فریده باستانی

Background & Aims :

Aging is associated with decreased physical and psychological functions. This study aims to investigate the ability to perform basic and instrumental activities of daily living (ADL) in elderly women with osteoporosis in Tehran, Iran.

Materials & Methods:

 This is a cross-sectional study conducted on 130 elderly women over 60 years of age referred to selected hospitals affiliated to Iran University of Medical Sciences in 2019-2020, who were selected by a consecutive sampling method. The data collection tools were a demographic form, the Barthel index for ADL, and the Lawton-Brody Instrumental ADL scale. The data was statistically analyzed in SPSS software, version 20.

Results :

The mean age of the women was 67.5±5.7 years. None of them had dependency for performing ADLs such as eating. The highest dependence was for urination (54.62%). Regarding instrumental ADLs, the highest inability was related to shopping (60.77%), and the lowest inability was related to managing one's own medication use (0.77%). The scores of basic and instrumental ADLs were significantly related to age and educational level (P<0.001).

Conclusion:

 More governmental, family and social support is needed for elderly women with osteoporosis (with older age and educational level) who have lower ability to perform their basic and instrumental ADLs.

The present study aims to determine the fear of COVID-19 in the elderly newly diagnosed with cancer referred to selected hospitals affiliated to Alborz University of Medical Sciences.

In this longitudinal study, 174 elderly people newly diagnosed with cancer referred to the selected hospitals participated, who were selected using a continus sampling method. To collect data, a demographic form, the Abbreviated Mental Test, and the 7-item fear of COVID-19 scale were used before diagnosis, one month after, and two months after. The data were analyzed in SPSS software, version 22.

Fear of COVID-19 level at the time of cancer diagnosis was moderate (mean score: 17.69±4.74). In the second stage (one month after the diagnosis), the mean score was 14.26±4.09. In the third stage (two months after diagnosis), the mean score was 11.81±4.13. Fear of COVID-19 at the time of cancer diagnosis was significantly different based on marital status (P=0.049), underlying diseases (P=0.014), and perception of health (P=0.004). 

Fear of COVID-19 can disrupt the process of treatment and chemotherapy in elderly patients with cancer. It is recommended to develop interventions to improve the mental health of the elderly with cancer during the pandemic.

Wrist fractures are the most common arm fractures in older adults. The impact of wrist fractures of older women as family care givers has been less studied than that of other types and so, less is known about the factors related to the quality of life of these fractures. This study is aimed to assess the quality of life of older women as family caregivers with wrist fractures.

A descriptive cross-sectional study included 200 older women aged 65 or more as family caregivers with wrist fractures in selected medical centers affiliated to Iran University of Medical Sciences, 2022 through continuous sampling. The data collection tool included the demographic characteristics form and the IOF QLQ quality of life questionnaire. Data analysis was done using descriptive and inferential statistical methods in SPSS-20 software.

The results showed that the mean score of the total quality of life of the subjects was 44.22 ± 20.41. The quality of life of 43.5% of the participants was bad and the quality of life of other participants (56.5%) was good. Poor economic status with a standard coefficient of 0.208 was the most related factor to the variable of the quality of life of the elderly women.

Despite the fact that about half of the women had a good quality of life, a significant percentage of the remaining women had a bad quality of life, which could probably be due to a low pain tolerance threshold or inability to perform activity of daily living which need family and social support.

The emerging diseases such as coronavirus disease 2019 (COVID-19) can cause a serious stress, fear, and anxiety in the elderly. This study aims to determine the perceived stress and fear of COVID-19 in the elderly referred to comprehensive health centers in Tehran, Iran.

In this descriptive cross-sectional study, 260 older people aged >60 years referred to two comprehensive health centers (130 from each center) in the west of Tehran participated, who were selected by cluster and stratified sampling methods. Data collection tools were a demographic form, the Perceived Stress Scale, and the Fear of COVID-19 Scale. Descriptive and inferential statistics were used to analyze the collected data in SPSS Software, version 20.

The mean score of perceived stress was 41.5±10.19, indicating high level of stress in the elderly. This variable had a statistically significant relationship with age, underlying disease, and self-perceived health (P<0.001). The results of the Scheffe post hoc test showed that perceived stress was significantly lower in married subjects, those with no underlying disease, and those with self-perceived health score of 5 or higher. Fear of COVID-19 with a mean score of 23.45±9.35, was also higher among the elderly.

The perceived stress and fear of COVID-19 are high among the elderly in Tehran, Therefore, a proper planning by the health system policymakers for this group is necessary during the pandemic.

 Due to the complexities of self-care in the elderly with chronic kidney failure, with information based on scientific evidence and appropriate health planning, the elderly with self-care and self-management of the disease from others will lead to a healthier life and a better quality of life. Therefore, this study aimed to determine self-care in the elderly with chronic renal failure referred to selected educational and medical centers of Iran University of Medical Sciences in 1399.Procedure: This study was a cross-sectional (descriptive) study. The study population was the elderly with chronic renal failure referred to selected educational and medical centers of Iran University of Medical Sciences. Two hundred ninety-two people initially stratified sampling with proportional allocation, and Then the continuous method was used in the centers. Data were collected using the short cognitive test form (AMT), demographic form, and Chronic Kidney Disease Self-Care Scale (CKDSC). Data analysis was performed using SPSS software version 20 in two sections, descriptive statistics, and inferential statistics, and the significance level of the test was considered p≥0.05.

 The results showed that the mean age of the elderly participating in this study was 69.3 ± 7.7 years. The mean of self-care in the elderly was 66.20 ± 6.06, and the highest score was for better self-care. It should be noted that the questionnaire did not have a poor, average, or good rating. 61.3% of the elderly received more than average self-care and 38.7 less than average. According to the maximum score of 72 in the present study, the elderly had good self-care. Among the demographic characteristics, the level of self-care had a significant relationship with the variables of employment status (0.001 ≥p), Duration of illness (p = 0.01), and gender (0.002). Among the demographic characteristics, the level of self-care had a significant relationship with the variables of employment status (0.001 ≥p), Duration of illness (p = 0.01), and gender (0.002), and the variables of employment status were one of the most effective roles for self-care 

 According to the results, it can be acknowledged that employment status, Duration of education disease, and the number of conditions are the underlying variables affecting self-care in the elderly were studied. Therefore, it is necessary to consider demographic variables in educational and counseling planning that can be intervened to increase the self-care of the elderly with chronic renal failure. It contributed to their health and quality of life.

Peripheral neuropathy due to chemotherapy is one of the serious complications of chemotherapy and its negative effects on various aspects of patients' lives can not be denied. The aim of this study was to determine the quality of life of the elderly with peripheral neuropathy due to chemotherapy in selected educational and medical centers of Iran University of Medical Sciences in 2016.

The present study was a cross-sectional (descriptive) study. The study population was the elderly with chemotherapy-induced peripheral neuropathy referred to the educational and medical center of Iran University of Medical Sciences. 170 people were selected by continuous sampling method. Data collection tools included demographic characteristics form and Lipad quality of life questionnaire (LEIPAD) and research data were completed during 3 months (from September 1399 to November 1399). Data were analyzed using descriptive and inferential statistics using SPSS software version 16 at a significant level (P<0.05).

The average quality of life of the elderly based on the total score was 59.37 14 14.29 (high quality of life) and based on zero to one hundred was equal to 63.84 15 15.37. The highest score was related to the mental function dimension with a score of 86.06 19 18.19 and the lowest score was related to sexual function with a score of 9.5 18 18.11. The results showed that the quality of life of most elderly people was at a high level (81.8%). Quality of life of the elderly with gender (P=0.003), comorbidities (P=0.045), income adequacy (P=0.002), employment status (P<0.001) and duration of illness (P=0.019) had a statistically significant relationship. The results of linear regression showed that the variables of employment status (unemployed) (P=0.041), duration of illness (P=0.033) and comorbidities (P=0.030) significantly affected the quality of life of the elderly Has had an impact. Findings showed that 0.22% of changes in quality of life can be explained by independent variables.

Considering that the research samples were more than the young elderly group, ie between 60 and 74 years old, and were not very old and disabled, and a significant percentage of them were married and benefited from family support, far from It was not expected that their quality of life would not be overshadowed and assessed as desirable, despite facing a cancer crisis, chemotherapy intervention, and neuropathic symptoms. However, the quality of life in the sexual dimension was poorer, which requires counseling interventions and more attention from health planners.

Successful aging is a positive inner feeling and satisfaction from the past and present life. The subjective meaning of successful aging focuses on the inner dimensions of the aging experience such as happiness, self-fulfillment, emotions, perceived social support, satisfaction, and vitality in life. Perceived or subjective social support refers to individualchr('39')s cognitive evaluation of their relationships, and studying and evaluating perceived social support is closely related to self-assessment of health, and paying attention to its understanding is of utmost importance in health care. One of the variables that effect successful aging, and improves health and quality of life of the elderly, is mental vitality which is somehow tied to the concept of psychological well-being and this concept refers to being positive, full of energy and cheerful. In other words, there is a very close relationship between mental vitality and happiness and social interactions. All of these states are positive and favorable concepts and are therefore associated with positive emotions and mood, which are very important in old age. Today, with the increase in the number of the elderly and the prolongation of life and life expectancy, efforts are being made to identify the components and factors associated with successful aging that guarantee a better quality of life, to provide an accurate sociological picture for proper health planning for the elderly. Therefore, the aim of this study was to determine successful aging in the dimensions of perceived social support and mental vitality in the elderly referred to the health centers of Iran University of Medical Sciences in 2020.

This is a descriptive cross-sectional study. The research samples included 245 elderly people referring to the health centers of Iran University of Medical Sciences (in Tehran) in 2020 who were selected by continuous sampling method and entered the study after obtaining informed written consent. Data collection tools included Abbreviated Mental Test form (AMT), elderly demographic characteristics form, Multidimensional Scale of Perceived Social Support developed by Zimmet, and Mental Vitality questionnaire developed by Ryan & Frederick. The questionnaires were completed in person and by interview (conducted by the researcher) during three months. Data were analyzed using descriptive statistics (frequency distribution tables and numerical indices) and inferential statistics (independent t-test, variance, Pearson correlation coefficient, and regression) in SPSS 16 at the significance level of p ≤0.05.

The results of the present study showed that the mean age of the elderly was 68.18 ± 6.25 years. In total, (55.5%) of the subjects were women. Most of them were literate with undergraduate and postgraduate education and about (76.5%) were married and over (80%) had social security insurance. More than half of the surveyed elderly (53.4%) considered their current health status better than their peers and (96.8%) stated that they were able to perform their daily tasks and activities independently without the help and supervision of others. (66.8%) of the elderly surveyed considered religion to play a significant role in reducing stress and 51.4% stated that they were very satisfied with their lives. Perceived social support was at a high level for (65.6%) of the studied units. This component was the highest in the family dimension with an average of 22.76 and the lowest in the friends dimension with an average of 16.24 among the dimensions of perceived social support. Also, education at the diploma level with a standard coefficient of -0.261 had the greatest effect on perceived social support. Regarding the mental vitality variable, 76.1% of the studied units were at the average level. The results showed that satisfaction with the insurance situation in terms of coverage of medical expenses with a standard coefficient of 0.232 and poor economic status with a standard coefficient of -0.235 had the highest direct and inverse effect on mental vitality.

Perceived social support and high mental vitality in the elderly can pave the way for achieving a successful aging phenomenon. This concept includes the recognition of various components of successful aging such as perceived social support and mental vitality, longevity, independence in life, and other factors in health and social planning. According to the results, more than half of the studied elderly had high perceived social support, which can be considered as a positive factor affecting successful aging, because perceived social support decreased with age of the participants in this study. Also, perceived social support in the family dimension with the highest average among its dimensions showed the impact and importance of family relationships in successful aging. However, most of the elderly participated in this study were "young seniors" who were between 60 and 75 years old, and therefore it is possible that the high perceived social support in the samples be related to their young age, their independence, and their living with a spouse and family. Also, a significant percentage of the samples in this study had moderate and high mental vitality, which was influenced by their independence and satisfaction and benefiting from the insurance covering medical expenses. A better understanding of the two concepts of perceived social support and mental vitality can be the basis for successful aging-related interventions. It seems that the Holistic Care approach in modern nursing can empower the elderly with lower education and income and those who are single, unmarried, incapable, and independent in carrying out daily activities of life, and with an unfavorable understanding of their health status by performing health interventions, feeling of vitality and having perceived social support, and take an effective step towards achieving successful aging. One of the important goals of this study is to use its results to increase the quality of services and solve existing problems. The researcher hopes that the findings of this study can be useful in improving the goals of healthy, successful, and active aging in society in the following areas. Due to the descriptive cross-sectional nature of this study and the fact that in the studies conducted in the world, perceived support and mental vitality, two components of successful aging are influenced by several factors, it is suggested that future studies evaluate the longitudinal and trend of these two indicators in the elderly to get more accurate results from these two components.

Along with the growth of the aging population, there are several challenges for this population group as well as for caregivers and health policymakers. One of the most important challenges is the increase in care needs due to the increased suffering of the elderly from chronic and malignant diseases and disabilities. Therefore, due to the high prevalence of cancer and also the growth of the aging population, palliative care appears to be one of the important priorities of the health system. Palliative care has been identified as an important and ongoing part of cancer care. Palliative care is an approach that improves the quality of life of the patient and his family in the face of problems related to life-limiting diseases by preventing the patientchr('39')s suffering and improving the patientchr('39')s symptoms and other physical, mental, spiritual, and social problems. In fact, palliative care alleviates the disease-related pain and its effects on the patient and her family from the diagnosis of the disease to the control of pain and other symptoms. Studies have shown that there is a significant relationship between palliative care received and the quality of life in patients with chronic diseases such as cancer. Quality of life is also a multidimensional concept and nurses have an important role in improving the quality of services and care by considering the physical, mental, spiritual, religious, cultural, and social aspects of the patients. Therefore, it is necessary to first investigate the existing conditions and the quality of palliative care in the health centers and then take effective measures to improve them. Therefore, this study was conducted to determine the quality of palliative care from the perspectives of the elderly with cancer admitted to Firoozgar Educational and Medical Center in 2019.

This was a cross-sectional study. A total of 123 elderly patients with cancer admitted to Firoozgar Hospital in 2019 (November to January 2019) were selected through continuous sampling procedure. Inclusion criteria were informed consent to participate in the study, no cognitive impairment (a minimum score of 7 out of 10 based on AMT test) in the elderly, the ability to communicate and answer the items of the questionnaire, no known mental illness (based on the patientchr('39')s medical record), confirmed cancer (according to the medical diagnosis and medical record). The exclusion criteria were no consent to participate in the study, non-cooperation in each stage of completing the questionnaire (AMT, demographic form, palliative care quality tools). Data collection tools included the short-form anxiety management training (AMT) to analyze the elderlieschr('39') mental health status and cognitive system, demographic form, and quality end of life questionnaire (QEOLC-10) which were completed through face-to-face interviews with the samples. The palliative care quality questionnaire assesses the quality of palliative care provided from the perspectives of patients with chronic diseases. This questionnaire includes 10 items with different dimensions of staff communication skills, patient-centered care system, symptom reduction management, staff emotional skills, and care based on patient values which are rated on an 11-point scale (range: 0-10). Data were analyzed using descriptive and inferential statistics such as independent t-test and ANOVA using SPSS Software version 16 at the significance level of P≤0.05.

The mean age of the elderlies was 65.55 ± 4.12 years. The highest frequency was related to the age group of 60-64 years, which shows that the subjects were classified as young-old. Among them, 76 (61.8%) cases were male and 47 (38.2%) were female. Almost all samples in these studies were married (95.9%), retired and unemployed elderly had the highest frequency with (47.2%) and (41.5%), respectively. More than half of the study samples, about (56.9%), had a history of hospitalization, among which (47.1%) declared that they were hospitalized for one to two weeks and (48%) of the elderly were suffering from gastrointestinal cancer, which was more common than other types of cancer. In this study, the quality of palliative care in various dimensions (patient-centered care system, personnel communication skills, symptom reduction management, personnel emotional skills, patient values) was at the desired level. (54.5%) of the elderly reported the quality of palliative care to be desirable. The mean and standard deviation of palliative care quality was 65.55 ± 4.12. In all dimensions of quality of care, the two variables of the current hospitalization period (P=0.012) and nursing skills (P<0.001) had the most statistically significant relationship with the quality of palliative care. The quality of palliative care in pain management had a statistically significant relationship with gender (p = 0.047), current hospitalization period (P=0.015), and nurseschr('39') skills (P<0.001), which was significantly higher in men than women, and had the highest frequency during 3-4 days of hospitalization, and nursing skills had a significant role in all the aspects.

In general, the results of this study showed that relief from physical, psychosocial, social, and spiritual problems through palliative care is possible for more than 90% of patients at the advanced stages of cancer. Palliative care to treat and alleviate the cancer-related symptoms and improve the quality of life of patients and their families can help people live more comfortably. It is especially true in places where there is a large number of patients with advanced cancer and there is little chance of treatment. In this study, the quality of palliative care from the perspective of the studied elderly was rated as desired, which is one of the reasons for providing such services in the special palliative care ward of Firoozgar Medical Center with experienced and trained caregivers. However, the main problem of the nursing system in Iran regarding palliative care for patients with cancer is that this type of care does not have a specific framework for nurses and is not seriously included in the formal curriculum.

The worldchr('39')s population is ageing, and the elderly constitute large number of the worldchr('39')s population. With ageing, the health status undergoes certain changes, and the risk of developing chronic diseases and disabilities increases in the final years of life. Given the increased index of life expectancy and the subsequent increase in the number of the elderlies in the world, the number of diabetic patients in this population also increases. Diabetes is an important health issue and a common physical illness, which causes numerous complications in old age. Type II diabetes has no definite diagnosis and requires long-term care and proper self-management. Since diabetes has no definite treatment, the early identification of the suspected cases could prevent and delay the associated complications through proper self-management. The self-management of diabetes is complex and may go beyond blood sugar control, requiring the balancing of multiple metabolic and lifestyle factors and helping the patients to discover and exploit their capabilities in this regard. If patients with chronic diseases refrain from self-management and do not actively partake in self-care, positive clinical outcomes will be hard or impossible to achieve. Self-management is a rehabilitative method in which the care activities mainly depend on the patient, and the aim is to attain maximum independence, decision-making, and health improvement based on the abilities and lifestyle of the patient. Therefore, self-management must be evaluated in vulnerable and targeted populations, such as the elderly. Due to the chronic nature of diabetes, the patient must follow a special, long-term medication regimen that is prescribed by the treatment team, which is only possible with the active participation of the patient in the treatment and implementation of the recommendations of the treatment team members; this is referred to as treatment adherence. One of the main concerns and clinical problems that is frequently faced by healthcare providers is the problems associated with the lack of adherence to the prescribed treatment, particularly in the patients with chronic diseases that require long-term treatment. In the absence of proper self-management and medication adherence in elderly patients, heavy costs of the treatment of the disease and its complications will be imposed on the patients, their family, the community, and the health system. In addition, the subsequent psychological and social costs should be considered in this regard, and special attention has to be paid to this issue. Several studies have shown the unsatisfactory state of self-management and medication adherence in elderly diabetic patients, emphasizing on the periodical and frequent assessment of this issue. Given the necessity of healthy, active, and successful aging, the present study aimed to evaluate self-management in the elderly with type II diabetes in the teaching hospitals affiliated to Iran University of Medical Sciences.

This descriptive, cross-sectional study was conducted on the elderly patients with type II diabetes referring to the endocrine clinics of the teaching hospitals affiliated to Iran University of Medical Sciences. The patients were selected via continuous sampling during January-May 2020. For the evaluation of self-management and treatment adherence in the patients, the minimum sample size was estimated at 280 patients at the confidence level of 95%, accuracy of d=0.2, and standard deviation of 1.7. The inclusion criteria of the study were age of more than 60 years and less than 75 years, at least one year since the definitive diagnosis of diabetes by a physician, treatment with antihypertensive drugs for a minimum of six months, and no cognitive impairment with the score of ≥7 in the abbreviated mental test (AMT). Data were collected using the short-form AMT, a demographic form, diabetes self-management questionnaire (DSMQ), and drug adherence questionnaire (MMAS). After the completion of the questionnaires by the researcher, the data were coded, and the analysis of the raw data was performed using descriptive statistics (adjusting frequency distribution tables, calculating frequency indices, and frequency numerical indices) for the qualitative variables. In addition, the minimum, maximum, mean, and standard deviation were determined using inferential statistics and Chi-square, independent t-test, analysis of variance (ANOVA), Pearsonchr('39') correlation-coefficient, Scheffe post-hoc test, and regression analysis at the significance level of P≤0.05.

The mean age of the patients was 66.64 years, and the majority were married (6%). Based on the questionnaire data, 77.1% of the elderly patients had at least one underlying diseases, and patients with cardiac diseases constituted the majority in this regard (50.4%). In addition, the duration of the disease was more than five years in most of the patients (70.4%) (Table 1). On a scale of 0-10, the mean score of self-management in the elderlies was 6.55, and 63.2% of the research units obtained a higher score than eight in drug adherence, which indicated favorable self-management and drug adherence. According to the data obtained by the multivariate analysis and among the regression factors, the variables of education level (P=0.017), housing status (P<0.001), and income adequacy (P=0.01) were significantly correlated with self-management. Furthermore, self-management in the domain of physical activity (mean score: 7.07) had the highest mean score, while the domain of diet control (mean score: 6.05) had the lowest mean score compared to the other domains. Self-management had a significant correlation with education level (P=0.017) and income adequacy (P=0.01). The results of independent t-test also showed that self-management was significantly lower in the unmarried patients (single/widowed/divorced) compared to the married elderlies (P=0.003). Drug adherence was significantly lower in men compared to women (P=0.015) and had significant correlations with education level (P=0.001), employment status (P=0.013), and income adequacy (P=0.019).

According to the results, self-management and drug adherence were generally satisfactory in the elderly patients with type II diabetes. However, self-management was significantly lower in the patients who were illiterate, unmarried (single/widowed/divorced), and had an insufficient income, regarded as the vulnerable segment of the society. Therefore, this group of elderlies needs more attention from the health system and healthcare planners, as well as educational-counseling interventions based on the empowerment of vulnerable elderlies in order to promote self-management behaviors, minimize the complications of diabetes, and experience a healthy, active, and successful aging.

Diabetes is a chronic, lifelong disease that could occur at any age. The incidence of type II diabetes increases with age. According to the International Diabetes Federation (IDF), the prevalence of type II diabetes is higher among the elderly compared to other age groups. Type II diabetes is associated with various complications and may lead to several physical and mental problems in the elderly. Loneliness is one of the psychological complications in the elderly with chronic diseases such as diabetes. Loneliness is a unique psychological structure, which is characterized by feeling unhappy due to the lack or reduction of the expected interpersonal relationships. Loneliness is an important indicator of psychological health, with a two-way relationship with diabetes as it is also an important factor in the treatment of these patients. Loneliness in the elderly could lead to chronic diseases such as cardiac disorders, hypertension, stroke, obesity, diabetes, lung diseases, and even death. Identifying the psychological issues associated with diabetes is prioritized in health care. The present study aimed to assess loneliness and the contributing factors in the elderly with type II diabetes in order to determine the significant factors that may be associated with loneliness. Examining the state of loneliness as a psychological component in the elderly with diabetes could lay the groundwork for nursing interventions and improving healthcare resources for these patients.

This descriptive, cross-sectional study was conducted on 257 elderlies diagnosed with insulin-dependent type II diabetes referring to the comprehensive health centers of the elderly affiliated to Iran University of Medical Sciences during October-December, 2019. The participants were selected via continuous sampling. The inclusion criteria were consent to participate, age of 60 years or more, no cognitive impairment (minimum score of 7 out of 10 in cognitive impairment test), ability to communicate, no known mental illnesses (based on the medical records statement of the patient), and definitive diagnosis of insulin-dependent diabetes (based on medical record). Data were collected using a demographic questionnaire consisting of data on age, gender, marital status, occupation status, education level, insurance status, type of insurance, housing state, having a companion/support in life, the most important needs in life, and living with others. In addition, we used the abbreviated mental test (AMT), which is a short cognitive test for the cognitive assessment of the elderly. AMT consists of 10 items, with scores ≤7 indicating the presence of a cognitive disorder (maximum score: 10). Another tool was the University of California at Los Angeles (UCLA) questionnaire, which was developed by Russell et al. in 1980 and has 20 four-response items, 10 negative statements, and 10 positive statements. This scale is used to measure the degree of loneliness. In the present study, the revised version of the loneliness questionnaire was used, and the content validity was confirmed by two faculty members. In addition, the reliability was confirmed at the Cronbachchr('39')s alpha of 0.9. Data analysis was performed in SPSS version 16 using descriptive statistics, including absolute frequency distribution and frequency percentage for qualitative variables and mean and standard deviation for quantitative variables, to describe the characteristics of the samples. Independent t-test and analysis of variance (ANOVA) were also applied for statistical analysis.

In total, 55.3% of the elderlies were aged 60-69 years. The sample population included 55.3% women and 44.7% men. Approximately 65.4% the participants lived with their spouse, and 96.9% had insurance. Regarding the correlation between loneliness and demographic characteristics in the patients, it was observed that age (P<0.001), marital status (P<0.001), occupation status (P<0.001), living with another elderly (P<0.001), maximum support (P<0.001), the most important needs in life (P<0.001) and insurance status (P=0.032) were significantly correlated with loneliness. In addition, paired comparison by Tukeychr('39')s test indicated that the feeling of loneliness was more significant in the elderly aged more than 80 years compared to those aged 60-69 years. Loneliness was significantly less in the married patients compared to the divorced, widowed, and single elderlies, while it was also significantly less in the widowed elderlies compared to the singles (P=0.003). Overall, 82.1% of the elderly patients reported slight loneliness, whereas 17.9% reported significant feelings of loneliness.

According to the results, feelings of loneliness were associated with the demographic and clinical characteristics of the elderly with insulin-dependent type II diabetes. Unlike most studies, the score of loneliness was relatively low in the current research, and the discrepancy may be due to the presence of trained elderly nurses in the ward and the demographic and clinical characteristics of the participants. Given the growing number of the elderly patients with type II diabetes, proper strategies should be adopted to improve physiological and psychological health of these individuals. Patients with type II diabetes (especially insulin-dependent diabetes) are more likely to feel lonely, and increased loneliness may reduce their desire and motivation for treatment. Therefore, we believe that nurses, physicians, and other healthcare providers should pay attention to the effects of loneliness on these patients during treatment and clinical care. In addition, preventive measures should be taken, and the importance of the issue should be explained to patients and their caregivers. It is recommended that interventional studies be performed to reduce the feeling of loneliness in the elderly with chronic diseases (e.g., diabetes). Furthermore, opportunities should be provided for the public awareness of the importance of loneliness as a mental health alert that may affect chronic illnesses (e.g., diabetes) and even mortality.

 Old age is associated with various health threats, including falls which have psychological, physical, and social consequences. One of these consequences is the fear of falling especially after orthopedic surgery. This study aims to evaluate the fear of falling and anxiety in older adults with a history of fall-related orthopedic surgery.

In this descriptive-correlational study with cross-sectional design, 280 older people with a history of fall-related orthopedic surgery referred to the selected hospitals affiliated to Iran University of Medical Sciences were selected using a convenience sampling method. Data collection tools were a demographic form, the Abbreviated Mental Test (AMT), the Fall Efficacy Scale-International (FES-I), and the subscale of Anxiety from the Depression, Anxiety and Stress Scale-21 (DASS-21). Data were analyzed using descriptive and inferential statistics such as independent t-test, Pearson correlation test, one-way ANOVA, and linear regression analysis in SPSS v. 20 considering a significance level of P≤ 0.05.

 The Mean±SD age of participants was 69.50±4.29 years and 65% were female. Most of them (99%) reported a high fear of falling level; 47.9% reported moderate anxiety and 26% reported severe to very severe level of anxiety. Their Mean±SD anxiety score (11.88±4.18) was higher than the cut-off point (10). Anxiety was significantly correlated with gender, educational level, marital status, history of fallinh, and history of chronic diseases (P<0.05). According to the results of Pearson correlation test, There was a statistically significant direct correlation between fear of falling and anxiety (r= -0.254, P=0.001). According to the results of linear regression analysis, being female had the greatest effect on anxiety (β=0.183), while being female and single, having good economic status, and living with spouse had the greatest effect on the fear of falling (β=0.236, 0.545, 0.047, and 0.545, respectively).

 Fear of falling seems to be high in older adults with a history of fall-related orthopedic surgery. Given the adverse consequences of the fear of falling and the high prevalence of anxiety in these people, it is recommended that counseling programs be provided for them at the time of discharge from the hospital.

The Patientchr('39')s health and improvement depends on the quality of nursing care. The purpose of this study was to determine and evaluate the quality of nursing care from the perspective of the elderly undergoing hemodialysis in educational-therapeutic centers affiliated to Iran University of Medical Sciences that done in 2018.

this cross-sectional descriptive study, conducted on 170 elderly people who were undergoing hemodialysis in educational centers affiliated to Iran University of Medical Sciences. Sampling method was questionnaire completion by interview. Data collection tools was included demographic information form, AMT questionnaire, and nursing care quality questionnaire (QUALPAC). For data analysis, Descriptive and inferential statistics including Pearson correlation coefficient, independent t-test were used for data analysis. p≤0.05

In this study, the disease duration was 78.8% of the elderly over one year. More than half of the elderly (67.6%) reported having a serious illness. The highest prevalence of serious comorbidities in the elderly under hemodialysis in this study was related to hypertension with 60% frequency. The The quality of nursing care from the perspective of the elderly was 61/2 in the psychosocial dimension and was 80% in the communication dimension which is desirable and quality of nursing care was 91/8% in physical dimension which is somewhat desirable. Generally the quality of nursing care was 64/1% of the elderly which is somewhat desirable.

Based on the findings of the present study, the quality of nursing care in hemodialysis elderly patients was somewhat favorable and far from optimal and standard status. Health and Nursing managers focus on improving the quality of nursing care to the optimal level in this group of vulnerable patients.

 Fractures, especially Hip fractures, are common events in old age that lead to disabilities, loss of functional independence in activity of daily living and patient dependence on family Caregivers, especially family Caregivers. Since the Care-Related Quality of Life of Caregivers is one of the influential and guaranteeing components of Quality of care high in the Older adults, The aim of this study was to determine Care-Related Quality of Life of Hip Fracture Older adults female Caregivers’ attending to the Clinics of Shafa Yahyaeian Hospital, 2019.

 This descriptive cross-sectional study was conducted on 175 Hip Fracture Older adults female Caregivers. The patients were selected via convenience sampling. The sampling took three months (August to October 2019). Data were collected using a questionnaire including demographic data of female caregivers’ and Older adult, Care-related Quality of Life (CarerQol) (Care-related Quality of Life-7 Dimensions and Care-related Quality of Life - visual analogue scale). The data were analyzed by descriptive and inferential statistics in SPSS software version 16 at the significant level of p≤0.05.

 The results showed that the mean age of the female was 44.0 (SD = 11.709). The mean score of Care-related Quality of Life among the female was 53.38 (SD = 32.62) that represents low level of Care-related Quality of Life. The mean happy score of Care-related Quality of Life among the female was 5.77 (SD = 2.57) that represents low level of happy. Some personal characteristics of female Caregiver such as ratio with the Older adult (p <0.001), education level (p = 0.022), marital status (p <0.001), job status (p = 0.033), period of time Older adult care (p <0.001), access to alternative for the Older adult care (p <0.001), insurance coverage status (p <0.001) and economic status (p <0.001) were significantly correlated with Care-Related Quality of Life of Older adults female Caregivers.

 According to the results, Care-Related Quality of Life of female caregiver was low level. Therefore, it is necessary to use educational and supportive interventions to improve the Care-Related Quality of Life in this group of female. Considering that Most female caregiver have multiple family, economic, and social roles and they facing many stresses in the care of hip fracture Older adult, require more attention and prosperity from community planners and officials.

Chronic obstructive pulmonary disease (COPD) is one of the most common diseases in the elderly. Elderly people with this disease have many problems, as sleep disorders, that can cause many complications such as falls, depression, memory disorders, irritability, fatigue, difficulty concentrating and dementia. The aim of this study was to determine the severity of insomnia in elderly patients with chronic obstructive pulmonary disease.

This is a cross-sectional, descriptive study that was performed on 170 elderly people with COPD referred to Hazrat Rasoul Akram Hospital in Tehran. The research instruments were short form of cognitive test and demographic characteristics, insomnia severity questionnaire. Data analysis was performed in SPSS software (V.16), using Pearson and Spearman correlation test, one-way ANOVA, independent t-test, logistic regression analysis and Tukey post hoc analysis.

The mean and standard deviation of insomnia in the elderly were found to be 14.4±5.6 which indicated moderate insomnia. Factors such as gender, marital status, patientchr('39')s occupation, history of sleep disorders, and history of hypnotic drugs use and duration of COPD were the variables that were significantly associated with patientschr('39') insomnia. (p<0.001)

Insomnia disorder in the elderly will have adverse consequences. Hence the control of effective factors in these patients can improve their health and quality of life.

Aging is associated with several health threats, including fall and fear of fall, as well as psychological, physical and social issues. Therefore, the aim of this study was to determine the depression, anxiety and stress and related factors in the elderly after orthopedic surgery. Therefore, the aim of this study was to determine mental health status of the elderly with fall related orthopedic surgery.

The present study was a cross-sectional (correlation-descriptive) study that included 280 elderly people with fall related orthopedic surgery who were attended to selected educational centers of Iran University of Medical Sciences in 2018. The subjects were selected by Available sampling method. The data gathering tool was a short form of cognitive test (AMT), demographic profile form, and depression, anxiety and stress scale (DASS). The internal consistency coefficients of the three scales of depression, anxiety and stress were: 93.9, 90.9, and 92.9 respectively. The test-retest coefficients (with a three-week interval) of depression, anxiety and stress scales were: 0.88, 89.9, respectively. And 90. In addition, the intra-class correlation between two runs is equal to 87.78, 87.8. And 80. The conditions for entering the elderly were: age 60-75 years, cognitive capacity and ability to answer questions (AMT), lack of neurological disorders, communication ability and absence of mental illness. Data were analyzed using descriptive statistics and inferential statistics such as Independent T and Anova Unilateral in SPSS software version 20 at significance level P ≤ 0.05.

The mean age of the elderly participated in this study was 69.51 ± 4.29 (SD = 4.29), 65% female and 35% male. Nearly half of the elderly had a mild to moderate depression (41.6%), about 47.9% had moderate anxiety and 23% had mild to moderate stress. In addition, each variable "stress, depression and anxiety" had a significant relationship with gender, education level, marital status and history of chronic diseases (P <0.05).

Considering the unfavorable outcomes of depression, anxiety and stress in the elderly, counseling programs during discharging and also the promotion of family and social support can provide a platform for health promotion and achieving healthy, successful and active aging Brought up.

Background &

Evidence suggests that the prevalence of chronic diseases (e.g., coronary heart disease) is on the rise in elderly patients, which is associated with increased psychological complications, such as hospital anxiety and depression. The present study aimed to investigate hospital anxiety and depression in the elderly patients with chronic heart failure in Firooz Abadi Teaching hospital in Tehran, Iran in 2018-2019.
Materials &

This cross-sectional study was conducted on 250 hospitalized elderly patients with chronic heart failure, who were selected via continuous sampling in 2019. Data were collected using a demographic questionnaire, the abbreviated mental test score (AMTS) for cognitive assessment, and the hospital anxiety and depression scale (HADS). The data collection tools were completed for each subject via face-to-face interviews with the researcher (15-20 minutes). Data analysis was performed in SPSS version 16 using descriptive and inferential statistics, independent t-test, and analysis of variance (ANOVA) at the significance level of P≤0.05.

The majority of the patients (64.8%) were aged 60-74 years, and 52% and 48% of the patients were male and female, respectively. The mean score of anxiety was 1.52±1.14, and the mean score of depression was 2.18±1.51, which indicated the normal levels of hospital anxiety and depression. Significant correlations were observed between hospital anxiety and depression with gender, so that the female elderly patients had significantly higher hospital anxiety and depression scores compared to the male elderly patients (P=0.024).

According to the results, hospital anxiety and depression in the elderly patients with chronic heart failure had low levels. Since even low levels of these conditions could disrupt the interactions and care process between healthcare providers and elderly patients, evidence-based data could be used to promote the quality of standard nursing care in the planning of elderly-friendly hospitals by healthcare managers and policymakers.

Urinary incontinence is a common physical issue in the elderly, which influences their quality of life and causes stress and psychological tension. High stress levels may play a pivotal role in the use of coping, self-care, self-efficacy skills in the daily life of patients. The present study aimed to assess perceived stress and the contributing factors in the elderly with urinary incontinence in 2017.

This cross-sectional, descriptive-correlational study was conducted on 125 individuals aged 60-74 years with urinary incontinence referring to Hashemi Nejad Teaching Hospital in Tehran, Iran. The participants were selected via convenience sampling. Data were collected using the abbreviated mental test (AMT), a demographic questionnaire, and Cohen’s perceived stress scale with acceptable validity and reliability. Data collection was performed during three months via face-to-face interviews (15-20 minutes). Data analysis was performed in SPSS version 16 using Pearson's correlation-coefficient, linear regression, and Scheffe test at the significance level of P<0.05.

The mean age of the subjects was 63.92 ± 2.66 years, and the sample population consisted of 53.6% women and 46.4% men. Nearly half of the subjects (43.2%) had high levels of perceived stress. In addition, significant correlations were observed between perceived stress and age, education level, marital and economic status, and duration of urinary incontinence (P<0.05).

Considering that urinary continence affects the daily life of the elderly, planning for the development of community-based nursing interventions, performing educational/counseling strategies for the control and management of stress, and provision of family and social support are recommended in order to enhance the functional capacity of the elderly with urinary incontinence.

Elderly affects their lifestyles and life satisfaction because of deprivation of social activity. Therefore, the aim of this study was to Investigate Life satisfaction and correlates in older adults attending West Health Center of Tehran.

The present study is a cross-sectional, descriptive correlation study. The research sample consisted of 200 elderly people attending West Health Center of Tehran through an accessible sampling method after obtaining written informed consent. The data collection tools consisting of a short form of AMT (Abbreviated Mental test) for cognitive test, a demographic Form, and Diener questionnaire (SWLS) for assessing life satisfaction. Data were analyzed by SPSS software version 20 using descriptive and inferential statistics including paired t-test and one way ANOVA.

The results showed that the mean age of the elderly was 64.53 (SD = 3.95). So that 51% were women and 49% were male. About 39% of the elderly had a moderate life satisfaction. The results of the relationship between life satisfaction with employment, health status, hypertension, diabetes, arthritis, respiratory diseases and other diseases were statistically significant (P <0.05).

The results of the study showed that a significant percentage of the elderly were satisfied with their life, and it seems that in having a life satisfaction, some personal characteristics such as being old and married and having a job status and desirable health are considered as an important component. It should be considered in nursing care of the elderly. Therefore, the results of this research can be used to apply positive aspects of "life satisfaction" in improving the health of the elderly referring to the health center and realizing the concept of "healthy and active aging".

Elderly people are exposed to potential threats, such as physical and mental disabilities, which overwhelm their functional independence and their daily activities. Therefore, the purpose of this study was to determine the functional independence of elderly patients referred to West Health Center in Tehran, Iran.

This descriptive-cross sectional study was conducted on 200 elderly people referred to West Health Center in Tehran during 2017. The participants were selected using the convenience sampling method. The data were collected utilizing an Abbreviated Mental Test, a demographic form, and the Barthel index to investigate the elderly functional independence. The data were analyzed in SPSS software (version. 20) through one way ANOVA, independent t-test, and Pearson correlation coefficient. P-value less than 0.05 was considered statistically significant.  

According to the results, the mean±SD age of the elderly participated in this study was (64.53±3.95), and 51% of the participants were female. About 95.5% of the elderly had complete independence for their daily activities. However, 4% and 0.5% of them had partial and moderate dependencies, respectively. Moreover, there was a reverse relationship between age and functional independence (P<0.001, r=-0.345). However, functional independence correlated significantly with educational level, marital status, hypertension, and joint pains (P<0.05).

According to the results, a majority of the elderly people has been independent in their daily activities; however, aging correlated with reduced levels of independence. Therefore, regarding holistic care in clinical nursing services, it is necessary to pay attention and develop programs to support the elderly in order to promote their health and provide the concept of "healthy and active aging".

Old age is associated with several health threats, including falls, with fear of falling considered to be one of its major complications, especially after orthopedic surgeries, which may lead to limited daily activities, isolationism, and lack of social participation. The present study aimed to assess the fear of falling and its contributing factors in the elderly patients with the history of falls following orthopedic surgeries, who referred to the orthopedic clinics of selected hospitals affiliated to Iran University of Medical Sciences. This cross-sectional, descriptive-correlational study was conducted on 280 elderly patients referring to the clinics of the hospitals in Tehran, Iran. The patients were selected via convenience sampling. Data were collected using the abbreviated mental test (AMT), a demographic questionnaire, and the falls efficacy scale instrument (FES-I), which were completed via face-to-face interviews with the elderly. Data analysis was performed in SPSS version 20 using descriptive and inferential statistics, independent t-test, one-way analysis of variance (ANOVA), and linear regression analysis at the significance level of P≤0.05. The mean age of the elderly was 69.50±4.29 years, and 65% and 35% of the patients were female and male, respectively. The results of Pearson's correlation-coefficient indicated a direct correlation between the fear of falling and age (P=0.008; r=0.159). Direct, significant correlations were also observed between the fear of falling and hypertension, the number of the used medications, and pelvic fractures (P<0.05). In addition, 97.9% of the patients had more than one orthopedic surgery, which was directly correlated with the fear of falling. According to the results, the frequency of fear of falling in the elderly with the history of orthopedic surgeries was significantly high. Considering the adverse outcomes of the fear of falling in elderly patients, it is recommended that counseling training programs be planned for the elderly patients after orthopedic surgeries for the health promotion of these individuals and active old age, as well as the reduction of the fear of falling in elderly patients.

Diabetes mellitus (DM) affects 4.5 million individuals in Iran. DM has a chronic, progressive nature and is associated with long-term complications, which adversely affect health due to the adoption of improper coping mechanisms, stemming from the psychological factor of ageing perception. The present study aimed to determine the correlation between the perception of aging and functional independence in the elderly patients with DM admitted to the diabetes center in Boroujen, Iran. This cross-sectional study was conducted on 123 elderly patients with DM (age range: 60-74 years), who were selected via non-probability sampling in Boroujen, Iran. After obtaining written informed consent, data were collected using Barthel functional independence scale and brief ageing perception questionnaire (B-APQ) via face-to-face interviews with the subjects (20 minutes) to complete the questionnaires. The mean total score of ageing perception in the patients was 58.21±7.5, which indicated the unfavorable perception of ageing, encompassing 16.1% of the dimension of negative perception of aging. In addition, the mean total score of functional independence was 95.71±4.8, indicating that 52.8% of the subjects had slight dependence, while the lowest number of the patients (11.4%) had moderate dependence. The obtained results of the study indicated an inverse, significant correlation between the total scores of functional independence and perception of aging (P≤0.001; r=-0.76). According to the results, which demonstrated the inverse, significant correlation of the perception of aging and functional independence in the patients, it seems that the awareness of the influential psychological factors in the health and functional capacity and independence of various age groups could help policymakers to adopt preventive strategies for comprehensive geriatric healthcare as a form of holistic care, which in turn results in the implementation of educational and counseling interventions. Therefore, it is recommended that the perception of ageing be enhanced in the elderly through the empowerment of these individuals and increasing their functional independence. Some of the suggested approaches to the reduction of the negative perception of ageing include empowerment education and counseling in order to enhance the positive perception of ageing, thereby helping the elderly in functional independence and health promotion.

Achieving the goals of successful ageing is considered to be an effective strategy for the promotion of health in the elderly. The concept of healthy and successful ageing encompasses significant components, including life satisfaction, positive perception of the changes in old age, longevity, lack of disability, and independence in life. The present study aimed to assess successful ageing in terms of life satisfaction and perception of ageing in the elderly patients referring to the health center in the west of Tehran, Iran. This cross-sectional, descriptive study was conducted on 200 elderly individuals referring to the health center in the west of Tehran, Iran in 2017, who were selected via convenience sampling based on the inclusion criteria. Data were collected using the abbreviated mental test (AMT), a demographic questionnaire, LSI-Z life satisfaction inventory, and ageing perception questionnaire (B-APQ). The questionnaires were completed via face-to-face interviews (15 minutes). Data analysis was performed in SPSS version 20 using independent t-test and one-way analysis of variance (ANOVA), as well as descriptive and inferential statistics at the significance level of P≤0.05. The mean score of life satisfaction in the participants was 15.2±2.2, which indicated the high level of life satisfaction. Significant correlations were observed between life satisfaction and age, gender, education level, economic status, occupation status, marriage, independence in daily tasks, and health and psychological status. In addition, the  mean score of the perception of ageing in the subjects was 53.08±3.9, and significant correlations were observed between this variable and age, marital status, education level, life status, economic status, health status, and independence in daily tasks (P<0.05). Considering that the participants in this research were mostly selected from the young elderly (age: 60-75 years) and had high life satisfaction and positive perceptions toward their ageing process, it seems that there is a positive association with life management strategies and healthy lifestyle. Therefore, the main slogan to achieve the goals of successful ageing would be to 'add life to the life year, rather than adding life years to life'.

Recently appropriate workability is widely considered in organizations. Developing appropriate workability in hospitals leads to many positive achievements for nurses and patients and totally for the whole health and treatment system. According to the researches, workability levels of persons are strongly related to their working place's conditions. So, this study was conducted to evaluate the level of working abilities of nurses in selected educational-medical centers of the Tehran University of Medical Sciences in 2012.
In this cross-sectional study, 150 nurses working in selected educational medical centers of the Tehran University of Medical Sciences were selected by the random sampling method. Data were collected using the demographic information and workability indicator questionnaire. Then, the data were analyzed by descriptive and inferential statistic tests and the SPSS 16 software.
Workability of 44.7% of the nurses was in an appropriate level. There was a linear and meaningful relation between the educational level and workability of the nurses (P = 0.003). A negative and meaningful statistical relation was found between diseases diagnosed by physicians and workability of the nurses (P Considering the good workability level of almost half of the nurses, maintaining this level of workability and improving it in nurses should be noticed more than before by nursing managers of the country and hospitals.

Premenstrual syndrome, is one of the most common disorders in women of reproductive age. This syndrome is a constellation of symptoms, psychological, and behaviors such as sleep disorders are included. Acupressure, an inexpensive and non-invasive method that can be useful in controlling the symptoms of this syndrome. The aim of this study the effect of acupressure on sleep quality in female students with premenstrual syndrome is done.
This study is a controlled clinical trial on 140 patients from two groups of students Inclusion criteria were found. The data collection tool, Pittsburgh Sleep Quality Index (PSQI) was. The experimental group was taught acupressure and control group received no intervention. Data were analyzed using SPSS software.
The results showed that 29.5% of students have had PMS. Units of the subjects had poor sleep disorder, five were high-score. Two groups at baseline in terms of demographic characteristics and quality of sleep (P = 0.99) were homogeneous, but after the intervention, the experimental group, disturbed sleep due to the effect of group was significant (P The findings suggest that applying acupressure on HT7 point as a non-pharmacological methods can be effective in improving sleep quality and nurses and midwives can use this simple, inexpensive and without side effects to be used as an adjunct with other treatments.

To date, many developments in the diagnosis, treatment and rehabilitation of people with Parkinson's have been occurred, however there is not clear view of self-care manner in these patients. Thus, further understanding of the problems, concerns and challenges in the care of these patients can be nececrry. The aim of this study was to explore challenges of self-care in people with Parkinson’s disease (PD).

This Study was an exploratory qualitative design and carried out using Grounded theory methodology. Data was collected via semi-structured in-depth interviews and field notes. 10 people with PD and 6 family caregivers were interviewd. Interviews were conducted in the private homes of participants or one of their family members. Analyzing of the data was carried out with the Corbin and Strauss (2008) approach.

Concepts of study were identified with using a micro analysis and general analysis. "fear of becoming crippled" was identified as a main concern in these patients. This concern fell into four categories including "progressive physical disability", "mental alteration", "financial burden of disease" and "self-change" and was created with the effect of PD on physical, emotional, mental, and social aspects of patients.

The results of this study showed that people with PD face a number of challenges to self-care. The findings also showed that demographic, familial and social factors have important roles in the self-care process of these patients.With understanding challenages of self-care, health care providers especially nurses can support people with PD in achieving and maintaining independence in self-care. On the other hand, the results of this study can be used in the formulation of policy and the standards of care in our country with providing the important concepts and a basic knowledge of the process of care of peoples with PD.