اثربخشی مثبت‌درمانی بر امید به زندگی و اضطراب مرگ سالمندان مقیم مرکز سالمندی

Background: In the contemporary era, characterized by increased life expectancy, older adults encounter psychological challenges such as death anxiety. Positive psychological interventions can play a pivotal role in enhancing their quality of life. Consequently, this study aimed to evaluate the effectiveness of positive psychotherapy training on life expectancy and death anxiety among older adults residing in residential care centers.
Method: This was a quasi-experimental study with a pretest-posttest design and a control group. The statistical population comprised all older adults residing in residential care centers in Tabriz, Iran, in 2024. Among the existing centers, one was selected via random sampling. Subsequently, 30 residents meeting the inclusion criteria were selected through convenience sampling and randomly assigned to experimental and control groups. The experimental group underwent eight weekly 90-minute sessions of positive psychotherapy, while the control group received no intervention during this period. The data collection instruments included the Miller and Powers Hope Scale and the Collett-Lester Death Anxiety Scale, which were completed by participants at both pre-test and post-test stages. Data were analyzed using univariate Analysis of Covariance (ANCOVA) in SPSS software, version 26.
Results: The results indicated that positive psychotherapy was effective in increasing life expectancy and reducing death anxiety among older adults in the Tabriz residential center. A significant difference was observed between the two groups in terms of life expectancy and death anxiety (p<.001).
Conclusion: The findings suggest that positive psychotherapy, by fostering constructive attitudes and strengthening psychological resources, successfully enhanced life expectancy and alleviated death anxiety in older adults. Therefore, it can be concluded that this therapeutic approach can be utilized as an effective intervention to promote the mental health of the aging population.
EXTENDED ABSTRACT
 Introduction
In light of the growing trend of population aging and its psychological implications, this study investigates the effectiveness of Positive Psychotherapy on life expectancy and death anxiety among older adults. Empirical evidence suggests that aging, often accompanied by diminished social roles and chronic illnesses, creates a predisposition for reduced hope and increased death anxiety; factors that can seriously threaten the quality of life in older adults. Conversely, recent research has underscored the significance of positive psychological constructs, such as hope, optimism, and resilience, in promoting mental health and adjustment among the aging population. Studies indicate that hope is positively correlated with outcomes such as life satisfaction, mental well-being, and social participation, whereas death anxiety is associated with depression, loneliness, and declined sleep quality. In response to these challenges, interventions based on positive psychology, including Positive Psychotherapy, have emerged as novel approaches. By focusing on positive emotions, instilling meaning in life, and fostering an optimistic attitude, these interventions can simultaneously lead to a reduction in death anxiety and enhancing life expectancy. Accordingly, utilizing a quasi-experimental design, the present research seeks to empirically evaluate the role of Positive Psychotherapy training in improving life expectancy indices and alleviating death anxiety among older adults residing in the Tabriz residential care center.
Method
In terms of purpose, this study was applied, and in terms of methodology, the present study employed a quasi-experimental method with a pre-test/post-test design and a control group. The statistical population comprised all older adults living in nursing centers in Tabriz, Iran, in 2024. Initially, one residential center was selected at random. Subsequently, 30 eligible older adults were selected through convenience sampling and randomly assigned to experimental and control groups (n=15 per group). The inclusion criteria were: (1) being over 60 years of age and a resident of Tabriz centers; (2) possessing adequate cognitive ability to participate in educational sessions (based on initial assessment and confirmation by the center’s physician); and (3) voluntary willingness to participate in the study and completion of the informed consent form. The exclusion criteria included: (1) simultaneous participation in other therapeutic interventions; and (2) having severe psychiatric disorders or acute physical illnesses preventing active participation. The research instruments included the Miller and Powers Hope Scale and the Collett-Lester Death Anxiety Scale. The experimental group underwent Positive Psychotherapy training over eight weekly 90-minute sessions, while the control group received no intervention. Data were collected at both pre-test and post-test stages and analyzed using descriptive statistics and univariate Analysis of Covariance (ANCOVA) in SPSS version 26.
Results
To describe the research variables, the means and standard deviations of life expectancy and death anxiety scores were calculated for both the experimental and control groups at the pre-test and post-test stages. Regarding death anxiety, the mean scores of the control group did not show significant change between the two stages, whereas a marked reduction was observed in the post-test mean scores of the experimental group compared to the pre-test. Conversely, regarding life expectancy, the experimental group demonstrated a greater increase in post-test mean scores compared to the pre-test, relative to the control group. To test the hypotheses, univariate Analysis of Covariance (ANCOVA) was utilized, controlling for the effect of the pre-test. The results are presented in Table 1.
The results indicated that after controlling for pre-test scores, there was a significant difference between the two groups in both dependent variables. Regarding life expectancy, the effect of the pre-test was significant (p = 0.001), and the group effect was also significant (p =.002, ηp² =.369); indicating that Positive Psychotherapy training significantly increased life expectancy in the experimental group. Regarding death anxiety, the effect of the pre-test was not significant (p =.160), but the group effect was significant (p =.001, ηp² =.277), indicating a considerable reduction in death anxiety in the experimental group compared to the control group. Overall, the results suggest that Positive Psychotherapy was able to significantly increase life expectancy and reduce death anxiety among the participating older adults.
Conclusion
The findings of this research demonstrated that Positive Psychotherapy training resulted in a significant increase in life expectancy and a decrease in death anxiety among older adults. These results align with previous studies, indicating that interventions based on positive psychology can improve key constructs associated with aging adjustment. By focusing on identifying and strengthening character strengths, enhancing the sense of control, and cognitive restructuring of negative beliefs, Positive Psychotherapy activates the two main components of Snyder’s Hope Theory, namely, goal-directed agency and pathways thinking, thereby elevating the level of hope for the future and motivation to live among older adults. Furthermore, by fostering positive emotions such as gratitude, meaning, satisfaction, and optimism, consistent with Fredrickson’s Broaden-and-Build Theory, this approach expands the thought-action repertoire of older adults and builds enduring psychological resources like resilience, self-efficacy, and social support, all of which play a protective role in reducing death anxiety. This explanatory model suggests that Positive Psychotherapy, through simultaneous intervention at cognitive, emotional, and social levels, can be employed as an effective approach to enhance the quality of life and mental health of the aging population.
Ethical Consideration
Ethical Code
Financial Support
This study did not receive financial support.
Authors’ Contributions
A.A: Conceptualization, methodology, data curation, software, formal analysis, writing - original draft; A.E.O: Conceptualization, methodology, validation, writing - review & editing, supervision; A.E: Conceptualization, methodology writing - review & editing, supervision
Conflict of Interest
The authors had no conflicts of interest.
Acknowledgments
We hereby express our sincere gratitude to the officials of Mehr Residential Care Center in Tabriz and all the older adults who participated in this research.
References
Afshari, A. (2024). The relationship of indivisible healthy lifestyle patterns, sensation seeking levels, and perceived stress with cognitive performance in elderly patients with hypertension. Aging Psychology, 10(4), 429–448. https://doi.org/10.22126/jap.2025.11352.1813 [Persian]
Afshari, A., & Hashemi, Z. (2019). The relationship between religious coping and psychological well-being with loneliness in the elderly. Aging Psychology, 5(1), 65–75. https://doi. org/ 10.22126/jap.2019.1180 [Persian]
Afshari, A., & Rezaei, R. (2022). The relationship of social support and coping styles with psychological well-being of the elderly: The mediating role of self-worth. Aging Psychology, 8(4), 401–418.
Afshari, A., Rezaei, R., & Adabi, A. A. (2025). The effectiveness of resilience training on improving mental health and reducing loneliness in the elderly. Aging Psychology, 11(2), 251–268. https://doi.org/10.22126/jap.2025.12230.1857 [Persian]
Afshari, A., Rezaei, R., & Dadras, M. (2018). The effectiveness of structured reminiscence on reducing anxiety and depression in the elderly. Aging Psychology, 5(3), 201–215. https:/ /doi.org/10.22126/jap.2019.4704.1368 [Persian]
Afsharpoor, Sh., Ganji, K., Keykhosravani, M., & Pouladi Rishahri, A. (2022). Comparison of the effectiveness of self-compassion therapy and positive psychotherapy on meaning of life, hope, and self-care behaviors in patients with type 2 diabetes. Razi Journal of Medical Sciences, 29(9), 86–99. URL: http://rjms.iums.ac.ir/article-1-7198-en.html [Persian]
Aghili, S. M., Majidi, F., & Asghari, A. (2023). Comparison of the effectiveness of compassion-focused therapy and positive psychotherapy on optimism and life satisfaction of women in marital conflict. Women and Family Cultural-Educational Quarterly, 18(62), 195–215. https://doi.org/20.1001.1.26454955.1402.18.62.8.2[Persian]
Alamdari, N., & Taghvaei Nia, A. (2024). The effectiveness of positive training program based on the PERMA model on optimism and hope in the elderly. Aging Psychology, 10(2), 183–198.
Al-Ghafri, B. R., Al-Mahrezi, A., & Chan, M. F. (2021). Effectiveness of life review on depression among elderly: A systematic review and meta-analysis. The Pan African Medical Journal, 40, 168. https://doi.org/10.11604/pamj.40.168.30040
Altıntaş, H. K., & Şahin, N. E. (2025). Depression and attitudes toward aging as predictors of death anxiety in older adults. BMC Geriatrics, 25(1), 454. https://doi.org/10.1186/s12877-025-05839-3
Arab, Sh., & Mohammadi, A. (2023). The effectiveness of cognitive-behavioral therapy on sleep disorders and death anxiety in the elderly. Aging Psychology, 9(1), 89–102. https:// doi.org/10.22126/jap.2023.8770.1687 [Persian]
Bojmehri, R., Izadipour, A., Fekri, N., & Rad, M. (2025). The effect of spiritual care on death anxiety in elderly residents of day-care centers in Neyshabur and Sabzevar: A clinical trial. Sabzevar University of Medical Sciences Journal, 32(2), 123–133. [Persian]
Borzo, S. R., Shadi, D., Kalvandi, N., Afshari, A., & Tapak, L. (2020). The effectiveness of spiritual care training on hopefulness of elderly residents in nursing homes of Hamadan province. Hayat, 26(2), 192–204. http://hayat.tums.ac.ir/article-1-3539-en.html [Persian]
Changiz, F., & Panahali, A. (2016). The effectiveness of group narrative therapy on hope and happiness in elderly residents of Tabriz. Education and Evaluation, 9(34), 63–76. [Persian]
Chen, L., Wang, H., & Zhou, M. (2024). Optimism and hope as predictors of psychological health in older adults: A positive psychology approach. International Journal of Aging and Human Development, 98(1), 34–52. https://doi.org/10.1177/00914150231123457
Chen, L., Zhang, Y., & Wang, H. (2025). Resilience and hope as protective factors for psychological well-being in older adults. Aging & Mental Health, 29(2), 245–253. https://doi.org/10.1080/13607863.2024.1234567
Chen, Y., Zheng, J., Xiao, H., Lin, X., & Zhang, X. (2022). Effects of a mind map-based life review program on anxiety and depressive symptoms in cancer patients undergoing chemotherapy: A randomized controlled trial. Cancer Nursing, 45(1), E116–E123. https://doi.org/10.1097/NCC.0000000000000874
Choompunuch, B., Wuttaphan, N., & Suk-erb, W. (2025). Hope and loneliness as predictors of quality of life among rural older adults in Thailand: A cross-sectional study. International Journal of Environmental Research and Public Health, 22(8), 1189. https://doi.org/10.3390/ijerph22081189
Collett, L. J., & Lester, D. (1969). The fear of death and the fear of dying. Journal of Psychology, 72(2), 179–181. https://doi.org/10.1080/00223980.1969.10543496
Farnam, A. (2016). The effect of positive thinking training on quality of life and hope in the elderly. Positive Psychology Research Journal, 2(1), 75–87. https://doi.org/10.22108/ ppls .2016.21298 [Persian]
Garcia, E., López, M., & Hernández, R. (2022). Life satisfaction and hope among older adults: A cross-sectional study. Journal of Aging Studies, 60, 100987. https://doi.org/ 10.1016/ j. jaging.2022.100987
Garcia, E., López, M., & Hernández, R. (2022). Life satisfaction, existential psychotherapy, and hope among older adults. Journal of Aging Studies, 60, 100987. https://doi.org/ 10. 1016 /j.jaging.2022.100987
Gharaei, H. A., & Sadeghi, M. (2024). Public-private partnership: An effective strategy for providing health services to the elderly. Health System Management Strategies, 9(2), 100–103. 10.18502/mshsj.v9i2.16519 [Persian]
Gianfredi, V., Nucci, D., Pennisi, F., Maggi, S., Veronese, N., & Soysal, P. (2025). Aging, longevity, and healthy aging: The public health approach. Aging Clinical and Experimental Research, 37, 125. https://doi.org/10.1007/s40520-025-03021-8
Goodarzi, F., Khoshravesh, S., Ayubi, E., Bashirian, S., & Barati, M. (2024). Psychosocial determinants of functional independence among older adults: A systematic review and meta-analysis. Health Promotion Perspectives, 14(1), xx–xx. https://doi.org/10.34172/hpp. 2024.xx
Haji Azizi, A. H., Bahmani, B., Nafiseh, M., Manzari T., & Bershan, A. (2017). The effectiveness of group logotherapy on death anxiety and hope in elderly residents of nursing homes in Kerman. Iranian Journal of Aging, 12(2), 220–231. https://doi.org/10.21859/sija-1202220  [Persian]
Heidari Al-Kathiri, Z., & Dasht Bozorgi, Z. (2021). The effect of positive thinking training on optimism, hope, and self-management in patients with diabetes. Culture and Health Promotion, 5(1), 108–115. URL: http://ijhp.ir/article-1-396-en.html [Persian]
IranDoust, K., Esmaeilzali, M., Parvari, A., & Noamani, F. (2021). Epidemiological study of death prevalence in elderly receiving home care services during 2012–2016 in Tehran. Mazandaran University of Medical Sciences Journal, 31(197), 190–196. [Persian]
Johnson, R., Smith, T., & Brown, L. (2021). The impact of positive therapy on quality of life and hope in older adults. Journal of Aging and Mental Health, 25(3), 456–467. https://doi.org/10.1155/2018/4086294
Kafi, H., Molaei Zarandi, H., & Manzari T., V. (2024). The effectiveness of positive psychology strategies training on forgiveness and death anxiety in elderly women. Aging Psychology, 10(1), 41–55. https://doi.org/10.22126/jap.2024.9649.1735 [Persian]
Kiaei, M., Mohammadi, F., Hosseinkhani, Z., & Matlabi, S. A. (2022). The mediating role of financial satisfaction in the relationship between financial literacy and quality of life in retired elderly in Qazvin. Iranian Journal of Aging, 17(3), 322–337. https://doi.org/10.32598/sija.2022.2778.5  [Persian]
Kim, J., & Park, S. (2021). Social anxiety and coping strategies in community-dwelling older adults: Evidence from therapeutic interventions. Journal of Clinical Gerontology and Geriatrics, 12(4), 210–217. https://doi.org/10.1016/j.jcgg.2021.07.005
Kim, S., & Park, J. (2023). Effectiveness of positive therapeutic interventions on death anxiety and quality of life in South Korean elders. Korean Journal of Geriatric Therapy, 12(4), 87–98. https://doi.org/10.12799/jkachn.2015.26.3.238
Li, X., Zhang, Y., & Chen, L. (2023). Perceived stress and psychological well-being in older adults: The role of positive psychology interventions. Journal of Geriatric Mental Health, 10(2), 145–153. https://doi.org/10.1177/23456789231123456
Majidi, M., Jahan, F., Sabahi, P., & Rezaei, N. (2024). Comparison of the effectiveness of positive mindfulness training and healthy lifestyle education on health hardiness and psychological flexibility in the elderly. New Psychological Research, 19(75), 134–143. https://doi.org/10.22034/jmpr.2024.61712.6218 [Persian]
Menzies, R., Brown, J., Turner, M., Cunnington, D., Burge, M., Dunican, I., & Meaklim, H. (2024). Is a fear of death keeping you awake at night? Examining the relationship between death anxiety and insomnia. Sleep Advances, 5(Suppl. 1), A12. https://doi.org/10.1093/sleepadvances/zpae070.032
Miller, J. F., & Powers, M. J. (1988). Development of an instrument to measure hope. Nursing Research, 37(1), 6–10. https://doi.org/10.1097/00006199-198801000-00002
Miri, F. S., Ghiai, M. M., & Khodaei, Z. (2019). Analysis of factors affecting hope in the elderly: Case study of nursing homes in Karaj. Social Welfare, 19(73), 301–339. https://doi.org/10.29252/refahj.19.73.301  [Persian]
Mohammadi, Sh., Fathi, A. A., & Pahhang, A. (2022). The effectiveness of positive psychotherapy on hope and self-efficacy in diabetic patients in Shahriar. Diabetes Nursing, 10(3), 1924–1936. URL: http://jdn.zbmu.ac.ir/article-1-536-en.html [Persian]
Mozaffari, B., Abdavi, F., & Khodadadi, M. (2024). Designing a model of indicators affecting hope in elderly athletes. Organizational Behavior Management in Sport Studies, 11(3), 43–52. https://doi.org/10.30473/fmss.2024.71706.2619 [Persian]
Naghipour, M., Kazemian M., & Haroon Rashidi, H. (2020). The effectiveness of positive psychology on suicidal ideation and death anxiety in the elderly. Aging Psychology, 6(4), 357–367. https://doi.org/10.22126/jap.2020.5833.1478 [Persian]
Namani, A., & Shahrabadi, Z. (2023). Testing a structural model of psychological capital and vitality with hope in the elderly: The mediating role of perceived perfectionism. Gerontology, 8(3), 56–70. https://doi.org/10.22034/JOGE.8.3.56  [Persian]
O’Hanlon, B., & Bertolino, B. (2012). The therapist’s notebook on positive psychology. Routledge. https://doi.org/10.4324/9780203810248
Orang, S., Saberi, H., & Taheri, A. (2023). Development and effectiveness of emotion-based therapy on cognitive emotion regulation and death anxiety in elderly women with cancer. Women and Family Cultural-Educational Quarterly, 18(63), 133–152. https://doi.org/ 20. 1001.1.26454955.1402.18.63.5.1 [Persian]
Parmar, D., Williams, G., & Dkhimi, F. (2014). Enrolment of older people in social health protection programs in West Africa: Does social exclusion play a part? Social Science & Medicine, 119, 36–44. https://doi.org/10.1016/j.socscimed.2014.08.011
Safari Nia, M., & Dartaj, A. (2017). The effectiveness of group logotherapy on hope and psychological and social well-being of elderly women in nursing homes in Dubai. Iranian Journal of Aging, 12(4), 482–493. https://doi.org/10.21859/sija.12.4.482 [Persian]
Saketi, Z., Farhadi, H., & Atashpour, S. H. (2023). The effectiveness of positive psychotherapy on psychological capital and social competence of married women without children. New Psychological Research, 18(71), 119–127. https://doi.org/10.22034/jmpr.2023.16929 [Persian]
Samiei, M. (1989). Validity and reliability of the Miller Hope Questionnaire among nursing students. Master’s thesis, Tehran University of Medical Sciences. [Persian]
Sarmadi, M., Safari Nia, M., Tizdast, T., & Nejat, H. (2022). The effectiveness of logotherapy on blood sugar, happiness, and death anxiety in elderly patients with type 2 diabetes. Mashhad University of Medical Sciences Journal, 65(6), 2626–2685. https://doi.org/10.22038/ mjms.2022.66438.3918 [Persian]
Shin, H., Kim, J., & Choi, S. (2021). Mental health and hope in community-dwelling elderly: The mediating role of resilience. Journal of Nursing Research, 29(3), e150. https://doi.org/10.1097/JNR.0000000000000415
Smith, J. L., Brown, E. K., & Davis, M. T. (2023). Combined training in spiritual intelligence and positive psychology: Effects on life expectancy and death anxiety in British elderly. British Journal of Psychological Interventions, 10(2), 145–160.
Smith, J., Williams, K., & Taylor, P. (2019). Positive therapy and its role in reducing depression and anxiety in the elderly. Journal of Gerontology, 13(4), 234–245.
Solimanpour Manzari, R., Moradi, M., & Sadeghmoghadam, L. (2024). The effect of psychological-spiritual self-care training through tele-nursing on death anxiety in elderly residents of Gonabad: A clinical trial. Iranian Journal of Aging, 19(1), 40–53. https://doi. org/10.32598/sija.2023.3542.1  [Persian]
Sreelekha, N., & Sia, S. K. (2022). Loneliness and psychological well-being among community-dwelling elderly people: The mediating role of death anxiety. Working with Older People, 26(4), 374–386. https://doi.org/10.1108/WWOP-08-2021-0042
Templer, D. I. (1970). The construction and validation of a death anxiety scale. Journal of General Psychology, 82, 165–177. https://doi.org/10.1080/00221309.1970.9920634
Usta, E., & Bayram, S. (2021). Determination of factors affecting self-transcendence and meaning in life among the elderly receiving institutional care. Journal of Religion and Health, 60(3), 2024–2036. https://doi.org/10.1007/s10943-020-01165-7
Vahedi Kojanagh, H., Afshari, A., Rezaei Malajagh, R., Eghbali, A., & Tayari, M. (2020). Predicting life satisfaction of the elderly based on health-promoting lifestyle. Aging Psychology, 6(3), 285–297.https://doi.org/10.22126/jap.2020.5626.1455 [Persian]
Valaei, N., & Zalipour, S. (2015). The effectiveness of logotherapy on death anxiety in the elderly. Aging Psychology, 1(1), 49–55. [Persian]
Woo, H., & Bae, J. (2021). Sleep quality, depression, and hope in elderly populations: Exploring psychological predictors of well-being. Sleep Health, 7(4), 465–472. https://doi.org/ 10.1016/j.sleh.2021.03.012
Yang, H., Lee, S., & Park, J. (2022). Emotional exhaustion and resilience among elderly populations: Effects of positive psychotherapy. Aging & Mental Health, 26(7), 1345–1354. https://doi.org/10.1080/13607863.2021.1956789
Yousefi, S., Ghadami, A., & Zamanpour, A. A. (2024). The effectiveness of group positive psychology therapy on resilience and death anxiety among individuals with COVID-19. Clinical Psychology Studies, 14(53), 93–106. https://doi.org/10.22054/ jcps.2024. 67504. 2739 [Persian]
Zolaghi, S. (2021). The effectiveness of positive psychotherapy on optimism, hope, and meaning of life in mothers of children with intellectual disabilities. Psychology and Educational Studies, 7(1), 50–74. [Persian]