رابطه احساس تنهایی، تحمل پریشانی و تاب‌آوری با سلامت معنوی سالمندان مقیم سرای سالمندان

Abstract
Background: Spiritual well-being, recognized as the fourth pillar of human health, is influenced by various factors. Accordingly, the present study aimed to investigate the relationship between loneliness, distress tolerance, and resilience with spiritual well-being among older adults residing in nursing homes.
Method: This descriptive-correlational study was conducted among older adults living in nursing homes in Isfahan, Iran, in 2024, among whom a sample of 150 individuals was selected through convenience sampling. The instruments included the Russell Loneliness Scale, Simons and Gaher’s Distress Tolerance Scale, the Connor-Davidson Resilience Scale (short form), and Paloutzian and Ellison’s Spiritual Well-Being Scale. Data were analyzed using Pearson’s correlation coefficients and multiple regression analysis (enter method) using SPSS version 26.
Results: The results indicated a significant negative correlation between loneliness and spiritual well-being (r=-.483), a significant positive correlation between distress tolerance and spiritual well-being (r=.509), and a significant positive correlation between resilience and spiritual well-being (r=.501) (p<.01). Furthermore, the regression analysis revealed that the predictor variables collectively accounted for 86.3% of the variance in spiritual well-being, with distress tolerance contributing the most to the prediction.
Conclusion: These findings suggest that reducing loneliness and enhancing distress tolerance and resilience are associated with higher levels of spiritual well-being among older adults residing in nursing homes.
EXTENDED ABSTRACT
 Introduction
Aging refers to a stage of life that begins at the age of 65 and represents a natural process accompanied by profound changes in physiological, psychological, and sociological dimensions. Studies indicate that the number of older adults is rapidly increasing, and the prevalence of mental disorders among this population is higher compared to other age groups. In Iran, the majority of older adults believe that nursing homes are not suitable places to live. They often perceive these facilities as places to await death, preferring instead to remain in their own homes. However, the complexities of modern life have reduced families’ ability to care for aging relatives, leading to a rise in the number of older adults residing in nursing homes. In such circumstances, the health of older adults undergoes significant changes, and one critical yet often overlooked dimension is spiritual well-being. Research has shown that spiritual well-being is associated with key psychological variables in aging, such as loneliness, distress tolerance, and resilience. To date, no study has specifically examined the relationship between these variables among older adults living in nursing homes. Therefore, addressing this gap in the literature, the present study aimed to investigate the relationship between loneliness, distress tolerance, and resilience with spiritual well-being in this population.
Method
This study employed a descriptive-correlational design. The statistical population included all older adults residing in nursing homes in Isfahan, Iran, in 2024. From this population, 150 individuals (48 men and 102 women) were selected through convenience sampling based on the sampling formula proposed by Fidell and Tabachnick (2007). Inclusion criteria were: (1) age 65 or older, (2) at least three months of residence in the nursing home, (3) basic literacy skills, and (4) full consent and willingness to participate. Exclusion criteria included: (1) acute psychiatric disorders and (2) physical limitations or illnesses preventing participation. Data collection took place at the Sadeghieh Nursing Home in Isfahan. Participants completed the Russell Loneliness Scale, Simons and Gaher’s Distress Tolerance Scale, the Connor-Davidson Resilience Scale (short form), and Paloutzian and Ellison’s Spiritual Well-Being Scale. Researchers patiently addressed any questions or ambiguities during the process. Data were analyzed at both descriptive and inferential levels. Descriptive statistics included means and standard deviations for predictor and criterion variables. Inferential statistics involved Pearson’s correlation coefficient and multiple regression analysis (enter method) using SPSS version 26.
Results
To assess the normality of the data, skewness and kurtosis indices were examined. Results showed that all values fell within the acceptable range
(-2 to +2), confirming the assumption of normal distribution. Tolerance values for all predictor variables exceeded 0.1, and variance inflation factors (VIF) were below 10, indicating no multicollinearity issues. The Durbin-Watson statistic was 1.753, within the acceptable range (1.5 to 2.5), confirming the independence of residuals. Pearson’s correlation coefficient revealed a significant negative relationship between loneliness and spiritual well-being (r = -.48), significant positive relationships between distress tolerance and spiritual well-being (r = .50), and between resilience and spiritual well-being (r = .50) (p < .01). In the regression model, all predictor variables, loneliness (β = -.234, p <.01), distress tolerance (β =.433, p <.01), and resilience (β =.404, p <.01), significantly contributed to predicting spiritual well-being. The simultaneous multiple regression model was statistically significant (Adjusted R² =.863, F = 235.826, p <.001), explaining 86.3% of the variance in spiritual well-being, with distress tolerance being the strongest predictor.
Conclusion
Chronic and persistent loneliness, when it interferes with the successful engagement in everyday activities, can lead to detrimental emotional, social, and even physical consequences. As such, this psychological variable significantly affects human health and may also influence spiritual well-being, which is considered the fourth dimension of overall health. Throughout life, individuals encounter numerous distressing events that can trigger emotional turmoil. Those with low distress tolerance tend to underestimate their coping abilities and exert considerable effort to avoid negative emotions. In contrast, individuals with high distress tolerance demonstrate better performance under challenging conditions and are generally less vulnerable to physical and psychological problems. Given the undeniable impact of distress tolerance on all aspects of health, it can also affect spiritual well-being by disrupting the balance between internal needs and external demands. Resilience is a quality that enables individuals and communities to navigate adversity. Therefore, resilience training is among the approaches that can effectively enhance the holistic health of older adults, including physical, psychological, and spiritual dimensions. Older adults with higher resilience are less likely to give up in difficult situations and persist in seeking appropriate strategies and solutions to overcome challenges.
Ethical Consideration
Ethical Code
To ensure compliance with ethical standards, this study was approved by the Ethics Committee of Islamic Azad University, Isfahan (Khorasgan) Branch, under the code IR.IAU.KHUISF.REC
.1403.102.
Financial Support
This study did not receive financial support.
Authors’ Contributions
N.M: Methodology, software, formal analysis, data curation, writing - review & editing; H.T: Conceptualization, methodology, supervision.
Conflict of Interest
The authors had no conflicts of interest.
Acknowledgments
The authors express their sincere gratitude to the older adults who participated in the study, the Research Department of Islamic Azad University, Isfahan (Khorasgan) Branch, the Welfare Organization of Isfahan Province, and the staff and administrators of Sadeghieh Nursing Home.
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