رابطه اضطراب سلامت و ادراک بیماری با کیفیت زندگی سالمندان مقیم مراکز سالمندان: نقش میانجی حمایت اجتماعی ادراک شده

With the rapid growth of older adults and the decline in quality of life (QOL) due to physical, psychological, and social challenges, the need to investigate factors that contribute to improving this condition has become increasingly important. Accordingly, the present study aimed to examine the relationship of health anxiety and illness perception with QOL among older adults residing in nursing homes, with the mediating role of perceived social support (PSS). This research employed a descriptive-correlational design using structural equation modeling (SEM). The statistical population included all older residents of nursing homes in Ardabil, Iran during the Autumn, 2024. A total of 335 participants were selected through convenience sampling and completed the World Health Organization QOL Questionnaire, Salkovskis et al.’s Health Anxiety Inventory, Broadbent et al.’s Illness Perception Questionnaire, and Zimet et al.’s PSS Multidimensional Scale. Data were analyzed using SEM in SPSS version 26 and SmartPLS 3. The results indicated that health anxiety and illness perception had a significant negative direct relationship with QOL. Furthermore, PSS played a significant mediating role in the relationship of health anxiety and negative illness perception with the QOL among older adults. Specifically, both health anxiety and negative illness perception were significantly negatively associated with PSS, which, in turn, had a significant positive association with QOL. These findings suggest that better illness perception and higher levels of PSS are significantly related to lower health anxiety and improved QOL among older adults. Therefore, designing and implementing psychosocial interventions aimed at enhancing these components may play a pivotal role in promoting mental health and QOL in older adults.
EXTENDED ABSTRACT
Introduction
With the growing population of older adults, increasing attention has been directed toward the quality of life (QOL) in this age group. QOL is influenced by a range of psychological factors, among which health anxiety and illness perception play a pivotal role. Health anxiety can lead to excessive concerns about physical well-being, while negative illness perceptions affect how individuals cope with their physical conditions. These factors are directly associated with a decline in the QOL among older adults. However, perceived social support (PSS) may serve as a mediating variable that moderates this relationship. By fostering a sense of security, being understood, and receiving emotional and instrumental support, social support may mitigate the adverse effects of health anxiety and negative illness perceptions, thereby enhancing QOL. Accordingly, the present study aimed to examine the mediating role of PSS in the relationship of health anxiety and illness perception with QOL among older adults.
Method
The present study was applied in terms of its objective and descriptive-correlational in terms of its nature and method, using structural equation modeling (SEM). The statistical population consisted of all older adults residing in nursing homes in Ardabil, Iran during the autumn of 2024. A total of 350 participants were selected using a convenience sampling method and based on predefined inclusion criteria. The inclusion criteria were: (1) willingness to participate in the study, (2) sufficient hearing and speaking ability to engage with the study and questionnaire, (3) minimum literacy to read and comprehend the questions, and (4) being at least 60 years old. The exclusion criteria included: (1) presence of acute psychiatric disorders, identified through clinical interviews conducted by the centers’ counselors, and (2) suffering from unstable acute physical illnesses that would prevent participation in the study.
Given the maximum of three independent variables in the measurement and structural model, a minimum of 124 observations was required to achieve a statistical power of 80% and a minimum coefficient of determination (R²) of 0.10 at a 5% significance level (Hoyle, 1995). However, to enhance the accuracy and consistency of estimates in the partial least squares (PLS) method and to account for potential sample attrition, 350 individuals were selected. Ultimately, 335 valid questionnaires were included in the statistical analysis. Data analysis was conducted using SEM through SPSS version 26 and SmartPLS 3 software.
Results
Prior to model analysis, it was confirmed that the distribution of scores for all variables was normal, and the results indicated no correlation among the residuals and no multicollinearity among the variables. The results of the correlation analysis revealed significant relationships among the main variables of the study, namely, QOL, health anxiety, illness perception, and PSS. To test the research hypotheses, the model fit was examined using SEM. The findings indicated that PSS was a significant positive predictor of QOL. Furthermore, health anxiety showed a negative relationship, while illness perception demonstrated a positive relationship with QOL. The analysis of indirect paths indicated that PSS plays a significant mediating role in the relationships of health anxiety and illness perception with QOL. This mediation effect was confirmed through the Sobel test. PSS had a significant positive relationship with QOL (β=0.647, p<.01). Health anxiety had a significant negative relationship with QOL (β=–0.510, p<.001), while illness perception also had a significant negative relationship with QOL (β=–0.563, p<.001). Furthermore, both health anxiety (β=.380, p<.05) and illness perception (β=.340, p<.05) had significant indirect relationships with QOL through the mediation of PSS. Based on these findings, the final model demonstrated an adequate explanatory power for predicting QOL among older adults.
Conclusion
The findings of this study revealed that health anxiety and illness perception are significant psychological factors that can influence the QOL among older adults both directly and indirectly. Specifically, higher levels of health anxiety and negative illness perception were associated with lower QOL. Moreover, PSS served as an effective mediator, mediating these relationships. Path analysis further confirmed that PSS can be positively related to QOL of older adults by mitigating the adverse relationship of this variable with health anxiety and illness perception. In other words, the more social support older adults receive, the less they experience the negative consequences of anxiety and negative attitudes toward illness, ultimately leading to improved quality of life.
These results suggest that enhancing the QOL in older adults requires more than addressing physical health alone. Psychosocial interventions must also be prioritized. Strengthening social support, particularly from family members, friends, caregivers, and support organizations, can be considered a key strategy for reducing anxiety and promoting more positive illness perceptions among older adults.
Accordingly, policymakers and aging-sector planners can take meaningful steps toward improving the well-being of this population by designing and implementing programs that foster social capital, teach effective coping strategies, and create psychologically safe environments for older adults.
From a theoretical perspective, the conceptual model proposed in this study may serve as a useful framework for explaining the psychological mechanisms that influence QOL among older adults within the socio-cultural context of Iran. Moreover, these findings open new avenues for future research in the field of geriatric psychology, particularly in exploring the roles of other potential mediators or moderators such as hope, resilience, and meaning in life. Therefore, identifying and intervening in the psychological and social factors associated with older adults’ QOL is essential not only at the individual level but also at the broader policy level.
Ethical Consideration
Ethical Code
This study was conducted independently with the necessary approval obtained from the Research Deputy of Mohaghegh Ardabili University and with permission to access nursing homes in Ardabil County.
Financial Support
This research received no financial support.
Authors’ Contributions
F.G: Conceptualization, Methodology, Validation, Formal analysis, Writing - Original Draft; M.K: Data curation, Writing-Review & Editing; H.S.: Writing-Review & Editing, Visualization; A.Sh: Project administration, Supervision, Visualization.
Conflict of Interest
The author had no conflicts of interest.
Acknowledgments
The authors would like to express their sincere gratitude to the Research Deputy of Mohaghegh Ardabili University and the administrators of the nursing homes in Ardabil County for their moral support and cooperation in conducting this study. They also extend heartfelt thanks to the older participants who completed the scales.
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