The Best Predictor of Anxiety, Stress, and Depression in Institutionalized Elderly

Ni Putu Wulan Purnama Sari, Maria Manungkalit


Anxiety, stress, and depression are the three most common negative emotional constructs found in the elderly. Evidences available worldwide about how psychological problem could be resulted in mental disorder, and there is significant difference in the context of living in the nursing home and in community setting. This study aimed to determine the best predictor of anxiety, stress, and depression in elderly living in the nursing home, useful for future modification and intervention development. This cross-sectional study involved 145 elderly in a private nursing home in Surabaya, Indonesia. HARS, SPST-20, and GDS were used in data collection. Linear regression and one way ANOVA tests were used in data analysis (α<0.05). Results showed that mostly in old individuals, mild anxiety and stress, and undepressed state were found. Sensory problems and concentration difficulties were the best predictor of anxiety and stress respectively, which were accounted for 61.2% and 65.6% variances of anxiety and stress in nursing home residents respectively. Spirits, life energy, happiness, and feeling wonderful to be alive could not predict depression significantly. Feeling inferior to others is the best predictor of depression, which was accounted for 25.9% variance of depression in this population. Low self-esteem leads to depression in nursing home residents.


G. J. Byrne, N. A. Pachana, “Anxiety and Depression in the Elderly: Do We Know Any More?,” Current Opinion in Psychiatry, vol.23, no.6, pp. 504-509, 2010.

M. Stanley, P. G. Beare, “Textbook of Gerontology Nursing (in Bahasa Indonesia),” 2006. Jakarta: EGC.

B. M. Wood, M. K. Nicholas, F. Blyth, A. Asghari, S. Gibson, “The utility of The Short Version of The Depression Anxiety Stress Scales (DASS-21) in Elderly Patients with Persistent Pain: Does Age Make a Difference?,” Pain Medicine, vol.11, no.12, pp. 1780–1790, 2010.

D. Seitz, N. Purandare, D. Conn, “Prevalence of Psychiatric Disorders among Older Adults in Long-Term Care Homes: A Systematic Review,” International Psychogeriatric, vol.22, no.7, pp. 1025-1039, 2010.

S. Kumar, K. R. Adiga, A. George, “Impact of Mindfulness-Based Stress Reduction (MBSR) on Depression among Elderly Residing in Residential Homes,” The Nursing Journal of India, vol.105, pp.6, pp. 248-251, 2014.

J. Snowdon, “Depression in Nursing Homes,” International Psychogeriatrics, vol.22, no.7, 1143-1148, 2010.

K. Pae, “Differences of Depression Level between Elderly Lives in The Nursing Home and at Home with Families (in Bahasa Indonesia),” Jurnal Ners Lentera, vol.5, no.1, 21-32, 2017.

E. Setyaningsih, Setiyawan, Saelan, “Correlation between Anxiety and Quality of Life in Nursing Home of Dharma Bhakti Kasih, Surakarta (in Bahasa Indonesia),” 2017. Retrieved from:

G. J. Diefenbach, D. F. Tolin, S. A. Meunier, C. M. Gilliam, “Assessment of Anxiety in Older Home Care Recipients,” The Gerontologist, vol.49, no.2, pp. 141-153, 2009.

M. Hamilton, “The Assessment of Anxiety States by Rating,” Br J Med Psychol, vol.32, pp. 50–55, 1959.

J. G. Beck, M. A. Stanley, “Characteristics of Generalized Anxiety Disorder in Older Adults: A Descriptive Study,” Behaviour Research and Therapy, vol.34, no.3, pp. 225-234, 1996.

S. Y. Tan, A. Yip, “Hans Selye (1907-1982): Founder of The Stress Theory,” Singapore Med J, vol.59, no.4, pp. 170-171, 2018.

N. Muramatsu, H. Yin, D. Hedeker, “Functional Declines, Social Support, and Mental Health in the Elderly: Does Living in a State Supportive of Home and Community-Based Services Make a Difference?,” Social Science & Medicine, vol.70, no.7, pp. 1050-1058, 2010.

M. M. Koampa, H. Bidjuni, F. Onibala, “Correlation between Stress Level and Independency Level in Elderly, Tombasian Village, West Kawangkoan District (in Bahasa Indonesia),” eJournal Keperawatan (e-Kp), vol.3, no.2, pp. 1-6, 2015.

A. A. A. R. Puspadewi, E. Rekawati, “Depression is Associated with Quality of Life in The Nursing Home of Tresna Werdha, Jakarta (in Bahasa Indonesia),” Jurnal Keperawatan Indonesia, vol.20, no.3, pp. 133-138, 2017.

Azizah, “The 4 University Research Coloquium 2016,” 2016. Retrieved from:

M. Zainuddin, W. Utomo, Herlina, “Correlation between Stress and Quality of Life in Type 2 Diabetes Mellitus (in Bahasa Indonesia),” JOM, vol.2, no.1, pp. 890-898, 2015.

S. Mahatnirankul, V. Pumpaisanchai, P. Tapanya, “The Construction of Suan Prung Stress Test for Thai Population,” Bulletin of Suan Prung, vol.13, no.3, pp. 1-11, 1997.

N. P. W. P. Sari, J. Artsanthia, “Comparison of Stress Level and Quality of Life in Elderly Who are Living with Chronic Illness in Bangkok and Surabaya,” Proceedings of the 9th International Nursing Conference (INC 2018), pp. 101-109, 2018.

J. I. Sheikh, J. A. Yesavage, “Geriatric Depression Scale (GDS): Recent Evidence and Development of A Shorter Version,” Clinical Gerontologist: The Journal of Aging and Mental Health, vol.5, no.1-2, pp. 165-173, 1986.

T. Babazadeh, R. Sarkhoshi, F. Bahadori, F. Moradi, F. Shariat, Y. Sherizadeh, “Prevalence of Depression, Anxiety and Stress Disorders in Elderly People Residing in Khoy, Iran (2014-2015),” J Anal res Clin Med, vol.4, no.2, pp. 122-128, 2016.

C. M. Teixeira, J. Vasconcelos-Raposo, H. M. Fernandes, R. J. Brustad, “Physical Activity, Depression and Anxiety among the Elderly,” Soc Indic Res, vol.113, pp. 307–318, 2013.

M. B. Sami, R. Nilforooshan, “The Natural Course of Anxiety Disorders in the Elderly: A Systematic Review of Longitudinal Trials,” International Psychogeriatrics, vol.27, no.7, pp. 1061–1069, 2015.

C. R. Gale, A. A. Sayer, C. Cooper, E. M. Dennison, J. M. Starr, L. J. Whalley, J. E. Gallacher, Y. Ben-Shlomo, D. Kuh, R. Hardy, L. Craiq, I. J. Deary, HALCyon Study Team, “Factors Associated with Symptoms of Anxiety and Depression in Five Cohorts of Community-Based Older People: The HALCyon (Healthy Ageing Across The Life Course) Programme,” Psychological Medicine, vol.41, pp. 2057–2073, 2011.

A. M. Ní Mhaoláin, C. W. Fan, R. Romero-Ortuno, C. Cunningham, R. A. Kenny, B. Lawlor, “Frailty, Depression, and Anxiety in Later Life,” International Psychogeriatrics, vol.24, pp. 1265–1274, 2012.

V. Bernabei, V. Morini, F. Moretti, A. Marchiori, B. Ferrari, E. Dalmonte, D. De Ronchi, A. R. Atti, “Vision and Hearing Impairments are Associated with Depressive-Anxiety Syndrome in Italian Elerly,” Aging & Mental Health, vol.15, no.4, pp. 467-474, 2011.

C. Heine, C. J. Browning, “Mental Health and Dual Sensory Loss in Older Adults: A Systematic Review,” Frontiers in Aging Neuroscience, vol.6, no.83, pp. 1-9, 2014.

A. Ciorba, C. Bianchini, S. Pelucchi, A. Pastore, “The Impact of Hearing Loss on the Quality of Life of Elderly Adults,” Clin Interv Aging, vol.7, pp.159-163, 2012.

G. Andersson, M. Green, “Anxiety in Elderly Hearing Impaired Persons,” Perceptual and Motor Skills, vol.81, no.2, pp. 552-554, 1995.

R. Boi, L. Racca, A. Cavallero, V. Carpaneto, M. Racca, F. D. Acqua, M. Ricchetti, A. Santelli, P. Odetti, “Hearing Loss and Depressive Symptoms in Elderly Patients,” Geriatrics Gerontology International, vol.12, no.3, pp.440-445, 2012.

G. Andersson, C. Hagnebo, “Hearing Impairment, Coping Strategies, and Anxiety Sensitivity,” Journal of Clinical Psychology in Medical Settings, vol.10, no.1, pp.35-39, 2003.

I. R. Hunter, M. C. Gillen, “Stress Coping Mechanisms in Elderly Adults: An Initial Study of Recreational and Other Coping Behaviors in Nursing Home Patients,” Adultspan Journal, vol.8, no.1, pp. 43-53, 2009.

R. Nishanthi, R. Priya, “Level of Psychological Problems and Coping Strategies of Elderly Persons Residing in Old Age Homes,” International Journal of Pharmaceutical and Clinical Research, vol. 9, no.10, pp. 660-664, 2017.

G. E. Lee, “Predictors of Adjustment to Nursing Home Life of Elderly Residents: A Cross-Sectional Survey,” International Journal of Nursing Studies, vol.47, no.8, pp. 957-964, 2010.

C. A. Walker, L. C. Curry, M. O. Hogstel, “Relocation Stress Syndrome in Older Adults Transitioning from Home to A Long-Term Care Facility: Myth or Reality,” J Psychosoc Nurs Ment Health Serv, vol.45, no.1, pp. 38-45, 2007.

M. F. Idrus, “Stress-related disorder (in Bahasa Indonesia),” 2016. Retrieved from:

J. N. Souza-Talaricoa, E. C. Chaves, R. Nitrini, P. Caramellic, “Chronic Stress is Associated with High Cortisol Levels and Emotional Coping Mechanisms in Amnestic Mild Cognitive Impairment,” Dement Geriatr Cogn Disord, vol.28, pp. 465–470, 2009.

J. Guerrero, M-A. Crocq, “Sleep Disorders In The Elderly: Depression And Post-Traumatic Stress Disorder,” Journal of Psychosomatic Research, vol.38, no.1, pp. 141-150, 1994.

A. Johansson, S. Nordin, M. Heiden, M. Sandstrom, “Symptoms, personality traits, and stress in people with mobile phone-related symptoms and electromagnetic hypersensitivity,” Journal of Psychosomatic Research, vo.68, no.1, pp. 37-45, 2010.

R. R. Brougham, C. M. Zail, C. M. Mendoza, J. R. Miller, “Stress, Sex Differences, and Coping Strategies among College Students,” Current Psychology, vol.28, no.2, pp. 85-97, 2009.

M. K. Wium-Andersen, D. D. Orsted, S. F. Nielsen, B. G. Nordestgaard, “Elevated C-Reactive Protein Levels, Psychological Distress, and Depression in 73,131 Individuals,” JAMA Psychiatry, vol.70, no.2, pp. 176-184, 2013.

T. Hamano, M. Yamasaki, Y. Fujisawa, K. Ito, T. Nabika, K. Shiwaku, “Social Capital and Psychological Distress of Elderly in Japanese Rural Communities,” Stress & Health, vol.27, no.2, pp. 163-169, 2011.

H. Bhandari, K. Yasunobu, “What Is Social Capital? A Comprehensive Review of the Concept,” Asian Journal of Social Science, vol.37, no.3, pp. 480-510, 2009.

R. F. Baumeister, “Self-Esteem: The Puzzle of Low Self-Regard,” 1993. New York: Springer, USA.

A. E. Steiger, M. Allemand, R. W. Robins, H. A. Fend, “Low and Decreasing Self-Esteem During Adolescence Predict Adult Depression Two Decades Later,” J PersSocPsychol, vol.106, pp. 325-338, 2014.

U. Orth, R. W. Robins, K. H. Trzesniewski, J. Maes, M. Schmitt, “Low Self-Esteem is a Risk Factor for Depressive Symptoms from Young Adulthood to Old Age,” J AbnormPsychol, vol.118, pp. 472-478, 2009.

S. A. Ali, N. Suhail, S. A. Ali, “Low Self-Esteem Leads to Depression among Elderly: Case Study of Nursing Home,” Journal of Universal Surgery, vol.4, no.2(52), pp. 1-4, 2016.

S. Robinson-Whelen, K. J. K. Kiecolt-Glaser, R. Glaser, “Effect of Chronic Stress on Immune Function and Health in the Elderly,” Behavior, Health, and Aging, vol.6, pp. 14, 2014.

M. Piadehkousar, F. Ahmadi, M. F. Khoshknab, A. Rasekhi, “The Effect of Orientation Program Based on the Activities of Daily Living on Stress, Anxiety and Depression in the Elderly,” International Journal of Community Based Nursing and Midwifery, vol.7, no.3, pp. 170-180, 2019.

S. S. Ghotbabadi, K. H. Alizadeh, “The Effectiveness of Spiritual-Religion Psychotherapy on Mental Distress (Depression, Anxiety and Stress) in the Elderly Living in Nursing Homes,” Health, Spirituality and Medical Ethics, vol.5, no.1, pp. 20-25, 2018.

L. Neslihan, L. Sefa, C. Muammer, “The Effect of Physical Activity on Depression Symptoms and Quality of Life among Elderly Nursing Home Residents: Randomized Controlled Trial,” Archives of Gerontology and Geriatrics, vol.70, pp. 92-98, 2017.

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