فصلنامه سالمند
پیاپی 66 (تابستان 1401)

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.

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.

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.

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.

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.

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.

Objectives :

One of the challenges facing societies today is the increased medical expenses of the elderly. Therefore, identifying the factors associated with this increase can help health policymakers control the costs imposed on the elderly and their families. This study aims to identify the factors related to the increase in hospitalization costs of the elderly with circulatory system diseases using the generalized gamma marginalized two-part model.

Methods & Materials :

In this retrospective cohort study, 335 samples were selected by a simple random sampling method from among the older patients of Imam Khomeini and Golestan hospitals in Ahvaz, Iran during 2015-2016 having circulatory system diseases and age ≥60 years. The relationship of age, gender, hospitalization status in intensive care unit (ICU), marital status, admission season, and number of hospitalization days with the increase in treatment costs of the elderly was examined using the generalized gamma marginalized two-part model in SAS  9.4 software. The response variable was the patients’ treatment costs. The significance level was set at 0.05.

Results :

The mean age of participants was 70.718.27 years, where 54% were female and 46% were male. The average medical costs in patients admitted to ICU was 3.70 times higher than that in patients who were not admitted to this unit. The odds ratio showed that, for each day of increase in hospital stay, the hospitalization costs of the patients increased by 1.11. The hospitalization costs for older men were 1.67 times higher than in older women. In single patients, it was 2 times higher than in married patients. Moreover, with each year of increase in age (after age 60), the hospitalization costs increased by 0.96. Using the marginalized two-part model, it was found that the variables of age, number of hospitalization days, marital status, gender, and admission to ICU had a significant relationship with the increase in the hospitalization costs of the elderly (P<0.05).

Conclusion:

 The burden of hospitalization costs on younger elderly with circulatory system diseases is higher. Older men incur more hospital costs than older women, and single elderly people incur more hospital costs than married ones. The increase in the number of hospitalization days is another factor that can increase the hospitalization costs of the older patients, especially in those admitted to ICU.

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.

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.

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.