فصلنامه سالمند
پیاپی 68 (زمستان 1401)

The use of herbal medicine is one of the most widely used methods of complementary medicine around the world. Studies have shown that the elderly use a variety of herbal medicines and believe that these products are harmless due to being natural. This study aims to evaluate the amount of herbal medicines prescribed by physicians for the elderly in Iran.
Methods & Materials: This is a secondary analysis study with a cross-sectional design. The study population consist of the paper prescriptions for all older adults in Tehran, Iran in 2020. Of these, 1591 paper prescriptions for older people aged >60 years referred to pharmacies in Tehran were selected by a cluster random sampling method. The data were analyzed using descriptive statistics (Mean, No. [%]) and inferential statistics (Chi-square test, independent t-test) in SPSS software, version 24.

 Out of 1591 prescriptions, 79(5%) contained herbal medicines. Laxatives, ginkgo, and ginseng were the most prescribed medicines. Chi-square test results showed the statistically significant relationship of the educational level of the elderly (P=0.018), having insurance (P=0.004) and polypharmacy (P=0.000) with the prescription of herbal medicines, but the gender and marital status of the elderly and the gender, age and work experience of the physicians had no significant relationship with the prescription of herbal medicines. The rate of herbal medicine prescription by general practitioners was 5.7% and by specialized physicians was 4.7%, but no significant relationship was found between them. Among the specialized physicians, infectious disease specialists prescribed the most herbal medicines (14%) followed by physical medicine specialists (12%) and orthopedics (9.2%). Chi-square test results showed a significant relationship between the expertise of physicians and prescription of herbal medicines (P=0.042).

 The rate of herbal medicine prescription in Tehran city is low, but due to the interest of the elderly in herbal medicines, producing various herbal medicines with suitable forms and dosages and increasing the knowledge of physicians about these medicines can help increase the prescription of herbal medicines.

 Social isolation of older adults is one of the major global concerns associated with widespread negative outcomes. The present study aims to investigate the psychometric properties of the Persian version of the social disconnectedness and perceived isolation scales in Iranian older adults.

 The translation/back-translation process was performed based on the standard protocol of world health organization. Face and content validities were assessed based on the opinions of a panel of experts. The content validity of the scales was evaluated by calculating the content validity ratio (CVR) and content validity index (CVI). Internal consistency, reliability, and construct validity were evaluated using Cronbach’s alpha, test-retest method, and factor analyses, respectively. Factorial structure of the scales was tested using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and structural equation modeling in a sample of 390 community-dwelling older adults aged ≥ 60 years residing in Tabriz, Iran. Data analysis was performed in SPSS software, version 26 and AMOS version 24.

For the social disconnectedness scale, CVR=‌0.98 and CVI=‌0.91; for the perceived isolation scale, CVR=‌0.91 and CVI=‌0.96. The EFA with the varimax rotation identified new factors in both scales. Cronbach’s alpha of 0.64 for the social disconnectedness scale and 0.76 for the perceived isolation scale showed that their internal consistency was acceptable. The number of factors in the social disconnectedness scale changed from two to three factors, and the number of factors in the perceived isolation scale changed from two to four factors in the Persian versions. The CFA and SEM confirmed the three-factor solution of the Persian version of the social disconnectedness scale (RMSEA=0.050, GFI=0.951, CFI=0.950, and TLI=0.955) and the four-factor solution of the Persian version of perceived isolation scale (RMSEA=0.045, GFI=0.955, CFI=0.955, and TLI=0.950).

Although the structures are different from those of the main versions, the Persian versions of the social disconnectedness and perceived isolation scales have acceptable reliability and validity to be used in Iranian older adults.

 Fear is one of the most frequent feelings associated with coronavirus disease 2019 (COVID-19). Older people are at risk for severe COVID-19 infection. Spiritual well-being can play an important role in patients’ coping and adaptation to stressful conditions. The present study aims to determine the role of spiritual well-being in predicting fear of COVID-19 among older adults in Qazvin, Iran. 

 This descriptive cross-sectional study was conducted on 400 community-dwelling older adults in Qazvin, Iran in 2021 who were selected using a cluster sampling method from public places in three urban areas. Data were collected using a demographic checklist, the Fear of COVID-19 Scale, and Paloutzian and Ellison’s Spiritual well-being scale. A multivariate regression model was used to determine the predictors of fear of COVID-19.

 The mean age of participants was 69.70±6.99 years. Their fear of COVID-19 was at a high level (Mean±SD=22±8.82). The results of regression analysis showed that sex (β=0.186, P=0.001), history of hypertension (β=0.130, P=0.006), history of diabetes (β=0.097, P=0.037), history of stroke (β=0.091, P=0.048), educational level (β=-0.142, P=0.007), economic status (β=0.145, P=0.007), and spiritual well-being (β=-0.117, P=0.013) were the predictors of fear of COVID-19. 

 Spiritual well-being, as well as educational level, history of chronic diseases, and economic status have a role in predicting the fear of COVID-19 in older adults. Therefore, the implementation of spirituality-related care programs can be useful for reducing the fear and anxiety of older adults during the COVID-19 pandemic.

The ageing of the population lead to various problems in terms of health care. An important issue related to the promotion of elderly health is preventive care. The health care systems make appropriate changes in the structure and process of providing these services to the patients. This study aims to identify the most important factors of providing primary preventive care services to the elderly in Iran.

 In this descriptive-survey study, the variables were measured using a questionnaire and the causal relationships between them were identified. First, the factors affecting the provision of primary preventive care services to the elderly in selected countries including Iran were compared. Then, using the experiences of a panel of experts (n=12), an initial questionnaire was designed. To obtain consensus from the panel of experts, a Delphi process was carried out in three rounds. After determining the face and content validity of the questionnaire and assessing its reliability using Cronbach’s alpha coefficient, the questionnaire were completed by 176 experts. To measure the effect of the components on the main variable, the structural equation modeling (SEM) was used.

The model had 6 dimensions (planning, organizing, resource supply, monitoring, leadership, and preventive care). The factor load for the variable of planning was 0.68 (t=5.22); for organization, 0.56 (t=4.54); for resource supply, 0.47 (t=3.65); for monitoring, 0.59 (t=2.67); for leadership, 044 (t=3.05); and for preventive care, 0.650 (t= 3.85). Eight indicators were identified for the planning dimension, six indicators for the organization dimension, seven indicators for the resource supply dimension, seven indicators for the monitoring dimension, three indicators for the leadership dimension, and six indicators for the preventive care dimension.

Planning, preventive care, monitoring, organizing, resource supply, and leadership are the most important factors of the provision of primary preventive care services to the elderly in Iran. Development of infrastructure, scientific and practical measures, promoting the health culture, and the seriousness of the health system in using the existing capacities and facilities, can help increase the quality of life and reduce health costs and disease burden in the elderly.

Aging is a sensitive period in life. Due to the increase in the aging population and the possibility of mild cognitive impairment (MCI) and depression in the elderly, it is necessary to prevent Alzheimer’s disease in these patients by improving their cognitive status and depression. The present study aims to investigate the effect of cognitive rehabilitation on the cognitive status and depression of older men with MCI.

 This is a quasi-experimental study with a pretest/posttest design using a control group. The study population consists of older men aged ≥60 years with MCI living in a nursing home in Kerman, Iran in 2021. Using a purposeful sampling method, 24 eligible older men were selected and randomly assigned to two groups of control (n=12) and intervention (n=12). Evaluation of cognitive state and depression was performed using the Mini-Mental State Examination and the Geriatric Depression Scale, respectively before and after the intervention. Cognitive rehabilitation program was presented at 12 one-hour sessions in the intervention group. The data were analyzed using analysis of covariance in SPSS software, version 19.

The cognitive rehabilitation program had a significant effect on improving cognitive state and reducing depression in the elderly with MCI (P<0.05). 

The cognitive rehabilitation program is recommended as a non-pharmacological treatment to improve cognitive status and reduce depression in older men with MCI.

This study aim to investigate whether psychological well-being of the elderly can be predicted by cognitive impairment and negative emotions mediated by coping self-efficacy and social support.

 This is a correlational study using structural equation modeling (SEM). Participants were 450 older adults, including 247 men (54.9%) and 203 women (45.1%), aged 60-80 years in Tehran, Iran who were selected by a convenience sampling method based on the entry and exit criteria. The demographic variables (age, marital status, number of children, education level and income level) and the history of physical diseases were recorded. The research tools included Ryff’s psychological well-being scale, Positive and Negative Affect Scale, Mini-Mental State Examination, Coping Self-Efficacy Scale, and Social Provisions Scale. Fitness of the study model was estimated using SEM in LISREL software. The mediating relationships in the proposed model was tested using the bootstrap procedure.

The Mean±SD age of male participants was 66.34±5.34 years and the mean age of female participants was 65.57±6.08 years. The results showed that the proposed model had good fit. The four indirect pathways were statistically significant. Cognitive impairment with standard coefficients of -0.57, -0.60, and -0.27 had an impact on social support, coping self-efficacy, and psychological well-being, respectively. Negative emotions also had an effect on social support, coping self-efficacy and psychological well-being with coefficients of -0.28, -0.34 and -0.11, respectively. The effect of coping self-efficacy on psychological well-being had a standard coefficient of 0.15, and the effect of social support on psychological well-being had a standard coefficient of 0.57.

These findings highlight the importance of coping self-efficacy and social support in improvement of psychological well-being and consequently prevention of adverse outcomes due to cognitive impairment in the elderly. It is recommended to develop comprehensive and practical strategies to strengthen the internal and external resources of older people and improve their health.

 The present study aims to investigate the effect of shoes with toe rocker angles of 10 and 15 degrees, compared to control shoes, on the plantar pressure distribution, force, and contact surface in healthy older adults to help maintain the independence and function of the elderly and prevent possible injuries.

 In this clinical trial, 35 healthy older adults (15 males and 20 females) with mean age of 65.2±4.37 years, who were selected using a convenience sampling method from those with no lower limb deformity, no orthopedic and neurological diseases, and with ability to walk without assistance devices. Three types of shoes were used including traditional shoes as controls, shoes with a toe rocker angle of 10 degrees, and shoes with a toe rocker angle of 15 degrees. The maximum plantar pressure in eight anatomical areas were measured using the Pedar system. Repeated measures ANOVA was used for data analysis.

There was no significant difference in pressure distribution (P>‌0.05), force (P>‌0.05) and contact surface (P>‌0.05) in eight anatomical areas of the sole of the feet between the three study groups.

It seems that the use of shoes with toe rockers do not affect the plantar pressure distribution, force and contact surface in older adults. These shoes can be used without the fear of changing the plantar pressure distribution and causing pain and injury in the elderly.

Delirium is an acute and fluctuating change in the patient’s mental state associated with decreased alertness and impaired attention. This study aims to investigate the prevalence of delirium and its related factors in older adults hospitalized in selected hospitals in Tehran, Iran.

 This is a cross-sectional study. The study population consists of all the elderly hospitalized in the emergency and internal departments of Firoozabadi and Rasoul Akram hospitals in Tehran, Iran. Using a simple random sampling method, 300 eligible patients were selected for the study. To collect the required information, a demographic and medical history questionnaire and the 4AT test were used. Related blood biomarkers were also examined. After collection, the data were analyzed in SPSS software, version 24 using descriptive statistics (Mean±SD) and inferential statistics (Pearson correlation test). The significance level was set at 0.05.

 The Mean age of patients was 70.91±8.77 years; 53% were male and 62% were married. Thirty-one percent were exposed to delirium and 43% had delirium. The patients’ delirium status had a significant relationship with the history of polypharmacy (r=0.503, P<0.001), independence in performing activities of daily living at home (r=0.404, P<0.001), history of hospitalization in the past month (r=0.390, P<0.001), hearing loss (r=0.362, P=0.001), vision loss (r=0.382, P=0.006), history of cognitive impairment (r=0.350, P=0.002), Parkinson’s disease (r=0.301, P=0.004), history of specialized treatment for depression (r=0.218, P=0.012), and chronic pain (r=0.251, P=0.043).

Early diagnosis of delirium can prevent its adverse effects. It is necessary to identify the risk factors of this syndrome and provide appropriate and comprehensive interventions for the hospitalized elderly with delirium.

 Due to the rapid growth of the elderly population, it is very important to pay attention to their mental health indicators including feeling of loneliness, social functions and depression. This study aims to determine the mediating role of depression in the relationship between feeling of loneliness and social functioning in the elderly.

 In this correlational cross-sectional study, 318 older adults covered by the comprehensive health centers in Bushehr, south of Iran in 2018 were selected using a simple random sampling method. To collect data, Russell’s UCLA loneliness scale (version 3), and Goldberg’s general health questionnaire (Depression and social dysfunction subscales) were used. We applied the partial least squares-structural equation modeling to analyze the data in PLS Graph version 3.00 software. The significance level was set at 0.05.

 The mean age of the participants was 66.74±5.87 years; 55.3% were male and the rest were female. The results showed that feeling of loneliness directly (β=0.199, P<0.01) and through mediation by depression (β=0.183, P<0.001) could cause social dysfunction. Felling of loneliness and depression together explained 20% of the variance in social dysfunction. The outer and inner model fit indices indicated the models’ good fit.

 Feeling of loneliness directly or by causing depression can reduce the social functioning of the elderly. The results of this study can be used in designing effective interventions to increase the social functioning of the elderly.

In nursing homes, intergenerational relationships has of particular importance because people of different ages and from different generations interact with each other. Health care workers, including nurses, can cover a wide range of intergenerational relationships in the form of care provided to the elderly. Despite the importance of intergenerational relationship among the elderly, the related challenges in nursing homes in Iran have not been studied yet. Therefore, this study aims to identify the factors affecting intergenerational relationships in nursing homes in Iran.

 This is a qualitative study that was conducted in three nursing homes in Tehran, Iran using the grounded theory method. Participants were 13 older residents and 8 employees working in nursing homes (Five nurses, one supervisor, one psychologist and one nursing home manager) who were recruited purposively. Semi-structured interviews were used to collect data and sorted by constant comparison method. Data analysis was performed using Strauss and Corbin’s grounded theory method.

 Data analysis yielded five main categories. “Intergenerational tensions” was the main variable. The causal condition for this variable was titled “Tensions based on psychological factors”. The contextual factors in nursing homes were in a group titled “defective platform of intergenerational relationships”. The intervening factors included facilitators of and barriers to intergenerational relationships. Strategies was titled “Efforts to preserve existence” and consequences were titled “living with insecurity”.

 Generational differences between nursing home residents and staffs make it difficult to establish effective relationships between them which can cause poor quality care. The findings can help nursing home managers to apply strategies to remove barriers to intergenerational relationships and know how to improve these relationships and create greater cohesion between generations so that it can lead to better care and subsequently improved quality of life in the elderly.