Psychometric properties of the Turkish version of the Geriatric Feelings of Burdensomeness Scale (T-GFBS) in Turkish community-dwelling older adults

The world population has been gradually aging due to developing healthcare and technology and increasing life expectancy. Türkiye still has a young population structure compared to countries with a proportionally older population structure; however, the old age population is increasing at a higher rate compared to the population in other age groups, and the population has started to age in recent years.1 Old age has been characterized by various health problems, and it is generally assumed that older individuals are a burden on society.2,3 Nevertheless, burdensomeness should be assessed subjectively due to involving individual perceptions. It has been emphasized that the feeling of burdensomeness is associated with several problems related to aging.4

Feelings of burdensomeness have been defined as a mental state that develops when social competence needs are not met and involves the belief that the person has become a problem for loved ones or society, such that they would feel better once the person left ("perceived burdensomeness").5,6 Individuals who experience feelings of burdensomeness may have distorted thoughts or false beliefs about themselves (such as being so imperfect as to complicate the lives of others, self-hatred, being useless), feelings of weakness and guilt, and fear of becoming a burden to others.6,7 Furthermore, perceiving oneself as a burden leads to an adverse outlook on life and a deterioration of self-image.8 Studies on feelings of burdensomeness have mostly focused on suicidal ideation and reported that individuals with elevated levels of this feeling are more likely to have suicidal thoughts and attempt suicide.4,9, 10, 11, 12, 13, 14, 15, 16, 17 In addition, in other studies in the literature, it has been stated that depressive rumination,18 depressive symptoms4,7,9,10,13 and hopelessness4,10,13,14 increased, and life satisfaction,18 meaning of life,14 self-care,19 self-control7 and help-seeking behavior10 decreased among older adults with elevated feelings of burdensomeness. It has been suggested that feelings of burdensomeness, which are considered to be associated with several psychological or behavioral conditions, are dynamic and suitable for therapeutic change.20 Therefore, measurement tools should be developed to perform a timely, accurate, and comprehensive assessment of older adults' feelings of burdensomeness.

The literature review did not reveal a scale in Turkish assessing the feelings of burdensomeness in older adults. On the other hand, validity and reliability studies have been conducted for the Turkish version of the Interpersonal Needs Questionnaire21 and Self-Perceived Burden Scale,22 which are used to assess the perception of burdensomeness. However, the study of the Interpersonal Needs Questionnaire addressed the perception of burdensomeness as a subscale, focused on items related to death, and included university students.21 The Self-Perceived Burden Scale focused on patients with heart failure who needed caregivers, and its content focused on the patient-caregiver relationship rather than issues related to aging.22 No measurement tool in Turkish assesses the feelings of burdensomeness specifically among older adults. Valid and reliable tools in Turkish should be developed to assess feelings of burdensomeness among older adults due to significant life-threatening situations such as suicidal thoughts and suicide.4,9, 10, 11, 12, 13, 14, 15, 16, 17.

The Geriatric Feelings of Burdensomeness Scale (GFBS) was originally developed in English by Lutz et al.4 as a 25-item self-report measurement tool for older adults in the United States. The original English version of the scale has been proven valid, reliable, and applicable (Cronbach's alpha = 0.97; average interitem correlation of r = 0.58; 0.05/9 correlations between GFBS and validity measures = 0.006); however, its applicability in different cultures has not yet been investigated. Healthcare professionals, especially nurses with a unique position to provide care to older adults,23 need reliable and comprehensive measurement tools to assess the feelings of burdensomeness among older adults. The feelings of burdensomeness may sometimes be false since it involves individual beliefs; even if individuals see themselves as a burden, people in their environment may not consider them a “burden”. Therefore, feelings of burdensomeness should be identified, and misbeliefs should be addressed. It is assumed that identifying feelings of burdensomeness will guide intervention studies to minimize these feelings and associated factors. Accordingly, this study aimed to translate the GFBS into Turkish and assess its psychometric properties among the Turkish population.

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