Elderly Health Journal

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Introduction: The decline of visual function with increasing age is a significant concern in elderly. Despite previous work on prevalence of specific ophthalmic pathologies, there has not been enough valid data about overall eye disorders in Tehran yet, and it is poorly defined and not underpinned by strong evidence. The purpose of this study was to investigate the common eye disorders in the elderly population of Tehran.

Methods: A total of 392 elderly community residents aged 60 to 96 were enrolled. The 278 older adults referred to Tehran’s Polyclinic of 6th Region of municipality and 114 older adults referred to the health centers of 9th Region of municipality between 2013 and 2014 were examined. All participants underwent an extensive ophthalmologic screening examination including cataract, diabetic retinopathy of optic nerve, macular degeneration, and glaucoma. The prevalence of various eye disorders was calculated as percentages of the total study population and categorized by age and sex.

Results: Of the 392 participants, 152 subjects (38.8%) had no eye disease. Common visual impairments in elderly were cataract (39.3%), macular degeneration (11.5%), diabetic retinopathy of optic nerve (5.6%) and glaucoma (4.8%). It has also showed cataract prevalence increased with age from (6.3%) in the 60-64 age group to (47.6%) for the patients 85years of age and older.

Conclusion: Cataract is the most frequent eye disease in community dwelling older adults that should be considered at a younger age by health officials to provide preventive programs. Improving accessibility to surgery for the treatment of cataract among the old people will help diminish of untreated cataract that lead to visual impairment.

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Introduction: Leisure activities are common among the elderly, however the effect of such activities on their mental health is poorly defined and not underpinned by strong evidence. This study aims to determine the prevalence of leisure activities and its relation to mental health in the elderly.

Methods: A cross- sectional study was conducted and 400 community dwelling older adults 60 years and more with appropriate cognitive function (Abbreviated Mental Test score 7 and more), were recruited through multi-stage stratified cluster sampling in Tehran, Iran. Data was gathered by demographic questionnaire and General Health Questionnaire (GHQ). The primary outcomes to measure were the prevalence of leisure activities, and GHQ score in subgroups. Data were analyzed by Kolmogorov-Smirnov test, ANOVA, independent t-test and multiple linear regressions.

Results: Of participants 62% were in their 7th decade (60-74 years), 56% (224) were female with mean age of 66.98 ± 8.22 , and 44% (176) male with mean age of 66.98 ± 8.22. GHQ scores showed 65% of participants had good mental health (0-23) and 35% had mental health problems (24 and more). Mean of GHQ score in participants (n = 377) was 21.8 ± 11.37 (0-28). watching television (77%), reading books ( 40.3%), walking (31.5%) and taking trip (36%) were more interesting leisure activities among older adults .Women, single, unemployed, alone and illiterate older adults had statistically significant(p ≤ 0.05) upper GHQ scores. Participating in active leisure activities such as taking trip and cultural classes, participating in non-government organization activities, going to parks and gym and walking had significant relationships with good mental health (p ≤0.05). 

Conclusion: Encouraging older adults to participation in active leisure activities would be an effective intervention in mental health improvement. On the other hand understanding of relationship between type of leisure activities and mental health, provides evidence for policy makers and health care planners to offer and facilitate a context in which older adults can improve participation  in active leisure activitie.

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Introduction: Iran and its aged society are facing some issues that significantly impact the current social structures in Iran. It will continue to do so on their growing as elderly with negative impacts on communal relations and unjust distribution of resources based on a gender basis that will affect the aging in place (AiP). The study aims to investigate the AiP within aged people and modifying role of the gender variables within it.

Methods: This study describes the current AiP of the aged people in Ahwaz city in the southwest Iran from a gender perspective. The population available for the study was citizens 60 years of age and older (N=51594) in Ahwaz city. Sampling method was cluster-ratio based on municipal zones, ethnicity, and gender with sample size 382 (195 male and 187 female). The data were analysed by descriptive statistics, F-test and geographical information system.

Results: Economically poor situation of the aged samples especially aged women, and their health status was moderated by low quality of nutrition and high prevalence of chronic conditions. For example, Arabs, Persian and Lor received low mean scores of 59.41, (SD = 7.332), 58.09 (SD = 11.963), and 57.02, (SD = 7.963) respectively in the health status. AiP characteristics are poor and discrimination was especially significantly prominent among elderly females. Multiple regression were found to modify AiP at the first step. The Generalized Linear Model revealed that gender-ethnic discrimination directly affected AiP and high prevalent amongst elderly minority females.

Conclusion: The current urban environment, in the southwest Iran, seems is unable to meet healthy needs of aged people. It needs to adjust upon gender and other relevant characteristics to monitor equality of outcomes for aged and minorities. The future research needs to focus on effect of ethnicity and gender-related issues on AiP, especially in developing countries like Iran.

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Introduction: Food habits play important roles in maintaining physical and mental health and preventing chronic illnesses in the elderly. The aim of the present study was to investigate dietary behaviors of elderly people residing in Yazd city which is located in central Iran.

Methods: The present analysis was conducted on 1684 participants entered to Yazd Health Study aged over 60 years during 2014-2015. Demographic characteristics, health status, physical activity, economic status, education and dietary behaviors were collected by using a validated questionnaire.

Results: Our analysis revealed that only 1.2% of the elderly consumed more than two servings of dairy per day. Furthermore only 3 and 9.8 percent of elders consumed more than three servings/day of vegetables and fruits, respectively. The study also showed that 22.9% ate more than five servings of sugar per day, 22.5% took more than four units of legumes weekly, 56.1% ate two to three servings of poultry per week, 77% reported eating fast foods for at least once a week, 47.8% consumed canned foods less than once a week of and 86.3% reported taking breakfast for at least five times a week. For cooking 18.9% of elderly still use hydrogenated vegetable oils, 52.8% of the elderly did not separate visible fats from red meat before cooking, 65.8% chose high-fat dairy and 24% of older people reported using frying and grilling as their primary cooking method. Our findings also suggest that dietary behavior is different between elder men and women.

Conclusion: Unhealthy dietary habits, including low vegetables, fruits and dairy products intake, are highly prevalent among elderly people residing in Yazd. Community based interventions targeting this age group, in order to improve their dietary intake, are highly recommended.

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Introduction: Most of the older adults have to be hospitalized and patients’ satisfaction from the provided services is one of the key performance indicators in healthcare centers. Feeling satisfied with the treatment process and provided services can motivate the elderly patients to continue their treatment, which ultimately leads to a reduction in the disease load and disability in older adults. The aim of this study was to examine the satisfaction status of elderly patients admitted in different wards in Yazd Shahid Sadoughi Hospital of provided services in winter 2015.

Methods: This was a cross-sectional study in which, the elderly patients who were hospitalized in different wards of Yazd Shahid Sadoughi Hospital were investigated. Totally, 100 patients entered in the study through convenience sampling during the winter 2015. A modified Persian version of patient satisfaction questionnaire III was applied for data collection. To analyze the data, In addition to descriptive statistics, in inferential section student-t and Pearson and Spearman correlation coefficients were applied.

Results: The mean score of total satisfaction from hospital services of Yazd Shahid Sadoughi Hospital was 65.4 (range 0-100). There was a significant positive relation between the different domains of satisfactions. It was only the financial aspects which was not in relation with other domains. The highest score of the patient satisfaction belonged to the technical quality (73.7) and nursing services (69.6) and the lowest score was in the communication domain (48.7). The score of satisfaction in financial aspects was lower in men than women (p < 0.05).

Conclusion: Most of the elderly patients had little satisfaction with the communication. Medical students and staff should consider good communication while delivering services to the elderly, and provide adequate information to help them decide which treatment pathway is suitable.

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Introduction: Old people appear to be most prone to loneliness and depression perhaps because of decrease in their ability in daily livings, increase in morbidity, loss of close ties caused by loss of friends and spouses. This study was conducted for investigation of the loneliness and its related factors in elderly people in Yazd.

Methods: In this cross sectional study, 200 old people (over 60 years old) from three zone; health centers, nursing home and retirement center by convenient sampling method. Data was collected by UCLA Loneliness Scale that was consisting of 20 items for loneliness measurement. Scores 41 and more defined as loneliness. Collected data was analyzed by proper statistical tests with SPSS software.

Results: Results showed that 71 % of subjects had Not Feel Lonely, 24 % moderate and 5 % severe felling of loneliness. Factors such as level of education, marital status, numbers of daughter and sons, previous job, residence site, current job status, living in nursing home, insufficient income, place of praying, sleep quantity and quality of sleep and feeling of healthy were associated with  loneliness status (p < 0.05).

Conclusion: Our findings showed loneliness is common in elderly that support needs for more investigations and attention to loneliness related factors, educational courses conduction for family to take care of their elders, preparing of recreational measures and social support groups to decrease the loneliness in old people and so they spend this period by good and healthy sensation. 

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Introduction: Alzheimer’s disease (AD) is a chronic condition characterized by gradual decline of mental abilities and behavioral disorders, which decreases the quality of life in elderly people. The aim of this study was to evaluate behaviors that may prevent elderly people from AD in Yazd.

Methods: This cross-sectional study was conducted on 220 people aged from 60 to 70 years in Yazd. Cluster random sampling method was used for selecting the participants. Data collection instrument was a researcher-made questionnaire that included demographic information and questions on AD preventive behaviors (physical activity, mental activity, nutrition, and social interaction). The score range of each part and the overall behavior score was from zero to 100. Data were analyzed by SPSS statistical software and application of descriptive and inferential statistical methods.

Results: The mean score of preventive behaviors was 44.6. The highest mean score (56.48) was for nutrition while the lowest mean score (32.03) was for mental activity. Only 15 % of the studied elderly consumed fruit regularly in their diet, which was followed by consumption of vegetable, 11.4 % and fish 9.1 %. There was a significant positive correlation between education level and behavior score (p < 0.001). However, there was no statistically significant gender difference (p > 0.05) in mean scores of the overall behavior and scores of married older adults compared to those of divorced or single, had a statistically significant difference (p = 0.007).

Conclusion: The overall AD preventive behaviors in elderly are undesirable, remarkably as noted in physical and mental domains. The majority of participants did not regularly have fruits, vegetables, and fish in their daily and weekly diets. Numerous socio-demographic factors affect these behaviors. More studies are required to identify barriers of healthy behaviors.

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Introduction: Due to the Increasing elderly population and the high prevalence of psychological, social and physical problems among them, this study was conducted to determine fear of falling and social participation status among elderly people in Mobarakeh city, Isfahan province, Iran in 2016.

Methods: This was a cross-sectional study in which 300 elderly residents of Mobarakeh city were randomly recruited by cluster sampling. Data collection tools were demographic questionnaire, Falls Efficacy Scale-International form and social participation scale of Canadian Community Health Survey. Mini Mental State Examination also was used to diagnose cognitive disorders. Data were analyzed with SPSS software using t-test, ANOVA and Pearson correlation coefficient.

Results: The mean age of participants was 70.83 ± 8.68 years and the mean score of fear of falling was 33.25 ± 16.37 (16-64). Regarding the fear level, 22.3 % had no fear, 34.3 % low fear, 20 % moderate fear, and 23% a high fear of falling. Mean score of social participation was 16 ± 4.63 (8-40). The most frequently reported social participation activity was attending religious ceremonies (99.7 %) while the least was attending professional and social forums (79.3 %). There was an inverse significant correlation between fear of falling and social participation (r = -0.421, p < 0.01).

Conclusion: Level of fear of falling in the elderlies was moderate while social participation was low. By using preventive measures, effective education, psychological and social interventions, disease-control programs and removing the existing obstacles, the fear of falling could be reduced and social participation could be promoted among the elderlies. 

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Introduction: Nutrition is an important determinant of health in the elderly. Older people are more susceptible to malnutrition that leaves adverse effects on their health. This study aimed to evaluate the nutritional status of the community-dwelling elderly in Tabriz City.
 
Methods: This cross-sectional study was conducted among non- institutionalized older people in Tabriz, Iran. A total of 1041 older adults (506 men and 535 women) were randomly selected based on Probability Proportional to Size sampling method. Data collection and evaluation of nutritional status using Mini Nutritional Assessment Short-Form, were conducted in the participants’ households.
 
Results: Of all participants, 2.5% (CI 95%; 1.7-3.6) suffered from malnutrition, 26.7% (CI 95%; 24.1%-29.5%) were at risk of malnutrition, and 70.8% (CI 95%; 68.0%-73.5%) had normal nutritional status. Malnutrition and risk of malnutrition were more prevalent in elderly women than men (malnutrition: 2.6% vs. 2.4%, risk of malnutrition: 30.3% vs. 22.9%, p = 0.024) and in single than married elderly (3.9% vs. 2.0%, p < 0.001). Moreover, it had an upward trend with increasing age and decreasing educational level.
 
Conclusion: Although most of the elderly people were nutritionally in normal status, a significant proportion were at risk of malnutrition that strengthens the need for designing and implementing appropriate interventions to improve lifestyle and prevent malnutrition in the elderly people.

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 Intestinal parasites (IP) are one of the most significant causes of infections among the eldely in developing countries, especially in tropical areas. Trichuris trichiura and Ancylostoma duodenale infect near 2.3 billion people, especially in elderly in all around the world (1). Intestinal protozoan like Giardia lamblia, Entamoeba histolytica and Cryptosporidium parvum are widespread in old people too and in addition to this mentioned IP, Ascaris lumbricoides, Taenia saginata, Enterobius vermicularis and Hymenolepis nana are other most reported IP in them. IP repeatedly was reported among old people in whole the world because of their easily transmission ways and due to debilitation of old people’s health system. A large number of affected elderly people by IP are living in nursing home and elderly care centers especially with poor sanitary and high population density highly prone to these contaminations. On the other hand, by looking at the elderly care centers in our country, unfortunately it seems that the some of them have poor sanitary conditions. in a study by Rasti et. al. to determine the prevalence of IP in elderly and handicapped people in a governmental nursing home in Kashan with 243 residents, 191 people (78.6%) were infected at least by one IP. A total of 11 types of IP was detected in this survey with Blastocystis hominis as a protozoan and Strongyloides stercoralis as a helminth highest prevalent IP in this center (2). Other developing countries also have a similar situation as our country. In a similar research by Shakya et. al. in rural areas of Nepal, from 235 elderly sampled people (41.7%) were infected by just one IP, and 30.6% had multiple parasitism (3). In general, physical problems and low personal hygiene along with dysfunction or malfunction of immune system, intestinal flora change, reduction of intestinal motility and finally achlorhydria make old people more prone to several infections cause by IP too. (4,5)

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Aging is reviewed by a variety of disciplines; demographers, sociologists, economists, health scientists, and politicians. However, there are still great disputes over aging because of its economic roles, and health expenditures. Several questions about aging should be answered. Is aging an illness? Are aged people a burden to community? Is it a threat, or an achievement? (1).
There are opposite views, either clinically or economically developed with regard to these questions, about aged people’s health and their health expenditures. Clinical view of aging is determined by dominance of chronic disease. These types of illness, was believed to belong to developed countries, well-to-do class, and aged populations. Today, however, developing countries, working class, and even young generation are suffered from theses illnesses (2). Aged people are neither homogeneous nor suffer similar pattern of illnesses. Moreover, gender and sex affect the health status of men and women differently. Apparently in old ages, socio-economic and gender gaps, are widen because of feminization of elderly and poverty.

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Introduction: One of the most important causes of chronic diseases in elderly people is lack of physical activity. Studies have shown that lack of physical activity in the elderly causes osteoporosis, obesity, depression and sudden death from cardiovascular disease, type 2 diabetes and colon cancer. The aim of this study was to determine the effect of an educational intervention on knowledge and practice of physical activity among the rural elderly in Zabol city.
 
Methods: In this semi-experimental study, 200 elderly people over 60 years of age living in rural areas of Zabol city who were selected by multi-stage random sampling were divided into two groups: intervention and control. The data collection instrument was a researcher-made questionnaire that comprised 3 parts: demographic and background variables, knowledge and practice. Before the intervention, the questionnaires were completed by intervention and control group. The educational content for the intervention group was the Healthy Lifestyle Handbook and face-to-face training which included a practical representation of six smooth movements. However, no intervention was performed in the control group. After 2 months, the same questionnaire was completed again and the data were analyzed using SPSS software.
 
Results: Before the intervention, there was no difference in the mean score of knowledge and practice of the participants, but these differences were significant in the post intervention (p < 0.001). The mean of knowledge and practice scores in the control group in pre-intervention stage was 35.17 ± 2.05 and 6.24 ± 2.82, respectively, Which was 35.59 ± 1.82 and 5.91 ± 2.64 in the post-intervention phase, respectively, But the mean score of knowledge and practice in the intervention group in pre intervention stage increased from 35.6 ± 2.47 and 6.73 ± 3.43 to 37.85 ± 1.38, and 12.83 ± 9.09 in the post-intervention phase, respectively.
 
Conclusion: Educational intervention is effective in increasing awareness and overall level of physical activity among the elderly.

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Introduction: Balance in the elderly is one of the important issues, and imbalance can create irreparable problems for the elderly. The aim of this study was to investigate the effect of Frenkel balance exercise and aerobic exercise (walking) on improving the balance of elderly patients in Kerman province in 2016-2017.
 
Methods: We used a randomized block design, with 4 participants in each block; 48 elderly men and women living in the nursing homes of Kerman province were randomly assigned to two groups, balance (Frenkel) exercises and aerobic exercises (walking). The two groups performed Frenkel exercises and aerobic exercises (walking) for three 10- to 15-min sessions a week for five weeks. The balance time using the Sharpened Romberg test was recorded to measure static balance and the Get Up and Go test used to measure dynamic balance before and after the exercise program. To describe the variables studied, central tendency indicators and dispersion were used. Paired t-test was used to compare the time of balance before and after intervention and independent t-test to compare changes in balance time between two groups.
 
Results: The mean static balance (with Sharpend Römberg test) was increased from 3.16 s to 6.01 s in Frenkel exercise, and from 3.33 s to 4.95 s in aerobic training group, indicating an improvement in the static balance after intervention. The mean time of dynamic balance (in the Get Up and Go test) during Frenkel exercise reduced from 17.07 s to 12.03 s, and during aerobic training from 17.08 s to 10.9 seconds, indicating an improvement in dynamic balance (p < 0.01). However, there was no significant difference in the mean changes in the duration of dynamic and static balance before and after intervention in the two groups.
 
Conclusion: Both Frenkel exercise and walking equally improve static and dynamic balance in the elderly in different settings.

 

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    Home health care is a wide range of health care services that can be given in your home for an illness or injury (1). During last decade, home health care is taken into consideration seriously. The concept of home health care began in the 1850's when traveling health care professionals provided in-home visits to patients in need of health care and unable to seek such care on their own (2). Now, these cares are used primarily to provide long-term care (3). In the inadequate access to these services in the home, the care of seriously and chronically ill elderly and terminal patients is frequently relegated to hospital and long-term care facilities, or to traditional home nursing services supplemented by episodic emergency room visits and crisis hospitalizations (4). This can be costly for governments, insurance companies and families as well as elder people prefer take care at home.
    Elderly health in Iran is of newly established issues (5, 6). Elder people have several needs such as insurance, psycho-social support, and health services which means that home health care services are an inevitable necessity. For example about wound care for pressure sores or a surgical wound, patient and caregiver education, intravenous or nutrition therapy, injections, and monitoring serious illness and unstable health status (1).
 

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According to a report by world health organization (WHO) in 2018, the population of the elderly over 60 years will double from 2015 to 2050, and will increase between12% to 22%. Also, in 2050, 80 % of the elderly will be from low and middle-income countries. Though population changes toward aging has begun from developed countries such as Japan, but in the middle of the 20th century, the elderly population of Iran has reached a notable level. WHO considered hearing loss, cataract and refractive errors, back and neck pain and osteoarthritis, chronic obstructive pulmonary disease, diabetes, depression and dementia as common public health problems of elderly population .It also noted environmental, social and physical conditions of individuals including homes, neighborhoods, and communities as factors of healthy aging due to their significant influence on the development and maintenance of health behaviors
 

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Introduction: Falling is one of the most common problems of the elderly people with a multi factorial nature and frequent cases. This study aimed to determine the risk factors of falls in old people covered by Mashhad University of Medical Sciences.
 
Methods: This retrospective case-control study was conducted on 15,600 elderly participants. Data were extracted from Sina Electronic Health Record System (SinaEHR^®, Iran). The obtained data were analyzed using STATA through odds ratio formula.
 
Results: Risk factors of falls in the elderly subjects included age, fear of falling, higher body mass index, diabetes, anemia, gastrointestinal problems, hypothyroidism, use of sedatives, and smoking, after adjusting the potentially confounding effects of other variables.
 
Conclusion: The current study provides evidence that patient-related factor such as diabetes, anemia, hypothyroidism and smoking are associated with falls in the elderly. The results of the present research can be used by health policy-makers to reduce fall-related costs of the old people by focusing on care services and high-risk individuals.

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Introduction: Fatigue is one of the most common causes of disability in most elderly people affected with diabetes. Considering the growing population of this group, the present study aimed to determine the effect of warm foot bath on the fatigue of the elderly people with diabetes.
 
Methods: The randomized clinical trial study was carried out on 66 elderly diabetic patients who had referred to the Diabetes Research Center in Yazd. Eligible participants were selected by convenience sampling and randomly divided into two experimental and control groups. Participants of the experimental group performed a warm foot bathing for 20 minutes during two weeks. The Piper Fatigue Scale was completed in three steps (at the beginning of the study, two and four weeks after intervention). Data were analyzed by SPSS software, using ANOVA for repeated measures, independent t-test, Chi-Square and Fisher exact test.
 
Results: The mean ± standard deviation of fatigue in the three phases of evaluation in the experimental group was 5.91 ± 0.81, 4.80 ± 1.19, 4.55 ± 1.57 and in the control group was 5.95 ± 0.97, 6.06 ± 1.13 and 5.79 ± 1.33, respectively. The difference in the mean of fatigue scores in both groups after the intervention was significant (p < 0.001).
 
Conclusion: Revealing the positive effects of warm foot bathing, this method, as a non-pharmacological and easy-to-use method, is recommended to improve fatigue condition in the elderly patients with diabetes.

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Introduction: As rapid urbanizing spreads throughout Thailand, the combination of urban-rural lifestyle has been gradually found. These changes may effect on health pattern of the older adults. This study was aimed to explore the incidence of health problems and life styles of the elderly in urban-rural areas.
 
Methods: A random interview survey with qualitative approach was used. Data were randomly collected from 14 areas in central sub-districts of Nakhonratchasima province, Thailand. Twenty-five older adults in each area were interviewed. The recording forms consisted of demographic data, perceived health status and health problems, medication use, activities of daily living, instrumental activities of daily living, mental health, social and religious activities, and accommodation and environment. Non-invasive physical examinations of the elderly were performed by weighing, measuring height and testing muscle strength with one leg standing.
 
Results: Most of the elderly reported having at least one chronic disease and/or degenerative problems that had impact on their daily lives. Forty percent rated their health status as moderate to poor, 18% encountered falls while 18% were hospitalized in the past six months. Only one-third underwent an annual health check–up while 30% of the female had cancer cervix screening. Most of the elderly could perform daily tasks on their own with assistive instruments and were healthy in mind. However, many of them drank tap water without boiling or filtering.
 
Conclusion: The older adults in the urban-rural areas had access to health care services and had a good health status. However, their health promotion and prevention behaviors are questionable.

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