مریم جدید میلانی

Old age is considered a critical phase in human life, and attention to the challenges and needs of this stage is essential from physical, psychological, and social perspectives. Loneliness during this period arises due to a reduction in social interactions, and poor sleep quality can lead to disruptions in individuals' emotions, thoughts, and motivation. The present study was conducted in 2023 with the aim of determining the relationship between loneliness and the sleep quality of the elderly visiting comprehensive health centers in the urban and rural areas of Varamin County.

The present study was conducted on 120 elderly individuals who sought care at the comprehensive health centers in the urban and rural areas of Varamin County in the year 2023. A multistage sampling method was employed for participant selection. Initially, Varamin County was divided into four clusters based on a map, and then four comprehensive health centers in urban/rural areas were randomly chosen. Subsequently, considering the total number of elderly individuals in Varamin County and the specific count for each center (information obtained from Varamin Health Center), the allocation of each center was determined based on the covered population. Continuing with the research, a continuous sampling method was utilized to select elderly participants. Data collection instruments included the UCLA Loneliness Scale for assessing loneliness and the Pittsburgh Sleep Quality Index (PSQI) for evaluating sleep quality. Data analysis was performed using SPSS version 26, employing descriptive and inferential statistics

The research findings revealed a significant and strong direct correlation between loneliness and sleep quality (r = 0.611, p < 0.001). Furthermore, 37% of the variance in loneliness can be explained by sleep quality. Sleep quality, with a positive beta coefficient of 0.611, predicts loneliness significantly (p = 0.015).

The findings of this study indicate the impact and correlation between loneliness and the sleep of the elderly. The results of this research can serve as a clear picture to better understand how the feeling of loneliness affects the sleep of the elderly. These findings can be utilized in providing practical strategies to increase awareness among families and even the elderly themselves, aiming to reduce loneliness and its detrimental effects on the quality of life and sleep. Furthermore, these results can be instrumental at the organizational level for officials in relevant institutions dealing with the elderly, helping in formulating appropriate policies and measures to manage loneliness and enhance the sleep quality of the elderly

understanding the feeling of comfort is one of elderly needs, especially those hospitalized, that nursing care has a significant effect on improving the patient's comfort level. One of these nursing interventions is relaxation.

Material: 

The present study is a randomized controlled experimental study that was performed on 71 elderly people admitted to the internal ward (34 in the experimental group and 37 in the control group) in Mostafa Khomeini Hospital in Tehran from June to October 2020.  Research tools were Abbreviated Mental Test and Hospice Comfort Questionnaire. In the experimental group, Benson relaxation was performed for 4 sessions and each session lasted for 10 minutes. In the control group, a routine intervention was performed. Chi-square, Fisher's exact test, independent t-test and paired t-test were used to analyze the data in SPSS software version 16.

By comparing the comfort level at the beginning and end of the research between the experimental and control groups, it was found that the distribution of the mean comfort level between the two groups is not statistically significant. Although the level of comfort between the two groups at the end of the study was not significantly different from the beginning of the study, but in both groups the mean of it w increased. There was a significant difference between the mean comfort level before and after the research within the experimental and control groups (p <0.0001).

It is suggested that health policymakers design a quiet environment and appropriate equipment, for example appropriate beds in hospitals or medical staff, especially nurses, create a stress-free ward and a suitable relationship to provide trust, confidence and responsibility for increasing the comfort of the elderly in hospital.

The COVID-19 pandemic has caused job burnout in nurses, followed by a decrease in the quality of life and the quality of care services provided to the patients. Regarding the prevalence of the COVID-19 pandemic and the researcher's experience, the present study aimed to determine the relationship between job burnout and the quality of life of nurses in intensive care units during the COVID-19 pandemic.

This descriptive-correlational study was conducted on 140 nurses working in the intensive care units (including ICU and CCU) of public hospitals in Ilam province from February 10 to March 10, 2021 (the sixth peak of COVID-19). The participants were selected using the total population sampling method. The required data were collected through demographic characteristics form, Maslach Burnout Inventory (1985), and the World Health Organization Quality of Life Instrument (2004). The collected data were then analyzed in SPSS software (version 26) through Pearson's correlation coefficient and regression at the significance level of P<0.05.

In this study, the mean±SD values of job burnout and quality of life were obtained at 76.1±11.4 and 72.9±5.9, respectively. There was a significant inverse correlation between job burnout and quality of life (r=-0.296, P<0.001). Furthermore, the linear regression test of the components of personality distortion and individual performance did not show a significant effect on the quality of life of nurses. The component of emotional exhaustion (P=0.001) had a significant negative effect on the quality of life of nurses working at intensive care units.

Managers must adopt support, encouragement, and educational programs to prevent adverse effects on nurses during the outbreak of health crises.

The elderly population in the world as well as in Iran has a growing trend, which can indicate a significant increase in chronic diseases, especially renal failure in the elderly and its associated complications, including sleep disorders, which cause trouble in daily activities and quality. Life goes down in these patients. Therefore, have been decided to conduct a study using exercise and its effect on sleep quality in elderly patients undergoing hemodialysis.

The present study is an experimental study that was conducted to investigate the effect of exercise on sleep quality in the elderly with Sheldon venous catheter undergoing hemodialysis referred to Ghiasi Charity Center in Tehran in 2020. This center covers 200 patients, of which 40 are active elderly patients over 60 years of age, 30 of whom met the inclusion criteria, which were randomly selected by lottery method (writing their names on paper) into two groups, the intervention and control groups (15 people in each group) were assigned. Initially, the cognitive health of the elderly was assessed using a short cognitive test tool, all of them had cognitive health. In the experimental group, one of sample was hospitalized and two were transferred to another dialysis center, thus, they were removed from the samples. Research tools included demographic information form, Abbreviated Mental Test and Sleep Quality questionnaire. The Abbreviated Mental Test(AMT) tool, developed by Hodkinson in 1972 to screen for cognitive disorders such as dementia and delirium in the elderly, to identify the elderly with dementia and remove them from the study. The tool includes 10 short and simple questions to measure orientation, focus and attention, short-term and long-term memory of the elderly, each item of which has 1 point and the sum of the resulting scores is 10. The cut-off point for distinguishing cognitive status is 7 out of 10, which normalizes status from abnormal. Foroughan et al. (2014) in Iran have translated this tool into Persian. The validation and internal reliability of the Persian version of this tool with Cronbachchr('39')s alpha coefficient of 0.76 has been acceptable. The Pittsburg Sleep Quality Index (PSQI) was developed by Buysse et al in 1989 and has 9 items, of which 5 questions contain 10 sub-items, so the whole questionnaire has 18 items. These questions are in seven components : Subjective sleep quality, Sleep latency, Sleep duration, sleep efficiency, Sleep disturbance, Use of sleep medication, Daytime dysfunction. The score of each question is between 0 to 3 scores of the questionnaire from 0 to 21. The higher the score, the lower the quality of sleep. Dr. Buysse et al. Obtained the internal consistency of the questionnaire using Cronbachchr('39')s alpha of 0.83. Farahi Moghadam et al. (2012) have also confirmed the validity and reliability of this questionnaire in Iran; Cronbachchr('39')s alpha coefficient of this questionnaire was 0.78 to 0.82. All instruments were completed by asking the elderly at two times, before the start of the study and in the eighth week of the study. In order to intervention in the experimental group, the elderly performed a sports activity protocol designed by a sports physiologist with the help of a researcher and under the supervision of the centerchr('39')s physiotherapist for 8 weeks and 3 times a week during dialysis. Exercises were performed due to the age of the samples in bed and during dialysis. In the first week, because the exercises were light and it was not possible to warm up and cool down in the real sense, the time to start the first exercise activity was 30 minutes in the first week. Then, 35 minutes in the second week, 40 minutes in the third week, 45 minutes in the fourth week, week. The fifth and sixth week were considered 50 minutes. One-half of the exercise time was devoted to aerobic exercise with a minibike (small bike) with arms and legs, and the rest of the time was equally devoted to other resistance exercise. In the first session, the method of conducting research, the rules of participating in the sessions, the impact of exercises on the body and how to do exercises were presented. At the beginning of each exercise session in the intervention group, vital signs were assessed and with the permission of the physician, the patient participated in exercise. Exercise started 30 minutes after the start of dialysis and stabilization of the patient. In the control group, except for routine interventions, no intervention is performed, but they were assured that if the research results are effective in the experimental group, exercise sessions will be held for them.

By comparing the quality of sleep between the first and eighth week of research in the experimental group, it was found that after exercise, sleep quality improved significantly (p <0.0001) but in control group the sleep quality between the first and eighth week of the study was significant reduced (P = 0.001). Comparison of the mean of sleep quality between the experimental and control groups before the study was statistically significant (P = 0.035). The control group had better sleep quality but the mean of sleep quality between the two groups in the eighth week of the study was significant (p <0.0001) and sleep quality was better in the experimental group than the control group.

The results of this study, in addition to being effective in increasing nursing knowledge, can also be used as a safe and low-cost method to improve sleep quality in the elderly undergoing hemodialysis

The population of the elderly has been on a rise, which shows more attention to ensuring the health and well-being of the elderly. On the other hand, the growth of the elderly population and its impact on the social and economic conditions of society leads to more attention to the issue of aging in society. In addition, physical and psychological abilities decrease with aging, which affects the quality of life of people. Overall, quality of life and well-being assessed by indicators such as health, happiness, and loneliness. Happiness is one of the most important needs of human beings, which considerably affects their psychological and physical health that helping the elderly cope with stressful situations. Another factor affecting well-being is self-transcendence, which is a powerful coping mechanism and can lead to personal transformation and improvement of the quality of life, thereby facilitating the process of understanding life changes such as aging. Therefore, self-transcendence is defined as a positive trait in relation to the expansion of one’s outlook on life. This issue includes factors such as spirituality, finding a purpose in life, optimism for the future, coping with problems, using power-based approaches, and connecting with others. In the elderly, by restoring the concept of aging and accepting disability, it reduces stress and focuses more on ability than disability. Therefore, happiness and self-transcendence are important factors in the elderly’s health dimensions. The present study aimed to determine the relationship between happiness and self-transcendence in the elderly of Khoshkrud, Zarandieh City.

This descriptive-correlational research performed on the elderly selected from those who referred to the health center to receive elderly-related care using sequential sampling. Data collection continued for three months (October-December, 2019), and 84 elderlies who were willing to participate in the research were selected. The inclusion criteria were the age of more than 60 years, the ability to respond to questions physically and mentally, having psychological health  which assessed  by Abbreviated Mental Test (obtaining a score above 7) and not losing a family member or experiencing a stressful situation in the past two months. Abbreviated Mental Test used to diagnose cognitive impairment, including dementia and delirium in the elderly, applied to assess concentration, attention, short-term and long-term memory. Notably, the Cronbach’s alpha of the tool was 0.76 in Iranian society. The Oxford Happiness Index has 29 questions that scored in a range of zero to 87 and includes five components of life satisfaction, self-honor, subjective well-being, satisfaction, and positive mood. Internal consistency was used to determine the reliability of the instrument. The Cronbach's alpha coefficient for the components of life satisfaction, self-honor, subjective well-being, satisfaction, and positive mood estimated at 0.85, 0.71, 0.74, 0.79, and 0.77, respectively. On the other hand, the self-transcendence questionnaire included 15 items scored in a range of 15-60, where a higher score was indicative of higher self-transcendence. Internal consistency was used to determine the reliability of the instrument and its Cronbach's alpha coefficient estimated to be 0.69. Researcher with questions from the elderly completed all tools and it took an average of 45 minutes for each elderly person to complete the tools. In addition, data analysis was performed in SPSS version 16 using descriptive statistics (to describe demographic variables and variables of happiness and self-transcendence) and parametric inferential statistics (Pearson’s correlation coefficient, independent t-test, and analysis of variance).

In this study, the mean age of the elderly was 65.7±4.8 (60, 79). Moreover, 55 subjects were female (65.5%), 81% were married, 59.5% were illiterate and 64.3% were homemakers. In addition, the mean number of children of the participants was 6.2±1.6 (0, 14). Furthermore, 66.7% had an underlying illness, 56% had a moderate economic status, 61.9% had a family support system and 79.8% lived with their spouse. According to the results, the mean of happiness and self-transcendence in the elderly were 54.42±14.3 and 39.4±5.9, respectively. There was a significant and direct relationship between self-transcendence and happiness (r=0.263, P=0.016), components of life satisfaction (r=0.348, P=0.001) and satisfaction (r=0.325, P=0.003). In addition, a significant difference was observed between the level of education (P=0.038 and P=0.009, respectively) with happiness and self-transcendence and between occupational status and happiness (P=0.039). Moreover, a significant difference was found between the number of children (P=0.037) and residential status (P=0.028) with self-transcendence.

According to the results of the study, happiness and its components were more than the average level in the elderlies. In addition, the results were indicative that level of education, job, and economic status had significant differences with happiness. A proper education, job and economic status creates safety in the individual, which improves happiness. Self-transcendence was moderate and economic status, level of education, residential status and number of children had significant differences with elderly’s self-transcendence. Good economic situation causes security in the person and the person can try to help himself without worry and play a role in promoting self-transcendence. On the other hand, the level of education promotes awareness and the ability to obtain information from various sources, which can empower the elderly in self-care and increase their adaptation to old age, and ultimately lead to the promotion of self-transcendence. The presence of children, their support, and care for parents cause security for the elderly, who in return try to adapt to the current situation in order to calm their children and accept their situation and ultimately improve their self-transcendence. In general, self-transcendence promoted by having a good friend and a person to talk to, and in the traditional society of Khoshkroud, communication with children, relatives, and neighbors can promote self-transcendence. Although in the present study, the economic situation was moderate and most of the elderly were illiterate, the level of happiness and self-transcendence of the participants was above average, which can be attributed to the existence of social relations at the family and traditional society and respect for the elderly. These factors played a key role in individual satisfaction and support of the elderly and covered the educational and economic states. Moreover, there was a direct and significant relationship between happiness and self-transcendence. Happy people feel more in control, think more about their abilities rather than inabilities, better cope with life stressors, have higher self-esteem, value themselves, and love themselves. Overall, happiness can affect the scope of life and the way people relate and interact with the environment. As such, happiness promotes other life aspects, including self-transcendence. In Khoshkroud, where the elderly and families adhere to their religious and traditional beliefs and the family has a special position, the elderly enjoy health in all dimensions, and they can accept the conditions of old age and use effective adaptation mechanisms to improve well-being. It recommend that the families and authorities by meeting the economic, social and spiritual needs of the elderly to increase their ability to understand and accept themselves, create a sense of satisfaction and happiness, which increases their health. By creating a happy and lively environment, their performance will be improve, which has positive consequences for the elderly, family, and society. Furthermore, conditions should be provided for them to benefit from each other's experiences and to be present in public to improve their health.

The most common cause of elderly admission is cardiovascular disease and also, anxiety can cause nonspecific symptoms in over 80% of elderly people admitted to intensive care units that threaten their lives. On the other hand, using drugs to control it have physical side effects or drug dependency. Therefore, anxiety management is one of the most important nursing cares that can be managed by using non-pharmacological methods including aromatherapy.

This study was a semi experimental that was performed on 60 elderly admitted to cardiac intensive care units who had no cognitive impairment. Coin tossing was used for random allocation (selecting interventional and control group (and sampling was based on sequential and admission to the ward. Data collection tools were demographic information questionnaires, Abbreviated Mental Test and Hamilton Anxiety Rating Scale which was completed before, first, second and third day of intervention for both groups with ethical considerations. The intervention in the interventional group was using of rose water for three consecutive nights. For data analysis, descriptive and inferential statistics (independent t-test and repeated measure) were used by SPSS software version 22.

Before intervention, there was a significant difference between the two groups in anxiety (p <0.0001) and the two groups were not homogeneous. At the end of the intervention, the level of anxiety decreased in both groups, statistically significant (p <0.009). There was no significant difference between the anxiety score in the control group before and after the intervention (p = 0.321). But in the interventional group, the anxiety score decreased from the time interval before the intervention to the third day of intervention, which is statistically significant between the four periods (p <0.0001). A two-way test between time intervals showed that there was a significant difference between the anxiety score of all two time intervals (p <0.005).

Considering the aged population of the country and the prevalence of heart disease among them, it is necessary to pay attention to management of anxiety in the elderly, especially when admitted to the intensive care units. In addition, it is possible to use complementary medicine, and with respect to Iranian’s culture rose water is the cheapest and most commonly used fragrance available to reduce the anxiety of elderly.

According to the self-transcendence model, interventions to promote the level of self-transcendence can in turn improve physical health status. Therefore, the aim of this study was to investigate the relationship between self-transcendence and perceived physical health in patients with multiple sclerosis (MS) attending peer support groups.

This quasi-experimental study used pretest and posttest to investigate the relationship between self-transcendence and perceived physical health in 33 patients with confirmed MS.Patients participated in three peer support groups (10 males in the male group, 11 females in female group and 12 males and females in the mixed group). Participants were required to attend 8 weekly sessions comprising 2 hours each. Data was collected by the Self-Transcendence Scale (STS) and physical health section of the Multiple Sclerosis Quality of Life Inventory (MSQLI). Wilcoxon, Kruskal-Wallis and Mann-Whitney U tests and Spearman and Pearson coefficients were used for data analysis.

Comparing mean scores of self-transcendence (pretest: 44.57 (8.2); posttest: 53.21 (6.2);P = 0.001) and physical health status (pretest: 151.84 (33.3); posttest 171.58 (37.5); P = 0.009) showed significant differences after attending peer support groups. There was a positive relationship between selftranscendence and physical health status (P = 0.01).

The results showed that promoting self-transcendence would lead to enhanced physical health status and the quality of life in general.