Introduction

COVID-19 is a newly emerged infectious disease which was first identified in

Wuhan, China on December 31, 2019 (Hui, Azhar, Madani, Ntoumi, Kock, Dar, et

al,2020). The World Health Organization (WHO) declared the disease as a pandemic

on March 11, 2020 due to its rapid spread throughout most countries across the globe

(WHO,2020) ,even December 2020 the number of death due to COVID-19 was 3360

in Kurdistan region (GOV.KRD ,2020) , The initial reports from Wuhan revealed that

more than half of all COVID-19 confirmed cases were among older adults, who have

higher morbidity and mortality rates than other age groups (Li et al. 2020). Medical

reports from Italy and the US, which are both suffering from a high burden of

COVID-19 cases, have also revealed that high case-fatality rates of COVID-19 are

significantly associated with advanced age, with most death cases occurring among

people aged 60 years and over (Onder, Rezza and Brusaferro 2020). Many research

studies and reports have confirmed that older adults are the most vulnerable age group

to COVID-19 (Onder et al. 2020; Covid and Team 2020), and that COVID-19

significantly impacts all aspects of older adults’ quality of life (Hall Laddu Phillips

Lavie and Arena 2020). The coronavirus disease 2019 (COVID-19) pandemic may be

stressful for people. Fear and anxiety about a new disease and what could happen can

be overwhelming and cause strong emotions in adults and children. Public health

actions, such as social distancing, can make people feel isolated and lonely and can

increase stress and anxiety (cdc.gov,2020), Although it is natural for older adults to

experience death anxiety (DA) , the COVID-19 pandemic has exacerbated feelings of

death anxiety in older adults (Chatard Renoux Monéger Jaafari and Selimbegovic

2020). Death anxiety refers the " fear of and anxiety related to the anticipation, and

awareness, of dying, death, and nonexistence. It typically includes emotional,

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cognitive, and motivational components that vary according to a person's stage of

development and sociocultural life experiences" (Lehto & Stein, 2009). Death anxiety

generally declines with age (Chopik,2016); however, death anxiety is an important

concern for older adults because, with age, death becomes more likely and salient, and

preparing for one’s death may be a developmental task of older adulthood (Erikson,

1950). Newton-John, Chambers, Menzies, and Menzies (2020) have argued that

COVID-19 presents unique challenges to our species because of the constant

reminders of death. What actually affects the presence of death anxiety is still

debatable. Many variables have been proposed to influence death anxiety amongst

them religiosity, gender, psychological state and age (Gonen, Kaymak, Cankurtaran ,

Karslioglu, Ozalp, Soygur,2012) One large study of 810 Australians specifically

explored fears of death in the context of the pandemic (Newton-John et al., 2020).

The findings revealed a significant positive correlation between death anxiety and

anxious beliefs and behaviours related to COVID-19 (e.g. estimated likelihood of

contracting the virus, estimated likelihood of wearing a mask in public, etc.) , fears of

death predict anxiety about the virus, which in turn is shown to predict broader

psychological distress. These findings may suggest a causal relationship between

death anxiety and psychological distress, Another study in Chine among 237

participants, aged 60-91 years 62 men and 175 women, high level of death anxiety

associated with younger age, a high level of psychological distress, and recent

stressors but unrelated to physical disorders, gender, income, marital status,

employment ( Wu, Tang, Kwok, 2002) .While the study by Azaiza et al. (2010) found

higher death anxiety among those in care institutions than those who were not,

( Moreno et al. 2008) found lower death anxiety among the former than the latter.

However,( Moreno et al.2008) failed to take a potentially confounding variable into

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account: age differences between the samples. Those in care institutions were

considerably older (mean age 83.28 yrs, SD 6.72) than the home group (mean age

70.65, SD 6.00).Increasing age is associated with lower death anxiety in general

(Fortner & Neimeyer, 1999). is noteworthy that gender differences in death anxiety

have rarely been found in studies of older individuals (Russac et al., 2007). The

studies by Azaiza et al. (2010) and Moreno et al. (2008), outlined above, again

yielded contradictory results, with the former finding higher death anxiety among

women, the latter reporting no gender differences. The fine-grained multidimensional

analysis should clarify whether there really is no difference in death anxiety between

these elderly men and women. the COVID-19 pandemic caused significant stress

(Bao et al., 2020). A recent survey study of the general public in China showed that

8.1% reported moderate to severe stress levels (Wang et al., 2020). This translates to

about 112 million people living in China. Similarly, a nationwide survey among

Italians reported %27.2 (~16.2 million people) experienced high to extremely high-

stress levels during the pandemic (Mazza et al., 2020). Prolonged stress are

significantly associated with mortality, poor mental health out- comes and lower

quality of life (Marshall et al., 2008; Nielsen et al.,2008; Prior et al., 2016). of much

of the research, some preliminary data support the idea that death anxiety may be

driving a significant amount of psychological distress during this pandemic(Ahorsu et

al., 2020).

Based on previous literature review, there is not any research which examines the

death anxiety and stress among older adults during COVID-19 pandemic specially in

kurdistan region . Moreover, there are only a few researches which examine the level

of death anxiety and stress but didn’t during the pandemic or COVID-19 pandemic .

Therefore, the findings of this research may be helpful for those who study

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psychological impact during pandemic and who interest to research about older adults

and provide psychological support for them.

The main focus in this study centered to indicating the level of death anxiety and the

level of stress among older adults during COVID-19 pandemic , also to find out the

level of both scale according to demographic information (gender, age, marital

status ,number of children and economic status ), besides investigating the

relationship between death anxiety and stress among older adults during COVID-19.

The study aims to find out the following specific objectives :

1. Determine the level of death anxiety among older adults during coved-19

pandemic.

2. Determine the level of stress among older adults during coved-19

pandemic.

3. Investigating the relationship between death anxiety and stress among

older adults during coved-19 pandemic.

4. Find out the level of death anxiety and stress according to gender.

5. Find out the level of death anxiety and stress according to age.

6. Find out the level of death anxiety and stress according to marital status.

7. Find out the level of death anxiety and stress according to economic status.

8. Find out the level of death anxiety and stress according to number of

children.

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