فصلنامه سالمند
پیاپی 63 (پاییز 1400)

Studies have indicated the feminization of aging in the world including Iran. The present study aims to investigate women’s aging trend and effects, status difference, factors affecting the health of older women, and how to achieve proper health for older women in Iran.

Methods & Materials: 

This review study was conducted according to PRISMA checklist. A comprehensive search was conducted in online databases including PubMed, Scopus, Elsevier, IranMedex, IranDoc, MagIran, NoorMags, SID, Google Scholar, and websites of the World Health Organization and the United Nations Population Fund on articles published until June 2020 using the keywords Elderly, Aged, Healthy Aging, Older Women and Health Services in English and Persian.

Increased population of older women and the feminization of aging is the result of the development and success of the health system. Poor aging management is a serious threat to health care, socio-economic and sustainable development systems. The differences in economic, social, demographic, and health indicators were more unfavorable in older women compared to older men due to different effects of health factors on women. The geriatric programs in Iran are often temporary without participation of the elderly, and are for managing individual, clinical, and case conditions. Provision of integrated care services is only at the first level of health and government services and lacks strategic, gender, and inter-sectoral approaches.

 Achieving older women’s health requires policy-making and planning at the levels of government, organization and service delivery with a gender justice approach. Interventions to achieve the goal should be elderly-centered, interactive, multi-disciplinary, continuous, participatory, coordinative at clinical, organizational and systemic levels with analysis, feedback, integrated information system, research and development. Training and employment of multi-skilled manpower considering the different needs of older women are recommended.

Aging is associated with an increased prevalence of chronic diseases and multidrug therapy, which increases the risk of drug side effects and changes in quality of life. With the increase of the world’s aging proportion, the quality and safety of prescribing drugs has become a global health concern. This study aims to determine the prevalence of Potentially Inappropriate Medications (PIMs) in the elderly in Qom, Iran according to STOPP (Screening Tool of Older Persons’ Prescriptions) criteria and its association with their Health-Related Quality of Life (HRQOL).

Methods & Materials:

 In this cross-sectional and descriptive-analytical study, participants were 783 older patients hospitalized in internal and surgical wards of selected hospitals affiliated to Qom University of Medical Sciences who were selected using a convenience sampling method. The instruments were a demographic/ health information form, Charlson Comorbidity Index (CCI), STOPP version 2, and the 15 D HRQOL questionnaire. The data were analyzed in SPSS v. 20 software using descriptive statistics and logistic regression analysis.

 The Mean±SD number of medications used by the elderly was 7.21±3.16, and 79.57% of patients had multidrug use. The CCI score of 29.9% was 4. The prevalence of PIM was 46.10% and the most common category of PIM were Drugs that adversely affect those prone to falls (13.79%), Duplicate Drug Class (12.39%), Central Nervous System and Psychotropics (5.36%). The Mean±SD score of HRQOL was 0.85± 0.12. Logistic regression analysis results showed that HRQOL (95%CI: 0.030-0.307, OR= 0.096), multidrug use (95%CI: 4.780-14.966, OR=8.46), and CCI (95%CI: 1.36-3.17, OR=2.079) had significant association with PIM use by the elderly (P<0.001).

 The use of PIM is a common health problem among the elderly and is associated with HRQOL, multidrug use, and CCI. Nurses should evaluate the elderly’s medication regimen to identify PIMs.

 Hypertension is one of the most common chronic diseases in old age. The self-care and quality of life of older people can improved by appropriate interventions. This study aims to assess the effects of an intervention based on 5A model on self-care and quality of life in the elderly with hypertension.

Methods & Materials:

 This quasi-experimental study was conducted on 80 older people with hypertension. They were randomly assigned into two groups of intervention and control. The intervention group received the 5A model-based treatment for two months, while the control group received only the routine care from community health centers. Before and after the intervention, data were collected using a demographic form, behavior subscale of the Hypertension Self-Care Profile questionnaire, and the Control, Autonomy, Self-Realization and Pleasure (CASP-19) questionnaire. The collected data were analyzed using independent t-test, paired t-test, Mann-Whitney U test, Chi-square test, and Fisher’s exact test in SPSS v. 20 software.

The Mean±SD self-care scores of the intervention group significantly increased (P<0.001) after the intervention (50.95±4.77) compared to pre-intervention score (46.67±5.83) and compared to the control group (40.92±4.86). The Mean±SD quality of life scores of the intervention group also significantly increased (P<0.001) after the intervention (39.02±6.76) compared to pre-intervention score (33.65±8.03) and compared to the control group (24.97±7.19).

 The intervention based on 5A model can improve self-care and quality of life of the elderly. This intervention, as a fast, accessible and easy method can be used in the health system to improve the health of the elderly.

One way to improve the social participation of the elderly is to pay attention to environmental adaptation, and ensure safety and independence of them in places they use. Due to the rapid growth of the aging population in Iran and considering the important role of mosques as one of the main religious-spiritual places for the elderly, conducting studies to determine the structural suitability components of the mosques in terms of geriatrics and ergonomics are necessary. Therefore, the present study aims to identify the structural suitability components of elderly-friendly mosques in Iran.

Methods & Materials:

 This is a qualitative study using the content analysis method conducted in 2020. Participants were 18 eligible older adults (13 women and 5 men) aged 61-72 years (Mean±SD age=66.33±2.99) attended the mosques of Babol city who had the ability to communicate effectively and the willingness to participate in the study. The mosques were selected based on the geographical distribution (in north, south, east, and west). The data collection method was in-depth and semi-structured interviews, which continued until data saturation. Each interview was transcribed and analyzed step by step according to Kvale’s method.

The extracted data were divided into 5 main categories and 18 subcategories as the structural suitability components of elderly-friendly mosques. Extracted main categories included: Outdoor Environment, Indoor Environment, Equipment, Basic Welfare Amenities, and Internal Facilities.

The identified components can help find and prioritize the needs and select the type of interventions to be conducted in the mosque according to the characteristics of the elderly.

Whole-Body Vibration (WBV) exercise seems to be an effective alternative to improve physical performance in the elderly. This study aims to compare the effects of eight weeks of WBV exercise combined with rope skipping at two different intensities on physical performance of older men.

Methods & Materials:

 This is a randomized single-blind clinical trial. Participants were 30 older men (Mean±SD age= 65.83±4.16 years; Mean±SD height= 169.26±3.90 cm; Mean±SD weight= 77.04±4.62 kg; Body Mass Index= 26.86±0.69 kg/m2) living in Mashhad, Iran in 2019, who were selected by purposive and convenience sampling methods and randomly divided into three groups: high intensity (HI; n=12), low intensity (LI; n=12) and control (n=10). The WBV exercise was performed at a frequency of 25-40 Hz and amplitude of 3 mm. Rope skipping was performed based on the Borg scale at 13-14 level intensities with 30-35 jumps per minute. Physical performance indicators, body mass index, and fat percentage were measured before and after eight weeks of intervention. Repeated measures analysis of variance was used for data analysis in SPSS v. 20 software. The significance level was set at P≤0.05.

In HI and LI groups, body fat percentage (-4.50%, -5.99%), lower body flexibility (105%, 102%), upper limb muscle strength (42.43%, 42.93%), handgrip strength (43.38%, 39.45%), dynamic leg strength (36.47%, 26.43%), lower limb muscular endurance (27.20%, 26.10%), cardiorespiratory function (10.27%, 10.90%), and dynamic balance (-32.60%, -24.10%) showed a significant improvement compared to the control group (P<0.05). There was no significant difference in body mass index between exercise and control groups (P>0.05), and no significant difference between the two exercise groups in any of the study variables (P>0.05)

It seems that low intensities of the WBV exercise + rope skipping is effective in improving body composition and physical performance in older men. The selection of intensity level depends on the physical condition of the elderly.

 The aging of the population in recent years in Iran has raised concerns among policymakers in various fields. Some economic theories consider the changes in the age structure and population aging as one of the important issues affecting the income inequality of societies. This study aims to assess the effect of population aging on the income inequality in Iran.

Methods & Materials: 

This study was conducted in 2020 using economic data from 1970 to 2018 extracted from the websites of the Statistical Center of Iran and the World Development Indicators. First, a model for income inequality was presented and demographic variables were considered in the model. Then, its coefficients were estimated using the AutoRegressive Distributed Lag method in Eviews 10 software. To evaluate the speed of adjustment from the short-run to the long-run equilibrium, the Error Correction Model (ECM) was estimated.

The increase in aging population led to increased income inequality in the long run such that 1% increase in aging index caused a 0.14% increase in Gini index (P<0.05). The literacy rate, trade openness, and the square of Gross Domestic Product (GDP) per capita had a negative significant effect, and GDP per capita and the Consumer Price Index had a positive significant effect on income inequality, both in the short and long term. The ECM value was reported 44.8%.

The aging of the population increases income inequality in Iran. Policymakers should reduce income inequality by investing in education and expansion of trading with other countries as well as stabilizing economic conditions, controlling inflation, and planning to reduce the effects of aging.

Healthy aging is a natural human right and emotion regulation is an important factor in improving mental health promotion in different developmental ages. This study aims to compare emotion regulation in older and younger adults.

Methods & Materials:

 This is a causal-comparative study. The study population includes all older and younger adults in Tehran in 2019. Of these, 235 were selected using a convenience sampling method. They completed Difficulties in Emotion Regulation Scale (DERS), Emotion Regulation Questionnaire (ERQ), Mentalized Affectivity Scale (MAS), and Emotion Regulation of Others and Self (ERO and ERS) questionnaires. Data analysis was performed using multivariate analysis of variance, independent t-test, and paired t-test in SPSS v. 20 software.

 The scores of DERS (F= 17.08, P<0.001), ERQ (F= 16.07, P<0.001), and ERS (t = -12.2, P= 0.35) were significantly higher in older adults than younger adults, while there was no significant difference between them in MAS (t = -1.29, P= 0.198) and ERO (F= 0.256, P= 0.614) scores.

The scores of DERS, ERS, and cognitive reappraisal subscale of ERQ are higher in older adults, but there is no significant difference between older and younger adults in the scores of MAS and ERO. Mental health professionals can take effective measures at the community level based on these findings to promote emotional health and psychological well-being of older people.

 Cancer is one of the leading causes of death among the elderly in the world. There are several factors involved in the development and progression of cancer. Therefore, knowing these factors and how they affect the cancer patient’s process can help in timely treatment of the disease. This study aims to evaluate the effects of admission age and Gleason score on the state transition in elderly patients with prostate cancer.

Methods & Materials: 

This is a historic cohort study conducted in 2018. The studied data are related to 125 elderly patients with prostate cancer (Mean±SD age= 72.12±7.32 years) who referred to the urology department of Imam Khomeini Hospital from 2004 to 2017 and underwent radical prostatectomy and were under different conditions (Radiation therapy, hormone therapy, or death) after surgery. The effect of admission age and Gleason score on the transition between states were tested using a multi-state model in R v.5.0 software.

 Those who underwent surgery and treatment remained 4.5 years in the local recurrence state, 2 years in the distant recurrence state, and 6.5 years in the death state. People who had surgery were 17% more likely to metastasize and accept hormone therapy; 8.8% more likely to have a local recurrence and accept radiotherapy; and 8% more likely to experience death. The effect of Gleason score on the change of state was not significant, but the age variable was effective transition from surgical state to hormone therapy.

 In elderly patients who have undergone radical prostatectomy, the risk of metastasis increases with age.

 In order to maintain and improve older adults’ health, the integrated and comprehensive geriatric care program has been developed and run by ministry of health. The present study was conducted to evaluate the effectiveness of this program on physical and mental health of older adults in Golestan province in 2019.

Methods & Materials: 

The present retrospective cohort study employed a multistage clustered random sampling technique to obtain 500 e-health records of older adults during 2017-2019. The data on blood pressure, depression, and BMI were extracted from e-health records. Data analysis was conducted using repeated measure anova, paired t-test and Wilcoxon tests. The SPSS statistics software v. 20 was used to perform data analysis

 Of the 500 cases studied, were male and female, respectively. The Mean±SD age of the participants was 69.97±7.45 years. The results of inferential statistics showed that the mean score of systolic blood pressure was significantly decreased through study period (P<0.001). However, through study period depression score was significantly increased (P≤0.05). There was no significant difference in BMI index.

 The results of this study showed that the integrated and comprehensive geriatric program was effective for controlling blood pressure, however was not effective for preventing depression. Therefore, stakeholders should pay more attention towards establishing appropriate program to improve older adults' mental health.

 Cardiovascilar disesases and sleep disorders are two major health problems common in old age. The aim of the present study was to examine the relationship between daytime sleepiness and cardiovascular indices among Iranian older adults.

Methods & Materials:

 A cross-sectional design was used. The sample included 321 older adults who were selected from primary healthcare centers in Kiar County, Chaharmahal and Bakhtiari Province, Iran, using Non-random sampling available method. The data was gathered after taking informed concent, using a demographic questionnaire, Epworth Sleepiness Scale, anthropometric measurements, and relevant paraclinical tests. Chi-squared test, Mann–Whitney U test, Kruskal Wallis test, and Spearman's correlation coefficient were used to analyze the data. All the analyses were performed using SPSS, version 23.

 The data showed 23.67%, 19%, and 7% of the participants had mild to moderate and severe daytime sleepiness, respectively. There was a significant association between daytime sleepiness and age (r=0.121, P=0.03). Moreover, significant positive correlations were found between daytime sleepiness and BMI (r=0.170, P=0.002), systolic blood pressure (r=0.235, P<0.001), diastolic blood pressure (r=0.216, P<0.001), abdominal obesity (r=0.293, P<0.001), and neck circumference (r=0.239, P<0.001).

 Given the positive relationships between daytime sleepiness and some cardiovascular health indices, daytime sleepiness assessment in primary healthcare services for the elderly, especially for those with a history of cardiovascular events, is suggested. More research to illustrate the cause and effect between these two is warranted.