With the onset of Covid 19 disease, the World Health Organization (WHO) has identified quarantine and social isolation as one of the safest ways to control and combat the disease. However, the quarantining a large segment of society will not be without the much dreaded psychological, social and economic effects (1). As a result, older people with active social life are probably experiencing major changes in their normal routine of life, leading to feelings of isolation, loneliness, or low mood (2).
Aging is a critical process of life where physical and mental needs are considered social necessity, and close attention on health-promoting behaviors is essential (3). As part of the aging process, older people would experience change in personality and behaviour, with incidences of loneliness and depression reported as common problems among the elderly (4, 5). Studies indicate that loneliness is a painful and nettlesome feeling for older people (6, 7), with possibility of multiple negative physical and mental health concerns (8). Needless to say, loneliness and depressions an existing concern among older people is exacerbated during the pandemic. Studies highlight that concerns regarding COVID-19 are higher among older (9), expressing higher vulnerability which impacts their overall attitude to aging (10). The concerns expressed by the elderly is likely justified as the fatality rate of COVID-19 is higher among older compared to younger adults. The health concern is connected to the level of expectations regarding aging, hence the importance of addressing this concern among the elderly (11).
Aging expectations (ERA) are beliefs that people have about their level of physical and cognitive health with age (12). The concept of “successful” aging as an alternative to “usual” aging was first mooted by Rowe and Kahn (1997) focusing on importance of health promotion and disease prevention. The proposition was for the elderly to play an active role in their health to enjoy full life as much as possible while maintaining full function (13).
Studies show that there is a positive relationship between attitude and tendency to participate in health-promoting behaviors such as physical activity, stress management, interpersonal relations, increased longevity and a better quality of life in older adults(14-20). Correspondingly, negative expectations were associated with lower ability to engage in physical activity, accepting a more sedentary lifestyle, a higher likelihood of experiencing acute medical events, negative health outcome, cognitive decline, and emotional responses to stress (21-24) and feelings of loneliness (25).
The importance of expectation in achieving and maintaining a high level of physical and mental function was explored by Sarkisian et al (2002) with a 38- item survey to measure expectations regarding aging (ERA-38) in the USA. The scale incorporated items of general health, cognitive function, mental health, functional independence, sexual function, pain, sleep, fatigue, urinary incontinence and appearance. Higher scores on the ERA-38 expressed an increased attainment of high physical and mental functioning with aging (12). It was interesting to note that functional status and the psychosocial components of health, such as depressive symptoms, social functioning, emotional well-being, and biological and cultural status have a more significant impact on perceptions compared to others aspect (26). It was also noted that older adults’ age expectations differed across race/ethnic groups (27).
The limitations of ERA-38, large number of items and the time required for completion, prompted the development of a shorter version, ERA-12. The 12-Item Expectations Regarding Aging Survey support three 4-item sub-scales (expectations about physical health, expectations about mental health, and expectations about cognitive function). The revised instrument, in contrast to ERA-38, does not attempt to show positive or negative conditions (28).
Since the risks of hospitalization or mortality resulted COVID-19 are higher in older adults than in young adults, the use of preventive approach in this group is more emphasized. An approach which is relatable to their view of aging and expectation regarding aging. The attitude adopted by older adults with concerns about COVID-19 can be seen from two perspectives. Firstly, a prescribed isolation may result in older adults feeling lonely or alternatively, Alternatively, the prescribed isolation may result in them feeling safe and more positive (29). If the expectations regarding aging remained relatively stable, a higher resilient was expressed in facing COVID-19 (30).
In justifying the use of ERA-12, it is noted that this instrument showed acceptable validity and reliability when applied to a sample of middle aged Singaporeans, middle aged Koreans and elderly women (31, 32). The focus of the present study is driven by two important considerations, (1) the increase in the elderly population as a vulnerable group in Iran, and (2) insufficient resources on aging expectations among Iranians which is key in developing informed and effective policies in this area. The present study, therefore, aims to evaluate the construct validity and reliability of Persian version of the 12-Item Expectations Regarding Aging Survey among an Iranian older adult population during COVID-19 pandemic.