Effectiveness of Logotherapy Training on Self-Esteem, Communication Skills and Impact of Event Among Older Adults

Background: The population aged 60 years and older is growing both in number and proportion. One treatment option for elderly patients with sleep issues and poor communication skills is logotherapy. this training assesses the effects of altering the meaning of life and attitudes of older persons through training in areas like self-esteem, communication skills, and the elements of mental helplessness when facing specific events. The study aimed to evaluate the effectiveness of logotherapy training in self-esteem, communication skills, and the impact of events among older adults. The setting of the study : The study was conducted in El-Sadat nursing home, Berket El-Saba nursing home, and Elderly Club, Shebeen El-Kom, Menoufia, Governate, Egypt. Subjects: A Convenience sample of 50 senior males and females. Research Design: A quasi-experimental design was used to achieve the aim of the study. Data collection : Four tools were used; Tool (1): Socio-demographic and clinical characteristics structured interview questionnaire. Tool (2): The Cooper smith Self-Esteem Inventory Tool (3) Human communication skills scale Tool (4) Weiss and Marmar’s Impact of Event Scale-Revised. Results: The findings of the study revealed that the mean age of the studied older adults was 67.98±6.02 and, more than half of them (52%) were females. There was a decrease in the mean score of the total impact of the event scale in the posttest (41.92) than the pretest (62.74). There was an increase in the mean score of self-esteem in the post-test (22.24) than pre-test (16.48). In addition, the mean score of the total communication scale was increased in the post-test (195. 6) than in the pretest (160.98) with a statistically significant difference. Conclusion : Applying logotherapy training among older adults proved to be effective in improving self-esteem, and communication skills, and decreasing the impact of events among older adults.


Introduction
The proportion of adults 60 and older is increasing, as is their number.In 2019, there were 1 billion persons 60 and older worldwide.There will be 1.4 billion people on earth by 2030 and 2.1 billion by 2050.This increase is occurring at an astounding rate and will continue to accelerate in the upcoming decades, particularly in developing countries (WHO,2022).Like many other countries, Egypt is enduring a demographic shift toward an aging society as global population aging accelerates in both developed and developing countries.The percentage of the population that was 60 or older in 2016 was 8.9%; however, it is anticipated that this percentage would rise to 10.9% in 2026 and to 12% by 2030 (Shaheen et al., 2017).
Because of the aging of the population, it is crucial to pay attention to their mental health where the enormous volume and diversity of stresses that older adults experience every day, such as losing their jobs and social status, close relatives, or their health, as well as changes in how they interact with others

Austrian physician and psychiatrist Viktor
Frankl created logotherapy in the 1930s based on "logos," the Greek word for meaning, Frankl created the term logotherapy and claimed that humans' search for meaning is one of their main drives.The foundation of Frankl's thesis is the idea that people are driven by a "desire for meaning."(Mortell, 2020).Logotherapy

Aim of the Study:
To evaluate the effectiveness of logotherapy training on self-esteem, communication skills, and the impact of the event among older adults.

Research hypotheses:
 Older adults who participate in
The researchers divided the total by 25 and multiplied by 100 to get the final self-esteem score.Responses are based on a Likert scale and are rated on a scale of 0 to 4, never, sometimes, often, and very highly.This scale includes his three subscales: Avoidance (8 questions), intrusive thoughts (7 questions), and hyperarousal (7 questions).In general, higher total scores on this scale indicate higher levels of emotional helplessness and vice versa.

Instruments' validity and reliability
To maintain the authenticity of the original validity, the questionnaire was back-translated into Arabic utilizing translation procedures.A jury of five nursing professionals, comprising psychiatry, community health, and administration experts, received the tools.The surveys were evaluated for their accuracy, clarity, completeness, and applicability.The instruments were proven to be valid in their eyes, and any necessary revisions were made.
The Cronbach's α for the self-esteem scale was 0,81, the communication scale was 0.81 and the impact of the event was 0.93 in this study.

A pilot study
To ascertain the tool's clarity, appropriateness, and the amount of time needed to complete the questionnaire, a pilot study was conducted using 10% of older persons.Some of the questions were altered and clarified in light of the findings of the pilot research.The current research total sample did not include the pilot sample to verify that the replies were consistent.

Ethical considerations
The ethical and research committee of the Nursing Faculty at Menoufia University provided its ethical approval.Each senior was given thorough information about the study's objectives before providing their informed consent.The older adults were informed of the study's ethical considerations, including the confidentiality of their identities and responses, and they were given the assurance that no one interferes in one's personal or family affairs; they were given the option of participating in the study on the condition that they did so.

Field of work:
The study was performed from the beginning of April to the end of August 2022.
Participants voluntarily participated.

Discussion
The current societal transformation is being influenced by the population's trend toward aging.
The forecast estimates that the proportion of individuals over 60 will increase from around 11% to 22 between 2000 and 2050 and that the total number of people 60 and older would increase from 605 million to 2 billion during that time.technique that is used to help people find meaning in their lives.This understanding helps people realize that while they cannot change some events in their lives, they can learn to change how they deal with these events and have a better reaction and response when facing those events.For people experiencing existential sorrow and failing to discover "a cause to live," logotherapy is available (Adhiya-Shah, 2017).
The current study's findings supported the aforementioned claim, showing a decline in the mean scores of the total impact of event scale, the Intrusion, Avoidance, and Hyperarousal dimensions of the total impact of event scale in the posttest (41.92, 7.31, 6.41, and 5.53) compared to the pretest (62.74, 16.78, 24.66, and 11.78, respectively).This may be a result of the impact of show that with the aid of the Logotherapy program, it is possible to find meaning, even when faced with a fate that cannot be changed.
Furthermore, these findings supported a study by According to the findings of the current study, sex and income and total Self-Esteem and Communication Skill are not significantly related.According to his findings, there was no significant difference between the perceptions of self-esteem of the class teachers and teachers' communication skills scores by gender, occupational seniority, education status, and age.

Conclusion
According to the study's findings, logotherapy training had a highly statistically significant positive impact on older persons' self-esteem, communication skills, and ability to respond appropriately to stressful life events.

Recommendation
 In light of current research, the results recommend performing logotherapy on older adults in a variety of settings to improve their self-esteem, communication skills, and their ability to respond appropriately to stressful life events.
 A future direction of research is to conduct such intervention studies in a variety of settings for larger groups of older people.

(
White & Casey, 2017).Older people assert that they are miserable or disgusted and unable to enjoy life.Furthermore, they blame themselves for their shortcomings and have a deep sense of worthlessness (León Navarrete et al., 2017).According to León Navarrete et al. (2017), depressed individuals are more prone than non-depressed individuals to have thoughts of personal misery, unfavorable expectations, low self-esteem, and helplessness.People with high levels of anxiety employ dysfunctional coping mechanisms to control their emotions because they are unable to think clearly and critically assess the situation due to their misunderstandings and misinterpretations of the circumstances.Self-esteem is defined as the subjective assessment of one's worth.It comprises having a positive outlook on oneself and a sense of self-acceptance.As a result of both great and negative life experiences, a person grows in confidence.Self-esteem rises most during a person's formative years and adulthood, peaks at age 60 to 70, and then steadily fall as they age.This could be brought on by decreased physical and mental capacity, a decline in social status, financial difficulty, and the passing of loved ones.(Ryszewska-Łab ędzka, D,2022).Older adults have trouble interpreting new cues that point out their errors and compel them to revise their opinions.A person's unwillingness to assess new knowledge decreases their flexibility, which in turn affects their ability to respond appropriately to tensions, leading to issues in their social interactions.(Soroush., et al 2021).
is assumed that a technique whose use can assist the individual in discovering meaning in his or her life since a meaningful life entails having a positive attitude toward life no matter what we encounter, whether suffering or death.While the precise circumstances of one's life cannot be changed, one can learn to alter the strategy used to deal with these experiences to have a better reaction and experience.Logotherapy helps the individual realize this.Logotherapy may be beneficial for persons going through existential sadness and not being able to discover "a cause to live." (Adhiya-Shah, 2017).Group logotherapy helps people by using techniques such as showing concern and empathy, sharing knowledge, giving them tools to help them change their views about how to solve difficulties, and assisting them ). in addition to Jahanpour, (2014) mentioned that logotherapy has an important role in psychotherapy and is used in mental health, self-esteem, happiness, and interpersonal relationships in different age fields.Significance of the studyElderly people represent a population group that needs a particular and comprehensive strategy that supports their well-being and health.Contextual variables, including the emergence of diseases, might have a negative impact on key areas of their life.(LeónNavarrete et al., 2017).The goal of logotherapy is to highlight the range of individual control and freedom while assisting the person in discovering a life purpose that is in line with their existence.The importance of accepting responsibility is extensively emphasized in logotherapy.Individuals are encouraged through logotherapy to view the world differently and work to rediscover their ideals (Golshan et al., 2020).
was approved byAli (2018).It was a valid and reliable Arabic scale to measure communication.This scale includes 46 items that explore the following skills: Dialogue skills (14 items); body language (12 items); listening skills (ten items); and speaking skills (ten items).a five-point Likert-type scale, ranging from one (rarely) to five (always)It was created byWeiss D., & Marmar, C. (1997).It was translated into Arabic byAlaedein et al., (2021) and is extremely useful for assessing the effects of routine life stress, acute stress, and everyday traumas.This questionnaire consists of 22 questions and aims to assess the components of emotional helplessness in the face of specific life events (avoidance, intrusion, hyperarousal).

Phase 2 :
Phase one: Assessment (pre-testing)-This phase was intended to establish a connection between researchers and older adults and to explain the purpose of the study and the intervention plan.The older adults were classified, each comprised of ten elderly adults to obtain a baseline assessment (pre-test).The intervention was carried out for each group twice a week on various days throughout five weeks, each session lasting approximately 45 to 90 minutes depending on the older adult's ability to understand and speak.Planning phase: This phase aims to develop logotherapy training.It was designed in the Arabic language based on relevant recent literature reviews.This phase includes: Determining the objectives and contents of the logotherapy training which include:  Concept of logotherapy. Benefit of logotherapy.Implementation of the intervention took place in sessions using different teaching methods and guides developed during the planning phase.The intervention lasted 5 weeks to provide sessions to assess the effects of logotherapy training on older adults.The general objective of this training was to evaluate the effect of logotherapy training on self-esteem, communication skills, and the impact of events among older adults.Sessions are scheduled as follows:Session 1: This session's goal was to motivate older adults to actively engage in logotherapy.This is done by getting to know the older adults, explaining the study's objective and nature, as well as the group's regulations regarding confidentiality.Discuss with the members about their skills, encouraging the group to come up with solutions to enhance their skills, and get a clear grasp of the interpersonal differences within the group or the environment.
Figure (1): Mean scores of the total impact of event scale, self-esteem scale, and communication scale among studied sample pre and post-test (n=50)

(
Asadollahi, et al., 2017).Dr. Victor Frankl developed the existential therapy modality known as logotherapy.Because it explores the spiritual aspect of human existence and places a strong emphasis on the meaning and purpose of life, this treatment is seen as being both deeper and more comprehensive than other psychological therapies.(Angelina and Rosalito, 2013) Logotherapy is a technique that can assist a person in finding meaning in their life.To live a meaningful life, one must respond positively to everything that comes their way.The majority of nations now practice logotherapy to raise the social, psychological, and physical well-being of older adults.(Soroush., et al 2021) Therefore, in this study, we examined the effect of Logotherapy training on self-esteem, communication skills, and the impact of events among elderly adults The current study's findings portrayed that the mean age of the studied sample is 67.98±6.02.Nearly two-thirds of the sample under study were married, and nearly half of the sample under study were female.Most people in the sample had a good relationship with their families.This result was in line with what studies by Soroush et al. (2021) on "the Effects of Group Logotherapy Training on Self-Esteem, Communication Skills, and the Impact of Event Scale-Revised (IES-R) in Older Adults" discovered the participants in his study ranged in age from 60 to 80 years, with 8 women (53.33%) and 7 men (46.66%).66.66 % were married and 73.33 % had strong relationships with their families.Furthermore, was reported in a study by Ravari et al., (2021) on "the Comparison of the Effects of Cognitive Therapy and Logotherapy on Iranian Elderly People's General Health". the age of the control was 68.63±5.48years.Since a meaningful life entails having a positive attitude toward life no matter what we face, including suffering or death, logotherapy is a logotherapy, which functions by demonstrating concern and empathy, disseminating knowledge, supplying resources for the diffusion of beliefs in problem-solving, and assisting the person in regaining their perspective on their interpersonal environment.Along with the three paths to finding one's life's purpose-creative, empirical, and orientation-creative values that have been realized through activity are typically reliant on some sort of action; they are produced by a tangible thing or an idea or by helping others, to be able to provide one's life's purpose.Additionally, this is also consistent with (Soroush et al., 2021), who suggested that logotherapy may be able to support older persons in having acceptable reactions when confronted with unfavorable life circumstances.It will avoid a lot of issues brought on by tensions after tense life events including the death of a spouse, handicaps, and loneliness.In another hand, this is in the same line with Angelina and Rosalito, (2013) title of the research "The Effectiveness of Logotherapy Program in Alleviating the Sense of Meaninglessness of Paralyzed In-patients" results young adults across their gender.In addition, this result is in accordance with Eylem et al., (2016) who found The mean scores of Students' Self-Esteem and Communication Skill Evaluation Scale were compared with the gender and income status of their parents The result of the statistical analyses showed that there was no difference.Concerning the relationship between total Self-Esteem and Communication Skills and age, and occupation.The current study's findings showed a significant relation.This study is contradicted by Derici Cevap & Mentiş (2018).who investigated " Investigation of the relationship between selfesteem and communication skills of primary school teachers in terms of various variables ".

affected by current events (Mortell, 2020). there are very few studies on
(Frankl, 2006)rankl, 2006).Allah says in verse 4, Sura Al-Balad: "We have certainly created man into hardship".Researchers and translators of the Quran believe that this verse indicates that the universe is accompanied by hardship, and according to Quran, hardships construct men (Shia News, 2013).being of older adults.Logotherapy is a method that helps the individual find meaning in her life.(Schulenberg et al., 2018).Current events can have an impact on an individual's mental health.It is thus probable that

total score of the impact of event scale in the
Table (2):Illustrated that there is a decrease in the mean score of Intrusion in the posttest (16.78± 7.31) than the pretest (24.66± 6.41).Also, there is a decrease in the mean score of Likewise, there is an increase in the mean score of Body language in the post-test (50.32± 6.43) than pre-test (41.66± 8.56).

Dadkhah et al., 2012; Ebrahimi et al 2014; Golmohammadian,2016).
diminish.This finding is consistent with Fredman et al., (2016), who found that PTSD symptoms, especially signs of effortful avoidance, that become apparent as soon as one month after