The mediating role of life satisfaction, social support, and loneliness in the relationship between elder abuse and death anxiety in Iranian older adult inpatients: a structural equation model.

backgroundPhysiological changes that accompany old age and hospitalization following sickness and need for treatment cause concern for older adults and increase death anxiety. However, few studies have addressed the factors associated with death anxiety among older adults. The present study aims to explore the mediating role of life satisfaction, perceived social support, and loneliness in the relationship between perceived elder abuse and death anxiety among older adult inpatients.

methodsThe present study is a cross-sectional study of 922 older adult patients hospitalized in a teaching hospital in southern Iran who were selected via convenience sampling. The study was conducted from March 2023 to May 2024. Data were collected via a hospitalized elder abuse questionnaire (HEAQ), a life satisfaction scale, Russell's Loneliness Scale, Zimet's Scale of Perceived Social Support, and the Templer's Death Anxiety Scale (DAS). The structural equation modeling (SEM) approach was used to evaluate the direct, indirect, and total effects of perceived elder abuse on death anxiety. SEMs were executed via M-Plus version 8.3.

resultsThe mean age of the participants was 75.35 ± 5.21 years. Of the 922 older adult inpatients, 566 were male (61.4%) and 356 were female (38.6%). The direct path from perceived elder abuse to perceived social support was statistically significant (β=-0.102, 95% CI=-0.156-0.049). Moreover, significant direct paths were found from perceived social support (β= -0.082, 95% CI = -0.136-0.028) and loneliness (β = 0.068, 95% CI = 0.014-0.122) to death anxiety. Path coefficients of the indirect effects among the variables revealed that the mediated pathway from perceived abuse to death anxiety via perceived social support yielded a statistically significant result (β = 0.008, 95% CI = 0.001-0.015). However, the indirect effects of perceived abuse on death anxiety through life satisfaction (β = 0.000, 95%, CI = -0.002, 0.001) and loneliness (β = 0.000, 95%, CI = -0.003-0.004) were not statistically significant.

conclusionElderly inpatients are at risk of abuse and death anxiety. The authorities at health organizations should develop monitoring systems for early identification of the more vulnerable patients and provide relevant counseling services. In addition, there is need for workshops to raise professional caregivers' awareness of elder abuse and death anxiety. Social support plays a mediating role in the relationship between abuse and death anxiety among older adult patients in hospitals. Preventive interventions designed to promote and expand family and social sources of support may help lower death anxiety among older adult inpatients.