فصلنامه سالمند
پیاپی 64 (زمستان 1400)

 Despite the growing population of the elderly in Iran, there is no clear picture of the prevalence of chronic diseases among them. Accordingly, the present study tries to specify the prevalence of the most important chronic diseases and multimorbidity among the elderly. In addition, the homogeneity of these diseases has been considered among different socio-economic groups.

Research data were obtained through a checklist of chronic disease status among the elderly. The sample was selected from the elderly over 60 years old in Tehran in 2019 through multi-stage sampling. The sample size of the study is 1280 persons and the prevalence rate and chi-square tests were used to describe and analyze the data.

The results showed that hypertension (40.2%), musculoskeletal disorders (40.2%) and hyperlipidemia (32.4%) had the highest prevalence rate among the elderly in Tehran. The prevalence rate of chronic disease multimorbidity was 79.8, which was lower among men, never married, college-educated, and working-age seniors. Cardiovascular disease, diabetes, hyperlipidemia, and ear diseases have also been found to have different prevalence rates among socioeconomic classes.

The prevalence of chronic diseases has varied widely among socioeconomic groups; so the importance of the socio-economic status must be accentuated. Therefore, the pattern of prevalence of some chronic diseases can be influenced by lifestyle. As a result, research and policy-making in this field should be based on the inequalities in socio-economic status.

Elderly patients are the largest and fastest growing group of patients under dialysis and their caregivers are faced with high burden care. Therefore, the present study was conducted to determine the predictors of caregiver burden among caregivers of older patients under hemodialysis residing in Qazvin province, Iran.

 This cross-sectional study was conducted on caregivers older patients under hemodialysis in 2020. The caregivers were selected by census method among eligible caregivers of older patients under hemodialysis referring to dialysis centers of Qazvin province, Iran. Data were collected using the demographic checklists, Zarit burden care Questionnaire, Bartell Scale, Multidimensional Scale of Perceived Social Support, general self-efficacy, and religious coping questionnaires. The collected data were analyzed by a multivariable regression model in SPSS 23.  

The mean and standard deviation of the age of 252 caregivers and older patients were 44.9 ± 13.16 and 69.4 ± 7.7 years old, respectively. The results of multivariate analyses showed that significant predictors of caregiver burden were perceived social support (β:0.333, p<0.05), disability (β:-0.137, p<0.05), health status (β=0.154,p=0.010), and financial level (β=0.154, p=0.010). As the caregiver burden was decreased by increasing the social support and decreasing the rate of disability. Furthermore, the caregivers with higher financial levels and better health status reported lower caregiver burden.

It can be concluded that enhancement of social support and more attention to the health of caregivers as potential patients are important factors for reduction of caregiver burden care.

Today, the issue of older adults’ well-being has become a serious challenge of policy-making and a key subject of researches. The complexity, multidimensionality, and multileveled nature of the concept of well-being have resulted in numerous objective and subjective indexes at the micro and macro levels. The aim of the article is to assess and measure  the well-being of Iranian elderly using the AgeWatch index. 

The method of the study was a secondary analysis of various data sources using Excel and SPSS 25 software in the methodological framework of the Global AgeWatch index. This method assesses the well-being of Iranian older adults at the national and provincial levels for 2016. The index provides a holistic view of older people's lives in four dimensions included income security, health status, capability, and the enabling environment.

The results indicated the significant provincial differences in the AgeWatch index and its various dimensions, especially income security, and health status. The AgeWatch index scores ranged from 6.5 in Sistan and Baluchestan province to 77.9 in Tehran province. In general, the highest rank goes to the provinces of Tehran, Semnan, and Fars, respectively, and the lowest rank goes to the provinces of South Khorasan, Ilam and Sistan and Baluchistan, respectively. The results showed a significant correlation between AgeWatch index and human development index in Iran. In addition, the results showed Iran is ranked 64th among 97 countries in AgeWatch index. Iran was the best in terms of health status (43rd) and worst in terms of capacity dimension (88th).

Economic and social policies supporting the employment, income, health, and independence of older adults play an important role in increasing the well-being and welfare of older adults. Therefore, dimensions of financial security, such as the development of universal coverage of pensions and poverty reduction, as well as capacity dimension, such as providing elderly self-employment and promoting the education and training of the elderly, should be a policy priority.

In elderly care provided by health centers, healthy elderly are neglected in care and education. This qualitative study aimed to standardize healthy ageing care.

This community-based participatory research with 4 steps (problem detection-design of change programs-implementation of interventions-evaluation) was conducted from 1395 to 1397 in Motahari Health Center of Mashhad, with the participation of 11 health care provider, 54 healthy elderly and 54 family members. The mean age of caregivers was 32.4±2.7 years and their mean work experience was 8.3 years. The mean age of the elderly was 64.3±‌3.9 years. Data were collected through SERVQUAL questionnaire, interviews, focus group discussions, and field notes. After identifying problems through interviewing 8 staff and 19 seniors, Group discussion sessions were held to design the program. After implementing the change plans, 30 interviews with the participants were conducted again and the comparisons were done and evaluated before and after the change plans. For qualitative content analysis, the method of describing reality was used, and for analysing quantitative data, descriptive statistics and paired t-test were used.

Designed program care could be improve healthy aging care in the health center environment by modifying attitudes, skills and staff empowerment. The mean score of quality of care for the elderly and their families in the pre-intervention phase was 63.02±‌9.46 and 61.83±‌9.05, respectively. In the post-intervention phase, these values reached 130.19±‌14.75 and 122.65±‌13.56, respectively, which were statistically significant (P=0.001).

The community-based participatory research promoted the quality of elderly services with features such as active, participatory, continuous, comprehensive and supportive care. So this model can be used in other health centers.

  It seems that psycho-physical factors of stroke patients undergoing tDCS treatment can affect implicit motor learning process in patient with stroke. The aim of this study was to determine the effects and adverse effects of tDCS on motor learning process in chronic unilateral stroke patients.

This crossover, sham-controlled, randomized, blinded study was conducted in 2020 on 12 patients with chronic unilateral stroke (mean age, 60.33±1.87 years), (The mean time elapsed since the onset of the disease, 1.96±1.36 years) referred to Mobasher Kashani clinic in Hamadan, Iran who were selected using a convenience sampling technique. Patients were randomly divided in to 2 groups: experimental (dual tDCS+SRTT) (n=6) and sham (sham tDCS+SRTT) (n=6) groups. After 3 weeks of washing out period, patients in each group were treated in other brain stimulation group again. Data were collected using the record of reaction time and error of sequenced blocks by related software. Also, adverse effects of tDCS, pain or discomfort, attention and fatigue of patients were assessed by visual analogue scale (VAS) questionnaire. The data were analyzed using linear mixed effects.

 Data analysis showed a considerable improvement in implicit motor learning in both brain stimulation groups. The most reported sensations were itching and tingling, which continued during all stimulation sessions. The pain or discomfort of the patients was negligible during the intervention sessions. Moreover, the type of brain stimulation, the time and their interaction had no significant effect on the fatigue, attention and pain of the patients (P>0.05).

Dual-tDCS technique does not cause serious adverse effects in patients with stroke. It can be used as an effective and useful therapeutic strategy for increase in implicit motor learning in chronic stroke patients.

 Frailty is characterized by an increased vulnerability to stressors. Frail older patients are at increased risk of Emergency Department (ED) visits, hospitalization, and disability. The aim of this study was to determine the relationship between frailty syndrome and polypharmacy in the elderly referred to the emergency department of Ardabil teaching hospitals.

 In this cross-sectional descriptive study, 505 elderly people referred to the hospital emergency department were selected by convenience sampling method. Frailty syndrome was measured using the five-item criteria of fried which include: 1) slow walking, 2) muscular weakness, 3) exhaustion, 4) low physical activity and 5) unintentional weight loss. Polypharmacy considered the use of 5 or more drugs. Data were analyzed using descriptive statistics including mean and standard deviation and inferential analysis including analysis of variance, independent t-test, correlation, and multiple regression using spss 22 statistical software.

The mean age of participants was 70.91±‌7.49 and 255 (50.5%) were male, 318 (63%) were married and 271 (53.7%) were illiterate. the results of the study showed that 204 (40.4%) of the elderly who referred to the emergency department had frailty and 177 (35%) had pre frailty. In this population, we identified a 42.2% (n=98) of frail with polypharmacy, 37.1% (n= 86) of prefrail with polypharmacy. The correlation test showed that there is a significant relationship between fertility and polypharmacy (p ˂0.001). Linear regression analysis showed the variables of age, education, living arrangement, hospitalization, and the number of medications used by the patient as predictors of frailty syndrome in the elderly referred to the emergency department.

Number of drugs used, age, education, living arrangement and number of hospitalizations were predictors of frailty syndrome in the elderly. Considering the living conditions of the elderly and the prevention of unnecessary hospitalizations can reduce polypharmacy and ultimately a preventive strategy to prevent and manage frailty. Of course, further research is needed to confirm the possible benefits of reducing polypharmacy in the development, reversion, or delay of frailty.

Fear of falling in the elderly can be a disabling disease that causes negative outcomes including reduced daily productivity, reduced physical activities, and lower quality of life. The present study evaluates effects of an 8-week training protocol with selected Fallproof exercises on fear of falling and quality of life in the elderly.

 This is a quasi-experimental study that initiated in 2019. Population of the study includes 53 elderly from nursing homes in Rasht, from among which 24 individuals aged 60-74 were selected using convenience sampling based on inclusion criteria. The subjects were randomly assigned to experimental (n=12،66/41±4/41(and control (n=12،66/16±2/40) groups. Fallproof exercises include a range of multisensory exercises (visual, vestibular, and somatosensory), center of gravity control, postural strategies, and power training including toe and heel walking, knee flexion and extension, adduction and abduction. Training intensity was increased based on overload principle and individual differences in an 8-week training protocol, three times a week for 60 minutes. Paired t-test and covariance analysis were used for intra-group and inter-group comparisons, respectively. Data analysis was performed using SPSS at significance level of P<0.05.

 Our results indicate that fear of falling P<0.001 and quality of life P<0.010 improved significantly in the experimental group while showing no differences in the control group.

It is concluded that Fallproof exercises significantly improve quality of life and reduce fear of falling in the elderly. This is observed in improvements in the experimental group. Considering multidimensional effects of Fallproof exercises and multifactor nature of fear of falling, these training protocols can be applied in rehabilitation programs in care centers for the elderly.

Considering the growth of the elderly population and the need of the elderly for health services and the importance of supplementary insurance on improving the quality of life of the elderly households, this study aimed to investigate the effect of supplementary health insurance on out-of-pocket payments for elderly households in urban areas of Iran.

 This descriptive-analytical and applied study was conducted at the national level using the two-stage Hackman econometric method in Stata 16 software in 2021. The sample size was 6171 elderly households which data was extracted from different sections of the cost and income questionnaire of Iranian urban households in 2019.

Increasing age, education, and employment of the head of the household, increasing household size, having a private home, increasing per capita health expenditures and income of household had a positive effect on the probability of purchasing medical insurance.Increasing the age, level of education and employment of the head of the household led to an increase in out-of-pocket payments for the elderly household by 61164, 84466 and 140032 Rials per month, respectively. Having supplementary health insurance, living in provinces with high human development and being an elderly head of household increased the out-of-pocket payments to 606207, 849739 and 109274 Rials per month, respectively.

 Elderly households were less likely than other households to purchase supplementary health insurance and having supplementary health insurance by an elderly household led to an increase in out-of-pocket payments compared to other elderly households. Therefore, to reduce out-of-pocket payments, increase coverage Insurance of health goods and services required by the elderly as well as reduction of the elderly franchise is offered.

 The global shift from infectious diseases to chronic diseases is a global problem that will reduce the quality of life and increase the need for services such as rehabilitation services and services related to disability. An important issue in relation to aging is preventive care and how it is managed in the world. This systematic review has conducted a comparative study on the management of preventive healthcare for the elderly in the world.

 This is a review study that was done comparatively in 2020. This study was conducted to model the existing policies and programs for the care of the elderly in the countries. To collect data, Persian and international databases as well as Google Scholar scientific search engine were used using appropriate keywords, and finally 200 suitable articles were identified. The studies were categorized and their management system was evaluated and differences and similarities were determined while comparing.

In the present study, it was found that 50% of the surveyed countries had insurance coverage for the elderly. 64% of the countries, management and organization of health prevention services at the national level, 7.5% local, 21.4% state-federal and 7.1% national. It was local. How to finance the provision of services for the elderly in 50% of the countries surveyed through taxes, 14.2% premiums, 7.1% national health system, 7.1 individual reserve funds and the rest of the countries through the payment of the federal government, health insurance and etc. In 50% of the surveyed countries, the providers of first level services were the public sector, 28.5% of the private sector and the rest of the countries were municipalities, government, etc.

The systems of elderly support and primary healthcare are intertwined in the main health system and function similar to the primary healthcare system of the country.

The goals of global growth of the elderly population and ensuring the health of the elderly is a global event and one of the most important challenges of the health system of countries, especially developing countries and Iran; In this regard, the study was conducted to explain the challenges of the Iranian health system in the face of future aging.

The study was qualitative content analysis. A total of 29 experts from various disciplines including geriatrics, psychology, social medicine, nursing, medicine, health and social welfare, health policy, health care management and health economics participated in the study. The data obtained from the semi-structured interview were classified by the content analysis method. Lincoln and GABA criteria were used to assess validity.

In identifying the challenges of the Iranian health system in the face of future aging Two general concepts including "policy challenges" including "barriers related to planning and implementation", "financial barriers", "vision barriers", "therapeutic barriers", "Health barriers", "educational barriers" and "individual social challenges" were identified, including "cultural value barriers", and "individual barriers".

The frequency and variety of challenges of increasing the elderly population in the country according to the findings of the study indicate the critical state of the health system in the near future. Identifying these challenges can be used by policymakers and planners for any planning and action.