فصلنامه سالمند
پیاپی 9-10 (پاییز و زمستان 1387)

Over the past two centuries, the rapid socio-economic transformations along with substantial advances in medicine have resulted in decrease of mortality rate, the significant increase of life expectancy, and the growth of the population aging. In despite of the increased proportion of elderly in the recent periods, their status has significantly decreased. Elderly in the traditional societies had high levels of mastery and authority, especially power, wealth, and prestige. In the light of these assets, they were able to play the vital role in both family and society. However, experiencing rapid changes in the society and family at the present time, the status of elderly is no longer as high as before. The falling trend of elderly's status in the modem societies has resulted in the formation of such stereotypes as elder are not able to take part actively in society. It is important to find exact responses to such questions as whether elderly are useless? and how society can profit their potential and actual abilities? In this regard, the first step is the investigation about roots of decreasing status of old people in the modem world. Overall, the literature review shows that the followings are amongst the most important factors affecting the status of elderly in the modem societies: the decreasing importance of traditional values to control social interaction, the increasing role of mass media and new forms of information technologies to transfer knowledge and science, the decreasing demand to elderly' participation in economic activities, the substantial decreasing in the family size and the emergence of nuclear family, the decreasing responsibilities and duties of family as a social institution, the increasing trend of women employment, the increasing generational gap, the increasing value of youth and beauty, and changing the architecture of residences. Since aging is a multidimensional phenomenon, every effort to empowerment of elderly and increasing their status is necessitated to coordinate and cooperate of all social, economic, political, legal, and medical institutions.

After age of 65, annually 10 percent of older adults> loss their independent in one or more daily task. Because of decreasing changes in neuromuscular system that is important factor in loss the balance and walking ability in this group of people. In according to these sentences, the aim of this research was to the comparison of mental, physical and mixed practices on static and dynamic balance in health older adults.Methods & Materials: The study is semi-experimental with pre and post test design and three experimental groups. Statistical sample included 60 older adults> with age range of 60-70 years from Shahre-kord, that randomly divided to three experimental groups. In this research, the Stroke stands test (standing with one leg) were used to measure the static balance and Star Excursion Balance Test (SEBT) test was used to measure the dynamic balance. After 8 session of training, subject of each group participated in post test that similar to pretest. The data were analyzed by one way ANOVA and Tukey post hoc and in order to detect the homogeny of variances, Leaven>s test was used in level of P<0.05.

Statistical results in three training methods (mental, physical and mixed) in static and dynamic balance showed significant difference between groups performance in post test. Further, result of Tukey post hoc show that there is significant difference between mixed group with other groups (P<0.001) and subjects in this group had a better performance than other groups. Furthermore, the performance of physical practice group was better than mental practice group (P<0.029).

according to result of percent study that show improvement in static and dynamic balance in mixed group, it could be concluded that, for increase in muscle strength in lower extremity and promote older adults> balance by strength training, coaches and related affairs can use this training method in their specific programs for older adults.

This study was under taken to consider the effect of strength training on some kinematics parameters of gait (step length, cadence and speed walking).Methods & Materials: Twenty-four healthy elderly women (with average and standard deviation age of 61.53±2.84 years, height of 157.1±5.5 cm, weight of 69.13±7.6 kg and BMI 28.1±3.6 kg/m) participated in this study. The strength of lower limb assessed using leg press test. The subjects were randomly divided in to control and experimental group. Video camera, 3DMax, Premier and Photoshop soft ware’s were used to measure speed walking, cadence and step length before and after training program. The control group continued their daily activity, while experimental group were in eight weeks for strength training for lower limb and body stabilizer muscles. Within group differences using T-test for independent groups and between group differences were analyzed using by T-test for dependent group before and after training at significant level of 0.05. The changes of speed walking and lower limb strength werent significant in control group. While significant differences observed in step length and speed walking and lower limb strength in experimental group. In comparison between groups, except of cadence, step length, speed walking and lower limb strength showed significant increase in experimental group. The results confirmed the effectiveness of strength training and increasing lower limb and stabilizer muscles strength on step length and speed walking in healthy elder women.

Verbal instructions related to directing the focus of attention to the movement itself or to its effects on or outcomes in the environment affects learning and performing movement skills. The pattern of these effects differs with increase in task difficulty. The goal of this study was to explore the effects of support surface and attention focus on the balance in elderly.Methods & Materials: Twenty-eight elderly (65 & older) with a history of one or more falls in the last year were participated in the study. The design of the study was two factors within group with repeated measures. Participants were tested in two conditions of moving and stable support surface and three conditions of baseline, internal, and external focus of attention. Difference in support surface from stable to moving (i.e. increasing task difficulty) generally decreased the level of performance. There was a strong interaction between conditions off support surface and conditions of attention focus (P<0.001). The maximum decrease in performance happened in internal focus of attention/moving support surface and the minimum decrease occurred in external focus of attention/moving support surface. The effectiveness of the external focus of attention was most significant and more beneficial to the balance performance in the moving unstable support surface (increased task difficulty) than other conditions of attention focus. The interesting finding was that not instructing at all is more effective on balance performance than internal focus of attention instruction in elderly people with a history of falling.

The Parkinson's disease is a progressive phenomenon that effort for maintain of independence in functional and self-care skills is considered as one of the most important aspects of their life. PASS (Performance Assessment of Self Care Skills) evaluates the activities of daily living (ADL), instrumental activities of daily living (IADL), and functional mobility (MOB) of the patients. Validity and reliability of this test has been evaluated in few disabilities and it has never been performed on patients with Parkinson's disease. The purpose of the present study was to assess the validity and reliability of PASS in evaluating the self-care skills of patients with Parkinson's disease.Methods & Materials: PASS was first translated into Persian and' after minor modifications, was given to 5 specialists (all were occupational therapists) along with a questionnaire especially designed for this purpose. For the purpose of testing the reliability 50 patients with Parkinson's disease aging 45-85 years were no randomly selected from 5 geographic regions of Tehran. The test and retest was performed on 2 consecutive days using the PASS manual for evaluating the self-care skills of the patients for 3 aspects of independence, safety, and outcome. Pearson correlation coefficient was measured between the results using SPSS 11package. There was a significant agreement (P=95%) between the scores of 5 specialists in all 3 aspects of independence (X2=5.83, DF=4), safety (X2=5.44, DF=4), and outcome (X2=2.45, DF=4). Pearson correlation coefficient for test-retest results was 93%, 91%, and 91% for independence, safety, and outcome respectively (P=0.01) which is indicative of very high reliability of PASS for evaluating self-care skills of patients with Parkinson's disease. The results of the present study indicate that PASS is highly valid and reliable in evaluating the self-care skills of patients with Parkinson's disease. These results were not unexpected in the sense that' as long as the standards of test performance are observed, there should be no difference between the test-retest results of the same patient performed in 2 sessions. One other important aspect is patient education and familiarization with the test procedure. This aspect was tried to be effectively observed during the tests. It can be concluded from the results of this study that PASS is an appropriate tool for assessment of the self-care skills of patients with Parkinson's disease by rehabilitation specialists including occupational therapists.

The most common indication for abdominal surgery in elderly (65 & older) is gallstone disease.The elderly are more prone to complication of such surgery due to their other co-morbidity and thus they may benefit mostly from a safer method of surgical procedure. The purpose of this study was to evaluate the safety and outcome of laparoscopic cholecystectomy in elderly compare to the conventional method.Methods & Materials: Via prospective study from June 2005 to March 2008 included all patient older than 60 years of age who underwent cholecystectomy by open (Group A) and laparoscopic (Group B) method in Milad Hospital.The demographic data (sex age), American Society of Anesthesiologists’ (ASA) score, postoperative mortality morbidity, length of stay and operative time were recorded for each patient and were compared between two methods. Data of patient’s analysis by SPSS with chi-square and t test.

The study included 311 elderlies (34% men and 66% women). Hundred fifty-seven patients underwent open cholecystectomy; 154 patients underwent laparoscopic cholecystectomy. The mean age was 7141 years. The outcome in group B (laparoscopic) included: morality 0%, morbidity 2%, postoperative hospital stay 1 days, mean operation time was 40 minutes. In group A(open): mortality and morbidity rate were 21% and 12% respectively with postoperative hospital stay 331 days and similar operation time as group A.

Laparoscopic cholecystectomy is the gold standard treatment and safe procedure in elderly patient and aging is not considered to be a contraindication laparoscopic surgery in such patients.

Among the elderly patients who are admitted in emergency departments, there is a sub-population of frail elderly who needs particular attention. The purpose of this study was to explore relationship between Barthel index and clinical outcome in elderly patients aged over 60 during a week follow up after initial admission.Methods & Materials: The method was a prospective cohort study. Fifty men and 56 women patients who were admitted in emergency department and met our inclusion criteria (age over 60 and having consent) were included in the study. All patients had been followed for 4 weeks after initial admission. During the follow up period, 81.1% of total patients were discharged home, 8.5% were still hospitalized and 10.4% were died. The result showed that for every extra unit of total Barthel index, the chance of discharging home in comparison with death is increased by 20%. More over; for every one year patients aged more, total Barthel index is decreased by 23% of score unit. The findings of this study suggest that the elder patients with less Barthel index score are more likely to experience death and bad clinical outcome and need particular attentions.

Awareness of elderly patient's experiences of myocardial infarction can assist to identify their need, problems, as well as promote their quality of lives. However, there is a little information about how elderly people experience myocardial infarction. This study aimed to explore elderly patients experience with myocardial infarction and their coping strategies.Methods & Materials: This paper is a part of a larger grounded theory. Eight old age patients (65+ years) with first time myocardial were interviewed as purposeful and theoretical sampling. Semi-structure interviews were used for data collection. Data collection and analysis were simultaneously conducted using Strauss and Corbin's grounded theory approach. The trustworthiness of data is confirmed through Lincoln and Guba' s criteria. Elderly patient's experiences of myocardial infarction were categorized as two main themes include: living in the shadow of fear, live with limitation, and their coping strategies namely as return to active life. Living in the shadow of fear is consisted of sub themes named fear of death/reinforcing, fear of physical inability, and fear of dependency on others. Live with limitation composed of feeling of physical incapacity, bodily symptoms, and adherence of medical regimen/family. Return to active life includes positive thinking and self-reliance. Elderly people with first time myocardial infarction experience severe stresses and more limitations due to suddenly threatening their lives and health. Adopting positive coping strategies could facilitate return to normal life and promote their quality of life.

The world population is graying increasingly and in the most countries, aging is seen as a critical issue. Aging is a natural process In human life and comes out from gradual erosion of vital organs. age, sex and ethnicity as individual factors and social, cultural and economical traits influence the aging time and grade. as the elderly quantity and number increases, attention to living quality in the elderly and determine of influential factors to correct and comprehensive policy making regarding this people has an importance. In this article we study the quality of life status in district's 2 elderly (Tehran).Methods & Materials: Study is a cross-sectional, analytical type that needed information has gathered by elderly specific questionnaire (lipad) and background variables checklist, in a 100 person sample. Kolmogrof and Smimof's (K-S) test and One Way Anova and T-test have used for data analyzing. Sample comprised from 70 men and 30 women and the most of subjects were between 60-70 years old, (M=70) for men and (M=69) for women. There was an significant difference between men and women in all dimensions of quality of life (P<0.05) and the men were high in all dimensions of quality of life. those who were married and high educated and had their own housing were high in quality of life. The elderly quality of life is under the influence of various factors that determining and finding of those factors, is very important in better planning regard to this class of society and their empowerment.

The purpose of this study is to assess disability among older persons, 60 years old or older, helping policy makers and program planners concerned elderly issues to provide proper services.Methods & Materials: The study included 600participants were chosen in a systemic classified cluster using 36-Item Interviewer Administered, without day codes version of world health organization disability schedule II (WHODAS II). It was assessed by comparing the converted points of the initial five scale points into one hundred scale points as the algorithm method presented by the WHO. Data analyzed by SPSS 11.5 with Chi- square, Mann- Whitney and Kruskal- Walis tests. Mean score of disability among older persons was 33.3(SD=25.9), men 33.0(SD=28.1) and women 33.6(SD=23.8). There was no significant difference on mean scores between men and women (P>0.05), but there was significant difference between age groups (P<0.05). Mean scores increased dramatically with increasing age groups. The greatest scores belonged to domains; Getting around, Life activities and Participation in society respectively. In comparison with other research the mean score of disability among older persons who lived in Tehran was high, especially in domains has mentioned above. Therefore it is necessary to pay more attention to prevention and treatment of diseases, disorders and impairments which caused disability on the right time. Also it is required to provide aid equipments and physical adaptation to decrease disability in the elderly.