فصلنامه سالمند
پیاپی 60 (زمستان 1399)

Retirement is a potentially challenging event in old age that has different‏ effects on older people’s lives. This study aims to identify the psychosocial consequences, barriers, and facilitators of adaption to retirement in Iran.

In this study, we used conventional content analysis. The samples consisted of 22 people with experience or expertise in the field of retirement, who were selected by maximum diversity and purposeful sampling strategy Data were collected through semi-structured interviews from February 2019 to September 2019. Graneheim and Lundman's approach was used for data analysis.

Of 22 participants, 59% were male and 41% were female. Four main categories and 13 sub-categories were extracted covering different psychosocial aspects of adaption to retirement Including: Psychosocial challenges (emotional deprivation, reduced psychological resilience, role loss, social isolation, and family challenges), post-retirement development (developing interests and activities, and feeling of being free), barriers to retirement adaptation (health problems, lack of a retirement plan, and macro-structural deficiencies), and contextual/supportive facilitators (individual characteristics, job characteristics, and social support systems).

After retirement, people face psychosocial challenges or opportunities for development. In the meantime, some barriers and facilitators can affect adaption to retirement. Therefore, preparation for retirement is an important issue in the field of gerontology services. Elderly care providers and health professionals can benefit from the finding of this study in their interventions to promote the psychosocial well-being of retirees and their families.‎

 Considering the rapid growth of Iran’s elderly population with consequent increase in the costs of health services, it is necessary to be aware of the pattern of outpatient health service utilization, in the elderly for resource allocation and health planning. This study aims to determine the pattern of outpatient service utilization for the elderly in Iran and explore determinant factors.

This is a cross-sectional study using secondary analysis method and the data from 2015 National Study of Health Service Utilization. Study population consists of older people aged ≥60 years. Of these, 8205 were selected as study samples. The data were collected using personal and household questionnaires collecting information on subjects’ need for, referral to, utilization from, and satisfaction with outpatient services. Logistic regression analysis was used to identify factors related to the need, referral, benefit, and satisfaction with the received outpatient services.

 Out of 8205 participants, 3172 (39%) reported the need for outpatient services, of which 66% referred for services; of these, 98% (N=2060) benefited outpatient services. Females, older subjects, villagers, unmarried and illiterate subjects were more in need of outpatient services, but their referrals to receive the services were not more than those of other groups. Lack of basic insurance, supplementary insurance, and a personal care had a significant impact on reducing the number of subjects referred to receive outpatient services. Inability to pay treatment costs (30%), self-treatment (28%) and lack of proper insurance coverage (13%) were the most important reasons for not referring to receive outpatient services. The highest satisfaction was related to the behavior of physicians and medical staff and the lowest satisfaction was related to the cost of outpatient services.

 Although the use of outpatient health services should be based on the need for these services, the present study showed that the older people with higher socio-economic status had higher utilization from the services in Iran. Therefore, there is an inequality in access to outpatient services in the elderly. The reasons for not using outpatient services and dissatisfaction with these services should be seriously considered by health policy makers.

 In the geriatric care provided in health centers, the healthy elderly are neglected. This qualitative study aims to improve the quality of geriatric care for the healthy elderly.

This community-based participatory study was conducted from 2016 to 2018 with the participation of 11 healthcare providers, 54 older people and 54 family members in Shahid Motahari Comprehensive Health Center in Mashhad, Iran. The mean age of healthcare providers was 32.4±2.7 years with a work experience 8.3 years. The mean age of the elderly was 64.3±3.9 years. Data were collected using the SERVQUAL questionnaire and interviews, focus group discussions, and field note taking. After identifying the problems through interviews with 8 personnel and 19 older people, group discussion sessions were held to design the change programs. After implementing the change programs, 30 interviews were conducted with the participants and comparisons were made before and after the programs. Descriptive statistics was used to analyze the qualitative data, and descriptive statistics and paired t-test were used to analyze the quantitative data.

 The mean total score of service quality according to the elderly and their families in the pre-intervention stage was 63.02±9.46 and 61.83±9.05, respectively. These values reached 130.09±14.75 and 122.65±13.56 in the post-intervention stage, and this difference was statistically significant (P=0.001). The presented dynamic care model was able to improve geriatric care for the healthy elderly in the comprehensive health center by modifying the attitude, skills and empowerment of staff.

 The dynamic care model can improve the quality of geriatric services for the healthy elderly with features such as active, participatory, continuous, comprehensive and supportive care. It can be used in other health centers.

 Older people are more prone to chronic diseases and are being treated than other age groups; as a result, they use more drugs that may be inappropriate and lead to adverse drug reactions. This study aimed to determine the rate of inappropriate drug use using the Beers criterion among the elderly in Amirkola City.

The current descriptive-analytical study is part of the comprehensive plan "Study of the health status of the elderly in the Amirkola City” AHAP" (No.: 892917) which has been conducted as a Cohort study since 2011 on all people aged 60 and over in the Amirkola City, north of Iran. Necessary information was collected by a trained person using standard questionnaires that included the number, type and duration of drug use. The collected data were analyzed after entering the SPSS statistical software using Chi-square, Fisherchr('39')s Exact Test, and Logistic Regression to evaluate the status of inappropriate drug. P-value=0.05 was considered as a significant level.

 The Mean±SD age of the elderly was 69.71±7.47 years. Prevalence of inappropriate drug use and drugs that should use by caution among the elderly was 37.58% and 29.85%, respectively. Glibenclamide (12.7%), Diclofenac (8.8%) and Clidinium C (5.4%) were among the most inappropriate drugs used in this population. The highest drug-drug interaction was related to the simultaneous use of two anticholinergic drugs. There was a statistically significant relationship between inappropriate drug use with gender, age, education level, employment status and marriage status (P<0.05).

 The rate of inappropriate drug use among the elderly in Amirkola is high compared to many other studies that expose the elderly to adverse drug reactions.

Elder abuse is a phenomenon that has become more apparent with the increase in aging population, but there are insufficient evidences about the prevalence of elder abuse and gender differences in this area. Therefore, this study aims to investigate the prevalence of elder abuse and its gender differences among community-dwelling older adults in Tabriz, Iran.

In this cross-sectional study, 414 older adults aged ≥60 years were recruited from health complexes and centers in Tabriz, Iran in 2018 by using random sampling method. Data collection tools were a demographic form and the Domestic Elder Abuse Questionnaire which were completed through interview. The collected data were analyzed in SPSS V. 22 software.

 It was reported that 52.6% had experienced abuse by family members. Emotional neglect was the most common type of elder abuse (26.6%) followed by financial abuse (17.6%). Physical abuse was the least common type of elder abuse. Except for financial abuse, older women had experienced more abuse than older men. Of those who were abused, only 31.7% recognized it as elder abuse.

 Most of older adults experience emotional neglect and financial abuse from family members and perceive them as their normal behaviors. Older women experience more abuse than older men. It is necessary to prevent elder abuse and familiarize older adults with different types of elder abuse.

 Healthy lifestyle along with spirituality affect the physical and mental health of older adults. Regarding the older clergymen’s experience of spiritual life, this study aims to evaluate the role of health-promoting lifestyle in predicting cognitive status of older clergymen. 

This cross-sectional study was conducted on 190 older clergymen living in Qom, Iran who were selected using a convenience sampling method and based on the inclusion/exclusion criteria. Health Promoting Lifestyle Profile II and Mini-Mental State Exam were used to collect data. The collected data were analyzed in SPSS V. 22 software using descriptive and inferential statistics (Correlation test, linear regression analysis, independent t-test, and ANOVA). The significance level was set at 0.05.

 The mean age of participants was 70.55±6.86. There was a significant positive relationship between health-promoting lifestyle and cognitive status (r= 0.295, P= 0.001). The results of multiple regression analysis showed that the dimensions of health responsibility and nutrition along with employment status explained almost 14% of the variance in cognitive status.

 it is necessary to pay more attention to nutrition and health responsibility in health-promoting interventions of older clergymen. Further studies with a qualitative approach are recommended to understand the mechanism of the effect of spirituality on health of older clergymen.

 Low quality sleep is one of the most common problems in old age. The present study aims to determine the effect of a sleep hygiene education program using Telephone Follow-Up (TFU) method on the sleep quality of the elderly.

This quasi-experimental study was conducted on 80 eligible elderly people aged 60-74 years who were selected using a systematic random sampling method and were randomly assigned into intervention and control groups. The intervention group received a one-hour face-to-face education session on sleep hygiene. The TFU were carried out two times per week in the first month and once a week in the second month after intervention. The control group received routine care. The data collection tools were a demographic form and the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The PSQI was completed for both groups immediately after the second month.

There was no statistically significant difference in the mean PSQI score before intervention in the intervention (8.02) and control (7.47) groups (P=0.32), but after the intervention, the mean PSQI score in the intervention group (5.42) was significantly reduced compared to the control group (7.67) (P<0.001).

Sleep hygiene education program based on TFU improves the sleep quality of the elderly. It is recommended that health care providers use this method to improve the sleep quality of the elderly.

 Clostridium difficile (C. diff) is a gram-positive anaerobic bacterium knwon as the most common cause of nosocomial diarrhea in nursing homes. The antibiotic susceptibility profile is the basic way for successful treatment due to antimicrobial resistance. This present study aims to assess the antibiotic susceptibility profile of C. diff isolated from older residents of a nursing home in Tehran, Iran.

Forty-two isolates of C. diff were used in this study collected from 289 residents of Kahrizak Nursing Home. Antibiotic susceptibility testing was conducted by using disk-diffusion method, agar dilution method, and Epsilometer test (E-test).

 All C. diff strains were susceptible to Metronidazole, Vancomycin, Rifampicin, Linezolid and Tigecycline. By using the disk-diffusion method, the highest rate of resistance was related to Clindamycin (100%), Levofloxacin (96.2%), Imipenem (81%), Azithromycin (61%) and Erythromycin (54.8%). All C. diff strains were susceptible to Metronidazole under E-test. Furthermore, 100% and 59.5% of strains were susceptible to Vancomycin and Erythromycin, respectively under agar dilution test.

 C. diff strains are sensitive to Vancomycin and Metronidazole. These two antibiotics can be used to treat C. diff infections in older adults. The disk diffusion method can be used as a screening test to determine antibiotic resistance.

 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 effects of anesthesia techniques and anesthetics on different systems and organs of the body, especially the immune system, in older patients undergoing surgery, have always been of interest to researchers. This study aims to compare the effects of general anesthesia with isoflurane and spinal anesthesia with lidocaine on oxidative and antioxidant parameters in older patients with inguinal hernia surgery.

This is a double-blinded randomized clinical trial with parallel design conducted on 70 older patients referred to the surgery department of hospitals in Tehran, Iran during 2018-2019. They were randomly divided into two groups of 35; the first group received general anesthesia with isoflurane and the second group received spinal anesthesia with lidocaine. Blood sampling was performed in two stages; one day before and one day after surgery. Advanced Glycation End Products (AGEs), Advanced Oxidation Protein Products (AOPP), Malondialdehyde (MDA), oxidized Low-Density Lipoprotein (LDL), Ferric-Reducing Ability of Plasma (FRAP), glutathione peroxidase, superoxide dismutase and catalase levels were measured before and after anesthesia using standard methods. Collected data were analyzed in SPSS v.22 software.

 The Mean±SD age of patients in the lidocaine group was 69.94±8.31 years and in the isoflurane as 70.23±4.98 (P>0.81). In the isoflurane group, there was a significant difference between pre- and postoperative levels of AOPP, MDA, oxidized LDL, FRAP, catalase, glutathione peroxidase and superoxide dismutase. In the lidocaine group, this difference was significant  in MDA, oxidized LDL, catalase and superoxide dismutase. 

 Given the positive effects of isoflurane on oxidative and antioxidant parameters in older patients with inguinal hernia surgery, it is recommended that this anesthetic be considered in the selection of anesthesia methods and drugs for this group of older patients.