Document Type : Original Article(s)


1 Department of Community Health and Aging, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

2 Associate Professor, Nursing and Midwifery Care Research Center AND Department of Mental Health Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

3 Assistant Professor, Department of Community Health and Aging, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran


BACKGROUND: Currently, researchers seek to identify factors related to length of hospital stay in elderly in order to reduce burden on the health system. The importance of either physiological or psychological factors in determining health outcomes has been well stablished; however, the possible contribution of psychosocial factors particularly in elderly patients with diabetes is also of special importance. This study aimed to know what psychosocial variables predicts length of hospital stay in elderly patients with diabetes. METHODS: This was a cross-sectional, correlational study conducted on 150 elderly patients from July-October 2015. Convenient sampling method was used to recruit the subjects. The data was collected by a three-part questionnaire consisted of demographic and health related characteristics, 21-item depression anxiety stress scale (DASS-21) and multidimensional scale of perceived social support (MSPSS). RESULTS: The mean ± standard deviation of length of hospital stay was 15.6 ± 7.7 days. Findings from multiple regression analysis showed that the models of predicting length of hospital stay in subgroups of both women (P = 0.001, F6,77 = 4.45) and men (P = 0.03, F6,71 = 2.43) were significant. The entered variables in subgroups of women and men accounted for 27% and 18% of total variance (R2) of the length of hospital stay, respectively. None of the psychosocial variables in women significantly predicted the lengths of hospital stay. However, one out of three predicting psychosocial variables (i.e. stress) in men significantly predicted the length of hospital stay (β = 0.39, t = 2.1, P = 0.04). CONCLUSION: The results emphasized the importance of promoting social support of elderly patients with diabetes, particularly in patients who are women, have higher levels of stress, have higher period of disease and a history of hospitalization in the past 6 months in order to lower length of hospital stay and finally promote health status in elderly patients with diabetes. Further studies regarding the effect of each of these factors on health condition of elderly with diabetes are recommended.   


  1. Rashedi V, Rezaei M, Gharib M, Nabavi S. Social support for the elderly: Comparison between home and nursing home. J North Khorasan Univ Med Sci 2013; 5(2): 351-6. [In Persian].
  2. Babapour M, Raheb G, Eglima M. The relationship between social support and life satisfaction among elderly nursing home residents in Tehran. Salmand Iran J Ageing 2014; 9(1): 136. [In Persian].
  3. Sarrafzadegan N, Rabiei K, Abedi H, Kelishadi R, Fereydoun MK, Alavi M, et al. Indicators developed to evaluate the international framework convention on tobacco control in Iran; a grounded theory study. Iran J Med Sci 2014; 39(2 Suppl): 213-7.
  4. Mokhtari M, Bahram ME, Pourvaghar MJ, Akasheh G. Effect of Pilates training on some psychological and social factors related to falling in elderly women. Feyz 2013; 17(5): 453-62. [In Persian].
  5. Arastoo AA, Ghasemzade R, Nasseh H, Kamali M, Rahimi Foroshani A, Arzaghi SM, et al. Factors affecting quality of life in elderly diabetic residents of the kahrizak geriatric nursing home of Tehran. Iran J Endocrinol Metab 2012; 14(1): 18-24. [In Persian].
  6. Sarrafzadegan N, Rabiei K, Alavi M, Abedi H, Zarfeshani S. How can the results of a qualitative process evaluation be applied in management, improvement and modification of a preventive community trial? The IHHP Study. Arch Public Health. 2011; 69(1): 9.
  7. Flanagan D, Moore E, Baker S, Wright D, Lynch P. Diabetes care in hospital--the impact of a dedicated inpatient care team. Diabet Med 2008; 25(2): 147-51.
  8. Mazloom Bafrooi N, Dehghani Firouzabadi T, Alizade B. Prevalence of depression and anxiety in patients with diabetes. Journal of Diabetes Nursing 2014; 2(4): 60-8.
  9. Barati M, Fathi Y, Soltanian Ar, Moeini B. Mental health condition and health promoting behaviors among elders in hamadan. Sci J Hamadan Nurs Midwifery Fac 2013; 20(3): 12-9. [In Persian].
  10. Collins-McNeil JC, Holston EC, Edwards CL, Benbow D, Ford Y. Physical activity, depressive symptoms, and social support among African-American women with type 2 diabetes. Can J Nurs Res 2009; 41(3): 24-43.
  11. Alavi M, Irajpour A, Abdoli S, Saberizafarghandi MB. Clients as mediators of interprofessional collaboration in mental health services in Iran. J Interprof Care 2012; 26(1): 36-42.
  12. Comino EJ, Harris MF, Islam MF, Tran DT, Jalaludin B, Jorm L, et al. Impact of diabetes on hospital admission and length of stay among a general population aged 45 year or more: a record linkage study. BMC Health Serv Res. 2015; 15: 12.
  13. Khairudin Z. Predictors of prolonged hospital stay in cardiac surgery. Journal of Asian Behavioural Studies 2012; 2(7): 67-80.
  14. Kato N, Kondo M, Okubo I, Hasegawa T. Length of hospital stay in Japan 1971-2008: hospital ownership and cost-containment policies. Health Policy 2014; 115(2-3): 180-8.
  15. Kimani KN, Potluri R, Natalwala A, Ghosh S, Heun R, Narendran P. Length of hospital stay is shorter in black and ethnic minority patients with diabetes. Diabet Med 2012; 29(6): 830-1.
  16. Nirantharakumar K, Saeed M, Wilson I, Marshall T, Coleman JJ. In-hospital mortality and length of stay in patients with diabetes having foot disease. J Diabetes Complications 2013; 27(5): 454-8.
  17. Stratton RJ, King CL, Stroud MA, Jackson AA, Elia M. 'Malnutrition Universal Screening Tool' predicts mortality and length of hospital stay in acutely ill elderly. Br J Nutr 2006; 95(2): 325-30.
  18. Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther 1995; 33(3): 335-43.
  19. Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. J Pers Assess 2010; 52(1): 30-41.
  20. Samani S, Joukar B. A study on the reliability and validity of the short form of the depression anxiety stress scale (DASS-21). Journal of Social Sciences and Humanities of Shiraz University 2007; 26(3): 65-77.
  21. Chenary R, Noroozi A, Noroozi R. Relation between perceived social support and health promotion behaviors in chemical veterans in Ilam province on 2012-13. Iran J War Public Health 2013; 6(1): 1-10.
  22. Prieto JM, Blanch J, Atala J, Carreras E, Rovira M, Cirera E, et al. Psychiatric morbidity and impact on hospital length of stay among hematologic cancer patients receiving stem-cell transplantation. J Clin Oncol 2002; 20(7): 1907-17.
  23. Thompson A, Shaw M, Harrison G, Ho D, Gunnell D, Verne J. Patterns of hospital admission for adult psychiatric illness in England: Analysis of Hospital Episode Statistics data. Br J Psychiatry 2004; 185: 334-41.
  24. Bhoraskar A. Inpatient management of diabetes mellitus. J Assoc Physicians India 2011; 59(Suppl): 29-31.
  25. Vlassoff C. Gender differences in determinants and consequences of health and illness. J Health Popul Nutr 2007; 25(1): 47-61.
  26. Contrada RJ, Goyal TM, Cather C, Rafalson L, Idler EL, Krause TJ. Psychosocial factors in outcomes of heart surgery: The impact of religious involvement and depressive symptoms. Health Psychol 2004; 23(3): 227-38.
  27. Misto K. The relationship between families' perceptions and nurses' perceptions of family nursing practice [PhD Thesis]. Kingston, RI: University of Rhode Island; 2014.
  28. Fulop G, Strain JJ, Fahs MC, Schmeidler J, Snyder S. A prospective study of the impact of psychiatric comorbidity on length of hospital stays of elderly medical-surgical inpatients. Psychosomatics 1998; 39(3): 273-80.
  29. Loren GL, Gascon Catalan A. Biopsychosocial factors related to the length of hospital stay in older people. Rev Lat Am Enfermagem 2011; 19(6): 1377-84.
  30. Mohammadebrahimi S, Bayati S, Mardani M, Karim H. Factors associated with patient length of stay, according to Sina hospital's admission data-Mashhad. Iranian Journal of Medical Informatics 2015; 4(4): 1-6.
  31. Alavi M, Irajpour A, Giles T, Rabiei K, Sarrafzadegan N. Barriers to education in cardiac rehabilitation within an Iranian society: A qualitative descriptive study. Contemp Nurse 2013; 44(2): 204-14.
  32. Lubkin IM, Larsen PD. Chronic illness: Impact and intervention. Burlington, ON: Jones & Bartlett Publishers; 2011.