مجله دیابت و متابولیسم ایران
سال سیزدهم شماره 6 (پیاپی 57، امرداد و شهریور 1393)

Reducing in mortality rate due to improved health status in recent years has led to an increased number of elderly people in the world. Therefore, this study aimed to determine the structure of the home care plane in developed countries to provide practical implementations for Iran. This paper is based on valid studies, library and internet searches in databases like science directly, Springer, Proquest, and advanced search in Google to review the literature on the home care programs in developed countries. Documents showed that developed countries have established the aimed, needs, priorities programming of the elderly home care plan. Those groups of countries have designed the home care services to care of older people in their homes respect to maintained of their function and ability as independent individuals. The investigations have been shown that community-based services and home care programs that is not considered as a medical service component, could be eliminated the support needs, and helped the elderly people to live independently and continue their life with quality. Considering the significant role of home services in the prevention of hospital readmission in elderly and to maintain of independency rate and also increasing the quality of life in elderly people, is a necessary issue in Iran that makes to improve on the quality of life in Iranian seniors.

Falling is one of the health problems among aged population. Elderly living in institutions are at greater risk of falling than those dwellings in the community, due to their health status and environmental conditions. This study was designed and conducted aimed to address the factors affecting falls in Kahrizak Charity Foundation (KCF).

This is a prospective longitudinal study, which 194 of residents of KCF were participating in it with inclusion criteria were selected by Random Cluster sampling. They were enrolled after signing an informed consent. At baseline the data of demographic, lifestyle, past medical history and visual ability were collected by interviewing. The anthropometric measurements were performed as well. Cognitive status data were collected using abbreviated mental test (AMT) questionnaire and mini mental state examination (MMSE), balance status was assessed using the Tinetti mobility test (TMT) and its balance and gait sub- scores, depression was detected using the geriatric depression scale-15 (GDS-15). The participants were monitored for the falls occurrence its complications by daily call with caregivers and filling out the special forms for the recording of the falls occurrence by the head nurse. Data were analyzed using univariate and multivariable Cox-regression models.

The mean age of the participants was76.02 (8.82) years and the mean follow-up days was 754.40±189.26 days. 44 cases of falls were recorded during follow-up (over two years). The fall rate was 22.7 subjects per 100 participants per year. History of stroke, Parkinson's disease, visual loss, taking antidepressants, TMT score and TMT balance sub-score after adjustment (for age, sex, body mass index and survival time) were associated with falls.

The falls among nursing home elderly residents were associated with a history of chronic diseases such as stroke and Parkinson's diseases, visual acuity, use of antidepressants and the TMT and its balance sub score.

Because of various health problems, the risk of the death in the elderly is higher than adults. The purpose of this study was to investigate the causes of the death, and comparing the cause of death that recorded on the death certificates and those were extracted from the medical records review. Variables included the demographic characteristics (age and sex), time of death and the cause of death were recorded in the death certifies and those were extracted from the medical records. The mean of death age was 83.8 (8.50) years and in women and men were 84.2 and 81.5 years, respectively, (P < 0.01).The most prevalent cause of death was sudden cardiac death based on both death certificates recorded and review of medical records were 42.5% and 25.9% respectively. Sudden cardiac death in both methods was higher in women than men. Using the kappa, the highest degree of correspondence about the cause of death between two method was about gastrointestinal bleeding (K = 0.76) and then the cancers (K = 0.71) and respiratory infections (K =0.67). Total Kappa of two methods for causes of mortality was 0.50. The most cases of death were reported during 12:00 – 13:59 and 8:00 – 9:59am, time period (16.2 % and 14.1% respectively). the causes of deaths, which are recorded in the elderly nursing homes, do not have enough accuracy. Due to the high incidence of sudden cardiac death in elderly in nursing homes, resuscitation facilities and teams may be helping to reduce these types of death.

Metabolic syndrome is a cluster of disorders which altogether increase the risk of cardiovascular disease and type 2 Diabetes. We evaluated the effect of consumption of Omega-3 Fatty Acids on different components of this syndrome. This was a double blind placebo controlled clinical trial on 199 elderly residents of Kahrizak charity foundation in Tehran. Participants were divided into two groups of intervention and control, consisting of 100 and 99 persons, respectively. The intervention group was given the Omega-3 Fatty Acid capsules contain 180 mg EPA and 120 mg DHA once daily. The control group was given placebo once per day. The duration of the study was 6 months in the beginning and after 6 months of the study, blood pressure, waist circumference and Serum levels of ESR, hs-CRP, APO B, APO A1 and Insulin were measured. The study was completed in 89 and 87 participants in the intervention and control groups, respectively. The mean age of intervention and control groups were 74.13 ± 9.96 and 75.17 ± 8.70 years, respectively. Consumption of Omega-3 Fatty Acids could decrease diastolic blood pressure (P = 0.001) and serum Triglyceride levels (P = 0.01) significantly compared to control group. No change was observed in other measured parameters. Consumption of Omega-3 Fatty Acids with dosage used in this study could probably improve symptoms of Metabolic syndrome in the elderly.

increasing the population of aged, Consequently Increasing rate of chronic disease and to decreasing quality of life level caused many problems in different communities. The important aim of this study was surveying the effect of an educational intervention by use of the educational components of precede model on quality of life in the elders. This semi-empirical research was performed on 54 aged people in two group-case and control- for the Aged in 2009. In this study two questionnaires; the designed questionnaire based on PRECEDE model and the questionnaire on the quality of life standard of the World Health Organization (WHOQOL) were used and the quality of life of the aged people in two groups before and after one month from the educational interference was evaluated. Independent t-test paired T-test, one way ANOVA, was used for data analysis. The average total score of the quality of life of the aged people of test group, showed a meaningful difference before and after educational interference with a p quality less than 0.05, but there wasn’t a meaningful difference between total scores of two groups. Though the relationship of attitude (predisposing factors), enabling factors (skills) and behavioral factors with quality of life of a p quality less than 0.05 was meaningful. But knowledge (predisposing factor) and reinforcing factors didn’t show a meaningful relationship with the quality of life. It seems that the health, education and health promotion programs are effective on quality of life in the aged people.

Health staffs have different attitudes and beliefs toward elders that have effect on their behaviors in health service delivery to elders. This study was done for determination of Golestan province health centers general practitioners (GPs) attitude toward elders. In this cross sectional study, 152 general practitioners of Golestan province health centers were selected via random sampling. The Kogan's Attitudes toward Older People Scale (KAOPS) questionnaire was used as data gathering tools. Data analysis was done in SPSS 16 software using Pearson correlation coefficient, paired t-test, t-tests and one way ANOVA test. Mean (standard deviation) of participants age was 34.73 (6.26) years. Mean (standard deviation) of total score of attitude toward elder scale was 115.48 (10.22) (score range in scale 34-204). 54.2 percent of GPs have lower score than mean. Negative attitude mean score were higher than positive attitude mean score which was statistically significant (P= 0.0001). According to our finding, only half of GPs had favorite attitude toward elder. Whereas negative attitudes were higher than positive attitude toward elder, designing some programs for change in attitude of heath care staffs is necessary.

One of the common problems of the elderly, which increase of its prevalence with aging is the dementia and the cognitive impairment. We can help the involved patients to have a better quality of life with early diagnosis of the cognitive impairment. The aim of this study was an assessment of the validity and reliability of the Persian version of the abbreviated mental test (AMT) among the older people in a nursing home setting. 176 eligible elderly people aged ≥ 60 years living in KahrizakCharity Foundation (KCF), were selected randomly based on medical record number. Demographic information and past medical history of the participants were collected. Geriatric depression scale 15 (GDS-15), global deterioration scale (GDS) forms and also the Persian version of the abbreviated mental test (AMT) were administered. The participants were assigned to two groups; the normal and impaired cognitive groups, based on DSM-IV diagnostic criteria. The GDS cut-points were used for assessment of validity, sensitivity and specificity of the Persian version of AMT. The mean age of the participants was 77.30 (7.94) years. The Persian version of AMT had good discriminated validity in diagnosis of normal and impaired cognitive participants (7.35 ± 2.33 and 5.99 ± 2.29, P < 0.01 respectively) and at cut-point AMT< 8,(based on GDS cut-point) it had a sensitivity and specificity 92.15 % and 81.50% respectively. The sensitivity and specificity based on theism IVcriteriawere 64.9% and 64.0% at cut-off point equal to 7, respectively. The internal consistency of the Persian version of AMT was acceptable (Cronbach’salpha coefficient =0. 76). As well as the external reliability (intra-rater) of this instrument was good; inter-class correlation coefficient (ICC) = 0.89) The Persian version of the AMT has appropriate validity and reliability in Iranian older people.

The world population is aging and it is expected that in 2020 more than one billion people in the world be elderly. The aim of this study was the evaluation of socioeconomic and physical health of elderly people in Ilam province in 2011. This study was a cross - sectional study in which 1012 elderly people residing in the city of Ilam and eight townships participated by proportional allocation methods. Data collected by using a standard questionnaire and the Data were analyzed by using SPSS statistical software. The mean age of the study population was 70/1 ± 8/02 years. The differences between employment status and job type of elderly in each township was Significant. Mean systolic and diastolic blood pressure in subjects was 133/03±28/38 and 11/76±8/02 excursively, and mean body of BMI was 25/72±4/48. 36/1% of the elderly had a history of heart disease, 15% are living with diabetes, and 22/5% had respiratory problems. 45/3% have surgery history, 72/8% experienced joint pain, 64/6% experienced musculoskeletal pain and 12/6% had a history of stroke. 23/8% had problems of knowing the time, 22/8% had problems recognizing the place, 22/2% had problems recognizing people and 25/9 % Shake hands and head. Common problems with physical health problems reported by elderly of Ilam the same in the rest of the country and major differences in socioeconomic status. Due to lower per capita income in Islam compared to other provinces of Iran, the health status of the elderly has been lowered in Ilam rather to another province.

Oral health is an important issue in elders’ life in both food consumption style and their self-esteem. The aim of this study was to survey the oral health among aged people in Gorgan city. In a cross sectional study and through a standard questionnaire, the data of 869 aged people who were resident in the areas where were covered by 4th and 5th Health Station of Gorgan Health Center, has been analyzed. Participants (over 60 years old persons) entered in the study through a census method are asked about their oral health by trained persons. Data analyzed by descriptive statistics and Chi-Square test. Alpha level set at 0.05. Complete toothless was 54.3 percent in male and 62.6 percent in female. Totally teeth preservation rate was 6.4 percent in male and 1.5 percent in female. The mean and standard deviation of tooth loss were 22.5±12.4 in male and 24.4±11.2 in female. The Complete toothless significantly was high in single people compared with married one. Completely toothless was low among aged people with less than or equal to four children and was low among aged people in the worst status of economic situation. Oral health among the study population was in a bad situation. For preservation of teeth till adult age, appropriate planning and interventions is necessary.

Dementia is a common health problem in the elderly. Studies have shown that levels of pulse wave velocity (PWV) could predict cognitive impairment. The objective of this study was assessment of the relationship between arterial stiffness levels and cognitive status among the older people. In this cross-sectional study, 60 individuals included 31 women and 29 men aged ≥ 60 years who were admitted to Khatam-Ol-Anbya hospital in Tehran and were eligible, were randomly selected according to admission code. Data such as demographic information, Global Deterioration Scale level, Geriatric Depression Scale -15 score, were collected by face to face interview. The arterial stiffness was measured using Sphygomocor system by calculation of carotid to femoral pulse wave velocity. Data analyzing was conducted using univariate and multivariable logestic regression models. The mean age of the participants was 72.62 (7.62) and it was significantly higher in cognitive impairment than those who had normal cognition [73.40(7.36) vs. 70.27(8.00) respectively, P = 0.05]. The average years of the schooling in individuals with normal cognitive status was higher than the other groups (P < 0.01). Average pulse wave velocity in the participants was 11.81(4.11) meters per second. The PWV was significantly increased with the exacerbation of the cognitive impairment (7.24 m/s in normal group vs. 15.52 m/s in the severe cognitive impaired group, P < 0.01). The pulse wave velocity has an inverse relationship with cognitive status. It seems that arterial stiffness associates with lower levels of cognitive status independent to other cardiovascular risk factors.