Iran Journal of Nursing

Introduction
Interpersonal cognitive distortion (ICD) is one of the psychological problems in old age that causes a person not to have a correct and logical understanding of relations. Its continuation can lead to anxiety and depression. Regarding the role of psychiatric nurses in recognizing cognitive disorders in people and the lack of sufficient study in the field of cognitive distortions of the elderly, this study aims to determine the ICDs among the community-dwelling elderly in Tehran, Iran.

Methods
In this descriptive-correlational study, after obtaining permission Iran University of Medical Sciences, sampling was done from December 2020 to October 2021. At first, three urban parks including Laleh (west), Mellat (north), Shahr (center) were selected, since most of the elderly population lives in these areas and these parks are the biggest parks in the area. The minimum sample size was calculated 200 at 95% confidence level and considering 80% test power. Each park was considered as a cluster. Then, the calculated sample size was divided by the number of clusters (n=3) and the sample size in each cluster was thus determined 66 (66 from Shahr Park, 66 from Laleh and 67 from Mellat Park). Sampling was started from Laleh Park, then from Shahr Park and finally from Mellat Park. The inclusion criteria were age over 60 years, reading and writing literacy, no cognitive problems, no mental illness, and willingness to participate in the study. Data collection tools included a demographic form, abbreviated mental test score (AMTS), and interpersonal cognitive distortion scale (ICDS). The ICDS has 19 items and three subscales of interpersonal rejection, unrealistic relationship expectation, and interpersonal misperception. questionnaires were answered by the self-report method which took 20 minutes to complete. The collected data were analyzed in SPSS software, verion 16 using descriptive statistics (mean, standard deviation, frequency, and percentage) and inferential statistics (Pearson correlation test, independent t-test, analysis of variance).

Results
The mean age of the elderly was 71.53 ± 4.71 years; 81% were male, 71.5% were married,46.5% had a bachelor’s degree or higher, 32.5% had three children, 72% were employed, and 40% had a history of high blood pressure. The mean total score of ICD was 52.53 ± 8.29 out of 95, which indicates the moderate level of ICD among the elderly. In terms of the dimensions of ICDS, the results showed that the unrealistic relationship expectations had the highest mean score (2.91±0.57), while the dimension of interpersonal rejection had the lowest score (2.64±0.52). In terms of the items of ICDS, the results showed that the highest average score in the dimension of interpersonal rejection was related to the item “It is beneficial to be alert to people around us” (3.27±1.01) and the lowest mean score was for the item “I believe that people do not accept me when I am in a social environment” (2.14±0.84). In the dimension of unrealistic relationship expectations, the highest mean score was for the item “I should be tolerant of others in order not to offend them” (3.31±0.91), while the lowest mean score was for the item “I should behave as others want me to behave in order to make them happy” (2.51±1.17). In the dimension of interpersonal Misperception, the highest mean score was for the item “I feel what they think even if people do not show it” (2.91±0.97), while the lowest mean score was for the item “Other people should know what I think even if I do not reveal my thoughts” (2.26±0.84). There was a significant relationship between the age of the elderly and their ICD (P=0.03). No significant relationship was found between ICD and other demographic characteristics (P>0.05).

Conclusion
The nurses working in healthcare centers in Mashhad should take actions to reduce the ICD of the elderly by using necessary measures and interventions. Considering the existence of a significant relationship between age and cognitive distortions, they should be taken into account in interventions for the elderly.

Ethical Considerations
Compliance with ethical guidelines
This study has an ethical approval obtained from the ethics committee of University of Medicine, Iran (Code: IR.IUMS.REC1400.108). All participants signed a written informed consent form. They were assured of the confidentiality of their information. 

Funding
This study is taken from the master's degree in nursing of the corresponding author from the Faculty of Nursing and Midwifery, University of Medicine, Iran.

Authors' contributions
Conceptualization, Investigation, Validation, and Visualization: Zahra Kashaninia; Funding acquisition and Project administration: Shima Haggani; Resources, Supervision, and Data curation, Writing, Review & Editing: Goharalsadat Sharifi; Methodology and Formal .Analysis: Naeime Seyedfatemi

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank all the seniors participated in the study for their cooperation.


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