Qom University of Medical Sciences Journal

Introduction
It is expected that 22% of the world population will be elderly by 2050, 79% of whom will be in the developing countries. The elderly people are at higher risk of diseases and hospitalization. They suffer from severe stress when their physical strength is decreased and have chronic diseases, long and frequent hospitalizations, and are away from the family. Therefore, it is essential to provide comfort for them during hospitalization. Elderly who are hospitalized for a long time define comfort as achieving vitality by medication therapy and finding friends. Providing comfort is a complicated process that is beyond pain relief and includes paying attention to the symptoms of stress and all human dimensions, and using interventions to reduce patient’s suffering. Some studies have defined the comfort for the elderly as a feeling of getting rid of discomfort and having satisfaction throughout life. Comfort for the elderly includes a balance between their well-being, wishes, and expectations. Nursing is as a human response to help the well-being of the elderly and the family is an important element for meeting the comfort needs and improving the quality of life of the elderly. The family members experience a lot of stress, especially those who spend several hours of the day taking care of the elderly. The lack of attention of nurses to meeting the needs of the elderly such as having hope and assurance, and asking nurses to stay with them can cause confusion and stress in the family members. On the other hand, physical, emotional and verbal abuses and ignoring the cultural and religious beliefs of the elderly by nurses, and the lack of professional skills of nurses to work with the elderly, not only cause suffering and discomfort in the elderly, but also cause discomfort in family members. Considering the importance of comfort for the elderly and its psychological and physical effects on the family members, this study aims to determine the relationship of the elderly patients’ comfort with their families’ stress, anxiety and depression.
Methods
This is a descriptive correlational study. The study population consists of all elderly patients hospitalized in public and private hospitals in Sari, Iran and their families. Of these, 136 were selected by a convenience sampling method. Inclusion criteria for the elderly were age over 60 years, hospitalization for at least 5 days, and physical and mental ability to answer the questions. Inclusion criteria for the families were age ≥18 years, being a first-degree relative. Data collection tools included the depression anxiety stress scale-21 (DASS-21) and the Hospice Comfort Questionnaire (HCQ). In this study, descriptive statistics such as mean and standard deviation were used to describe the data. Pearson correlation test was used to examine the correlation between comfort in the elderly and stress, anxiety and depression in the families. Linear regression analysis was used to predict the stress level of families and comfort level of hospitalized elderly patients.
Results
The mean age of the family group was 39.4±8.7 years; 50.9% were female and 77% were married. The depression, anxiety and stress of families were mostly at normal level (33.9%, 32.1%, and 40.6%, respectively); only 29.1%, 37%, and 23% reported severe-very severe depression, anxiety and stress, respectively. Family members over 50 years of age showed more anxiety, stress and depression than other age groups (P<0.001). The highest score of comfort was related to socio-cultural domain (58.88±12.03), while the lowest score was related to psychospiritual domain (35.81±15.45). The results of Pearson correlation test indicated all domains of comfort for the elderly patients had a significantly negative relationship with depression, anxiety and stress of their families (P<0.05). The linear regression model showed that the comfort in the elderly patients was able to explain the stress of family members (P<0.001); by increase of one unit in the comfort score, the stress level decreased by 20%.
Discussion
Findings of this study indicate that the highest amount of comfort in the hospitalized elderly was related to sociocultural comfort, while the lowest amount was related to psychospiritual comfort. One of the HCQ items that the elderly highly agreed with was the item stated “there are people I can rely on when needed”. Contrary to this finding, Kim (2017) showed that although the hospitalized elderly had family members, friends, or neighbors nearby, they were anxious because they believed that they could not expect basic help from them. They were grateful for the treatment provided by the nurses and felt comfortable because they believed that they were freed from the need to be taken care by the family. The might because the elderly considered the hospital environment safe or the medical staff took care of them 24 hours a day.
The results of this study showed that the male and female family members of elderly patients had different levels of anxiety, stress and depression, where females reported higher anxiety, stress and depression than males. Mehta (2005) in assessing the stress of the family members of Singaporean elderly patients, showed that males experienced less stress than females. Our study also showed that married members had higher levels of stress, and as the age of the family members increased, their depression, anxiety and stress increased. This is because older members have more experiences of diseases, hospitalization, or being present in clinical settings, or have more concerns about the lack of timely attention to the needs of the elderly by health care providers.
Further studies are recommended on the elderly in nursing homes or other hospital departments to obtain more comprehensive results in terms of comfort in the elderly and psychological conditions of their families. It is also recommended to investigate the relationship between family pattern and the comfort level of hospitalized elderly patients in future studies.
Ethical Considerations
Compliance with ethical guidelines
This study has been approved by the ethics code of IR.SHAHED.REC.1399.120 in Shahed University.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for profit sectors.
Authors contributions
All authors contributed equally in preparing all parts of the research.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
The researchers would like to thank all the patients and their families for their cooperation in the research. Also, the authors of this article are grateful for the sincere cooperation of Hemmat Gholinia-Ahangar for counselling and statistical analyses of this study.