رابطه بین نگرش به سالمندی و احساس تنهایی از طریق نقش میانجی تاب‌آوری و عزت نفس در سالمندان ایرانی

Individuals’ attitudes toward aging (ATA) play a crucial role in their quality of life, particularly in reducing feelings of loneliness. Psychological factors such as resilience and self-esteem may serve as effective mediators in mitigating the negative effects of aging-related changes on loneliness. Therefore, this study aims to examine the relationship between ATA and loneliness, with the mediating roles of resilience and self-esteem in older adults (60 and over) in Iran. This study utilized a descriptive-correlational design, using structural equation modeling (SEM). The target population consisted of older adults residing in Kermanshah Province, Iran in 2024. A sample of 320 participants was selected through convenience sampling. Data were collected in person using standardized questionnaires, including Laidlaw et al.’s ATA Scale, Connor-Davidson Resilience Scale, Rosenberg Self-Esteem Scale, and UCLA Loneliness Scale. The collected data were analyzed using SPSS26 and AMOS24 software. Findings revealed that higher positive ATA was associated with lower loneliness. This effect was observed both directly and indirectly through the mediation of resilience and self-esteem. Resilience and self-esteem played a significant mediating role in the relationship between ATA and loneliness. Although longitudinal evidence is needed to investigate the causal pathway, the results of the current study suggest that it may be important to enhance psychological factors, such as resilience and self-esteem, as well as to foster positive ATA, as key strategies to reduce social isolation among older adults. These results offer valuable insights for developing supportive policies and comprehensive programs to reduce the sense of loneliness in older adults.
EXTENDED ABSTRACT
 Introduction
Loneliness emerges as one of the critical challenges in the aging process, profoundly affecting individuals’ mental health, well-being, and longevity. Loneliness affects the emotional, social, and physical dimensions of life and is associated with negative outcomes such as depression, anxiety, and social isolation. Additionally, loneliness can itself be a consequence of social isolation, creating a reinforcing cycle. Among factors influencing loneliness, subjective aging is particularly significant, referring to individuals’ perceptions of their own aging process, which can differ from their chronological age. Several measures exist to assess subjective aging, including felt age, aging perceptions, awareness of age-related changes and attitudes toward aging (ATA, individuals’ feelings and beliefs about their personal aging experience). ATA is associated with better physical and mental health, improved cognitive functioning, and prolonged life expectancy. Individuals with positive ATA focus on age-related gains, such as greater freedom and accumulated wisdom. In contrast, negative ATA is characterized by a focus on losses, such as decreased energy and memory decline, which can contribute to loneliness and psychological distress. Resilience and self-esteem are vital psychological factors that mediate the relationship between ATA and loneliness. Resilience enables individuals to recover quickly and adapt to adversity, while self-esteem represents an individual’s sense of self-worth and competence. Despite the importance of these factors, their mediating roles in the context of ATA and loneliness remain insufficiently explored. This study aims to examine the relationship between ATA and loneliness, along with the mediating roles of resilience and self-esteem.
Method
This cross-sectional study employed a descriptive-correlational design using structural equation modeling (SEM). The statistical population included all individuals aged 60 years and older residing in Kermanshah Province, Iran, in 2024–2025. A total of 320 participants (148 men and 172 women) were recruited through convenience sampling. The inclusion criteria were: (1) being aged 60 years or older, (2) residing in Kermanshah Province, Iran, and (3) willingness to participate. Exclusion criteria included (1) having used psychiatric medication for less than six months, and (2) scoring below 21 on Folstein et al.’s Mini-Mental State Examination. Participants completed Laidlaw et al.’s ATA, Connor-Davidson resilience, Rosenberg self-esteem, and UCLA loneliness scales. For individuals who experienced difficulty completing the questionnaires due to age-related limitations or low literacy skills, family members were asked to read the questions aloud and record the answers. A total of 350 surveys were initially collected, of which 30 incomplete forms were excluded, resulting in a final sample of 320 participants. The collected data were analyzed using Pearson’s correlation coefficients and SEM in SPSS-24 and AMOS-24 software.
Results
Prior to conducting the analysis, the assumptions of SEM, including normal distribution, error independence, multicollinearity, and linearity, were assessed. The normality of the variables was examined using skewness and kurtosis, and the results confirmed that the distribution of all variables was normal (i.e., values ranging from –2 to +2). Error independence was evaluated using the Durbin-Watson test, which demonstrated no autocorrelation among the errors (D.W= 1.84; acceptable range
between 1.5 and 2.5). Multicollinearity among predictor variables was assessed using the Variance Inflation Factor (VIF) and tolerance values. The results indicated no multicollinearity, with VIF values less than 10 and tolerance values greater than 0.1. Lastly, the assumption of linearity between the independent and dependent variables was verified through Pearson's correlation analysis.
The results indicated that the direct effects among the research variables were statistically significant (p<.01). Path coefficients demonstrated the following relationships. ATA was associated with resilience (β=.19, t=3.49, p<.001), self-esteem (β=.29, t=6.40, p<.001), and loneliness (β=-.30, t=-8.04, p<.001). Resilience was negatively associated with loneliness (β=-.48, t=-5.77, p<.001), and self-esteem was negatively associated with loneliness (β=-.35, t =-6.63, p<.001). To assess the mediating roles of resilience and self-esteem in the relationship between ATA and loneliness, Sobel’s test was conducted. Results confirmed the significance of both mediators, with resilience (z=10.82, p<.001) and self-esteem (z=10.45, p<.001) playing substantial roles in mediating the relationship between ATA and loneliness.
Conclusion
This study aimed to explore the mediating roles of resilience and self-esteem in the relationship between ATA and loneliness. As hypothesized, both resilience and self-esteem significantly mediated this relationship. A negative correlation was observed between ATA and loneliness, indicating that a positive ATA is correlated with decreased feelings of loneliness. Positive ATA can mitigate the impact of age-related losses, while negative attitudes can exacerbate feelings of loneliness. The first hypothesis, asserting the relationship between ATA and loneliness via resilience, was supported. Higher resilience was associated with lower levels of loneliness, as resilience aids in reducing negative emotions and loneliness. Resilience plays a critical role in helping older adults adapt to changes, emotional needs, and social network contraction associated with aging. The second hypothesis, regarding the relationship between ATA and loneliness via self-esteem, was also supported. Higher self-esteem correlated with lower levels of loneliness, suggesting that individuals with higher self-esteem tend to maintain more satisfying interpersonal relationships and a more positive self-image. Furthermore, self-esteem reinforced by a positive ATA was found to predict loneliness effectively. Limitations include reliance on self-report measures, which may affect the validity of the results, and the cross-sectional design, limiting causal interpretations. Future research could employ longitudinal studies to establish causality, integrate additional predictors, and explore cultural differences to enhance the generalizability of findings. Addressing loneliness among older adults and fostering resilience and self-esteem through targeted interventions could significantly improve their psychological and social well-being.
Ethical Considerations
This research adhered to all ethical guidelines. Informed consent was obtained from participants, and their confidentiality was maintained. Participation in the study was voluntary, and data were used solely for research purposes.
Financial Support
This research did not receive any financial support.
Authors’ Contributions
Kh.M and P.J: Conceptualization, design, Writing - Review & editing, Visualization; S.S: Conceptualization, Writing - Review & Editing; P.N: Writing - Original draft, Data curation, Software, Validation, Formal analysis.
Conflict of Interest
The authors declare no conflicts of interest
Acknowledgments
The authors would like to express their gratitude to all the participants for their valuable contribution to this research.
References
 Abbas, N.,  Abrar ul Haq, M., Ashiq, U &  Ubaid,  S . (2020).   Loneliness among elderly widows and its effect on social and mental well-being., Global Social Welfare , 7 (September), 215–229.
Alipour, F., Sajadi, H., Foruzan, A., Biglarian, A., & Jalilian, A. (2008). Elderly quality of life in Tehran's district two. Salmand: Iranian Journal of Ageing, 3(3 and 4), 75-83. http://salmandj.uswr.ac.ir/article-1-104-en.html [Persian]
Angevaare, M. J., Roberts, J., van Hout, H. P. J., Joling, K. J., Smalbrugge, M., Schoonmade, L. J., Windle, G., & Hertogh, C. M. P. M. (2020). Resilience in older persons: A systematic review of the conceptual literature. Ageing research reviews, 63, 101144. https://doi.org/10.1016/j.arr.2020.10114                     
Azizi M, Azadi A, Otaghi M. The effect of a self-care programme on urinary incontinence and self-esteem in elderly men dwelling in nursing homes in Iran. The Aging Male. 2020; 23(5):687-93. https://doi.org/10.1080/13685538.2019.1573891
Beutel, M. E., Klein, E. M., & Brähler, E. et al. (2017). Loneliness in the general population: prevalence, determinants and relations to mental health. BMC Psychiatry 17, 97. https://doi.org/10.1186/s12888-017-1262-x
Boeder, J., & Tse, D. C. K. (2021). Measuring Self-Perceptions of Aging: Differences Between Measures When Predicting Health Outcomes. The Journals of Gerontology: Series B, 76(5), 825–835. https://doi.org/10.1093/geronb/gbaa064
Brothers, A., Kornadt, A. E., Nehrkorn-Bailey, A., Wahl, H.-W., & Diehl, M. (2021). The Effects of Age Stereotypes on Physical and Mental Health are Mediated by Self-Perceptions of Aging. The Journals of Gerontology, 76(5), 845–857. https://doi.org/10.1093/geronb/gbaa176
Brown, J. D., & Marshall, M. A. (2001). Self-esteem and emotion: Some thoughts about feelings. Personality and Social Psychology Bulletin, 27(5), 575-584.
Bryant, C., Bei, B., Gilson, K., Komiti, A., Jackson, H., & Judd, F. (2012). The relationship between attitudes to aging and physical and mental health in older adults. International Psychogeriatrics, 24(10), 1674–1683. https://doi.org/10.1017/S1041610212000774
Chen, H. (2018). Mediating Effect of Self-worth and Depression on the Relationship between Subjective Age and Subjective Well-being of the Elderly. NeuroQuantology, 16(6), 22-27. https://doi.org/10.14704/NQ.2018.16.6.1551
Cheung, Y., Chau, P. H., & Yip, P. S. (2008). A revisit on older adults’ suicides and severe acute respiratory syndrome (SARS) epidemic in Hong Kong. International Journal of Geriatric Psychiatry: A Journal of the Psychiatry of Late Life and Allied Sciences, 23(12), 1231-1238. https://doi.org/10.1002/gps.2056
Chmitorz, A., Kunzler, A., Helmreich, I., Tüscher, O., Kalisch, R., Kubiak, T., Wessa, M., & Lieb, K. (2018). Intervention studies to foster resilience - A systematic review and proposal for a resilience framework in future intervention studies. Clinical psychology review, 59, 78–100. https://doi.org/10.1016/j.cpr.2017.11.002
Crewdson, J. A. (2016). The effect of loneliness in the elderly population: A review. Heal Aging & Clin Care Elder, 8(1), 80-85.  https:// doi:10.4137/HACCE.S35890
Ferreira, H. G., & Casemiro, N. V. (2021). Loneliness in the Elderly and associated factors. Revista Família, Ciclos de Vida e Saúde no Contexto Social, 9(1), 90-98. https://doi.org/10.18554/refacs.v9i1.5199
Fletcher D., SarKar M. Psychological resilience: A review and critique of definitions, concepts, and theory. Eur. Psychol. 2013; 18:12–23. https://doi.org/ 10.1027/1016-9040/a000124
Ge, L., Yap, C. W., Ong, R., & Heng, B. H. (2017). Social isolation, loneliness and their relationships with depressive symptoms: A population-based study. PLoS ONE, 12 (8), 23-47. http://dx.doi.org/10.1371/journal.pone.0182145
Guner, T.A., Erdogan, Z., & Demir, I. (2021). The Effect of loneliness on death anxiety in the elderly during the COVID-19 pandemic. First published April 20, 2021. https://doi.org/10.1177/00302228211
Infurna F. J. (2021). Utilizing Principles of Life-Span Developmental Psychology to Study the Complexities of Resilience Across the Adult Life Span. The Gerontologist, 61(6), 807–818. https://doi.org/10.1093/geront/gnab086
Khosravan, S., Alaviani, M., Alami, A., Tavakolizadeh, J. (2014). Epidemiology of loneliness in elderly women. Journal of Research & Health, 4(4), 871-877.  [Persian] https://sid.ir/paper/214486/fa
Kunuroglu, F., & Vural Yuzbasi, D. (2021). Factors promoting successful aging in Turkish older adults: Self compassion, psychological resilience, and attitudes towards aging. Journal of Happiness Studies, 22(8), 3663-3678.
Laidlaw, K., Power, M. J., & Schmidt, S. (2007). The Attitudes to Ageing Questionnaire (AAQ): Development and psychometric properties. International Journal of Geriatric Psychiatry, 22(4), 367–379. https://doi.org/10.1002/gps.1683
Levy, B. R., & Myers, L. M. (2004). Preventive health behaviors influenced by self-perceptions of aging. Preventive Medicine, 39(3), 625–629. https://doi.org/10.1016/j.ypmed.2004.02.029
Levy, B. R., Slade, M. D., Kunkel, S. R., & Kasl, S. V. (2002). Longevity increased by positive self-perceptions of aging. Journal of Personality and Social Psychology, 83(2), 261–270. https://doi.org/10.1037/0022-3514.83.2.261
Lee, S. S. (2013). The Study on the relationships between age-identity, Attitude toward the elderly and self-esteem of the elderly. Korean Journal of Human Ecology, 22(1), 57-74.
Lima, G. S., Figueira, A. L. G., Carvalho, E. C., Kusumota, L., & Caldeira, S. (2023). Resilience in Older People: A Concept Analysis. Healthcare (Basel, Switzerland), 11(18), 2491. https://doi.org/10.3390/healthcare11182491
Lucas-Carrasco, R., Laidlaw, K., Gómez-Benito, J., & Power, M. (2012). Reliability and validity of the Attitudes to Ageing Questionnaire (AAQ) in older people in Spain. International Psychogeriatrics / IPA, 25(3), 490-499. https://doi.org/10.1017/S1041610212001809
Ludolph, P., Kunzler, A. M., Stoffers-Winterling, J., Helmreich, I., & Lieb, K. (2019). Interventions to Promote Resilience in Cancer Patients. Deutsches Arzteblatt international, 51-52(51-52), 865–872. https://doi.org/10.3238/arztebl.2019.0865
Mäkikangas A, Kinnunen U, Feldt T. Self-esteem, dispositional optimism, and health: Evidence from cross-lagged data on employees. Journal of Research in Personality. 2004; 38(6):556-75 https://doi.org/10.1016/j.jrp.2004.02.001
Martín-Albo J, Núñiez JL, Navarro JG, Grijalvo F. The rosenberg self-esteem scale: Translation and validation in university students. The Spanish Journal of Psychology. 2007; 10(2):458-67. https://doi.org/10.1017/S1138741600006727
   O'Súilleabháin, P .S .,Gallagher, S., & Steptoe, A. (2019). Loneliness, living alone, and all-Cause mortality: The Role of emotional and social loneliness in the elderly during 19 years of Follow-up. Psychosom, 281(6), 521–526 ‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏  https:‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏/‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏/doi:org‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏/10.1097/PSY.0000000000000710
Pearce, E., Myles-Hooton, P., Johnson, S., Hards, E., Olsen, S., Clisu, D., Pais, S., Chesters, H.A., Shah, S., Jerwood, G., Politis, M., Melwani, J., Andersson, G., Shafran, R.  (2021). Loneliness as an active ingredient in preventing or alleviating youth anxiety and depression: a critical interpretative synthesis incorporating principles from rapid realist reviews. Translational Psychiatry. 10, 11(1), 628-835. https://doi.org/10.1038/s41398-021-01740-w
Rantanen, T., Saajanaho, M., Karavirta, L., Siltanen, S., Rantakokko, M., Viljanen, A., Rantalainen, T., Pynnönen, K., Karvonen, A., Lisko, I., Palmberg, L., Eronen, J., Palonen, E. M., Hinrichs, T., Kauppinen, M., Kokko, K., &Portegijs, E. (2018). Active aging - resilience and external support as modifiers of the disablement outcome: AGNES cohort study protocol. BMC public health, 18(1), 565. https://doi.org/10.1186/s12889-018-5487-5
Rejeh, N., Heravi, M., Vaismoradi, M., Griffiths, P., Nikkhah, M., & Bahrami, T. (2017). Psychometric properties of the Farsi version of Attitudes to Aging Questionnaire in Iranian older adults. Clinical Interventions in Aging, 12, 1531–1542. https://doi.org/10.2147/CIA.S139321
Russell. D. (1996). UCLA Lonliness Scale (version 3): Reliability, Validity and factorstructure. Journal of personality Assessmentm, 66 (1), 20-40.
Sabatini, S., Ukoumunne, O. C., Martyr, A., Ballard, C., Lamont, R. A., Collins, R., Pentecost, C., Hunt, A., Quinn, C., Thom, J. M., & Clare, L. (2021). Relationship between self-perceptions of aging and ‘living well’ among people with mild-to-moderate dementia: Findings from the ideal programme. Archives of Gerontology and Geriatrics, 94, 104328. https://doi.org/10.1016/j.archger.2020.104328
Spitzer, N., Segel-Karpas, D., & Palgi, Y. (2022). Close social relationships and loneliness: the role of subjective age. International psychogeriatrics, 34(7), 651-655. https://doi.org/10.1017/s1041610219001790
Valtorta, N. K., Kanaan, M., Gilbody, S., & Hanratty, B. (2016). Lone-lines, social isolation and social relationships: what are we measuring? A novel framework for classifying and comparing tools. British Journal of Sports Medicine, 6 (4), 1-8. https://doi.org/10.1136/bmjopen-2015-010799
 Van As, B. A. L., Imbimbo, E., Franceschi, A., Menesini, E  & Nocentini, A. (2021).  The longitudinal association between loneliness and depressive symptoms in the elderly: a systematic review International Psychogeriatrics, 34(7), 657-669. https://doi.org/10.1017/S1041610221000399
Varlı, Ü., & Alankaya, N. (2022). Effect of health anxiety on disease perception and treatment compliance in elderly patients during the COVID-19 pandemic in Turkey. Archives of Psychiatric Nursing, 40, 84-90. https://doi.org/10.1016/j.apnu.2022.05.002
Westerhof, G. J., Miche, M., Brothers, A. F., Barrett, A. E., Diehl, M., Montepare, J. M., Wahl, H. W., & Wurm, S. (2014). The influence of subjective aging on health and longevity: a meta-analysis of longitudinal data. Psychology and aging, 29(4), 793–802. https://doi.org/10.1037/a0038016
Wurm, S., Tomasik, M. J., & Tesch-Römer, C. (2010). On the importance of a positive view on ageing for physical exercise among middle-aged and older adults: Cross-sectional and longitudinal findings. Psychology and Health, 25(1), 25–42. https://doi.org/10.1080/08870440802311314
Xie, J., Zhang, B., Yao, Z., Zhang, W., Wang, J., Zhao, C. N., & Huang, X. (2022). The effect of subjective age on loneliness in the old adults: The chain mediating role of resilience and self-esteem. Frontiers in Public Health, 10, 907934. https://doi.org/10.3389/fpubh.2022.907934