نشریه سالمندشناسی
سال ششم شماره 4 (پیاپی 23، زمستان 1400)

In recent years, the effect of cognitive exercises on improving gait parameters has been studied, but the effects of these exercises on coordination inter-joint of the lower limbs have received less attention. Therefore, the aim of this study was to investigate the effect of dual task motor-cognitive training on inter-join coordination during walking in elderly with balance impairment.

30 elderlies with the mean age of 73.8 participated in this study. The elderly's functional balance score (Berg) was lower than 52, and the Mini Mental Status Exam (MMSE) was higher than 23. These individuals were purposefully divided into two groups, the experimental group participated in 24 training sessions after the pre-test and the control group engaged in normal daily activities. To assess the inter-join coordination, the participants had to walk a 12-meter path and the coordination was recorded at the sagittal level in four gait cycle by vector coding. The data were analyzed by repeated measures and one-way ANOVA at the significance level of p < 0.05.

The findings of this study showed that after training, the amount of coupling angle has decreased in most gait cycles. The greatest effect of dual training in the experimental group is in the loading response and push off (p <0.05). Some temporal characteristics of gait, such as walking speed, were also significantly improved by dual task training (p <0.05).

According to the results, it can be concluded that the dual task training had improved the coordination characteristics between the lower limbs joints. This change in coordination with the improvement of some temporal parameters was a sign of increased balance and better posture control in the elderly with balance impairment.

Falls are one of the most common and serious problems in the elderly, having a threatening consequence for them. Therefore, finding the most effective nursing interventions to maintain the health and safety of this age group is very necessary, so this study was conducted to investigate the nursing interventions performed in field of the elderly falling.

By searching the databases; SID, IranDoc, Google scholar, PubMed, Medline, Scopus, Cochrane Library, Science Direct and using the keywords "Elder", "Prevention", "Intervention" and "Fall/Falling"; all articles examining nursing interventions in prevention of falling in older adults, were included in the study. Electronic search was performed during 2015-2021. From 72 studies which were reviewed and screened, 20 studies were evaluated and analyzed based on inclusion and exclusion criteria for data extraction.

Findings of 20 selected studies showed; falling is one of the most important harmful factors for older adults that have adverse effects on their health status. According to the findings, making the environment safer, performing periodic examinations, teaching safe and self-care behaviors to the elderly, adjusting medication and exercising are the most effective steps to reduce and moderate the risk of fall in the elderly.

According to reviewed studies, despite the fact that old age, due to physical and mental limitations, puts older adults at a higher risk of falling, but with a set of measures, the risk and injury extent can be reduced. Maintaining the elderly health and preventing their injuries is one of the most important health care providers’ duties and can provide a dynamic and qualified period for them, so trying to find effective interventions to prevent and reduce risk of falling in these people should always be considered.

 Physical activity can slow down the body's destructive process in old age. The aim of the present study was to determine the effect of eight weeks of home-based Otago exercise on balance, quality of life and fear of falling of the elderly.

 26 elderly people over 60 years old in Arak city participated in this semi-experimental study voluntarily and were randomly divided into experimental and control groups (each group includes 9 women and 4 men). The experimental group performed Otago exercises for 8 weeks 3 sessions per week for 60 minutes each session. The control group had a normal routine during this period. Static and dynamic balance, fear of falling and quality of life were assessed using 4 stage static balance test and timed up and go test, Falls Efficacy Scale-International Questionnaire (FES-I) and Older People’s Quality of Life Questionnaire (OPQOL-35), respectively. Statistical analysis was performed using analysis of covariance test and SPSS software version 22 (P<0.05).

 The results of statistical analysis showed a significant improvement in static (P<0.001) and dynamic balance (P<0.001), quality of life (P<0.001) and fear of falling (P<0.001) in the Otago compared to the control group.

 Due to the limitations of the elderly to perform physical activity outdoors, especially in the pandemic conditions of Covid-19 disease and the positive effects of performing Otago home-based exercise in the present study, it is recommended to use this training method to increase the quality of life and balance and reduce the fear of falling of the elderly.

Ageism and ageist behaviors can significantly affect health care. Medical professionals should offer health care to all patients equally and patients should not be discriminated under any positions based on sex, nationality, sexual identity, or age.This study aimed to investigate the development and psychometric properties of self-directed and other-directed ageism scale in care settings.

This research is an exploratory sequential mixed method study.This study was carried out from 2018 to 2020. The qualitative phase of the research was conducted using directed content analysis based on Sao Jose's theory. 20 hospital caregivers were recruited using purposive sampling. Data were collected using semi-structured interviews. Data analysis was performed using Hesie and Shannon content analysis method. The quantitative stage of the study was conducted for instrument psychometric. Psychometric properties of the scale also investigated using face validity and content validity, construct validity and reliability by internal consistency and consistency.

95 items were obtained from the analysis of qualitative section .  After calculating the item impact index, 23 items were removed.  In the assessing of content validity ratio and content validity index 27 and in the initial analysis by loop method two items were removed.The result of exploratory factor analysis was two factors: "self-directed ageism" and "other-directed ageism". Which all togheter could explaian 41.373 of the variance. The final scale after the psychometric measures had a content validity ratio of 0.62, Cronbach's alpha coefficient of 0.90 and intra-class correlation of 0.98.

 The analysis of research data showed that the designed scale has acceptable validity and reliability. Therefore this scale can be used to measure ageism in care settings and lead to the development of knowledge in relation to this phenomenon.

Prescribing medication for the elderly is an important health issue and improper prescribing of medication is associated with side effects and requires more care. The aim of this study was to determine the amount of potentially inappropriate drugs prescribed to the elderly admitted to teaching hospitals in Ilam.

The present descriptive cross-sectional study was conducted in 2020 on the ward of patients admitted to teaching hospitals in Ilam city, which was selected by regular (systematic) random sampling. Patients aged 60 years and older with complete medical records were included in the study, The beers2019 criterion was used to evaluate the prescribing of potentially inappropriate drugs. In order to analyze the data of SPSS software version 22 and descriptive and inferential statistics were used.

mean age of 71/29 ± 8/45. The rate of prescribing potentially inappropriate medications in the study population was 40. 7%. Pain Medication (26. 7%) are the most common potentially inappropriate medications groups. Aspirin (11. 1%) and ketorolac (10. 8%) are the most common potentially inappropriate medications. There was a statistically significant relationship between the type of elderly insurance and the prescription of potentially inappropriate drugs.
Discussion and

The rate of prescribing potentially inappropriate medications in the study population was 40. 7%. Potentially inappropriate medications are more common in older women than men. Our findings showed the necessity of developing scientific guidelines for drug use, promoting the criteria for drug prescription and enhancing physicians' knowledge, which can result in careful monitoring of the drug regimens of the elderly. Moreover, supervisions by Ministry of Health and Medical Council of Iran can play an important role in improving the current situation. The work history of physicians and their relationship with prescribing potentially inappropriate drugs was not investigated due to lack of accurate, complete and comprehensive information.

Following the increase in the rate of population aging in Iran, the life quality of the elderly in need has also been the focus of the government and support institutions. The purpose of this study was to design a model to improve the life quality of the elderly in need under the support of the Imam Khomeini Relief Foundation in Fars province.

This research has a qualitative inductive approach and has an applied orientation which has been done by content analysis method. The statistical population of the study consists of university professors in the fields of social sciences and sociology, as well as managers and social workers active in the field of elderly working in the relief committee. The statistical sample of the research was selected by purposeful method and up to 18 people were selected up to the theoretical saturation stage. The required data were collected through semi-structured interviews with open-ended questions.

The results show that "maintaining physical health and providing mental health", "skills training and employment", "providing livelihood and biological needs", “adaptation of physical places and spaces of the living environment "," maintaining intergenerational cultural balance”, "providing and planning for leisure time", "providing emotional support and social communication".

The most important comprehensive themes needed to improve the life quality of the elderly, and considering their effects on public health and socio-economic status of society, accurate understanding of the issue of poverty in older and the discourse about it is one of the most important issues in any country.

Aging is one of the critical periods of human life that with this event, the gradual process of destruction and weakening of various organs of the body is accelerated. About half of older people over the age of 60 have metabolic syndrome. Therefore, the aim of this study was to investigate the effect of resistance training with body weight on inflammatory markers in elderly women with metabolic syndrome.

In a quasi-experimental study, 18 elderly women with metabolic syndrome were randomly divided into two groups: resistance training with body weight (n = 9) and control (n = 9). The resistance training program with body weight included 12 movements and was performed for 8 weeks and three sessions per week. Kolmogorov-Smirnov test was used to evaluate the normality of data distribution and correlated t-test was used for statistical analysis. Calculations were performed at the significance level (p <0.05).

The results showed that 8 weeks of resistance training with body weight caused a significant decrease in serum CRP levels (p <0.009) compared to pre-test values ​​in elderly women with metabolic syndrome. Also, the results showed that in the resistance training group with TNF_α body weight (p <0.0001) after 8 weeks of resistance training was significantly reduced. No significant difference was found in any of the indicators in the control group.

Resistance training reduces inflammatory factors in elderly women with metabolic syndrome. It is possible that this type of exercise improves the health and well-being of the elderly by reducing the inflammation caused by the metabolic syndrome, while improving this condition.

It is essential understanding causes of falls among the older adults in order to design effective interventions; therefore, the aim of the present study was to investigate the role of muscle weakness in balance and postural instability among older adults with and without a history of falls.

This was a systematic review of articles that were published during the years 1986 to 2021. These articles investigated the role of muscle weakness in balance and postural instability among older adults with and without falls. The search process was performed in intentional databases of PubMed, Web of Science, Cochrane Central Register of Controlled Clinical Trials, Google Scholar, and Scopus as well as Persian databases of Magiran, Irandoc, IranMedex, MedLib, using equivalent Persian keywords. Besides, a manual search and full review of article references was performed.

According to the inclusion and exclusion criteria, 23 articles entered the final review phase. Eighteen of the above twenty-three studies reported that lower-limb muscles play an important role in balance and postural stability, and five articles investigated the role of lower-limb muscles in balance and falls among the older adults.

It seems that muscle weakness is a risk factor for falls among the older adults. Both the distal and proximal muscles of the lower limb play an important role in the balance and fall among the older adults. Studies showed that upper-limb muscles play a more important role in balance, postural instability, and falls among the older adults than uper-limb muscles. Therefore, to prevent muscle weakness-related falls among the older adults, training programs should be considered to increase the muscle strength and thus to reduce the risk of falls in this age group and increase the number of active older adults in the society.