Developing a Conceptual Framework for an Age-Friendly Health System: A Scoping Review.

BACKGROUND: Population aging is usually associated with increased health care needs. Developing an age-friendly health system with special features, structure, and functions to meet the special needs of older people and improving their health status and quality of life is essential. This study aimed to develop a conceptual framework for an age-friendly health system, which would offer a conceptual basis for providing the best possible care for older people in health system to let them experience a successful, healthy, and active aging. METHODS: A scoping review was used to design the conceptual framework based on Arksey and O'Malley's model, including six stages, with the final stage of using expert's opinions to improve and validate the initial framework. The health system model of Van Olmen, was selected as the baseline model for this framework. Then, by reviewing the available evidence, the characteristics of an age-friendly health system were extracted and incorporated in the baseline mode. RESULTS: Using the electronic searching, initially 12 316 documents were identified, of which 140 studies were selected and included in this review study. The relevant data were extracted from the 140 studies by two reviewers independently. Most studies were conducted in 2016-2020, and mostly were from United States (33.6%). To have an age-friendly health system, interventions and changes should be performed in functions, components and objectives of health systems. This system aims to provide evidence-based care through trained workforces and involves older people and their families in health policy-makings. Its consequences include better health acre for older people, with fewer healthcare-related harms, greater care satisfaction and increased use of cost-effective health services. CONCLUSION: To meet the needs of older people, health systems should make interventions in their functions for better performance. In line with these changes, other parts of society should work in harmony and set the health of older people as a top priority to ensure they can have a successful aging.

Prevalence and Determinants of Severe Mental Disorders in Iran: Evidence from the National Survey of STEPs- 2016.

BACKGROUND: The determinants and correlates of severe mental disorders are less understood compared to the common mental disorders, both in the world and in Iran. In this study, we aimed to identify a wide range of determinants of severe stress, severe anger, and severe sadness among Iranian population. METHODS: This study is part of a large nationwide cross-sectional survey entitled STEPs conducted using a comprehensive questionnaire to determine the prevalence of main preventable risk factors of non-communicable diseases (NCDs) in Iran by age and sex groups in 2016. In total, 30541 people aged 18+participated in this study. Univariate and multivariate logistic regression analyses were used to examine the associations between the dependent variable, which is severe mental disorders, and independent variables including socio-economic factors, lifestyle and selected NCDs. RESULTS: The prevalence of severe stress, severe anger and sever sadness in the Iranian society was 33%, 35%, and 25%, respectively. Of the investigated socio-economic factors, being men, older, never married and living in rural areas were associated with significantly lower experience of severe mental disorders compared to other groups. For education, income and wealth index, there was no linear and clear pattern. Among lifestyle factors, being nonsmoker, having low physical activities, and higher intake of fruits and vegetables were found to be preventive of severe mental disorders. Additionally, having NCDs including hypertension, high cholesterol, diabetes and heart attacks were also significantly correlated with severe mental disorders. CONCLUSION: determining factors associated with severe mental disorders in this study would help in raising people's awareness on avoiding harmful factors, and taking healthier lifestyle such as quitting smoke, and consuming enough vegetables and fruits. Screening high risk people in terms of mental health could contribute to the reduction of mental disorders in the Iranian community.

Gender Interaction in Association of Perceived Social Support and Health-Related Quality of Life Among Iranian Older People: A Cross-sectional Survey.

Background: The purpose of this study was to examine the relationship between perceived social support (PSS) and dimensions of health-related quality of life (HRQoL) and to examine possible gender interaction in the mentioned associations. Methods: A community-based cross-sectional study conducted among 644 participants over the age of 60 years old in Tehran. The data were collected through face-to-face interviews conducted in their own homes, by using a structured multi-sectional questionnaire. The version 1 of the SF-12 scale was used to measure the HRQoL, consisting of two summary measures; PCS (Physical Component Score) and MCS (Mental Component Score). The Persian version of the Social Provisions Scale (SPS) was used to measure PSS. Four multilevel mixed-effects logistic regression models were used to examine the associations. Results: Older people with poor SPS score were 1.8 times more likely to be in the worst quartile of the MCS distribution (CI=1.11-2.93, P =0.021), and twice as likely to be in the worst quartile of the PCS distribution (CI=1.18-3.54, P =0.011). We found strong evidence to support the hypothesis of gender interaction in the association between economic status and PCS [Men: OR 0.28, CI (0.11-0.71); Women: OR 1.00, CI (0.53-1.88); P of Interaction 0.021], and a borderline evidence for gender interaction in the association between physical activity and PCS [Men: OR 5.32, CI (2.14-13.20); Women: OR 1.80, CI (0.82-3.93); P of Interaction 0.051]. Conclusions: Social support could be regarded as one of the main social determinants affecting HRQoL among older people. Men with poor economic status and poor physical activity, compared to women, are more likely to suffer from poor quality of life, thus men should be prioritized in financial support and life style and physical activity interventions.