فصلنامه سالمند
پیاپی 59 (پاییز 1399)

Increasing care needs for the elderly are of concern in different countries, especially in countries where their population is aging. It is important to understand the factors that influence the use of health services in the elderly for health policy making in identifying potential problems and developing appropriate interventions to improve their utilization and increase access. Therefore, the purpose of this study was to identify the barriers and facilitators of the outpatient health services utilization in the elderly.

In the current systematic review, published English studies from 1996 to 2018 were searched and reviewed electronically from the Web of Science, PubMed and Scopus databases using PRISMA guidelines and related keywords. After eliminating duplicate and irrelevant articles, the quality of articles was evaluated by two evaluators independently, based on STROBE checklist. Narrative synthesis method was used to combine the data.

Forty-four eligible studies were included in this review and the determinants of health service utilization were categorized into three categories as predisposing (age, gender, marital status, ethnicity), enabling (income, insurance coverage, education level, employment status, social network, social support), and need related factors (having chronic illness, self-assessment status, severity of illness, number of illnesses, having two or more diseases at the same time, physical disability and unhealthy lifestyle). Findings showed that over age 80, ethnic minority, unemployed and retired, low level of education, small and limited social network, disability were identified as barriers to accessing health services, and being female, married, having insurance, social support, having a companion, spouse or child, high income levels, shorter distances to the health care center were identified as facilitators of outpatient health services utilization in the elderly.

This systematic review revealed that a set of factors is consistently associated with health services utilization in the elderly. The present study identified the factors affecting the utilization of elderly health services in the framework of Anderson Health Services Behavioral Model. Overall, evidence has shown that single, male, over 80s, educated and low income, unemployed or retired people with chronic illness should be high on the health policy priorities of the elderly to prevent the burden of health services resulting from diseases.

Obtaining measurement errors in aging samples studies is of high importance mainly because of the study itself as well as the attention and consideration that are required in recording such data. This study aims to introduce a simple formula to obtain and interpret the Total Deviation Index (TDI) and encourage researchers to use it as a suitable tool in defining reliability in psychometrics studies.

In a cross sectional study in the year 2019, 105 aging individuals were selected from city of Tehran. The SF-36 questionnaire was completed for them within two weeks. The ICC value and TDI were obtained for each subscale and compared together.

The results show that the lowest TDI value belongs to physical functioning subscale, while mental health has the highest. To be more accurate, the maximum measurement error in physical functioning and mental health, with 95% likelihood, is 22 and 34 (of 100 units), respectively.

Considering the easy interpretation of Total Deviation Index, also due to ICC index not being capable of identifying how much of the subscales variations come from measurement errors, it is suggested that researchers report and obtain the Total Deviation Index in their reliability studies.

Telehealth management systems for elderly people should have the features, capabilities, and infrastructure that meet the diverse needs of home care management. Since there is no valid and reliable questionnaire to determine these requirements, the main purpose of this study was to determine the requirements of a tele-health monitoring system for elderly people and to present it as a valid and reliable questionnaire.

This study was a descriptive-analytical one that performed in 2019. Questionnaire items were obtained from a systematic review study. For the review phase, the selected keywords such as elderly, home care, telecare, telehealth, and information technology from 2013 to October 2019 were searched on selected databases.

Based on the findings of this study, the parameters and requirements of tele-health monitoring system for elderly people were identified in 97 items. Furthermore, the first 31 items of the questionnaire were removed due to low validity and reliability. In the next phase, the final questionnaire with 66 items, content validity ratio of 99%, Cronbachchr('39')s alpha coefficient (0.9) and desirable correlation coefficient (r = 0.85, p-value <0.05) were designed.

In this study, the requirements of tele-health monitoring system for elderly people were determined and a valid and reliable questionnaire was developed using these requirements. The questionnaire was designed in five parts: applications, functional requirements, non-functional requirements, tools, and communication infrastructure. The results of the present study can be used by health care system designers to determine the applications and requirements of elderly health monitoring systems.

The purpose of this methodological study was to design and determine the psychometric properties of a new and specific questionnaire for assessing elderly happiness in the context of Iranian culture.

This study was a methodological research that was conducted from May 2018 to June 2019. It was conducted in four phases recommended by Schneider and et al (2004).In the first phase, content analysis was applied to explore the meaning of elderly happiness phenomenon. In the second phase, in order to achieve the factors of elderly happiness questionnaire, the factors of happiness were extracted based on the review of texts, measurement tools, and interviews with the participants. a questionnaire was created, using the results of the qualitative research implemented in the first phase, in conjunction with the inductions from the expert panel. In the third phase, the validity determination including face validity, content validity and construct validity were measured. In the fourth phase, internal consistency, and test- retest reliability were measured.  304 elderly people who were selected randomly participated in the last stage.

The initial 77 item questionnaire designed using the results of first and second phases of study, reduced to 39 items in the process of determining the face and content validity. The result of exploratory factor analysis showed that this questionnaire contains 5 factors including human rights, enjoyable life, good morals, health and spirituality. These 5 factors explained nearly 70.49% of the variance. The results of known groupschr('39') comparisons showed that this questionnaire could successfully discriminate between subgroups of elderly people in the indexes of gender and education status. The internal consistency (Cronbach’s alpha) was 0.838–0.950. Test-retest reliability (ICC) of the questionnaire with interval time of two weeks was 0.95(p < 0.001).

We concluded that the Elderly Happiness Questionnaire with 39 items in community-dwelling older samples is valid and reliable Thus, the questionnaire can be recommended for use as a trait-measure in Iranian older adults. It can be used among older adults in different settings such as clinical settings, homes and research environments by health care providers, psychologists and researchers.

 The purpose of this research was to investigate the psychometric properties of Persian version of the multidimensional body-self relations questionnaire (MBSRQ) among Iranian elderly people.

The research method was non-experimental research that its necessary information was collected with cross-sectional method. The statistical population was composed of all elderly people over 60 years age in Tehran city. The statistical sample included 1035 people who were completed the Multidimensional Body-Self Relations Questionnaire (MBSRQ). This questionnaire consists of 69 questions and 9 components. Data were analyzed with confirmatory factorial analysis based on structural equations, Cronbach’s alpha coefficient and intra-class correlation coefficient tests.

Result showed that the content, face and concurrent  were validity acceptable (P<0.05). Also, Result showed that the Multidimensional Body-Self Relations Questionnaire (MBSRQ) has acceptable fit indexes (such as RMSEA=0.042, CFI=0.903, TLI=0.978, PNFI=0.075, and PGFI=0.886). Forthermore, the internal consistency and temporal reliability were acceptable (P<0.05).

The Persian version of Multidimensional Body-Self Relations Questionnaire (MBSRQ) has acceptable reliability and validity in Iranian elderly and researchers, older adults, and elderly specialists can use this questionnaire for its evaluations and researches.

The purpose of this study was to investigate the effect of unilateral and bilateral electrical stimulation of the brain on balance in elderly.

Thirty-six elderly in Ilam city participated in study. In the pre-test, static balance was taken and then the participants were randomly divided into three groups: unilateral brain stimulation, bilateral brain stimulation and sham. The intervention took in 3 sessions. In unilateral stimulation group, the anode electrode was positioned at O point and the cathode was above the left ophthalmic cavity (FP1). In bilateral stimulation group, the anode electrode was positioned at O1 and the cathode was positioned at O2. The intensity of stimulation was 2 mA and the duration of treatment was 15 minutes per session. In control group, the anode and cathode electrodes were placed on the O and FP1 points, respectively, but the excitation current was stopped after 30 seconds. After the last training session, the post-test was performed. Data analyzed were using one-way ANOVA.

The results showed that there was no statistically significant difference between the three groups in pre-test phase (P<0.535). But at post-test was a difference between groups (P<0.002). Post-hoc test results showed that there was a difference between unilateral stimulation with control group (P=0.001) and bilateral stimulation with control group (P=0.005). But there was no significant difference between unilateral stimulation group and bilateral stimulation group (P=0.599).

In conclusion, it can be concluded that unilaterally and bilaterally cerebellar stimulation can be improved in the elderly.

Health literacy is one of the most important social determinants of the elderly health. This study was aimed to determine the effectiveness of educational intervention on knowledge, attitude and nutritional behaviors of the elderly with adequate health literacy and inadequate health literacy.

An experimental study was conducted with the participation of 192 people 60 years and older in Ilam from May to September 2016. The elderly were assigned into four groups (48 subjects in each group) includes two intervention groups with adequate and inadequate health literacy as well as two control groups with adequate and inadequate health literacy. The elderly nutrition education program consisted of four lecture sessions with questions and answers, along with an elderly nutrition manual for the intervention group. The level of health literacy among the elderly was assessed using the Test of Functional Health Literacy in Adults. Also, the level of knowledge, attitude and nutritional behaviors was assessed using a researcher-made questionnaire in two stages before and two months after the educational intervention. The SPSS software version 21 was used for data analysis. Descriptive statistics and Chi-square, paired t-test and Fisherchr('39')s exact test were used for data analysis.

The mean age of the men was 61.24±2.38 years and the mean age of women was 61.35±2.45 years. The majority of men with adequate health literacy were men (84.37%), while the proportion of men and women in those with inadequate health literacy was almost the same. Also, all participants with adequate health literacy and 89.58% of those with inadequate health literacy were married.After the educational intervention, the mean scores of knowledge, attitude and behavior in the intervention group with adequate health literacy increased significantly (p≤0.013), (p≤0.015) and (p <0.001), respectively. In the intervention group with inadequate health literacy, only knowledge mean score after the intervention showed a significant increase, (p≤0.035). However, there was no significant change in the mean scores of knowledge, attitude and behavior in both control groups (p>0.05).

According to the results of the study, the effectiveness of educational intervention in relation to nutrition of the elderly is significantly influenced by the level of health literacy.

Loneliness is a significant concern among the elderly, and requires measurement and intervention. This study was conducted with the aim of translating and psychometric evaluation of the 6-item de Jong Gierveld Loneliness Scale in Iranian elderly people.
Material&

This  is a descriptive study carried out in 2018.After receiving permission from the  tool designer the original version of  6-item de Jong Gierveld Loneliness Scale was translated into Persian by the translation-back translation method. Then its face and content validities were determined. The Persian final version was completed by 224 eligible elderly residents in Khorramabad. The data were analyzed using confirmatory factor analysis (CFA), the Pearson correlation coefficient, the intra-class correlation coefficient (ICC) and the Cronbachchr('39')s alpha. The softwares SPSS and AMOS were used and the significance was determined at the level of p≤ 0.05.

The Persian version of the 6-item de Jong Gierveld Loneliness Scale had an acceptable content validity (CVI = 0.874).  Confirmative factor analysis indicated the extraction of two factors: emotional loneliness and social loneliness (CMIN/DF=1.48, GFI=0.983, IFI=0.983, RMSEA=0.004). The overall loneliness score showed significant correlation with hospital anxiety and depression scale. The reliability of the scale was accepted by intra-class correlation coefficient and Cronbachchr('39')s alpha coefficient.

 The Persian version of the 6-item de Jong Gierveld Loneliness Scale is a reliable and valid measure of loneliness in Iranian elders.

The increasing trends in achieving old age call for the consideration of ADL and social support in the elderly as effective factors in improving their health. This study aimed to investigate the correlation between social support and background variables as well as ADL level among older adults in the rural community in southern Iran.

This descriptive-analytical cross-sectional study was carried out on 302 elderly people aged 65 years and a bove  in the rural community of southern Iran using stratified random sampling method. The social support questionnaire (Procidano, M. E., Heller, K.) and ADL scale for the elderly were used.

The mean age of the participants was 7/067±69/67. The mean score of perceived social support was 3/10± 16/55 and the mean score of ability to perform ADLs was 28/237±55/68. Social support, education and age were effective in performing ADLs among the elderly (P <0/001) while marital status and gender had no effect on ADL level (P <0/05). The age of older adults was inversely correlated with their ability to perform ADL, so that their independence in doing ADL will decrease with age.

Many variables affect ADL level among the elderly. Therefore, health care providers should facilitate the elderly’s independent living through educational programs so that they can maintain and promote a healthy and active life.

Leisure activity helps the elderly to improve their physical and mental health. The aim of this study is to assess interlink between the leisure activity and mental health in older people.

We select 413 people over 60 years old.  We collected data using GHQ 15-question survey, Nagi questionnaire and a new reliable and validated designed questionnaire. Our data was analyzed using spearman correlation, and regression analysis in SPSS21.

The findings of this study showed that the most leisure activity in the elderly is watching television. We report a relationship between recreation and religious activities with mental health in elderly (pvalue <0/0001). Among the confounding factors, physical health imposed the most significant effect.

Physical health is an effective factor in the relationship between leisure time and mental health of the elderly. Considering the significant relationship between religious classes and mental health of the elderly individuals, planners should consider the role of mosques, husites and municipalities as a custodians of leisure centers. On the other hand, considering the effect of physical health on the relationship between leisure time and mental health, provision of situation that can involve elderly people in sports and recreational activities is an effective step to increase the mental health of the elderly individuals.