فصلنامه سالمند
پیاپی 72 (زمستان 1402)

Andropause is the common term for menopause in older men, which is characterized by a decrease in testosterone levels. Many elderly men with andropause have difficulty or are embarrassed to talk about sexual topics, which causes a lack of information or wrong beliefs and attitudes towards this issue, especially among families. The existing studies in Iran have not had a deep and special attention on this issue. Therefore, this study aims to qualitatively investigate the factors affecting the quality of sexual life in Iranian elderly men with andropause. 

This is a qualitative study conducted in 2022 using the content analysis method. Using a purposeful sampling method, 14 elderly men with andropause were selected from among those who visited five health centers in different areas of Mashhad city in Iran. Data were collected using a semi-structured interview. Data analysis was done at the same time as sampling by using the conventional content analysis method. MAXQD software was used for data management. 

The mean age of the participants was 70 years. Eight men had primary education, three had middle school education, one had a high school diploma, and two were illiterate. The findings included 290 codes, 19 subcategories, 9 categories, and 3 themes. The themes were perceived sexual impotence, non-sexual feelings and experiences, and the desire to have an active sexual life. 

The result of in-depth interviews with the elderly with andropause showed the components that can be addressed by officials and researchers for facilitating appropriate planning in this area. The knowledge of the existing situation and how the affecting factors can be the basis of new studioes in this field.

Heart failure is one of the common chronic diseases in old age and is considered as a progressive and debilitating disorder. Nowadays, the use of supportive and non-pharmacological methods in disease management and empowerment of elderly patients is of increasing importance. This study was aims to assess the effect of a 5A model-based self-management program on self-management ability and dyspnea severity in the elderly with chronic heart failure.

This is a randomized controlled clinical trial that was conducted on 75 eligible elderly people with heart failure (Class II or III) in Babol, Iran. They were randomly divided into two groups of intervention and control. The intervention group received the self-management training program based on the 5A model for 12 weeks. The control group received the usual training. The data before and immediately after the intervention were collected using the self-management ability scale (SMAS) and the five-item modified Medical Research Council (MMRC) dyspnea scale. The collected data was analyzed in SPSS software version 24. 

The mean age of patients was 68.026±3.956 in the intervention group and 69.595±4.079 in the control group. There were no statistically significant differences between the two groups in terms of demographic and clinical characteristics. After the intervention, the total SMAS score and severity of dyspnea in the intervention group were significantly higher than in the control group (P<0.001). The difference was also significant in all subscales of SMAS between the two groups (P<0.001). 

Considering the positive effect of the 5A model-based self-management program on improving self-management ability and reducing the severity of dyspnea in the elderly with chronic heart failure, it can be used as a simple, low-cost, effective method, without the need to go to medical centers, to improve the quality of life of these patients.

Older people experience physical and psychological changes that can negatively affect their life satisfaction and result in unhappiness. Life review therapy can be an effective intervention in increasing the positive feelings and happiness of the elderly. This study aims to determine the effects of a life review therapy program on self-actualization and happiness among older adults. 

This is a quasi-experimental study with a pre-test/post-test/follow-up design. Participants were 22 elderly people aged ≥60 years referred to a daycare center in Tehran, Iran. They were randomly divided into two intervention (n=11) and control (n=11) groups. The perma flourishing scale and the Oxford happiness questionnaire were used to collect data before, immediately after, and one month after the intervention. The life review therapy was performed according to Haight and Webester’s protocol. The collected data were analyzed in SPSS software, version 26. 

There was a significant increase in the total mean scores of happiness and flourishing scores in the intervention group immediately and one month after the intervention (P<0.001), but no significant change was reported in the control group. The mean scores of happiness and flourishing in the intervention group in the pre-test phase were 50.27 and 98.63, respectively. In the post-test and follow-up phases, these scores reached 58.27 and 57.09 for happiness and 111.63 and 104.81 for flourishing, respectively. 

The present study shows that life review intervention in can provide an opportunity for flourishing and psychological development and also an increase in the level of happiness among older adults.

The impact of population aging on health expenditure is inevitable. It affects health expenditure by causing changes in people’s health status and the demand for health care services. In this study, we aim to investigate the age-related and gender-related differences in hospital admission rate, length of stay, and hospital costs of people in Iran.

This is a quantitative, descriptive-analytical study with a cross-sectional design conducted on data of 41 million Iranian people covered by the Iran Health Insurance Organization in 2020. Hospital admission rate, length of stay, and hospital costs were dependent variables. Hospital costs included insurance payments, patients’ out-of-pocket spending, and government subsidies. Age and sex of the patients, ownership of the hospital, type of patients’ medical files were descriptive variables. The Mann-Whitney U test was used to compare hospital costs between elderly (>60 years of age) and non-elderly (<60 years of age) groups and between females and males. Spearman’s correlation test was used to find the correlation between age and dependent variables. 

During the study period, there were about 3,800,000 hospital admissions. The rate of hospital admission in the elderly was 3.7 times higher than that of non-elderly groups. The average length of stay was 1.3 days for the elderly, and 2.2 days for the non-elderly. In the elderly group, men had a higher hospital admission rate than women, while in non-elderly groups, women had a higher admission rate. The average hospital cost was 28 million IRR for the non-elderly and 45 million IRR for the elderly. The average cost of surgery, hospitalization, medicine and medical consumables for the elderly was 1.5 times more than that of the non-elderly. There was a positive and significant relationship between the hospital admission rate and age of the patients (r=0.879, P<0.001). As the age of the patients increased, the length of stay in the hospital increased significantly (r=0.582, P<0.001). The relationship between patients’ age and the average hospital cost was also positive and significant (r=0.582, P=0.006).

Hospital admission rate, length of stay, and average hospital costs are significantly higher for the elderly in Iran.

Hospitalization is a vulnerable period for the elderly. During this period, they are at risk of falling. There are various clinical guidelines for fall prevention, whose usefulness depends on their quality and clinical acceptance. This study was to evaluate the methodological quality of selected clinical guidelines for fall prevention in hospitalized elderly people in Iran using the Appraisal of Guidelines, Research, and Evaluation (AGREE) checklist. 

A systematic search was conducted for clinical guidelines published from 2009 to 2020 using the keywords clinical guideline, falling, prevention, aged, and hospitalization. Of 351 clinical guidelines identified, 4 guidelines were selected based on the inclusion and exclusion criteria and by a purposive sampling method. The quality of the selected guidelines was evaluated by 5 experts independently using the AGREE II checklist. Based on the quality scores, the guidelines were categorized as “highly recommended” or “recommended with modifications”. 

The "Falls Assessment and Prevention of Falls in Older People", "Preventing Falls and Harm From Falls in Older People", and "Preventing Falls and Reducing Injury from Falls" were categorized as highly recommended, while the "Post Fall Multidisciplinary Management Guidelines for Western Australian Health Care Settings" was categorized as “recommended with modifications”. Therefore, they can be localized and used to reduce the risk of falls in hospitalized elderly people in Iran. The mean overall scores of 6 domains for the guidelines were as follows: 91. 1% for “clarity of presentation”, 86. 6% for “scope and purpose”, 83. 6% for “stakeholder involvement” 72. 08% for “editorial independence”, 71. 14% for “rigor of development”, and 66. 66% for “applicability”. 

Evaluation of the methodological quality of clinical guidelines using the AGREE tool should be done to be able to be used in clinical practice. It is recommended to use these tools in updating the current or future clinical guidelines to ensure their methodological quality.

The increase in the aged population, associated with various diseases and problems that threaten physical and mental health, as well as the social and economic developments and changes in individual and family lifestyles, have caused inappropriate emotional responses such as stress, anxiety and depression in the elderly in Iran. The present study aims to determine the relationship of perceived social support with sleep quality and mental health in elderly people referred to health centers in Tehran, Iran. 

This is a descriptive-analytical study with a cross-sectional design that was conducted on 420 elderly people referred to health centers affiliated to Shahid Beheshti University of Medical Sciences in Tehran in 2021, who were selected by a multi-stage random sampling method. A demographic form, the pittsburgh sleep quality index (PSQI), the depression anxiety stress scale-21 (DASS-21), and the multidimensional scale of perceived social support (MSPSS) were used to collect information. Data analysis was done using Pearson’s correlation test and descriptive statistics (frequency, percentage, mean, standard deviation, skewness, and kurtosis) in SPSS software version 25 and path analysis in EQS software, version 6.4. 

The findings indicated that 54.5% of the elderly had depression, 64% had anxiety, 49.3% had stress, and 91.4% had sleep disorders. A negative and significant correlation was found between perceived social support and mental health components (depression, anxiety, and stress) in the elderly (P<0.001). and also between perceived social support and sleep quality (P<0.001). 

Considering the positive relationship of perceived social support with mental health and sleep quality of the elderly in Tehran, there is a need to pay more attention to their perceived social support.

This study aims to assess the relationship of the meaning of life, self-compassion and perceived social support with the fear of aging in the elderly in Iran, mediated by spiritual well-being. 

This is a descriptive-correlational study with a cross-sectional design. The study population consists of the elderly aged 65-80 years in Ila, Iran. Using a purposive sampling method، 300 elderly (men and woman) were selected. The assessment tools included Steger et al. ’s Meaning of Life Questionnaires, Neff’s Self-Compassion Scale, Phillips et al. ’s Social Support Appraisals Scale, Lasher and Faulkender’s Anxiety about Aging Scale, and Paloutzian & Ellison’s Spiritual Well Being Scale. Data were analyzed using Pearson’s correlation test, descriptive statistics, and the maximum likelihood method (ML) in SPSS software, version 26, and structural equation modeling in AMOS version 24.

Participants were 140(46.77%) males and 83(28.33%) females. In terms of age range, 157 (53.33%) were in the age group of 65-69 years, 85 (28.33%) in the age group of 70-75 years, and 58 (19.33%) in the age group of 76-80 years. The values of path coefficients indicated that the meaning of life (39%)، self-compassion (43%), and perceived social support (27%) directly explained the changes in the fear of aging. The meaning of life and self-compassion variables were indirectly related to the fear of aging through spiritual well-being. Spiritual well-being did not statistically mediate the relationship between perceived social support and fear of aging (P>0.05). 

Meaning in life, self-compassion, perceived social support, and spiritual well-being can be used in educational interventions for the treatment of fear of aging in the elderly.

Age stereotypes, as common social beliefs about the aging process and the age groups, can have a considerable impact on the physical and mental health. Considering the lack of a reliable tool in Iran to measure age stereotypes, the present study was aims to investigate the validity and reliability of the Persian version of the age stereotypes questionnaire.

This is a descriptive-cross-sectional study. Participants were 360 elderly people over 60 years old in Kermanshah, Iran, who were selected based on the inclusion criteria using a convenience sampling method. Participants completed the Persian versions of Kornadt and Rothermund’s age stereotypes questionnaire and Kaspar et al.’s awareness of age-related changes (AARC) questionnaire. Data analysis was done using descriptive statistics and confirmatory factor analysis in SPSS software, version 26 and AMOS version 24. The significance level was set at 0.05.

The mean age of participants was 67.66±5.88 years. Participants were 175(48.6%) males and 185(51.4%) females. In assessing internal consistency, Cronbach’s alpha for the subscale of family and partnership was obtained 0.871; for the friends and acquaintances subscale, 0.842; for religion and spirituality subscale, 0.747; for leisure activities and social or civic commitment subscale, 0.774; for personality and way of living subscale, 0.809; for financial situation and dealing with money-related issues, 0.846; for work and employment subscale, 0.859; and for physical and mental fitness, health and appearance, 0.874. The results of confirmatory factor analysis showed that the eight-factor model had a very good fit. The results of Pearson’s correlation test showed that the subscales of the age stereotypes questionnaire had a positive and significant correlation with the two subscales of the AARC questionnaire.

The Persian version of the age stereotypes questionnaire has good validity and reliability for older adults. It can be used in future studies in Iran to examine the relationship between age stereotypes and other important variables related to old age.

During the outbreak of the infectious diseases, the elderly are at a higher risk. The future wheel model can help understand the different dimensions and effects of these diseases. The present study aims to determine the different effects of the emerging infectious disease pandemics on elderly people based on the experiences from the COVID-19 pandemic in Iran using the future wheel model.

In this qualitative expert-oriented study conducted in 2022, the second version of the future wheel was used to identify the effects in three steps. First, the effects were extracted by brainstorming method with a panel of experts (the Aging Committee of the Research Institute for Future Studies in Health, Kerman, Iran). Then, the effects were analyzed with the STEEP method and in interaction with other two panel of experts. In the next step, the effects were examined, and after reaching a consensus, the future wheel of the effects and their time horizon was provided.

In this study, 81 effects of the emerging infectious disease pandemics on the elderly were identified in 6 dimensions of socio-psychological (n=25), technological (n=3), economic (n=7), environmental (n=1), political (n=3), and health (n=38). Of these, 10 opportunities and 9 threats and their time horizons were extracted. 

The outbreak of the emerging infectious diseases such as COVID-19 can leave multi-dimensional effects on the elderly in the world including Iran. We can take advantage of the experiences of facing the COVID-19 pandemic and consider the requirements and solutions for dealing with similar pandemics in the future.

Due to the increase in the aged population and the need to improve their health and quality of life, the demand for social services and health care has increased. The present study e aims to investigate the willingness to work with the elderly and the related factors among Iranian dental students.

This descriptive-analytical study was conducted in 2021. The study population consists of all male and female students in dentistry from the Islamic Azad University, Tehran Dental Branch. Of these, 287 were selected by a purposive sampling method. The Willingness to Work with elderly people scale, with 20 items and 4 subscales, was used for data collection. Due to the COVID-19 pandemic, the data was collected online. The collected data were analyzed in SPSS software, version 23 using the independent t-test, multiple linear regression analysis, and one-way analysis of variance.

The mean age of students was 23.9±3.807 years, and the mean score of willingness was 51.69±13.004. Having the gerontology course did not have a significant effect on increasing the willingness (P>0.05). The willingness level was significantly different in terms of experience working with the elderly, visiting senior care and rehabilitation centers, attending conferences and workshops about gerontology, and voluntary activities (charities) for the elderly (P<0.001).

The Iranian dental students’ willingness to work with the elderly is not favorable. The students with experience working with the elderly, visiting senior care centers, or attending workshops or conferences on gerontology are more willing to work with the elderly. Therefore, designing educational courses and holding workshops or conferences on gerontology for dental students can be effective in increasing their willingness to work with the elderly.