Showing papers in "Iranian Journal of Ageing in 2022"

Predictors of Perceived Caregiving Burden among Caregivers of Older Hemodialysis Patients

Abstract: Introduction: Elderly patients are the largest and fastest growing group of patients under dialysis and their caregivers are faced with high burden care. Therefore, the present study was conducted to determine the predictors of caregiver burden among caregivers of older patients under hemodialysis residing in Qazvin province, Iran. Materials and Methods: This cross-sectional study was conducted on caregivers older patients under hemodialysis in 2020. The caregivers were selected by census method among eligible caregivers of older patients under hemodialysis referring to dialysis centers of Qazvin province, Iran. Data were collected using the demographic checklists, Zarit burden care Questionnaire, Bartell Scale, Multidimensional Scale of Perceived Social Support, general self-efficacy, and religious coping questionnaires. The collected data were analyzed by a multivariable regression model in SPSS 23. Results: The mean and standard deviation of the age of 252 caregivers and older patients were 44.9 ± 13.16 and 69.4 ± 7.7 years old, respectively. The results of multivariate analyses showed that significant predictors of caregiver burden were perceived social support (β:0.333, p<0.05), disability (β:-0.137, p<0.05), health status (β=0.154,p=0.010), and financial level (β=0.154, p=0.010). As the caregiver burden was decreased by increasing the social support and decreasing the rate of disability. Furthermore, the caregivers with higher financial levels and better health status reported lower caregiver burden. Conclusions: It can be concluded that enhancement of social support and more attention to the health of caregivers as potential patients are important factors for reduction of caregiver burden care.

Prevalence of chronic diseases among the older adults in Iran: Does socioeconomic status matter?

Abstract: Objectives: Despite the growing population of the elderly in Iran, there is no clear picture of the prevalence of chronic diseases among them. Accordingly, the present study tries to specify the prevalence of the most important chronic diseases and multimorbidity among the elderly. In addition, the homogeneity of these diseases has been considered among different socio-economic groups. Methods & Materials: Research data were obtained through a checklist of chronic disease status among the elderly. The sample was selected from the elderly over 60 years old in Tehran in 2019 through multi-stage sampling. The sample size of the study is 1280 persons and the prevalence rate and chi-square tests were used to describe and analyze the data. Results: The results showed that hypertension (40.2%), musculoskeletal disorders (40.2%) and hyperlipidemia (32.4%) had the highest prevalence rate among the elderly in Tehran. The prevalence rate of chronic disease multimorbidity was 79.8, which was higher among men, never married, college-educated, and working-age seniors. Cardiovascular disease, diabetes, hyperlipidemia, and ear diseases have also been found to have different prevalence rates among socioeconomic classes. Conclusions: The prevalence of chronic diseases has varied widely among socioeconomic groups; so the importance of the socio-economic status must be accentuated. Therefore, the pattern of prevalence of some chronic diseases can be influenced by lifestyle. As a result, research and policy-making in this field should be based on the inequalities in socio-economic status.

Perceived Stress and Burden of Care in Elderly Caregivers: The Moderating Role of Resilience

Abstract: Objectives This study aimed to investigate the moderating role of resilience in the association between perceived stress and the burden of care among elderly caregivers at nursing homes in Tehran in 2016. Methods & Materials In this cross-sectional, correlational study, the data were collected from 142 caregivers engaged in nursing homes in Tehran, of which 50 were men and 92 were women, through the census sampling method. Research tools included the questionnaire of perceived stress-14 (PSS-14), Cohen et al., (1983), Zarit et al. (1986) Burden of care questionnaire, and connor and davidson resilience questionnaire (2003). The collected data were analyzed in SPSS software v. 20. The significance level was set at P<0.05. Results The results showed that the average perceived stress score (35.11) was higher than the average (28). The burden of care was significantly positively associated with perceived stress (r>0 or P=0.001), and there was a negative and significant relationship between resilience and responsibility of care (β=0.110). Also, the interaction effect of perceived stress and resilience on the burden of care was negative and significant, and resilience moderated the relationship between perceived stress and care burden (P<0.001). Conclusion According to a positive relationship between perceived stress and burden of care among elderly caregivers and the moderating effect of resilience on this relationship, governmental and non-governmental organizations in the elderly field and health policymakers should bring in the concept of resilience in their executive actions, policies, and protocols and improve it through proper training interventions. Further research is needed to study other internal and external moderating factors to improve the service quality and address the psychological, social, and physical complications of elderly caregivers.

Prevalence of Caregiver Abuse by the Elderly in Nursing Homes of Tehran and its Related Factors

Abstract: Objectives Several studies have assessed elder abuse, while caregiver abuse by the elderly has been less addressed. The present study aims to assess the prevalence and associated factors of caregiver abuse by the elderly in nursing homes of Tehran, Iran. Methods & Materials This cross-sectional study was conducted in 2018 on 124 caregivers of the elderly who were selected using a convenience sampling method from 14 nursing homes in Tehran, Iran. The caregiver abuse was measured by the Survey of Violence Experienced by Staff (SOVES). The data were analyzed using descriptive and inferential statistics in SPSS v. 24. Results The mean age of participants was 36.74±8.38 years, and 68.5% were female. The prevalence of caregiver abuse in the previous 12 months was 42.7%. Of these, 37.1% had experienced verbal abuse, 12.9% threats, and 24.2% physical abuse. The chi-square test results revealed a significant association between employment status and caregiver abuse, where full-time caregivers were four times more likely to experience abuse (χ2(1) =7.43, P=0.006, OR=4.03). The age, gender, work experience, direct contact, and receiving educational program had no significant association with caregiver abuse by the elderly. Conclusion There is a high prevalence of caregiver abuse by the elderly in nursing homes of Tehran. Policymakers should plan and take measures to protect the caregivers in nursing homes.

The relationship between frailty and polypharmacy in the elderly referred to the emergency departments of Ardabil, 2020

Abstract: Objectives: Frailty is characterized by an increased vulnerability to stressors. Frail older patients are at increased risk of Emergency Department (ED) visits, hospitalization, and disability. The aim of this study was to determine the relationship between frailty syndrome and polypharmacy in the elderly referred to the emergency department of Ardabil teaching hospitals. Methods & Materials: In this cross-sectional descriptive study, 505 elderly people referred to the hospital emergency department were selected by convenience sampling method. Frailty syndrome was measured using the five-item criteria of fried which include: 1) slow walking, 2) muscular weakness, 3) exhaustion, 4) low physical activity and 5) unintentional weight loss. Polypharmacy considered the use of 5 or more drugs. Data were analyzed using descriptive statistics including mean and standard deviation and inferential analysis including analysis of variance, independent t-test, correlation, and multiple regression using spss 22 statistical software. Results:The mean age of participants was 70.91 ± 7.49 and 255 (50.5%) were male, 318 (63%) were married and 271 (53.7%) were illiterate. the results of the study showed that 204 (40.4%) of the elderly who referred to the emergency department had frailty and 177 (35%) had pre frailty. In this population, we identified a 42.2% (n=98) of frail with polypharmacy, 37.1% (n= 86) of prefrail with polypharmacy. The correlation test showed that there is a significant relationship between fertility and polypharmacy (p ˂0.001). Linear regression analysis showed the variables of age, education, living arrangement, hospitalization, and the number of medications used by the patient as predictors of frailty syndrome in the elderly referred to the emergency department. Conclusions:Number of drugs used, age, education, living arrangement and number of hospitalizations were predictors of frailty syndrome in the elderly. Considering the living conditions of the elderly and the prevention of unnecessary hospitalizations can reduce polypharmacy and ultimately a preventive strategy to prevent and manage frailty. Of course, further research is needed to confirm the possible benefits of reducing polypharmacy in the development, reversion, or delay of frailty.

Improving the Quality of The Integrated Care for The Elderly in A Comprehensive Health Center

Abstract: Objectives: In elderly care provided by health centers, healthy elderly are neglected in care and education. This qualitative study aimed to standardize healthy ageing care. Methods & Materials: This community-based participatory research with 4 steps (problem detection-design of change programs-implementation of interventions-evaluation) was conducted from 1395 to 1397 in Motahari Health Center of Mashhad, with the participation of 11 health care provider, 54 healthy elderly and 54 family members. The mean age of caregivers was 32.4 ±2.7 years and their mean work experience was 8.3 years. The mean age of the elderly was 64.3 ± 3.9 years. Data were collected through SERVQUAL questionnaire, interviews, focus group discussions, and field notes. After identifying problems through interviewing 8 staff and 19 seniors, Group discussion sessions were held to design the program. After implementing the change plans, 30 interviews with the participants were conducted again and the comparisons were done and evaluated before and after the change plans. For qualitative content analysis, the method of describing reality was used, and for analysing quantitative data, descriptive statistics and paired t-test were used. Results: Designed program care could be improve healthy aging care in the health center environment by modifying attitudes, skills and staff empowerment. The mean score of quality of care for the elderly and their families in the pre-intervention phase was 63.02 ± 9.46 and 61.83 ± 9.05, respectively. In the post-intervention phase, these values reached 130.19 ± 14.75 and 122.65 ± 13.56, respectively, which were statistically significant (P=0.001). Conclusions: The community-based participatory research promoted the quality of elderly services with features such as active, participatory, continuous, comprehensive and supportive care. So this model can be used in other health centers.

A Systematic Review of Management of Preventive Healthcare for the Elderly in the World

Abstract: Objectives: The global shift from infectious diseases to chronic diseases is a global problem that will reduce the quality of life and increase the need for services such as rehabilitation services and services related to disability. An important issue in relation to aging is preventive care and how it is managed in the world. This systematic review has conducted a comparative study on the management of preventive healthcare for the elderly in the world. Methods & Materials: This is a review study that was done comparatively in 2020. This study was conducted to model the existing policies and programs for the care of the elderly in the countries. To collect data, Persian and international databases as well as Google Scholar scientific search engine were used using appropriate keywords, and finally 200 suitable articles were identified. The studies were categorized and their management system was evaluated and differences and similarities were determined while comparing. Results: In the present study, it was found that 50% of the surveyed countries had insurance coverage for the elderly. 64% of the countries, management and organization of health prevention services at the national level, 7.5% local, 21.4% state-federal and 7.1% national. It was local. How to finance the provision of services for the elderly in 50% of the countries surveyed through taxes, 14.2% premiums, 7.1% national health system, 7.1 individual reserve funds and the rest of the countries through the payment of the federal government, health insurance and etc. In 50% of the surveyed countries, the providers of first level services were the public sector, 28.5% of the private sector and the rest of the countries were municipalities, government, etc. Conclusions: the systems of elderly support and primary healthcare are intertwined in the main health system and function similar to the primary healthcare system of the country.

Effect of Education and Telephone Follow-Up on Care Burden of Caregivers of Older Patients with Stroke

Abstract: Objectives Stroke is the second leading cause of death and the third leading cause of disability worldwide. Caregivers of stroke patients experience high levels of care burden that can affect their physical and psychological health. It is necessary to use interventional programs for family caregivers to prevent or reduce their care burden. This study aims to determine the effect of education and telephone follow-up on care burden of the family caregivers of older patients with stroke. Methods & Materials This randomized controlled clinical trial was conducted on 79 family caregivers of older patients with stroke admitted to the neurology department of Bu-Ali hospital in Qazvin, Iran who had been discharged in the past 1-6 months. Then, they were randomly divided into intervention and control groups by the block randomization technique. For the intervention group, 12 weeks of education and follow-up was presented through telephone and social media. Data were collected by demographic checklist, Barthel Index for Activities of Daily Living, and Zarit burden interview. The independent t‐test, paired t‐test, and chi‐square tests were used for analyzing the data. Results Before the intervention, there was no significant difference between the two groups in the amount of care burden (26.20 ± 11.08 for intervention group and 28.70 ± 11.63 for the control group) (P = 0.333); however, after the intervention, the care burden of the intervention group (18.28 ± 10.07) and the control group (29.80 ± 11.76) showed a significant difference (P < 0.001). The results showed that 12 weeks of education & telephone follow-up caused a significant reduction in the care burden of the family caregivers (P< 0.001). Conclusion The education and telephone follow-up can be a useful and cost-effective method for reducing the care burden of the family caregivers of older patients with stroke.

Health-Related Needs of Older Adults in Rafsanjan County, Kerman, Iran

Abstract: Objectives The need for meeting the needs of the elderly to promote active aging among them is becoming more important. For appropriate planning in this field, accurate needs assessment is necessary. In this regard, this study aims to investigate the health-related needs of the elderly in Rafsanjan county, Kerman, Iran. Methods & Materials This cross-sectional study was conducted on 267 older people in Rafsanjan county in 2020 who were randomly selected from among six comprehensive health centers. A demographic form and the Camberwell Assessment of Need for the Elderly questionnaire were completed and data were analyzed in SPSS v. 26 software. Results The highest frequency of unmet needs in terms of psychological needs was psychological distress (12.3 %); in terms of physical needs, it was memory (9.3 %); and in terms of environmental needs, it was accommodation (5.2%). The highest frequency of met needs was related to physical needs in terms of medication (67.5%) and physical health (64%). The most unnecessary needs were related to psychological needs in terms of receiving benefits, drinking alcohol, deliberate self-harm and accidental self-harm. The highest rate of received help from unofficial sources was in the field of psychological distress (0.4%), and highest rate of received help from official sources were the fields of accommodation and physical health (0.4%). Conclusion The elderly in Rafsanjan county need more help in the field of psychological and physical needs. Therefore, attention should be paid to these needs in policy-making and executing programs in the field of elderly care.

Explaining the Challenges of the Iranian Health System in the Face of Future Aging: A Qualitative Study

Abstract: Introduction: The goals of global growth of the elderly population and ensuring the health of the elderly is a global event and one of the most important challenges of the health system of countries, especially developing countries and Iran; In this regard, the study was conducted to explain the challenges of the Iranian health system in the face of future aging. Materials and Methods: The study was qualitative content analysis. A total of 29 experts from various disciplines including geriatrics, psychology, social medicine, nursing, medicine, health and social welfare, health policy, health care management and health economics participated in the study. The data obtained from the semi-structured interview were classified by the content analysis method. Lincoln and GABA criteria were used to assess validity. Findings: in identifying the challenges of the Iranian health system in the face of future aging Two general concepts including "policy challenges" including "barriers related to planning and implementation", "financial barriers", "vision barriers", "therapeutic barriers", "Health barriers", "educational barriers" and "individual social challenges" were identified, including "cultural value barriers", and "individual barriers". Conclusion: The frequency and variety of challenges of increasing the elderly population in the country according to the findings of the study indicate the critical state of the health system in the near future. Identifying these challenges can be used by policymakers and planners for any planning and action.

The Effect of Short-Term Conditional-Equilibrium Exercises on Balance and Functional Limitations in Aged Women With Frailty Syndrome: A Randomized Controlled Trail

Abstract: Objectives Increasing frailty syndrome is one consequence of the aging population. Frailty syndrome can adversely affect the independent life and social activities of the elderly by threatening their balance and mobility. This study aimed to investigate the effect of short-term postural-balance training on balance and functional limitations in elderly women with frailty syndrome. Methods & Materials The present clinical trial study was performed on 54 elderly women with frailty syndrome. Participants were randomly selected from one of the daycare centers for the elderly in Shiraz and were divided into two groups intervention (n=27) and control (n=27). For the intervention group, 12 sessions of short-term postural-balance exercises were held. Data were collected using the Fried Frailty Index, berg balance scale (BBS-9), and the survey of activities and fear of falling in the elderly (SAFE) Questionnaire at the beginning of the study and the end of the intervention and analyzed using SPSS software v. 25. Results The mean age of participants was 66.77 years, and 94.4% had at least one chronic disease. Following the intervention, there was a significant improvement in the mean scores of frailties such as physical activity, walk time, balance, and motor limitation of the elderly in the intervention group. In contrast, the intervention could not significantly affect other frailty indicators, i.e., unwanted weight loss, exhaustion, and grip strength in the intervention group Conclusion Postural-balance exercises significantly improve the physical characteristics of malnutrition and motor and functional limitations in daily life activities in the elderly.

Relationship of Health Status and Micronutrients Level With Nutritional Status of the Elderly With Psychological Disorders

Abstract: Objectives Elderly with psychological disorders are at risk of malnutrition. Investigating the nutritional status and identifying the effective factors among the preventive and control measures. This study aims to investigate the nutritional status and its relationship with health status and micronutrients level in older people with psychological disorders. Methods & Materials In this cross-sectional survey, 101 older people admitted to Razi Psychiatric Hospital in Tehran, Iran in 2018 participated. The data were collected after blood sampling and assessing body mass index (BMI) using a demographic form, the Mini Nutritional Assessment tool and a health status questionnaire. The collected data were analyzed by the chi-square test, ANOVA and logistic regression analysis in SPSS v. 21. Results Almost three-quarters of the participants had an abnormal nutritional status. The results showed that the nutritional status of participants had a significant relationship with dental health status, physical activity, the serum levels of vitamin D and vitamin B12, and BMI (P<0.05). After logistic analysis, vitamin B12 level (OR=1.007, 95% CI: 1.002-1.012), physical activity (OR=8.539, 95%CI: 1.142-63.85) and dental health status (OR=23.119, 95%CI:1.401-38.788) were reported as the predictors of nutritional status. It was reported that 95% of the elderly had vitamin D deficiency. Conclusion Most of the elderly with psychological disorders are at risk of malnutrition or have malnutrition. The identified predictors of malnutrition for this group are modifiable. Therefore, regular screening and nutritional management should be strengthened for their therapeutic interventions.

Assessing Mediating Role of Financial Satisfaction in the Relationship of Financial Literacy With Quality of Life in Retired Older Adults

Abstract: Objectives The world’s population is rapidly aging; hence, paying attention to the quality of life (QoL) of the elderly is of great importance. Financial satisfaction is one of the important components of QoL. The present study aims to determine the association between financial literacy and QoL among retired older adults mediated by their financial satisfaction. Methods & Materials This descriptive and cross-sectional study was conducted in 2020 on 270 retired older adults in Qazvin, Iran. The samples were selected through stratified random sampling method from 8 retirement centers in Qazvin, Iran. The data were collected using demographic checklist, the control, autonomy, self-realization, and pleasure (CASP) scale, financial literacy scale, and financial satisfaction scale. Structural equation modeling was used to determine the mediating role of financial satisfaction in the relationship of financial literacy with the QoL. Results The mean age of older adults was 65.17±4.57 years. The majority of them were male (n=166, 61.85%) and married (n=245, 90.7%). Their Mean score of financial literacy and financial satisfaction were 51.60 and 35.11 out of 100, respectively. Their quality of life was at a moderate level (Mean= 63.89 out of 100). The results of the regression analysis showed the significant association of financial literacy (P=0.006, β=-0.17) and financial satisfaction (β=0.25, P<0.001) with the quality of life. The results also confirmed the mediating role of financial satisfaction (P=0.014). Conclusion Financial literacy of the elderly has a significant and positive association with their quality of life mediated by financial satisfaction. Therefore, policymakers in Iran are recommended to develop pre-retirement financial education programs for improving the financial literacy of the elderly.

Investigating the Effect of Longitudinal Biomarkers on Hemodialysis Elderly Survival: A Single Central Study

Abstract: Objectives This study aims to identify the factors affecting the survival of hemodialysis patients using a two-stage survival/multivariate longitudinal modelling. Methods & Materials The is a retrospective cohort study on 395 patients aged > 60 years who underwent hemodialysis in Hasheminejad Hospital in Tehran, Iran. Data were collected over a 15-year period from 2004 to 2019. Phosphate, calcium, parathormone and creatinine variables were considered as longitudinal variables and mortality as a survival response. The two-stage survival and multivariate longitudinal modeling for long-term hemodialysis patients were fitted and the results were compared according to theirs likelihood function. Data analysis was performed in RStudio v. 3.4.3 and SAS v. 4.9 applications. The significance level was set at 0.05. Results The mean age of patients was 70.41±6.11 years. Of 395 patients, 249(63%) were male. Based on the log-likelihood function, the communication structure of the cumulative effect of longitudinal biomarkers and survival data was selected. Assuming that other variables were constant, the significance of values for mobility impairment, calcium level and parathormone level indicated that these variables were good predictors of the occurrence of death in hemodialysis patients over time. By each unit increase in each variables of mobility impairment, calcium level, and parathormone level, the risk of death increased by 1.391, 0.927, and 0.967, respectively. Conclusion By using a two-stage modelling, the variables of mobility impairment, calcium level and parathormone are found as factors affecting the risk of death in hemodialysis patients. Therefore, therapists should focus on changing health behaviors of these patients in consuming calcium and parathormone.

The Relationship Between the Use of Medicinal Plants and Medication Adherence in the Elderly with Chronic Diseases

Abstract: Objectives Many older patients use medicinal plants, assuming that they are safe and without side effects. The present study aims to investigate the relationship between the use of medicinal plants and medication adherence in the elderly patients with chronic diseases. Methods & Materials In this descriptive cross-sectional study, 358 patients aged ≥60 years with chronic diseases were selected by a convenience sampling method. Data collection instrument was a three-part questionnaire assessing demographic information, history of using medicinal plants, and medication adherence using the Morisky medication adherence scale (MMAS). The data were entered into SPSS v.21 and analyzed using one-way analysis of variance, Chi-square test, independent t-test and logistic regression. Results The mean age of participants was 69.44±8.13 years and 52.23% were female. The majority of them were married (87.68%) with a junior high school education (71.64%).The overall mean score of MMAS was 5.48 (poor adherence). The percentage of patients with a history of taking medicinal plants in the last year with the prescription of physician was 41.34% (n=148) while the percentage of those used medicinal plants without the physician’ prescription was 27.3% (n=98). The mean of MMAS score in the groups who used medicinal plants was lower than in the group with no history of using medicinal plants (P=0.001). The number of used medicinal plants, the frequency of using medicinal plants, and the duration of chronic disease had a statistically significant relationship with the medication adherence (P <0.05). Conclusion Due to the high consumption of medicinal plants in the elderly with chronic diseases and its relationship with poor medication adherence, it is necessary to educate them about the correct use of medicinal plants, their side effects, herb-drug interactions, the need to inform the doctor about use of medicinal plants, and adherence to medication.

Investigating the Relationship Between Social Support, Cognitive Status, and Depression With Daily Life Activities of the Elderly in Amirkola City

Abstract: Objectives The rapid growth of the elderly population has led to more problems, such as declining independence. Due to the importance of doing independent daily living activities in the elderly, this study was conducted to determine the relationship between social support, cognitive status, and depressive symptoms with daily activities in the elderly in Amirkola City. Methods & Materials This matched case-control study is part of the first phase of the cohort project for the elderly in Amirkola City, which was conducted on all people aged 60 years and more in Amirkola City. To collect the data, various questionnaires, including demographic characteristics, mental brief assessment (MMSE), duke social support index (DSSI), elderly depression index (GDS), activity of daily living (ADL), and instrumental activity of daily living (IADL) were used. Statistical analysis of variables was performed using descriptive (frequency, mean and standard deviation) and analytical tests (independent t-test, conditional logistic regression) and at a significant level (P<0.05) with the SPSS v. 21 software. Results In this study, the mean cognitive status of the elderly without a functional disability was significantly higher than the elderly with a functional disability (P=0.001). Also, in the elderly with functional disabilities, the mean score of depression and the presence of disease was significantly higher, and the mean of social support and ability to perform the activity of daily living were substantially lower (P=0.001). Findings of adjusted conditional logistic regression analysis showed that the elderly with cognitive impairment, chronic diseases, and lack of social support are more likely to be disabled in their activity of daily living (P<0.05). Conclusion The presence of cognitive impairment and concomitant chronic diseases in the elderly has played the most significant role in the disability of the elderly in activities of daily living. However, increasing social support effectively improved the ability to act for the everyday living of the elderly. Therefore, annual screening of the elderly regarding health status and chronic diseases, cognitive status, and improvement and expansion of the social support network for the elderly can play an effective role in preventing functional disabilities.

The Effectiveness of Bedtime Exercises on Sleep Quality Parameters and Chronic Nonspecific Chronic Low Back Pain After Sleep in the Elderly Male

Abstract: Objectives The elderly population is increasing, and one of the common problems in the elderly is a sleep disorder. Poor sleep quality causes various musculoskeletal problems, including chronic nonspecific Low back pain. In this regard, this study aimed to evaluate the effectiveness of pre-sleep exercises on sleep quality parameters and chronic nonspecific chronic low back pain after sleep in the elderly. Methods & Materials This study was quasi-experimental. A total of 40 retirees over 60 years old of Isfahan University of Technology with a Mean±SD age of 64.52±3.18 years, a weight of 81.99±7.35 kg, and a BMI of 27.91±2.21 in a targeted manner available were selected and randomly divided into two experimental and control groups of 20 people. The Pittsburgh Standard Questionnaire was used to assess sleep quality parameters; the VAS Pain Intensity Questionnaire was used to assess low back pain and the Oswestry Low Back Pain Disability Questionnaire. The exercise program intervention was performed for 28 sessions for 15 minutes. Descriptive statistics were used to analyze the data; also, the analysis of variance (ANOVA) with repeated measures was used. All analyzes were performed using SPSS software v. 24. Results The results showed a significant difference between groups in sleep quality parameters such as mental quality of sleep (P=0.001), delay in falling asleep (P=0.019), duration of sleep (P=0.006), sleep efficiency and effectiveness (P=0.001), sleep disorder (P=0.016), use of sleeping pills (P=0.001), inappropriate performance during the day (P=0.002). The overall sleep quality among elderly males was P=0.001. Also, bedtime exercises can significantly affect nonspecific chronic low back pain parameters such as pain intensity (P=0.039) and disability (P=0.014) in this age group. Conclusion Doing light exercise before bed on a light to moderate basis, according to the exercise program presented in this study, can improve the disability and reduce pain severity. This seems to be one of the most critical problems in old age, namely the quality of sleep and related parameters in the elderly male with nonspecific chronic low back pain. Therefore, it is recommended that the elderly engage in regular exercise.

Design and Psychometric Evaluation of the Place Attachment Scale for Older Adults in Iran

Abstract: Objectives Due to the importance of place attachment in older adults, it seems necessary to identify their perception of this concept and its dimensions. The present study aims to design and assess the psychometric properties of a place attachment scale for older adults in Iran. Methods & Materials The is a sequential exploratory mixed method study that was conducted in 2018-2019 in two quantitative and qualitative phases. Participants were 414 community-dwelling older adults with a mean age of 70.43±8.84 years in Aran & Bidgol city, Iran who were selected by cluster sampling according to the inclusion criteria. By literature review and interview, the items were formulated. The face and validity content validity of the initial draft was assessed by a panel of experts and older adults. The construct validity was determined by exploratory and confirmatory factor analyses. The internal consistency and test-retest reliability were also determined. SPSS software, version 24 and AMOS version 24 applications were used for statistical analysis. Results In examining content validity, most of items had content validity ratio >0.7, content validity index >0.79, and kappa coefficient >0.74. In examining construct validity using exploratory factor analysis, three factors of emotional bond, physical bond, and dependence were extracted for the subscale of attachment to home and three factors of emotional bond, social bond, and physical bond were extracted for the subscale of attachment to neighborhood, which explained 61.75% and 50.06% of the total variance, respectively. The measurement models of attachment to home (GFI=0.877, CFI=0.916, RMSEA=0.080) and neighborhood (GFI=0.809, CFI=0.860, RMSEA=0.077) had acceptable fit to the data. Moreover, the scale had acceptable internal consistency (α= 0.9) and test-retest reliability (ICC= 0.8). Conclusion The designed 42-item place attachment scale with two domains of attachment to home and neighborhood for the community-dwelling older adults in Iran has acceptable validity and reliability. This tool can be used in further studies and by policymaking in Iran.

Measuring of Older Adults’ Well-Being in Iranian Provinces Using Age Watch Index

Abstract: Aims: Today, the issue of older adults’ well-being has become a serious challenge of policy-making and a key subject of researches. The complexity, multidimensionality, and multileveled nature of the concept of well-being have resulted in numerous objective and subjective indexes at the micro and macro levels. The aim of the article is to assess and measure the well-being of Iranian elderly using the AgeWatch index. Materials and Methods: The method of the study was a secondary analysis of various data sources using Excel and SPSS25 software in the methodological framework of the Global AgeWatch index. This method assesses the well-being of Iranian older adults at the national and provincial levels for 2016. The index provides a holistic view of older people's lives in four dimensions included income security, health status, capability, and the enabling environment. Results: The results indicated the significant provincial differences in the AgeWatch index and its various dimensions, especially income security, and health status. The AgeWatch index scores ranged from 6.5 in Sistan and Baluchestan province to 77.9 in Tehran province. In general, the highest rank goes to the provinces of Tehran, Semnan, and Fars, respectively, and the lowest rank goes to the provinces of South Khorasan, Ilam and Sistan and Baluchistan, respectively. The results showed a significant correlation between AgeWatch index and human development index in Iran. In addition, the results showed Iran is ranked 64th among 97 countries in AgeWatch index. Iran was the best in terms of health status (43rd) and worst in terms of capacity dimension (88th). Conclusion: Economic and social policies supporting the employment, income, health, and independence of older adults play an important role in increasing the well-being and welfare of older adults. Therefore, dimensions of financial security, such as the development of universal coverage of pensions and poverty reduction, as well as capacity dimension, such as providing elderly self-employment and promoting the education and training of the elderly, should be a policy priority.

The Effect of Supplementary Health Insurance on Out-of-Pocket Payments for Elderly Households in Urban Areas of Iran: Heckman Selection Model

Abstract: Objectives: Considering the growth of the elderly population and the need of the elderly for health services and the importance of supplementary insurance on improving the quality of life of the elderly households, this study aimed to investigate the effect of supplementary health insurance on out-of-pocket payments for elderly households in urban areas of Iran. Methods: this descriptive-analytical and applied study was conducted at the national level using the two-stage Hackman econometric method in Stata 16 software in 2021. The sample size was 6171 elderly households which data was extracted from different sections of the cost and income questionnaire of Iranian urban households in 2019. Results: Increasing age, education, and employment of the head of the household, increasing household size, having a private home, increasing per capita health expenditures and income of household had a positive effect on the probability of purchasing medical insurance. Increasing the age, level of education and employment of the head of the household led to an increase in out-of-pocket payments for the elderly household by 61164, 84466 and 140032 Rials per month, respectively. Having supplementary health insurance, living in provinces with high human development and being an elderly head of household increased the out-of-pocket payments to 606207, 849739 and 109274 Rials per month, respectively. Conclusion: Elderly households were less likely than other households to purchase supplementary health insurance and having supplementary health insurance by an elderly household led to an increase in out-of-pocket payments compared to other elderly households. Therefore, to reduce out-of-pocket payments, increase coverage Insurance of health goods and services required by the elderly as well as reduction of the elderly franchise is offered.

Effects of Selected Fallproof Exercises on Fear of Falling and Quality of Life in the Elderly

Abstract: Objective: Fear of falling in the elderly can be a disabling disease that causes negative outcomes including reduced daily productivity, reduced physical activities, and lower quality of life. The present study evaluates effects of an 8-week training protocol with selected Fallproof exercises on fear of falling and quality of life in the elderly. Methods & Materials: This is a quasi-experimental study that initiated in 2019. Population of the study includes 53 elderly from nursing homes in Rasht, from among which 24 individuals aged 60-74 were selected using convenience sampling based on inclusion criteria. The subjects were randomly assigned to experimental (n=12،66/41±4/41( and control (n=12،66/16±2/40) groups. Fallproof exercises include a range of multisensory exercises (visual, vestibular, and somatosensory), center of gravity control, postural strategies, and power training including toe and heel walking, knee flexion and extension, adduction and abduction. Training intensity was increased based on overload principle and individual differences in an 8-week training protocol, three times a week for 60 minutes. Paired t-test and covariance analysis were used for intra-group and inter-group comparisons, respectively. Data analysis was performed using SPSS at significance level of p<0.05. Results: Our results indicate that fear of falling p<0.001 and quality of life p<0.010 improved significantly in the experimental group while showing no differences in the control group. Conclusion: It is concluded that Fallproof exercises significantly improve quality of life and reduce fear of falling in the elderly. This is observed in improvements in the experimental group. Considering multidimensional effects of Fallproof exercises and multifactor nature of fear of falling, these training protocols can be applied in rehabilitation programs in care centers for the elderly.

Comparison of the Effect of 8 Weeks of Land Exercise Therapy and Hydrotherapy on Functional Activities of Elderly Women with Knee Osteoarthritis

Abstract: Objectives Knee osteoarthritis is one of the most common musculoskeletal problems in older adults. Pain, stiffness, tenderness, decreased muscle strength and joint range of motion, impaired proprioception, and balance problems lead to impaired physical function, making the person incapable of performing functional activities. Therefore, it is necessary to use strategies to control and reduce the complications of this disease and improve the daily functional activities of patients. This study aims to compare the effects of land-based exercise and hydrotherapy on functional activities in older women with knee osteoarthritis. Methods & Materials Fifty-four female patients with knee osteoarthritis aged 60-69 years (Mean height:159.96 ±5.53 cm, mean weight:76.93±9.50 kg) were selected using a convenience sampling method and randomly divided into two groups of land-based exercise and hydrotherapy. The interventions were performed for 8 weeks. To evaluate the patients' functional activities, timed up & go test, 30- second chair stand test, 40-meter fast-paced walk test, stair climb test, and 6-minute walk test were used. Repeated measures analysis of variance was used for data analysis in SPSS v. 26. Results Both land-based exercise and hydrotherapy caused significant changes in the scores of functional tests (P≤0.05). The difference between them was not significant (P≥0.05), which indicates their same effects. Conclusion Both land-based exercise and hydrotherapy can improve the performance of older women with knee osteoarthritis in timed get up & go test, 30-second chair stand test, 40-meter fast-paced walk test, stair climb test, and 6-minute walk test. These two methods are recommended based on the conditions of each patient.

Coronavirus Anxiety and Obsession and Their Relationship With Depression and Activities of Daily Living in Older Adults

Abstract: Objectives In addition to physical damage, the coronavirus disease 2019 (COVID-19) can cause psychological problems in people. The present study aims to assess the prevalence of anxiety and obsession caused by the COVID-19 in the elderly and their relationship with depression and the ability to perform activities of daily living (ADL). Methods & Materials This descriptive-analytical study with a cross-sectional design was conducted on 300 older adults aged ≥60 years in Maneh and Samalghan county who were selected by a simple random sampling method. Data were collected by using a demographic form, the coronavirus anxiety scale (CAS), obsession with COVID-19 scale (OCS), ADL scale, Instrumental ADL scale, and geriatric depression scale (GDS). Data analysis was performed in SPSS v. 18 using Mann-Whitney U, Kruskal-Wallis, and Spearman’s correlation tests. Results Among participants, 214 (71.2%) had age <70 years. The prevalence of OCS and CAS in the elderly was 5.3% and 9%, respectively. Statistical analysis showed that the scores of OCD (r=0.220, P<0.001) and CAS (r=0.322, P<0.001) had a significant correlation with depression. The CAS score had a significant negative correlation with ADL (r=-0.114, P<0.05) Conclusion The prevalence of obsession and anxiety caused by the COVID-19 in the elderly is not different from that in other age groups. However, there is significant increase in them during the COVID-19 pandemic compared to their pre-pandemic levels. it seems necessary to pay attention to screening, referral, and more detailed follow-up of mental health services in clinics and health centers for the elderly during the COVID-19 pandemic.

A Comparison Study on the Effectiveness of Acceptance and Commitment Therapy and Sleep Hygiene Education on Sleep Quality and Physiological Parameters in Older Adults

Abstract: Objectives Due to the high prevalence of insomnia and physiological problems in the elderly, this study aims to compare the effects of acceptance and commitment therapy (ACT), sleep hygiene education (SHE) and their combination on sleep quality and physiological parameters (blood pressure, heart rate, and oxygen saturation in the blood) in the elderly. Methods & Materials This is a quasi-experimental study with a pre-test/post-test/follow-up design using a control group. The study population consists of the elderly members of Jahandidegan center in Shiraz, Iran in 2018. Using a convenience sampling method and based on the inclusion and exclusion criteria, 80 subjects were selected and randomly divided into four groups, three experimental groups (ACT, SHE, and ACT+SHE) and one control group. The SHE and ACT programs each were presented for four weeks. The control group was put on a waiting list. The subjects were assessed with Pittsburgh Sleep Quality Index, a mercury sphygmomanometer, and a pulse oximeter. Data analyses were conducted in SPSS v. 23 using a two-way mixed analysis of variance and multivariate analysis of covariance. Results Participants had a mean age of 70.41±4.05 years. the changes in sleep quality, systole blood pressure, and oxygen saturation in three experimental groups were significant after intervention (P<0.001). The highest effect on sleep quality was related to the combined therapy (0.83), followed by SHE (0.67) and ACT (0.60). Conclusion All three treatment methods (ACT, SHE, and combined therapy) can improve the sleep quality and consequently systolic blood pressure and oxygen saturation in the blood of the elderly. Each of these methods are useful and can improve their psychological and physical health, where the combined therapy has superiority. Training and applying these methods are recommended for health care workers in elderly care.

Effect of Combining Adapted Physical and Artistic Activities on Feeling of Loneliness and Aggression in the Elderly Living in Nursing Homes

Abstract: Objectives Feeling of loneliness and aggression are common problems in the elderly living in nursing homes that can have serious psychological and physical consequences for them. Due to the growing number of the elderly population, it is essential to use practical strategies for reducing their isolation and aggression. This study aims to assess the effect of combining adapted physical and artistic activities on feeling of loneliness and aggression in the elderly living in nursing homes. Methods & Materials In this quasi-experimental study, 68 older residents of a nursing home in Shiraz, Iran with feeling of loneliness and aggression and without acute psychological and physical problems participated, who were selected using a convenience sampling method and then assigned into two groups of control and intervention by block randomization method. The control group received routine care, while the intervention group participated in 16 sessions of adapted physical and artistic activities. Data were collected using the UCLA Loneliness Scale and Buss-Perry Aggression Questionnaire before and immediately after the intervention. Data were analyzed using descriptive (Mean±SD, and frequency) and inferential statistics (Chi-square test, Mann-Whitney U test, and Wilcoxon test) in SPSS software, version 22. Results The participants’ mean age was 70.93±7.99 years in total, and 69.1% were women. The scores of loneliness and aggression significantly reduced after the intervention in the intervention group (P<0.001). The scores of loneliness (P<0.001) and aggression (P=0.001) in the intervention group were significantly lower than in the control group. Conclusion Feeling of loneliness and the level of aggression in the elderly living in nursing homes can be reduced significantly by combining adapted physical and artistic activities. This practical and cost-effective intervention can be used to reduce feeling of loneliness and aggression in the elderly living in nursing homes.

Facilitating and Inhibiting Factors of Social Participation in the Elderly Based on Health-promoting Behaviors: A Cross-sectional Study

Abstract: Objectives Social participation is a determining factor for promoting health and well-being. This study aims to investigate the factors facilitating and inhibiting the social participation of the elderly in Kerman, Iran based on their health-promoting behaviors. Methods & Materials This cross-sectional study was conducted on 276 elderly people over 60 years old in Kerman city in 2020. They completed a demographic from, the questionnaire of social participation based on the Canadian Community Health Survey, and the questionnaire of health- promoting behaviors. Descriptive statistics and statistical tests including univariate and multivariate regression were used for data analysis. Data were analyzed in SPSS software, version 26, and P<0.05 was considered statistically significant. Results The Mean±SD score of social participation was 6.71±4.01. Illness and health problems (50.3%), costs (39.1%), commuting problems (31.1%), low mood (29.3%), and COVID-19 pandemic (28.2%) were the most common barriers to social participation. The elderly who were single (P<0.001), younger (P<0.001), with academic degree (P<0.001), and low number of children (P<0.001) had significantly higher social participation. Multivariable analysis showed that physical activity (P=0.033), disease prevention (P=0.002), and physical and social health (P<0.001) were the factors affecting social participation of the elderly. Conclusion The social participation of the elderly in Kerman is affected by multiple factors. Therefore, planning to manage diseases, increase income, and solve the transportation problems of the elderly are recommended to improve their social participation.

Relationship Between Individual Factors of Empowerment and General Health in Older Adults Attending Neighborhood Houses in Tehran, Iran

Abstract: Objectives By the rapid growth of the elderly population, the need to pay attention to this group becomes more obvious. General self-efficacy, self-control and self-esteem are the effective individual factors for the empowerment of the elderly. This study aims to examine the relationship between these individual aspects of empowerment and general health in older adults attending neighborhood houses in Tehran, Iran. Methods & Materials In this descriptive-analytical study with cross-sectional study design, 320 older men and women over 60 years of age participated who were selected by a cluster sampling method. Data were collected using a demographic form, the 28-item general health questionaire, 10-item general self-efficacy scale, Rosenberg self-esteem scale, and Tangney’s brief self-control scale. Data was described using mean and standard deviation, and analyzed using chi-square test, Spearman correlation test, one-way-ANOVA, and linear regression in SPSS sofwtare, version 22. Results The mean age of the elderly was 68.42±8.3 years. Their mean score of general health was 21.95±13.4. A significant negative correlation was found between general health, general self-efficacy, self-esteem and self-control (P<0.001). Their general health had a significant relationship with their educational level (P<0.001), years of employment (P=0.002) and housing status (P<0.001). The multivariate regression results showed that housing status (P=0.156), self-esteem (P<0.001), self-control (P<0.001), and general self-efficacy (P<0.001) were the significant predictors of general health in the elderly. Conclusion There is a relationship between general health, general self-efficacy, self-esteem, and self-control of the elderly in Tehran. Their general health is related to their educational level, years of employment, and housing status. Housing status, self-esteem, self-control and general self-efficacy are predictors of their general health. Attention should be paid to these factors in developing health promotion programs for the elderly.

The Multilevel Analysis of the Social Network in the Older Adults on the Urban-Heart 2

Abstract: Objectives Social network in older adults refers to interpersonal relationships and the perception of these relationships. Given the importance of the social network, the current study was conducted to answer three pivotal questions. First, do personal and regional factors affect the social network of the elderly? Second, how much share do the individual and regional factors have in the social network of the elderly? And third, which of these factors affect the social network of the elderly at each level of the personal and regional relationships. Methods & Materials The study was conducted based on the second round of the Tehran city health equity and response tool (Urban-Heart 2). Thus, 5760 individuals (age <60 year) were selected from 22 urban regions in Tehran City. These data were then analyzed using the multilevel regression model. Results The personal and regional levels explained about 89% and 11% of the social network of the elderlies, respectively. The individual factors explained 21% of the variance in the social network. Out of these parameters, age between 60 and 74, illiteracy, self-reported health, and mental health affected the social network significantly. At the regional level, the feeling of security, the control of corruption, the waiting time for bus arrival, and the sense of responsibility were the most influential factors explaining 19% of the variance in the social network. Conclusion Not only is the social network of the elderlies affected by personal factors such as age, education level, and self-reported health and mental health, but it is also affected by regional factors (feeling of security, the control of corruption, the sense of responsibility, and waiting time for bus arrival). Although these regional factors are out of personal control, they can be improved for the elderly in society.

The Effects and Adverse Effects of tDCS on Motor Learning Process in Chronic Unilateral Stroke Patients

Abstract: Objectives: It seems that psycho-physical factors of stroke patients undergoing tDCS treatment can affect implicit motor learning process in patient with stroke. The aim of this study was to determine the effects and adverse effects of tDCS on motor learning process in chronic unilateral stroke patients. Methods & Materials: This crossover, sham-controlled, randomized, blinded study was conducted in 2017 on 12 patients with chronic unilateral stroke (mean age, 60.33±1.87 years), (The mean time elapsed since the onset of the disease, 1.96±1.36 years) referred to Mobasher Kashani clinic in Hamadan, Iran who were selected using a convenience sampling technique. Patients were randomly divided in to 2 groups: experimental (dual tDCS + SRTT) (n = 6) and sham (sham tDCS + SRTT) (n = 6) groups. After 3 weeks of washing out period, patients in each group were treated in other brain stimulation group again. Data were collected using the record of reaction time and error of sequenced blocks by related software. Also, adverse effects of tDCS, pain or discomfort, attention and fatigue of patients were assessed by visual analogue scale (VAS) questionnaire. The data were analyzed using linear mixed effects. Results: Data analysis showed a considerable improvement in implicit motor learning in both brain stimulation groups. The most reported sensations were itching and tingling, which continued during all stimulation sessions. The pain or discomfort of the patients was negligible during the intervention sessions. Moreover, the type of brain stimulation, the time and their interaction had no significant effect on the fatigue, attention and pain of the patients (P>0.05). Conclusion: Dual-tDCS technique does not cause serious adverse effects in patients with stroke. It can be used as an effective and useful therapeutic strategy for increase in implicit motor learning in chronic stroke patients.

Prevalence of Elder Abuse by Family Members and its Related Factors in Gonabad, Iran

Abstract: Objectives Elder abuse is one of the major social health problems in communities which has significant effects on decreasing their health and safety. The present study aims to investigate the prevalence of elder abuse by family members and its related factors in Gonabad, Iran. Methods & Materials This analytical cross-sectional study was conducted in 2020 on 401 elderly people in Gonabad, Iran. Who were selected using cluster random sampling. Data collection tools were a two-part questionnaire including a demographic form and the questionnaire of elder abuse by family members. The questionnaires were completed in a community health center. Data were analyzed in SPSS software version 23, using descriptive and inferential statistics. The significance level was set at 0.05. Results The mean age of participants was 68.53±6.75 years. The prevalence of elder abuse by family members was 44.6%. The highest prevalence of elder abuse was related to care negligence and the lowest prevalence was related to rejection. The educational level (P=0.03), history of hospitalization (P<0.001), sleep quality (P<0.001), income level (P<0.001) and level of dependency (P<0.001) had a statistically significant relationship with the prevalence of elder abuse by family members. Conclusion Given the high prevalence of elder abuse in Gonabad city, it seems necessary to have programs to increase the awareness of the elderly, their caregivers, and health personnel to prevent and reduce elder abuse.