Iran Journal of Nursing

Introduction
The new coronavirus disease that was first detected in 2019 and is known as COVID-19, is an infectious disease that caused many deaths due to the development of acute respiratory syndrome in people. The Centers for Disease Control (CDC) estimated that nearly 8 out of 10 death cases from COVID-19 in the United States were related to people aged 65 and older. Resilience is defined as a person’s ability to maintain psychological balance and recover from challenging conditions. Due to the very important role of family caregivers in the treatment of older patients with COVID-19, attention to their health and well-being has been increased. Considering that no study has been conducted in Mashhad city during the pandemic to investigate the resilience of the family caregivers of older people, this study aims to determine the resilience of the family caregivers of older people during COVID-19 pandemic in this city.

Methods 
This descriptive-analytical study was conducted on 120 family caregivers of older people who referred to urban health centers in Mashhad, Iran. Sampling was done using cluster random sampling method in 2022. According to Mahdieh et al.’s study, the sample size was calculated to be 102, which increased to 120 samples by considering the sample drop. The samples were selected from the urban health centers in different regions based on the inclusion criteria. The inclusion criteria were: Age ≤60 for older people, consent to participate, caregiving of at least 1-2 older people, age 18-60 years for caregivers, no debilitating physical disease in the caregivers, not using psychiatric drugs by the caregiver, and no history of infection with COVID-19 in the elderly according to the report of the caregiver. Exclusion criteria were unwillingness to continue participation, or not completing the questionnaire. After obtaining informed consent from the elderly and their caregivers, a two-part questionnaire was completed through the phone included demographic form (surveying age of the elderly and caregiver, gender of caregiver, educational level of caregiver, employment status of caregiver, marital status of caregiver, and the relation of caregiver with the elderly) and the Connor-Davidson resilience scale [16]. Data analysis was done in SPSS software, verion 23 using descriptive statistics (mean and standard deviation) and inferential statistics ( Pearson’s correlation test, independent t-test or one-way analysis of variance).

Results 
The mean age of family caregivers and elderly were 39.94±1.32 and 74.3±44.17 years, respectively. The age of caregivers ranged 20-74 years and the age of the elderly ranged 60-89 years. The mean resilience score of caregivers was 49.40±13.07, which is low (<50). There was a significant relationship between resilience score and educational level (P<0.05), marital status (P<0.001) and employment status of family caregivers (P<0.05). Married caregivers had more resilience compared to single caregivers. Retired caregivers had more resilience compared to self-employed, housekeeper, and unemployed ones and self-employed caregivers had higher scores in resilience compared to housekeeper and unemployed caregivers. Unemployed caregivers had the lowest scores. The correlation between resilience and caregiver’s age (r=0.17) and elderly’s age (r=0.13) was positive, but weak.

Conclusion
Family caregivers of the elderly in Mashhad city have low resilience. Their educational level, employment status, and marital status are related to their resilience level. Attention to these factors can help health care providers to develop plans increasing their resilience and improving the quality of life of the elderly. Those employed in governmental sections had higher resilience, may be because they still had their regular salaries during the pandemic and thus had stable financial conditions which provided peace of mind and increased their resilience. It seems that the effect of employment and financial status on the resilience of the family caregivers of the elderly is different in different cultures and countries. Caregivers with higher educational level usually have high social relations and personal and social resources which can help increase resilience by increasing interactions.

Ethical Considerations
Compliance with ethical guidelines
This study has an ethical approval obtained from Mashhad University of Medical Sciences (Code: IR.MUMS.NURSE.REC.1400.062). All participants were assured of the confidentiality of their information.

Funding
The study was funded by the School of Nursing and Midwifery, Mashahd University of Medical Sciences. 

Authors' contributions
The authors contributed equally to preparing this article.

Conflict of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank all participants for their cooperation.


References

1. United Nations. World population ageing 2020 Highlights:Living arrangements of older persons. New York: United Nations; 2020.
2. World Health Organization. Aging and health. Geneva: World Health Organization; 2022. [Link]
3. Karami Matin B, Alinia S, Shaahmadi F, Kazemi A. [Ageing in Iran in 1410, a warning to health care system (Persian)]. Teb Va Tazkiye. 2013; 22(2):9-18. [Link]
4. Mehra A, Rani S, Sahoo S, Parveen S, Singh AP, Chakrabarti S, et al. A crisis for elderly with mental disorders: Relapse of symptoms due to heightened anxiety due to COVID-19. Asian J Psychiatr. 2020; 51:102114. [DOI:10.1016/j.ajp.2020.102114] [PMID] [PMCID]
5. Seyedfatemi N, Ahmadzad Asl M, Bahrami R, Haghani H. [The effect of virtual social network based psycho-education on resilience of family caregivers of clients with severe mental disorders (Persian)]. Iran J Psychiatr Nurs. 2019; 6(6):1-8. [DOI:10.21859/ijpn-06061]
6. Frouzande Z, Mami S, Amani Q. [The effectiveness of group logotherapy on resiliency, depression and quality of life in elderly (Persian)]. J Gerontol. 2020; 5(1):19-29. [Link]
7. karimirad M R, Seyedfatemi N, Noghani F, Amini E, Kamali R. [Resiliency family caregivers of people with mental disorders in Tehran (Persian)]. Iran J Nurs Res. 2018;13(1):57-63. [DOI:10.21859/ijnr-13018]
8. Aboozadeh Gotabi Kh, Ghanbari Moghaddam A, Mohammadi M, Zarei F. [The burden of family caregivers caring for older adults and its relationshipwith some factors (Persian)]. Nurs J Vulnerable. 2016; 3(6):27-36. [Link]
9. Mousavi SM, Yazdanirad S, Sadeghian M, Abbasi M, Naeini M. [Relationship between resilience and hypochondriasis due to COVID-19: A case study in an occupational environment (Persian)]. J Occup Hyg Eng. 2021; 7(4):35-43. [Link]
10. Jangi Aghdam Kh, Sardari B. [The effect of religious attitudes (religiosity) on resilience of cancer patients (Persian)]. Iran J Cancer Care. 2019; 1(2):1-8. [DOI:10.29252/ijca.1.2.1]
11. Baradari E, Kasir S, Amani K, Senobar A. [Comparing psychological capitals between the healthy elderly and those with diabetes and hypertension (Persian)]. Middle Eastern J DisabilStud. 2020; 10:170. [Link]
12. Almasi A, Hatami F, Sharifi A, Ahmadijouybari T, Kaviannezhad R, Ebrahimzadeh F. [Effectiveness of stress coping skills training on the resiliency of mothers of handicapped children (Persian)]. Sci J Kurdistan Univ Med Sci. 2016; 21(2):34-42. [Link]
13. Nasirzadeh M, Akhondi M, Jamalizadeh nooq A, Khorramnia S. [A survey on stress, anxiety, depression and resilience due to the prevalence of covid-19 among Anar City Households in 2020: A short report (Persian)]. J Rafsanjan Univ Med Sci. 2020; 19(8):889-98. [DOI:10.29252/jrums.19.8.889]
14. Bagherinia H, Yamini, M, Ilderabadi E, Bagherinia F. [Relationship between personality traits and mental health with resilience mediation in nurses (Persian)]. J Sabzevar Univ Med Sci. 2016; 22(6):1063-70. [Link]
15. Norouzinia R, Ebadi A, Yarmohammadian MH, Chian S, Aghabarary M. [Relationship between resilience and self-efficacy with professional quality of life in EMS personnel (Persian)]. J Hayat. 2021; 27(2):176-89. [Link]
16. Connor KM, Davidson JR. Development of a new resilience scale: The Connor-Davidson resilience scale (CD-RISC). Depress Anxiety. 2003; 18(2):76-82. [DOI:10.1002/da.10113] [PMID]
17. Mohammadi M, Jazayeri Rafie AH, Pourshahbaz A. [Resilience factors in individuals at risk for substance abuse (Persian)]. J Psychol. 2006; 1(3-2):203-24. [Link]
18. Sriwantha S, Jullamate P, Piphatvanitcha N. Factors related to resilience among elderly patients with end stage renal disease. Bangkok Med J. 2018; 14(1):29. [DOI:10.31524/bkkmedj.2018.02.006]
19. Leppert K, Gunzelmann T, Schumacher J, Strauss B, Brähler E. [Resilience as a protective personality characteristic in the elderly (German)]. Psychother Psychosom Med Psychol. 2005; 55(8):365-9. [DOI:10.1055/s-2005-866873] [PMID]
20. Khalili Z, Gholipour F, Habibi Soola A. [Evaluation of resilience and its related factors in the elderly of Ardabil City (Persian)]. J Health Care. 2021; 22 (4):286-94. [Link]
21. Samadaee-Gelehkolaee K, Mccarthy BW, Khalilian A, Hamzehgardeshi Z, Peyvandi S, Elyasi F, et al. Factors associated with marital satisfaction in infertile couple: A comprehensive literature review. Glob J Health Sci. 2016; 8(5):96-109. [DOI:10.5539/gjhs.v8n5p96] [PMID] [PMCID]
22. Resnick BA, Inguito PL. The Resilience Scale: Psychometric properties and clinical applicability in older adults. Arch Psychiatr Nurs. 2011; 25(1):11-20. [DOI:10.1016/j.apnu.2010.05.001] [PMID]
23. Southwick SM, Litz BT, Charney D, Friedman MJ. Resilience and mental health: Challenges across the lifespan. Cambridge: Cambridge University Press; 2011. [DOI:10.1017/CBO9780511994791]
24. Izadi-Avanji FS, Hasani P, Rakhshan M, Alavi Majd H. [Structure of resilience in older adults with chronic conditions (Persian)]. J Qual Res Health Sci. 2017; 6(4):314-25. [Link]
25. Hildon Z, Montgomery SM, Blane D, Wiggins RD, Netuveli G. Examining resilience of quality of life in the face of health-related and psychosocial adversity at older ages: What is "right" about the way we age? Gerontologist. 2010; 50(1):36-47. [DOI:10.1093/geront/gnp067] [PMID]
26. Wells M. Resilience in rural communitydwelling older adults. J Rural Health. 2009; 25(4):415-9. [DOI:10.1111/j.1748-0361.2009.00253.x] [PMID]