Identifying the Components of Cognitive Decline from the Perspective of Older Adults and Examining the Roles of Self-Criticism, Fear of Aging, and Psychological Distress: A Mixed-Methods Study

Maryam  Barghi Irani; Ahmad Alipour; Ziba Barghi Irani; Parvaneh  Ghodsi

Authors

Maryam Barghi Irani Department of Psychology, CT.C., Islamic Azad University, Tehran, Iran Author https://orcid.org/0009-0007-8406-4907
Ahmad Alipour Professor, Department of Psychology, Payame Noor University, Tehran, Iran https://orcid.org/0000-0002-5126-5653
Ziba Barghi Irani Associate Professor, Department of Psychology, Payame Noor University, Tehran, Iran Author https://orcid.org/0000-0002-0612-4923
Parvaneh Ghodsi Department of Psychology, CT.C., Islamic Azad University, Tehran, Iran Author https://orcid.org/0009-0008-7405-6214

Keywords:

Cognitive decline, Psychological Distress, Fear of Aging, Self-Criticism, Older Adults, Mixed-Methods Study

Abstract

Purpose: This study aimed to identify the components of cognitive decline from the perspective of older adults and examine their relationships with self-criticism, fear of aging, and psychological distress.

Methods and Materials: This applied study employed a mixed-methods design comprising qualitative and quantitative phases. The study population in both phases consisted of older adults residing in Districts 1 and 3 of Tehran, Iran. In the qualitative phase, participants were selected purposively, and semi-structured interviews were conducted with 17 older adults until theoretical saturation was achieved. Interview data were analyzed qualitatively to identify the perceived components of cognitive decline. Based on the qualitative findings, a questionnaire assessing cognitive decline was developed and subjected to validity assessment. In the quantitative phase, 106 older adults were recruited through convenience sampling, with the sample size determined according to the Tabachnick and Fidell formula. Participants completed the developed Cognitive Decline Questionnaire, the Lasher and Faulkender Anxiety about Aging Scale (1993), the Levels of Self-Criticism Scale (LOSC; Lewis, 2004), and the Kessler Psychological Distress Scale (Kessler et al., 2003). Quantitative data were analyzed using Pearson correlation coefficients.

Findings: Pearson correlation analyses demonstrated statistically significant positive relationships between the components of cognitive decline and self-criticism among older adults (p < .05). Significant positive correlations were also observed between cognitive decline components and fear of aging (p < .05). Furthermore, higher levels of psychological distress were significantly and positively associated with the identified components of cognitive decline (p < .05). These findings indicate that greater self-criticism, stronger fear of aging, and higher psychological distress are each associated with greater perceived cognitive decline in older adults.

Conclusion: The findings suggest that psychological factors, particularly self-criticism, fear of aging, and psychological distress, are significantly associated with perceived cognitive decline among older adults. Assessment and intervention programs targeting these psychological characteristics may contribute to identifying individuals vulnerable to cognitive difficulties and supporting psychological and cognitive well-being in later life.

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References

Arakawa, T., Otani, T., Kobayashi, Y., & Tanaka, M. (2021). 2-D Forward Dynamics Simulation of Gait Adaptation to Muscle Weakness in Elderly Gait. Gait & Posture, 85, 71-77. https://doi.org/10.1016/j.gaitpost.2021.01.011

Atkins, J., Naismith, S. L., Luscombe, G. M., & Hickie, I. B. (2013). Psychological Distress and Quality of Life in Older Persons: Relative Contributions of Fixed and Modifiable Risk Factors. BMC psychiatry, 13, 1-10. https://doi.org/10.1186/1471-244X-13-249

Beaudreau, S. A., & O'Hara, R. (2008). Late-Life Anxiety and Cognitive Impairment: A Review. The American Journal of Geriatric Psychiatry, 16(10), 790-803. https://doi.org/10.1097/JGP.0b013e31817945c3

Bergman, Y. S., & Weissberger, G. H. (2024). Ageist Attitudes and Psychological Distress in Older Adults: The Moderating Role of Reflective Functioning. Stress and Health, e3408. https://doi.org/10.1002/smi.3408

Brodaty, H., Chau, T., Heffernan, M., Ginige, J. A., Andrews, G., Millard, M., & Valenzuela, M. (2025). An online multidomain lifestyle intervention to prevent cognitive decline in at-risk older adults: a randomized controlled trial. Nature medicine, 31(2), 565-573. https://doi.org/10.1038/s41591-024-03351-6

Bu, Z., Huang, A., Xue, M., Li, Q., Bai, Y., & Xu, G. (2021). Cognitive Frailty as a Predictor of Adverse Outcomes among Older Adults: A Systematic Review and Meta-Analysis. Brain and Behavior, 11(1), e01926. https://doi.org/10.1002/brb3.1926

Charmaz, K. (2017). Constructivist Grounded Theory. The Journal of Positive Psychology, 12(3), 299-300. https://doi.org/10.1080/17439760.2016.1262612

Cheli, S., MacBeth, A., Popolo, R., & Dimaggio, G. (2020). The Intertwined Path of Perfectionism and Self-Criticism in a Client with Obsessive-Compulsive Personality Disorder. Journal of Clinical Psychology, 76(11), 2055-2066. https://doi.org/10.1002/jclp.23051

Ebrahimi, S., Laripour, R., Ghiasi, H., Rameshini, M., & Delbari, A. (2020). Fear of Aging and Its Related Factors among Students of the University of Social Welfare and Rehabilitation Sciences in Tehran. Salmand: Iranian Journal of Ageing, 15(1), 82-93.

Elgharib, Z., Saad, M., & Elashri, N. (2024). Effect of Aging Educational Program on Nursing Students' Knowledge, Ageism Attitude and Gerascophobia. Mansoura Nursing Journal, 11(2), 115-129. https://doi.org/10.21608/mnj.2024.379241

Faraziani, F., & Eken, Ö. (2024). Physical Activity, Cognitive Decline, and Quality of Life in Older Adults. International Journal of Sport Studies for Health, 7(2), 13-22. https://doi.org/10.61838/kman.intjssh.7.2.2

Franks, K. H., Rowsthorn, E., Bransby, L., Lim, Y. Y., Chong, T. T. J., & Pase, M. P. (2023). Association of Self-Reported Psychological Stress with Cognitive Decline: A Systematic Review. Neuropsychology Review, 33(4), 856-870. https://doi.org/10.1007/s11065-022-09567-y

Golant, S. M. (2020). The Distance to Death Perceptions of Older Adults Explain Why They Age in Place: A Theoretical Examination. Journal of Aging Studies, 54, 100863. https://doi.org/10.1016/j.jaging.2020.100863

Halamová, J., Kanovský, M., Brockington, G., & Strnádelová, B. (2023). Automated Facial Expression Analysis of Participants Self-Criticising via the Two-Chair Technique: Exploring Facial Behavioral Markers of Self-Criticism. Frontiers in psychology, 14, 1138916. https://doi.org/10.3389/fpsyg.2023.1138916

Hofmann, W., Schmeichel, B. J., & Baddeley, A. D. (2012). Executive Functions and Self-Regulation. Trends in Cognitive Sciences, 16(3), 174-180. https://doi.org/10.1016/j.tics.2012.01.006

Holvast, F., van Hattem, B. A., Sinnige, J., Schellevis, F., Taxis, K., Burger, H., & Verhaak, P. F. (2017). Late-Life Depression and the Association with Multimorbidity and Polypharmacy: A Cross-Sectional Study. Family Practice, 34(5), 539-545. https://doi.org/10.1093/fampra/cmx018

Iso-Markku, P., Aaltonen, S., Kujala, U. M., Halme, H. L., Phipps, D., Knittle, K., & Waller, K. (2024). Physical activity and cognitive decline among older adults: a systematic review and meta-analysis. JAMA Network Open, 7(2), e2354285-e2354285. https://doi.org/10.1001/jamanetworkopen.2023.54285

Jing, Z., Li, J., Fu, P. P., Wang, Y., Yuan, Y., Zhao, D., & Zhou, C. (2021). Physical Multimorbidity and Lifetime Suicidal Ideation and Plans among Rural Older Adults: The Mediating Role of Psychological Distress. BMC psychiatry, 21, 1-10. https://doi.org/10.1186/s12888-021-03087-4

Kaspar, R., Wahl, H. W., & Diehl, M. (2023). Awareness of Age-Related Gains and Losses in a National Sample of Adults Aged 80 Years and Older: Cross-Sectional Associations with Health Correlates. Innovation in Aging, 7(4), igad044. https://doi.org/10.1093/geroni/igad044

Lee, Y. C., Kang, J. M., Lee, H., Kim, K., Kim, S., Yu, T. Y., & Myung, W. (2020). Subjective Cognitive Decline and Subsequent Dementia: A Nationwide Cohort Study of 579,710 People Aged 66 Years in South Korea. Alzheimer's Research & Therapy, 12, 1-13. https://doi.org/10.1186/s13195-020-00618-1

Li, X., Wang, L., & Li, Z. (2025). Association Between Cognitive Decline‐related Appraisal, Cognitive Emotion Regulation Strategy, and Positive/Negative Affect in Older Individuals With Mild Cognitive Impairment. Geriatrics and Gerontology International, 25(8), 1115-1122. https://doi.org/10.1111/ggi.70120

Ma, Y., Zhang, B., Zhang, X., & Hu, Y. (2023). Experiencing Daily Negative Aging Stereotypes and Real-Life Cognitive Functioning in Older Adults: A Diary Study. Psychology and Aging. https://doi.org/10.1037/pag0000774

Mahmoudi, Z., Rahimian Boogar, E., & Tale Pasand, S. (2023). Predicting Age-Related Cognitive Decline and Executive Functions Based on Social Isolation, Physical Activity, and Dietary Habits in Older Adults. Aging Psychology, 9(4), 437-454.

McCord Stafford, A., & Burke Draucker, C. (2019). Emerging Adult Women's Views-of-Self in Intimate Partner Relationships That Are Troubled. Issues in Mental Health Nursing, 40(4), 289-296. https://doi.org/10.1080/01612840.2018.1524529

Mello, B. H. D., Lenardt, M. H., Moraes, D. C., Setoguchi, L. S., Seima, M. D., & Betiolli, S. E. (2021). Cognitive Impairment and Physical Frailty in Older Adults in Secondary Health Care. Revista da Escola de Enfermagem da USP, 55, e03687. https://doi.org/10.1590/s1980-220x2019029803687

Musaiger, A. O., & D'Souza, R. (2009). Role of Age and Gender in the Perception of Aging: A Community-Based Survey in Kuwait. Archives of Gerontology and Geriatrics, 48(1), 50-57. https://doi.org/10.1016/j.archger.2007.10.002

Ondrejková, N., & Halamová, J. (2022). Prevalence of Compassion Fatigue among Helping Professions and Relationship to Compassion for Others, Self-Compassion and Self-Criticism. Health & Social Care in the Community, 30(5), 1680-1694. https://doi.org/10.1111/hsc.13741

Panza, F., Lozupone, M., Solfrizzi, V., Sardone, R., Dibello, V., Di Lena, L., & Logroscino, G. (2018). Different Cognitive Frailty Models and Health- and Cognitive-Related Outcomes in Older Age: From Epidemiology to Prevention. Journal of Alzheimer's Disease, 62(3), 993-1012. https://doi.org/10.3233/JAD-170963

Sanprakhon, P., Suriyawong, W., Chusri, O., & Rattanaselanon, P. (2024). Exploring the Association Between Loneliness, Subjective Cognitive Decline, and Quality of Life Among Older Thai Adults: A Convergent Parallel Mixed-Method Study. Journal of Applied Gerontology, 43(11), 1795-1807. https://doi.org/10.1177/07334648241253989

Shimada, H., Makizako, H., Lee, S., Doi, T., Lee, S., Tsutsumimoto, K., & Suzuki, T. (2016). Impact of Cognitive Frailty on Daily Activities in Older Persons. The Journal of Nutrition, Health & Aging, 20, 729-735. https://doi.org/10.1007/s12603-016-0685-2

Sugimoto, T., Arai, H., & Sakurai, T. (2022). An Update on Cognitive Frailty: Its Definition, Impact, Associated Factors and Underlying Mechanisms, and Interventions. Geriatrics & Gerontology International, 22(2), 99-109. https://doi.org/10.1111/ggi.14322

Vidal, J., & Soldevilla, J. M. (2023). Effect of Compassion-Focused Therapy on Self-Criticism and Self-Soothing: A Meta-Analysis. British Journal of Clinical Psychology, 62(1), 70-81. https://doi.org/10.1111/bjc.12394

Wei, J., Ying, M., Xie, L., Chandrasekar, E. K., Lu, H., Wang, T., & Li, C. (2019). Late-Life Depression and Cognitive Function among Older Adults in the US: The National Health and Nutrition Examination Survey, 2011-2014. Journal of psychiatric research, 111, 30-35. https://doi.org/10.1016/j.jpsychires.2019.01.012

Xiao, S., Shi, L., Xue, Y., Zheng, X., Zhang, J., Chang, J., & Zhang, C. (2022). The Relationship between Activities of Daily Living and Psychological Distress among Chinese Older Adults: A Serial Multiple Mediation Model. Journal of affective disorders, 300, 462-468. https://doi.org/10.1016/j.jad.2021.12.069

Yaghubi, H. (2016). Psychometric Properties of the 10-Question Version of the Kessler Psychological Distress Scale (K-10). Applied Psychological Research Quarterly, 6(4), 45-57.

Yuan, Y., Lapane, K. L., Tjia, J., Baek, J., Liu, S. H., & Ulbricht, C. M. (2021). Physical Frailty and Cognitive Impairment in Older Adults in United States Nursing Homes. Dementia and Geriatric Cognitive Disorders, 50(1), 60-67. https://doi.org/10.1159/000515140

Zou, C., Yu, Q., Wang, C., Ding, M., & Chen, L. (2023). Association of Depression with Cognitive Frailty: A Systematic Review and Meta-Analysis. Journal of affective disorders, 320, 133-139. https://doi.org/10.1016/j.jad.2022.09.118