Psychosocial predictors of death anxiety in older adults: the differential role of social health and active ageing dimensions

Abstract

Death anxiety is a significant psychological concern in later life that can adversely affect mental health and well-being among older adults. Although social health and active ageing are widely considered protective factors, their specific roles in relation to death anxiety remain insufficiently understood, particularly in non-Western contexts. This study examined the extent to which social health and active ageing are associated with death anxiety among community-dwelling older adults in Iran. A cross-sectional descriptive-analytical study was conducted in October 2025 and January 2026 among 317 community-dwelling older adults in northeastern Iran (Torbat-e Heydarieh and Gonabad). Participants were selected using stratified random sampling from comprehensive health centre registries. Data were collected using validated instruments, including Bao’s Social Health Scale for Older Adults, Mohammadi’s Active Ageing Questionnaire, and Templer’s Death Anxiety Scale. Statistical analyses included Pearson correlations, independent t-tests, one-way ANOVA, and multiple linear regression using SPSS version 24. Statistical significance was set at p < 0.05. The mean death anxiety score was 52.47 ± 18.32 on the Templer Death Anxiety Scale (range 6.67–88.33). Bivariate analyses showed no significant associations between total social health or overall active ageing and death anxiety. However, multivariate regression analysis indicated that age, female gender, and the active ageing insight dimension were independently associated with death anxiety, collectively explaining 11% of its variance (Adjusted R² = 0.11, p < 0.001). Older participants reported lower death anxiety scores, female participants reported higher death anxiety scores, and greater active ageing insight was associated with lower death anxiety. In this sample of community-dwelling older adults in Iran, global measures of social health and active ageing were not significantly associated with death anxiety. Instead, the cognitive-psychological dimension of active ageing—particularly perceived insight and agency—demonstrated an independent association with lower death anxiety. These findings suggest that targeting psychological empowerment, especially among older women and socioeconomically vulnerable groups, may be relevant for interventions aimed at reducing death-related anxiety; however, these implications require confirmation through longitudinal or interventional studies.