Low physical activity and depression are the prominent predictive factors for falling in older adults: the Birjand Longitudinal Aging Study (BLAS).

BACKGROUND: Falling in the older adults has many irreparable consequences, including hospitalization to long-term care centers and loss of independence, depression and social isolation, financial burden, and death. The present study was conducted to estimate the incidence of falls and their associated factors among community-dwelling older adults. METHODS: This program is a population-based prospective cohort study (≥ 60 years) in Birjand City from 2019 to 2020. A total of 1418 participants were included in the study, and 1344 participants were analyzed according to the inclusion criteria. Thirty-nine risk factors were evaluated. Basic information included demographic information, lifestyle factors, general health and medical history, and mental and functional health. RESULT: The incidence of falls among community-dwelling older adults in the previous approximately 24 months in the present study was 9.26% in women and 2.65% in men. In the multiple Cox proportional regression model based on fall risk factors, there was a strong significant relationship between male sex (HR = 0.37, CI = 0.21 to 0.64), being physically active (HR = 0.59, CI = 0.36 to 0.96), moderate-to-severe depression (HR = 2.97, CI = 1.47 to 6.01), severe depression (HR = 3.26, CI = 1.24 to 8.54), and high risk of falls according to the TUG test (HR = 1.73, CI = 1.10 to 2.72). CONCLUSIONS: Inactivity and depression were recognized as important factors in falls in older adults. It is recommended for older adults to have an active lifestyle to prevent falls and to prioritize the diagnosis and treatment of depression in older adults. Women as a group at higher risk should be considered in prevention programs. In addition, the use of the TUG test to identify high-risk older adults should be considered.

Low physical activity is the strongest factor associated with frailty phenotype and frailty index: data from baseline phase of Birjand Longitudinal Aging Study (BLAS).

BACKGROUND: Frailty is the most complicated expression of aging that is related to disability or multi-morbidity. The aim of the present study was to estimate the prevalence of frailty and its associated factors among community-dwelling aged population. METHODS: A total of 1529 eligible community- dwelling older adults (≥ 60 years) were enrolled in the baseline phase of Birjand Longitudinal Aging Study (BLAS) from 2019 to 2020. Their frailty status was assessed using the Fried's frailty phenotype and frailty index. Sociodemographic factors, including sex, age, marital status, and education level, were collected. Health status assessment included the history of hypertension, diabetes mellitus, cardiovascular disease, Alzheimer's diseases and dementia, and other health conditions. Furthermore, functional assessment (ADL, IADL) and anthropometric measurements including height, weight, waist, calf, and mid-arm circumference were made and the body mass index was calculated. The nutrition status and polypharmacy (use 3 or more medication) were also evaluated. RESULTS: The prevalence of frailty was 21.69% according to the frailty phenotype and 23.97% according to the frailty index. A multiple logistic regression model showed a strong association between low physical activity and frailty phenotype (OR = 36.31, CI = 16.99-77.56, P < 0.01), and frailty index (OR = 15.46, CI = 5.65-42.34, P < 0.01). Other factors like old age (≥80), female sex, malnutrition, polypharmacy, obesity, and arthritis were also associated with frailty. The Kappa coefficient of the agreement between these two instruments was 0.18. CONCLUSION: It seems that low physical activity is the most important determinant of frailty. Low physical activity and some other factors may be preventable or modifiable and thus serve as clinically relevant targets for intervention.

Facilitators and barriers for families caring for adults living with Alzheimer's dementia: A qualitative study.

This study investigates the barriers and promoters of caring for older adults living with Alzheimer's Dementia (AD) in families. This was a qualitative study through content analysis (based on the Granheim and Lundman method), and the participants were selected using purposive sampling from the families of older adults living with AD who were receiving care in the community. We used semi-structured interviews to collect data from 32 family members. The validity and reliability of the data were assessed using the Lincoln and Guba criteria. In this study, 70.58% of primary caregivers were women. Caregiving facilitators included "Efficient family," "Capable caregiver," and "Motivated caregiver." Caregiving barriers included "Lacking awareness and knowledge," "Vulnerable family," "Older person with complex/multiple needs," and "Lack of care infrastructures." Training families and caregivers and developing care infrastructures for older adults with AD can help reduce caring barriers in older adults.

Socioeconomic Determinants of Social Capital Inequality among Older Adults of Tehran: A Population-Based Study (Urban HEART-2).

Background: Social capital (SC) is an essential concept of communities, and there is more SC inequality. In the current study, we studied SC Inequality concerning the explanatory socioeconomic factors. Methods: In a cross-sectional observational study, the household data were retrieved from an Urban Health Equity Assessment and Response Tool survey in 2011. Over 5000 elderlies in Tehran (> 60 years old) consented toparticipate in the study and filled out 2 SC questionnaires (SCQ) and a household properties questionnaire (HPQ). Subsequently, the collected HPQ data were then statistically analyzed and used to measure the economic status of households. Besides, the statistical concentration index of the SC was applied to measure socioeconomic inequality and decomposed into its determinants using both SCQ and HPQ data collections. The concentration index and the decomposition analysis were used to analyze the study data. Results: The overall concentration index of the SC in Tehran senior citizens was 0.059 (95%CI,0.044-0.076). Among the SC dimensions, collective activity, social coherence, voluntary help, and social network were more concentrated in the poor older adults. Simultaneously, reciprocity was more focused onthe wealthy class, and there was no inequality in trust. The decomposition of the concentration index showed that economic status made the most considerable contribution to the SC inequality among citizens (69.11%), followed by the level of education (12.695) and the elderlies'job type (9.58%). Conclusion: Given that the economic status and level of education are the 2 main determinants of SC inequality, a holistic policy approach should be adopted to address the socioeconomic inequalities that are taken root in Tehran's senior communities.

Validation of Pain Assessment Checklist for Seniors with Limited Ability to Communicate-II (PACSLAC-II) in Iranian older adults with dementia living in nursing homes.

BACKGROUND: Some dementia patients can self-report pain although the reports are not valid in severe dementia. Observational scales have been developed for pain assessment in these patients. This study aimed to assess the psychometric properties of the Persian version of Pain Assessment Checklist for Seniors with Limited Ability to Communicate-II (PACSLAC-II). METHODS: This validation study was conducted on 138 older adults with dementia suffering from chronic pain who lived in nursing homes. The PACSLAC-II Persian version was applied through observations during activity and rest. Reliability of the PACSLAC-II was evaluated by Cronbach's alpha and intra-class correlation coefficients. Construct validity was determined by confirmatory factor analysis, divergent and convergent validity. The Spearman's rank correlation between PACSLAC-II scores and Faces Pain Scale was calculated for concurrent validity. Known-group validity during activity and rest was calculated by Wilcoxon signed ranks test. RESULTS: Cronbach's alpha coefficient for facial expression (0.82), verbalisation (0.72), and body movement (0.84) subscales indicated good internal consistency. The intra-class correlation coefficients between two raters was 0.76 and in three times evaluation, the value was 0.76. Convergent validity with Iranian Brief Pain Inventory and divergent validity with 15-item Geriatric Depression Scale confirmed the construct validity of PACSLAC-II. Three factors structure of PACSLAC-II was approved, and most of the variance was explained by facial expressions. The PACSLAC-II can discriminate between pain and non-pain events and has a moderate correlation with Faces Pain Scale (r = 0.33). CONCLUSIONS: PACSLAC-II Persian version is a valid and reliable scale for pain assessment in older adults with dementia.

Validity and Reliability of 11-face Faces Pain Scale in the Iranian Elderly Community with Chronic Pain.

BACKGROUND: Accurate pain assessment in elderly population is essential for pain management and nurses have a pivotal role. The 11-face Faces Pain Scale (FPS-11) is a well-established pain assessment measure that has not been validated in the Iranian elderly. AIM: The aim was to study the property assessment of the Iranian version of FPS-11 (FPS-11-IR) among elderly outpatients with chronic pain. METHODS: This is a cross-sectional validation study that conducted in three outpatient clinics in Tehran, Iran, in 2017. Older people aged ≥60 years (n = 217) with chronic knee pain due to degenerative joint disease were participated. The construct validity was examined by applying contrast constructs, and the face validity was determined by rank-ordering test. To assess concurrent validity, the Spearman's correlation coefficient was calculated between the scores of 11-point Numeric Rating Scale (NRS) and FPS-11-IR. Test-retest reliability was determined in 1-week interval. RESULTS: Most of elderly participants (72%) agreed that pain construct displays in faces of the FPS-11-IR and participants" agreement on face rank ordering were vary for each face, ranging from 80% to 100%. Spearman's correlation coefficient between FPS-11-IR and NRS scores was very strong (r = 0.91, P < 0.01). Intraclass correlation coefficient between test-retest scores was 0.96 that indicates excellent reliability. CONCLUSIONS: The FPS-11-IR is a reliable and valid pain assessment scale to use in geriatric patients chronic pain.

Incidence and Risk Profile of Dementia in the Regions of Middle East and North Africa.

BACKGROUND: The risk of dementia is reported as "epidemic" and "looming" over the Middle East and North Africa (MENA) region. For this, we performed a multi-language review and feasible analysis on the incidence of dementia to offer apt conclusions. METHODS: Totally, 3 databases (Magiran, Scientific Information Database, and PubMed) and 1 non-database source (Google) were searched in French, English, and Persian by using specific keywords and their combinations. All searches were independent and had no restriction for the year or type of publication. We also calculated cumulative incidence of dementia for Egypt and Israel-Palestine from relevant prevalence estimates by using standard formula. RESULTS: Little information on incidence was available, sparing Israel (2.4/100,000/year; pre-senile). Ten (48.0%) countries had none-to-little information (of any kind) on dementia, indicating considerable awareness deficit in this region. Cumulative incidence of dementia in Egypt and Israel-Palestine was 2.7% over 20 years (55 new cases) and 14.7% (130 new cases) over 6 years, respectively. In Lebanon, cumulative incidence was 7.5% over 20 years. Data looked across dementia-related factors (i.e., fertility rate, polygamy, violence, hypovitaminosis D, diabetes, hypertension, life expectancy, age structure) did not seem to support epidemic proportions of dementia for MENA. CONCLUSIONS: MENA is youthful and dementia here is neither likely to be an epidemic nor looming over. The only possible exception might be Arab pocket in Israel. To us, previous attributions on dementia do not seem to be based on the realities of this region and, therefore, may prevent pragmatic addressal of dementia. Lastly, values-based collaborations are invited to jointly fill the awareness deficit in a unique low-cost manner.

Effect of vibration on postural control and gait of elderly subjects: a systematic review.

BACKGROUND AND AIM: Gait and balance disorders are common in the elderly populations, and their prevalence increases with age. This systematic review was performed to summarize the current evidence for subthreshold vibration interventions on postural control and gait in elderly. METHOD: A review of intervention studies including the following words in the title/abstract: insole, foot and ankle appliances, vibration, noise and elderly related to balance and gait. Databases searched included PubMed, ISI Web of Knowledge, Ovid, Scopus, and Google Scholar. Fifteen articles were selected for final evaluation. The procedure was followed using the preferred reporting items for systematic reviews and meta-analysis method. RESULTS: There was reduction in center of pressure velocity and displacement especially with eyes closed using vibration in healthy elderly subjects and this effect was greater in elderly faller and patients with more balance deficiency. Vibration programme training increased speed of walking, cadence, step time and length in stroke subjects. The vibratory insoles significantly improved performance on the Timed Up and Go and Functional Reach tests in older people. CONCLUSION: Vibration was effective on balance improvement in elderly subject especially elderly with more balance deficiency and it can improve gait parameters in patients with greater baseline variability.

Life satisfaction as the main factor behind the elderly`s health knowledge utilization: A qualitative study in an Iranian context.

Background: The elderly population's health has become a priority as their numbers are on the rise and they are increasingly becoming vulnerable to physical and mental diseases. Studies show that an elderly person's health depends on his/her utilization of health knowledge in daily life. Hence, here we investigated the contributing factors of knowledge utilization in the elderly population. Methods: A qualitative study was conducted through conventional content analysis. Semi-structured in-depth interviews were held with 29 elderly individuals from Tehran. A focus group discussion was conducted (eight elderly individuals), and an expert panel was held with nine experts to complement the results. Results: Upon data analysis, four categories and seven subcategories were extracted. The main categories included provision of basic needs, maintaining dignity, life satisfaction, and negative feelings toward self and others. The concept of 'life satisfaction' held a pivotal role in relation to the other categories. Conclusion: Life satisfaction was the main category in the utilization of health knowledge among the elderly. Aging should be foreseen and forethought to increase life satisfaction. The followings can be effective in increasing life satisfaction in the elderly: Promoting positive-thinking, placing greater emphasis on spiritualism in life, employment of the elderly, and promoting the culture and tradition of respecting the elderly.

Mental Health and Pain in Older Adults: Findings from Urban HEART-2.

Pain is an important component of disability problems, and plays a key role in mental health of older adults. This study aims to investigate the relationship between mental health and pain in older adults of Tehran, Iran. This was a cross-sectional study using data on 5326 older adults aged ≥60 years old from a large population-based survey (Urban HEART-2). A multistage cluster random sampling method was used to select the participants in Tehran, Iran, in 2011. General Health Questionnaire (GHQ-28), pain questionnaire, and socioeconomic questionnaires were used to collect the data. A total of 5326 older adults, 3811 (71.6%) married and 2797 (52.5%) female, were included into the study. The mean age of the participants was 68.92 ± 7.02 years. Mean of GHQ-28 scores in the sample was 51.08 ± 10.94, which indicates of a good level of mental health. The majority of the older adults had knee and back pain (more than 50%). Regardless of the chronicity, time, and the mode of reaction to it, knee and back pain were the highly reported pains among the participants. There was a statistically significant difference between two groups of older adults, with and without pain, in terms of GHQ-28 scores. Multiple regression analysis revealed that there was a relationship between mental health and the following factors: pain in head, shoulder, teeth, upper and lower limbs, education, gender, age, and marital status. Whatever the explanation, the relation of lowered health status to pain in all body parts among older people is considerable. This renders this matter as a top priority in health policy making.

A Population-Based Survey to Determine Association of Perceived Social Support and Self-Efficacy With Self-Care Among Elderly With Diabetes Mellitus (Kerman City, Iran).

This survey examined association between social support and self-efficacy with self-care in elderly with diabetes. A total of 374 subjects were identified in Kerman city, Iran who responded to questionnaires on self-care, social support, and self-efficacy. Data were analyzed by using SPSS. Along with customary descriptive statistics, we also determined group difference for self-care, and Pearson correlation, and prediction value of various variables by using hierarchical multiple regression. And 67.37% of subjects were classified as poor adherence to self-care; 55.9% patients reportedly had good foot care habits, while 68.4% patients were not taking adequate physical activity. There was a significant correlation between self-care with social support and self-efficacy. Independent variables accounted for 44.3% of the variance in self-care. Diabetes care programs should aim to implement (a) weekly free-of-cost mass physical activity programs, (b) mass education adapted for gender- and age-based needs, and

The effect of aging on gait parameters in able-bodied older subjects: a literature review.

BACKGROUND: Gait disorders are common in the elderly populations, and their prevalence increases with age. Abnormal gait has been associated with greater risk for adverse outcomes in older adults, such as immobility and falls, which in turn lead to loss of functional independence and death. AIM: The purpose of this review was to evaluate all of the original papers that measured gait parameters in the healthy elderly subjects. METHOD: The search strategy was based on Population Intervention Comparison Outcome method. A search was performed in Pub Med, Science Direct, Google scholar, ISI web of knowledge databases by using the selected keywords. Forty-two articles were selected for final evaluation. The procedure using the PRISMA method was followed. RESULTS: Stride lengths of older subjects ranged between 135 and 153 cm, and they preferred to walk with a 41 % increase in step width compared to young subjects. Cadence was reported to be between 103 and 112 steps/min in older adults. They consumed an average of 20-30 % more metabolic energy than younger subjects. All except one study demonstrated that older people have significantly reduced gait symmetry. CONCLUSION: The progression toward shorter steps and slower walking and increased step width and prolonged double support in older adult, may therefore emerge as a compensatory strategy aimed at increasing stability, avoiding falls, or reducing the energetic cost of mobility.

Seizures and epilepsy in elderly patients of an urban area of Iran: clinical manifestation, differential diagnosis, etiology, and epilepsy subtypes.

The incidences of seizures and epilepsy in the population show a peak after 60 years of age. Due to the lack of reported clinical aspects of seizure and epilepsy in the older patients in our region in Iran, this study was conducted to describe the clinical manifestation, etiology, differential diagnosis, and epilepsy subtypes of epilepsy and seizure. A cross-sectional retrospective study was performed on all consecutively elderly seizure and epilepsy patients, referred to the Epilepsy Association in the city of Qom, Iran over a 10-year period. A total of 466 patients aged >60 years were admitted. 31 % of the patients had epilepsy or seizure and 69 % of them had non-epileptic events. The most prevalent differential diagnoses in the beginning were syncope and cardiovascular disorders. The most frequent clinical symptom of epilepsy was generalized tonic-clonic seizures (75 %). The most common cause of seizure was systemic metabolic disorder (27 %). In epileptic elderly patients, no cause was ascertained for 38 % and the most frequently observed pathological factors were cerebrovascular diseases, which accounted for 24 %. The most common type of epileptic seizure was generalized epileptic seizures (75 %). 10 % of elderly epileptic patients suffered from status epilepticus, which was primarily caused by anoxia. Despite the rising rate and potentially profound physical and psychosocial effects of seizures and epilepsy, these disorders have received surprisingly little research focus and attention in Iran. Referring older patients to a specialist or a specialist epilepsy center allows speedy assessment, appropriate investigation and treatment, and less likely to miss the diagnosis.

Effects of hospital-to-home transitional care on health outcomes of elderly patients in Islamic Republic of Iran.

Background: Hospitalization has a negative effect on the functional and clinical outcomes of elderly patients. Aims: To evaluate the effect of a care transition intervention on functional and clinical outcomes and quality-of-life of elderly patients in the Islamic Republic of Iran after hospital discharge during a 3-month follow-up. Methods: We conducted a randomized controlled trial of 304 elderly hospitalized patients in Tehran from December 2018 to January 2020. The intervention group (n = 152) received care transition intervention and the control group (n = 152) received routine hospital discharge. All patients were assessed during hospital stay and at 30, 60 and 90 days after hospital discharge. Participants were evaluated using the Minimum Data Set-Home Care form, which assesses daily living activity, instrumental daily living activity, cognitive performance, cognition, pain, and depression. Rehospitalization and qualityof- life were evaluated, and differences between the groups and trends in quality-of-life were assessed. Results: Only instrumental daily living activity in the functional outcomes and quality-of-life were greater in the intervention group than the controls. The intervention (odds ratio (OR): 0.11; 95% confidence intervals (CI): 0.01-0.97), age (OR: 1.16; 95% CI: 1.01-1.33), and cognition (OR: 1.24; 95% CI: 1.02-1.51) predicted instrumental daily living activity. Age (coefficient: -0.009, P = 0.001), depression (coefficient: -0.157; P < 0.001), cognition (coefficient: -0.023, P < 0.001) and pain (coefficient: -0.106, P = 0.007) predicted quality-of-life. Conclusion: Care transition interventions can help maintain the independence of older adults after hospital discharge and improve their quality-of-life.

Working Condition and Job Satisfaction of Nurses as Predicting Factors of the Prevalence of Health care-associated Infections among Elderly Inpatients.

Background: Health care-Associated Infections (HCAIs) are among the most common adverse events (AEs) that can negatively affect both patients and health systems. The elderly is among patients at high risk for infections. Some controllable risk factors have received less attention in research. Therefore, this study aims to investigate the relationship between prevalence of HCAIs among elderly inpatients, job satisfaction of nurses, and working condition. Materials and Methods: This cross-sectional study was conducted on 211 nurses working in hospitals affiliated with Iran University of Medical Sciences, Tehran, in 2021. The data were collected from HCAIs reports by the Nosocomial Infection Control Committee, a demographic questionnaire, the Practice Environment Scale of the Nursing Work Index (PES-NWI), and the Minnesota Satisfaction Questionnaire (MSQ). The data were statistically analyzed using Pearson correlation coefficient, ANOVA, t-test, and multiple linear regression (MLR) in SPSS 26. Results: The results showed that there was a significant relationship between the PES-NWI and MSQ (r = 0.68, p < 0.00). The MLR results indicated that staffing and resource adequacy, nurse participation in hospital affairs, job satisfaction, nursing manager's leadership, and nursing foundations for quality of care are predictive factors that these could explain 78% of the changes in the prevalence of HCAIs and the goodness of fit of the regression model was acceptable [F6.210 = 129.47, p < 0.001]. Conclusions: Since job satisfaction and the work condition could predict HCAIs among the elderly patients, healthcare administers are recommended to consider these two variables in the development of HCAIs prevention and control programs.

Psychometric properties of the Persian version of the "Intergenerational relationship quality scale for aging parents and their children".

BACKGROUND: Investigating the status of intergenerational relationships of elderly parents with their adult childen is very important in examining issues related to the status of the elderly such as well being and quality of life and other aspects of elderly life. Giveeen the significance of the topic, the current study aimed to examine the psychometric properties of the Persian version of "Intergenerational Relationship Quality Scale for Aging Parents and Their Children" (IRQS-AP). MATERIALS AND METHODS: A total of 463 community-dwelling elders (aged 60 years or older) in Tehran participated in this study through multistage cluster sampling method. To investigate reliability, the construct and convergent validity of the IRQS-AP, confirmatory factor analysis (CFA), and interclass correlation coefficient were done. RESULTS: The content validity index was 0.84 for the entire tool. In the CFA, we found the instrument had a four-factor structure and adequate internal consistency. The scale had a significant and positive correlation with the two measures of loneliness and depression. Furthermore, Cronbach's alpha was estimated at 0.77, and the high value of the interclass correlation was 0.82. CONCLUSION: The IRQS-AP is a valid and reliable scale that can be used to examine the status of intergenerational relationship quality in Iranian elder population.

The intergenerational relationship patterns between aging parents and their adult children.

Background: Older parent-child relations and their impact on the elderly's lives are of importance; thus, the present study aimed to investigate the patterns of the intergenerational relationships between aging parents and their adult children. Methods: The current cross-sectional study was conducted on 463 elderly men and women, aged ≥60 years who were residing in Tehran City, Iran. The study participants were selected using the stratified cluster sampling method. The Bai's (2017) 13-item Intergenerational Relationship Quality Scale for Aging Parents (IRQS-AP) was used to evaluate the patterns of intergenerational relationships among the study subjects. The obtained data were analyzed in SPSS. The significance level of the tests was set at P ≥ 0.05. The logistic regression model was employed to investigate the factors related to the patterns of intergenerational relationships. Results: The mean ± SD age of the explored aging parents was 67.93 ± 7.0 years. Besides, the mean ± SD number of children in the study participants was 3.55 ± 1.80. The mean ± SD scores of solidarity (structural, associational, consensual, affectual, functional, and normative) and conflict were measured to be (58.95 ± 17.55) and (64.10 ± 20.92), respectively. Furthermore, the mean ± SD score of the ambivalence pattern was calculated as (51.46 ± 21.61). The mean score of conflict was higher than those of solidarity and ambivalence. Additionally, the mean score of consensual-normative solidarity was higher than those of other dimensions of solidarity. The obtained data suggested a significant difference between age and the patterns of intergenerational relationships (p ≤ 0.05). Moreover, the mean scores of solidarity and conflict in the examined female elderly and their adult children were higher than those of their male counterparts and their adult children; however, the mean score of ambivalence in the male elderly and their adult children was higher than that in their female counterparts. Logistic regression analysis results indicated that aging parents who were literate (OR = 1.5), those who lived alone (OR = 1.2), and those who assessed their general health status as good (OR = 4), reported high levels of solidarity with their adult children. Conclusion: The present research results demonstrated that the level of conflict between aging parents and their adult children exceeded the solidarity level, indicating the intergenerational gap. Therefore, the necessary implications should be adopted to promote intergenerational relationships within the family by providing family counseling. Further research is recommended to consider the essential role of predictive factors, such as age, gender, educational level, occupational status, living arrangements, health status, and socioeconomic status of aging parents concerning the intergenerational relationships between aging parents and their adult children.

The effect of toe-only rocker sole shoes on gait variability of the elderly.

Gait variability could associate with fall risk in older people. Rocker sole shoes are commonly prescribed to reduce plantar pressure and facilitate forward movement. Thus, it may affect gait stability. The purpose of this study was to investigate the effects of toe-only rocker shoes on gait variability in the elderly. Seventeen healthy elderly participants walked on a treadmill under six different conditions including barefoot (BF), normal shoe (NS), and four types of toe-only rocker sole shoes with various degrees of rocker angle (RS10, RS20, RS30, and RS40). Then the step length variability (SLV), the step time variability (STV), the step width variability (SWV), and the stance time variability were measured. Increasing rocker angle in toe-only rocker did not significantly affect gait variability more than the standard shoe. It seems that different rocker angles in toe-only rocker sole shoes do not pose a threat to gait variability compared to the standard shoes in healthy elderly. Findings of the study suggested that the toe-only rocker sole can be used to facilitate forward progression in the elderly. Further investigation is also required to examine the long-term effects of toe-only rocker sole shoes on gait variability in frail elderly.

Nonlinear analysis of dynamic stability in walking with toe-only rocker sole shoes in elderly.

BACKGROUND: Elderly subjects are at the risk of falling. One type of shoe intervention used for this group of the subjects is the shoe with rocker. The aim of this study was to investigate the effects of shoes with various degrees of rockers on dynamic stability of elderly subjects while walking. METHOD: 15 elderly subjects were recruited in this study. A motion analysis system was used to record the motions of body while walking on a treadmill. The local dynamic stability (LDS) was evaluated based on use of Lyapunov exponent of center of mass (COM) movement. The subjects were asked to walk barefoot, with shoe with no rocker and with shoe with various rockers (10, 20, 30 and 40°). RESULTS: The mean values of LDS (λmax-S) in anteroposterior direction were 0.95 ± 0.46, 0.78 ± 0.51 and 0.74 ± 0.54 in bare foot, shoes with no rocker and shoe with 10° rocker, respectively. The mean value of LDS (λmax-S) in vertical direction varied between 1.21 and 1.23. There was no significant difference between LDS of elderly subjects while walking with shoes with various rocker angles. DISCUSSION: Use of shoes with various rocker angles dose not influence on dynamic stability of elderly subjects while walking. Therefore, it is recommended to use this kind of shoe intervention for other trapeutic purposes.

Older people's perceptions of intergenerational relationships in nursing homes: A qualitative content analysis.

Introduction: Intergenerational conflict is one of the components which helps to inappropriate communication patterns and ineffective interactions. Intergenerational research aims to promote deeper understanding and respect between generations and helps to create more cohesive communities, suggesting that it can have numerous health and social benefits. Despite the importance of intergenerational relationships in the elderly, the older people's perceptions of intergenerational relationships in nursing homes are not well understood. The purpose of this study was to explore the older people's perceptions of intergenerational relationships in nursing homes in relation to nurses. Methods: This was a qualitative content analysis in which 12 elderly residents and 6 employees (3 nurses, 1 supervisor, 1 psychologist and 1 nursing home manager) in the nursing home were recruited purposively from three nursing homes located in Tehran, Iran. Semi-structured interviews were used to collect information. Data were analyzed via qualitative content analysis and continuous comparison and were based on self-interactional group theory (SIGT). Results: During data analysis, "Struggle for existence" was extracted from three subthemes as the main theme. Subthemes such as "prejudicious tendencies", "Communication nodes" resulting from intra-group and inter-group analysis, respectively, and the "umbrella of society," which influences both concepts, formed the intergenerational relationships in the nursing homes. Conclusion: Generational differences between nursing home residents and nurses make establishing effective communication between them difficult and lead to lack of quality care. The study findings can help nursing home managers apply strategies to remove barriers to intergenerational relationships, improve these relationships and increase cohesion between generations to lead to better care and subsequent improvement in their quality of life.