based group counseling on sleep quality and rumination in older people. Journal of Assessment and Research in Applied Counseling; 2(2), 35-51. http://dx.doi.org/10.52547/jarcp.2.1.35 [Persian]
Khalvati, M., Babakhanian, M., Khalvati, M., Nafei, A., Khalvati, M., & Ghafuri, R. (2021). Death anxiety in the elderly in Iran: A Systematic Review and Meta-analysis. Iranian Journal of Ageing, 16 (2), 152-171. http://dx.doi.org/10.32598/sija.16.2.862.2 [Persian]
Koerner, N., Mejia, T., & Kusec, A. (2017). What’s in a name? Intolerance of uncertainty, other uncertainty-relevant constructs, and their differential relations to worry and generalized anxiety disorder. Cognitive Behavior Therapy, 46(2), 141-161. http://dx.doi.org/10.1080/16506073.2016.1211172
Kwon, Ch. Y., Chung, S. Y., & Kim, J. W. (2021). Mindfulness meditation program for the elderly in Korea: A preliminary review for planning the program. Ntegrative Medicine Research; 10(1) 100451. https://doi.org/10.1016%2Fj.imr.2020.100451
Khodabakhsh Pirkalani, R., Ramezan Saatchi, L., & Maleki Majd, M. (2018). The Effectiveness of mindfulness-based cognitive therapy (MBCT) on depression, death anxiety and life expectancy in elderly women. Journal of Gerontology (JOGE) joge 3(3), 11-20. http://dx.doi.org/10.29252/joge.3.2.11 [Persian]
Liqing, L., & Luyao, Y. (2022). The Influence of pension mode on the mental health of older adults’ evidence from older adults in china, International Journal of Environmental Research and Public Health, 19(1), 119. https://doi.org/10.3390/ijerph19010119
Majidi, A., & Moradi, O. (2018). Effect of teaching the components of spiritual intelligence on death anxiety in the elderly. Iranian Journal of Ageing, 13(1), 110-123. http://dx.doi.org/10.21859/sija.13.1.110 [Persian]
Mikaeili, N., Ahmadi, S., Habibi, Y., Fallahi, V., Moradi, A., & Hashemi, J. (2018). Role of dead anxiety and anxiety sensitivity in prediction of tolerance of ambiguity in patients with lung cancer. Nursing and Midwifery Journal. 16(8), 612-621. http://unmf.umsu.ac.ir/article-1-3475-fa.html [Persian]
Motamedi, A., Mostafapour, V., & Farokhi, H. (2018). The Effectiveness of hope group therapy on enhancement of happiness and quality of life in elderly women in tasouj. Aging Psychology3(4), 243-252. https://jap.razi.ac.ir/article_832.html?lang=en.
Mollahadi, M., & Salaree, M. M. (2020). The effect of conscript general training on sleep quality of soldiers, Military Caring Sciences Journal. 7 (1), 8-16. http://dx.doi.org/10.29252/mcs.7.1.8 [Persian]
Ohayon, M., Wickwire, E. M., Hirshkowitz, M., Albert, S. M., Avidan, A., Daly, F. J., Dauvilliers, Y., & Vitiello, M. V. (2017). National sleep foundation's sleep quality recommendations: First report. Journal of the National Sleep Foundation, Sleep Health, 3(1), 6-19. https://doi.org/10.1016/j.sleh.2016.11.006
Peng, L. (2021). A Correlative study on epistemic modal use and tolerance of ambiguity: Based on functionalist theories in second language acquisition. International Journal of Language and Linguistics, 9(4), 169-179. doi=10.11648/j.ijll.20210904.15
Poorsharifi, H., & Farahmand Sabet, M. (2015). The relationship between social support and sleep quality with general health in residing nursing house elderly. Aging Psychology1(1), 31-39. https://jap.razi.ac.ir/article_287.html?lang=en [Persian]
Rachel, E., Menzies, R., E., Zuccala, M., Sharpe, L., & Nimrod, I. D. (2018). The effects of psychosocial interventions on death anxiety: A meta-analysis and systematic review of randomised controlled trials. Journal of Anxiety Disorders, 59 64-73. https://doi.org/10.1016/j.janxdis.2018.09.004
Samadifard, H., & Narimani, M. (2017). Prediction of death anxiety of elderly based on mindfulness and irrational Beliefs. Iranian Journal of Psychiatric Nursing (IJPN), 5(3), 15-21. http://ijpn.ir/article-1-945-fa.html [Persian]
Salmani, M., & Zoghi, L. (2022). The Relationship between loneliness, spiritual intelligence and general health with death anxiety in the elderly: The Mediating Role of Mindfulness. Aging Psychology8(1), 55-69. https://jap.razi.ac.ir/article_2141.html?lang=en [Persian]
Sedighi Arfaee, F., & Namaki Bidgoli, Z. (2016). Examining the relationship of mindfulness to resilience in university students. Journal of Fundamentals of Mental Health18 (Special Issue), 627-632. https://doi.org/10.22038/jfmh.2016.8096 [Persian]
Tavakoli, G., Rezai Dehnavi, S., & Montajabian, Z. (2021). The Effectiveness of positive psychotherapy on the vitality in the elderly. Aging Psychology6(4), 299-308. https://jap.razi.ac.ir/article_1577.html?lang=en [Persian]
Trabelsi, KH., Ammar, A., Masmoudi, L., Boukhris, O., Chtourou, H., Bouaziz, B., Brach, M., Bentlage, E., How, D., Ahmed, M., Mueller, P., Mueller, N., Hsouna, H., Elghoul, Y., Romdhani, M., Hammouda, O., Paineiras-Domingos, L. L., Braakman-Jansen, L, M., Wrede, CH., & Bastoni, S. (2021). Sleep quality and physical activity as predictors of mental wellbeing variance in older adults during COVID-19 Lockdown: ECLB COVID-19 International Online Survey. International Journal of Environmental Research and Public Health, 18(8), 4329. https://doi.org/10.3390/ijerph18084329
Valizadeh, H., & Ahmadi, V. (2021), Effectiveness of mindfulness-based therapy on sleep quality and death anxiety in the elderly with hypertension. Caspian Journal of Health and Aging (cjhaa). 6(2), 71-84, http://dx.doi.org/10.22088/cjhaa.6.2.7 [Persian]
Yaremchuk, K. (2018). Sleep disorders in the elderly. Clinical Geriatric Medicine, 34(2), 205-216. https://doi.org/10.1016/j.cger.2018.01.008
Zarani, F., Farmani, F., & Safavi, S. (2019). Explanation of relationship between cultures and psychopathology with emphasis on sleep disorders. Rooyesh, 8(3), 1-10. http://frooyesh.ir/article-1-816-fa.html [Persian]  

Keywords


References
Apouey, B. H. (2018). Preparation for old age in France: The roles of preferences and expectations. The Journal of the Economics of Ageing, 12, 15-23. https://doi.org/10.1016/j.jeoa.2017.11.003  
Baharvandi, B., Kazemianmoghadam, K., & Haroon Rashidi, H. (2020). The Effectiveness of compassion-focused therapy on ambiguity tolerance and death anxiety in the elderly. Aging Psychology6(1), 13-26. https://jap.razi.ac.ir/article_1446.html?lang=en [Persian]
Barghi Irani, Z., Aliakbari, M., & Bagian Kulehmarz, M. J. (2015). The Effectiveness of cognitive-behavioral therapy on sleep and memory state in the elderly. Aging Psychology1(1), 19-30. https://jap.razi.ac.ir/article_286.html?lang=en [Persian]
Beh-Pajooh, A., & Solimani, S. (2017). The relationship between quality of sleep and the quality of life of the elderly in three districts of Tehran. Aging Psychology3(2), 107-114. https://jap.razi.ac.ir/article_747.html?lang=en [Persian]
Belmi, P., & Peffer, J. (2016). Power and death: Mortality salience increases power seeking while feeling powerful reduces death anxiety. Journal of Applied Psychology, 101(5), 702–720. https://doi.org/10.1037/apl0000076
Dorri, S., Hakimi, H., Rafii, F., Ashghali Farahani, M., & Mohammadi, H. (2019). Concept of active aging in diabetics: A qualitative article. Journal of Hayat, 25(3), 325-341. http://hayat.tums.ac.ir/article-1-3133-fa.html [Persian]
Fadayevatan, R., Bahrami, M., Mohamadzadeh, M., & Borhaninejad, V. (2020). Relationship of sleep quality with mental health and blood sugar control in elderly people with diabetes mellitus. Iranian Journal of Ageing, 14(4), 380-391. https://doi.org/10.32598/sija.13.10.120 [Persian]
Fernandez, L. A., Smith-Plaza, A. M., Barrea-Castillo, M., Prado-Suarez, J. P., Lopez-Garica, E., Rodriguez-Artalejo, F., & Alberto, L. (2021). Sleep patterns and physical function in older adults attending primary health care. Family practice, 38(2), 147-153. https://doi.org/10.1093/fampra/cmaa085 [Persian]
Gholmi, M., hafezi, F., Askari, P., & Naderi, F. (2016). The Comparison between the effectiveness of mindfulness and spiritual/religious coping skills on death anxiety and blood pressure of the elderly patients with hypertension. Aging Psychology2(2), 143-151. https://jap.razi.ac.ir/article_580.html?lang=en [Persian]
Ghadampour, E., moradizadeh, S., & Shahkarami, M. (2018). The Effectiveness of mindfulness training on increasing happiness and improving quality of life in elderly. Aging Psychology4(1), 27-38. https://jap.razi.ac.ir/article_900.html?lang=en [Persian]
Hajatnia, B., Tajeri, B., & Haji Alizadeh, K. (2021). The effectiveness of spiritual therapy on the quality of sleep, resilience, and death anxiety of the elderly, Journal of Preventive Medicine, 8(2), 17-26. http://dx.doi.org/10.52547/jpm.8.2.26 [Persian]
Hokett, E., Arunmozhi, A., Campbell, J., Verhaeghen, P., & Duarte, A. (2021). A systematic review and meta-analysis of individual differences in naturalistic sleep quality and episodic memory performance in young and older adults. Neuroscience and Biobehavioral Reviews, 127, 675-688. https://doi.org/10.1016/j.neubiorev.2021.05.010
Hoshi, N., Kjodabakhshi Kolaei, A., & Falsafinejad, M. (2020). The Effectiveness of mindfulness-based group counseling on sleep quality and rumination in older people. Journal of Assessment and Research in Applied Counseling; 2(2), 35-51. http://dx.doi.org/10.52547/jarcp.2.1.35 [Persian]
Khalvati, M., Babakhanian, M., Khalvati, M., Nafei, A., Khalvati, M., & Ghafuri, R. (2021). Death anxiety in the elderly in Iran: A Systematic Review and Meta-analysis. Iranian Journal of Ageing, 16 (2), 152-171. http://dx.doi.org/10.32598/sija.16.2.862.2 [Persian]
Koerner, N., Mejia, T., & Kusec, A. (2017). What’s in a name? Intolerance of uncertainty, other uncertainty-relevant constructs, and their differential relations to worry and generalized anxiety disorder. Cognitive Behavior Therapy, 46(2), 141-161. http://dx.doi.org/10.1080/16506073.2016.1211172
Kwon, Ch. Y., Chung, S. Y., & Kim, J. W. (2021). Mindfulness meditation program for the elderly in Korea: A preliminary review for planning the program. Ntegrative Medicine Research; 10(1) 100451. https://doi.org/10.1016%2Fj.imr.2020.100451
Khodabakhsh Pirkalani, R., Ramezan Saatchi, L., & Maleki Majd, M. (2018). The Effectiveness of mindfulness-based cognitive therapy (MBCT) on depression, death anxiety and life expectancy in elderly women. Journal of Gerontology (JOGE) joge 3(3), 11-20. http://dx.doi.org/10.29252/joge.3.2.11 [Persian]
Liqing, L., & Luyao, Y. (2022). The Influence of pension mode on the mental health of older adults’ evidence from older adults in china, International Journal of Environmental Research and Public Health, 19(1), 119. https://doi.org/10.3390/ijerph19010119
Majidi, A., & Moradi, O. (2018). Effect of teaching the components of spiritual intelligence on death anxiety in the elderly. Iranian Journal of Ageing, 13(1), 110-123. http://dx.doi.org/10.21859/sija.13.1.110 [Persian]
Mikaeili, N., Ahmadi, S., Habibi, Y., Fallahi, V., Moradi, A., & Hashemi, J. (2018). Role of dead anxiety and anxiety sensitivity in prediction of tolerance of ambiguity in patients with lung cancer. Nursing and Midwifery Journal. 16(8), 612-621. http://unmf.umsu.ac.ir/article-1-3475-fa.html [Persian]
Motamedi, A., Mostafapour, V., & Farokhi, H. (2018). The Effectiveness of hope group therapy on enhancement of happiness and quality of life in elderly women in tasouj. Aging Psychology3(4), 243-252. https://jap.razi.ac.ir/article_832.html?lang=en.
Mollahadi, M., & Salaree, M. M. (2020). The effect of conscript general training on sleep quality of soldiers, Military Caring Sciences Journal. 7 (1), 8-16. http://dx.doi.org/10.29252/mcs.7.1.8 [Persian]
Ohayon, M., Wickwire, E. M., Hirshkowitz, M., Albert, S. M., Avidan, A., Daly, F. J., Dauvilliers, Y., & Vitiello, M. V. (2017). National sleep foundation's sleep quality recommendations: First report. Journal of the National Sleep Foundation, Sleep Health, 3(1), 6-19. https://doi.org/10.1016/j.sleh.2016.11.006
Peng, L. (2021). A Correlative study on epistemic modal use and tolerance of ambiguity: Based on functionalist theories in second language acquisition. International Journal of Language and Linguistics, 9(4), 169-179. doi=10.11648/j.ijll.20210904.15
Poorsharifi, H., & Farahmand Sabet, M. (2015). The relationship between social support and sleep quality with general health in residing nursing house elderly. Aging Psychology1(1), 31-39. https://jap.razi.ac.ir/article_287.html?lang=en [Persian]
Rachel, E., Menzies, R., E., Zuccala, M., Sharpe, L., & Nimrod, I. D. (2018). The effects of psychosocial interventions on death anxiety: A meta-analysis and systematic review of randomised controlled trials. Journal of Anxiety Disorders, 59 64-73. https://doi.org/10.1016/j.janxdis.2018.09.004
Samadifard, H., & Narimani, M. (2017). Prediction of death anxiety of elderly based on mindfulness and irrational Beliefs. Iranian Journal of Psychiatric Nursing (IJPN), 5(3), 15-21. http://ijpn.ir/article-1-945-fa.html [Persian]
Salmani, M., & Zoghi, L. (2022). The Relationship between loneliness, spiritual intelligence and general health with death anxiety in the elderly: The Mediating Role of Mindfulness. Aging Psychology8(1), 55-69. https://jap.razi.ac.ir/article_2141.html?lang=en [Persian]
Sedighi Arfaee, F., & Namaki Bidgoli, Z. (2016). Examining the relationship of mindfulness to resilience in university students. Journal of Fundamentals of Mental Health18 (Special Issue), 627-632. https://doi.org/10.22038/jfmh.2016.8096 [Persian]
Tavakoli, G., Rezai Dehnavi, S., & Montajabian, Z. (2021). The Effectiveness of positive psychotherapy on the vitality in the elderly. Aging Psychology6(4), 299-308. https://jap.razi.ac.ir/article_1577.html?lang=en [Persian]
Trabelsi, KH., Ammar, A., Masmoudi, L., Boukhris, O., Chtourou, H., Bouaziz, B., Brach, M., Bentlage, E., How, D., Ahmed, M., Mueller, P., Mueller, N., Hsouna, H., Elghoul, Y., Romdhani, M., Hammouda, O., Paineiras-Domingos, L. L., Braakman-Jansen, L, M., Wrede, CH., & Bastoni, S. (2021). Sleep quality and physical activity as predictors of mental wellbeing variance in older adults during COVID-19 Lockdown: ECLB COVID-19 International Online Survey. International Journal of Environmental Research and Public Health, 18(8), 4329. https://doi.org/10.3390/ijerph18084329
Valizadeh, H., & Ahmadi, V. (2021), Effectiveness of mindfulness-based therapy on sleep quality and death anxiety in the elderly with hypertension. Caspian Journal of Health and Aging (cjhaa). 6(2), 71-84, http://dx.doi.org/10.22088/cjhaa.6.2.7 [Persian]
Yaremchuk, K. (2018). Sleep disorders in the elderly. Clinical Geriatric Medicine, 34(2), 205-216. https://doi.org/10.1016/j.cger.2018.01.008
Zarani, F., Farmani, F., & Safavi, S. (2019). Explanation of relationship between cultures and psychopathology with emphasis on sleep disorders. Rooyesh, 8(3), 1-10. http://frooyesh.ir/article-1-816-fa.html [Persian]