Death Anxiety in the Elderly in Iran: A Systematic Review and Meta-analysis
Authors:   Department of Social Work, Faculty of Paramedical, Mashhad University of Medical Sciences, Mashhad, Iran., Khalvati Maliheh , Babakhanian Masoudeh ,   Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran., Khalvati Mahboube ,   Department of English Literature, Faculty of Human Sciences, University of South Africa, Pretoria, South Africa., Nafei Ayub ,   Department of Social Welfare Management, University of Social Welfare and Rehabilitation Science (USWR), Tehran, Iran., Khalvati Monire ,   Department of French Literature, Faculty of Foreign Languages, Central Tehran Branch, Islamic Azad University, Tehran, Iran., Ghafuri Ronak ,   Education Organization of District 9, Tehran, Iran.
Published: September 2021

Objectives: Aging is one of the most critical stages of human development that has its own characteristics and conditions. One of the most common issues in old age is the mental health whose achievement requires special attention from both health system policymakers and service providers to the elderly. Death anxiety is one of the most common mental health issues in old age, because this period is full of feelings of shortcomings and disabilities. Since death anxiety is a multidimensional factor, it is expected to affect many aspects of the elderly. The present study aims to review and analyze published studies in the field of death anxiety in the elderly in Iran. Methods & Materials: This is a systematic review and meta-analysis conducted on the studies related to the death anxiety of the elderly in Iran published in Persian from 2011 to 2019. A search was conducted in national databases, including SID, IranDoc, MagIran, IDML, and CIVILICA using the keywords: Death anxiety, elderly, and older adult. Initial search yielded 61 articles. After screening, 33 studies that met the entry and exit criteria were selected for the final review. We used Stata v. 14 and SPSS v. 22 applications to perform meta-analysis. Results: In the studies, 40.35% of the participants were older women and the rest were older men with a mean age of 67.80±6.44 years. The mean score of death anxiety was higher in men than in women, and the elderly living in nursing homes had the highest score (11.8). Studies were categorized into three sections: comparison (3 studies), intervention (11 studies), and factors affecting the death anxiety (18 studies). The results of meta-analysis showed no significant relationship between spiritual therapy and reduction of death anxiety in the elderly (P>0.05). In studies with spiritual and behavioral therapies, the heterogeneity was significant and, thus, a significant positive relationship was observed between the reduction of death anxiety and these treatments methods. Conclusion: The death anxiety level of the elderly in Iran is low. Religious beliefs, hopes for the intercession of imams and religious leaders, and hopes for freedom from the hardships of worldly life seem to have contributed to low death anxiety in Iran. Different death anxiety scores have been reported for older men and women in Iran may be due to the effect of culture, religion, and traditions, the difference in the roles of men and women, and even the expression of fear and anxiety. Most of men have less tendency to express their emotions, including fear, while women are more likely to express their feelings. Behavioral and spiritual interventions lead to a decrease in the elderly’s death anxiety through affecting their finding meaning in life.