Representation of Aging in Elementary School Textbooks in Iran.

The attitude toward older adults is developed from childhood. School textbooks are one of the most important sources of shaping attitude in children. So, the present study aimed to analyze the visual and textual content of the aging concept in elementary school textbooks after the Irans's Islamic Revolution (1979). The method of the present study was content analysis, and 112 textbooks were reviewed. The analysis unit included 118 images and 91 subset of texts pertaining to aging concept. The results showed that aging concepts are classified into two positive and negative stereotypes categories. The positive stereotype included social interaction, authority and respect, wisdom, spirituality, positive traits, and independence. Social interaction was the most frequent of them. Negative stereotypes included abuse, negative personality traits, illness, and disability, of which the negative personality traits were the most frequent. In addition, the results suggested that 87.7% of the concepts of aging in the textbooks were positive. Although the positive stereotypes were more frequent in textbooks, the active older adults were presented in low-status jobs, and the ethnic minorities and older women were less considered. Accordingly, policymaking through the textbooks and from childhood is necessary for developing successful aging and decreasing ageism in society.

Prescription pattern among Iranian community dwelling older adults.

Aim To assess prescription pattern among Iranian communitydwelling older adults. Methods This cross-sectional study employed a cluster random sampling to obtain a sample of 1591 patients aged 60 years and over referred to pharmacies in Tehran, 2017. Data were collected using a questionnaire: socio-demographic characteristics, type of pharmacy visited, the municipal district, the university covering the pharmacy, the number and names of prescribed drugs, drug category, type of insurances and physician's socio-demographic profile (age, gender, type of specialization, and work experience). Results The mean age of the patients was 70.51±7.84. A total of 5838 drugs were prescribed, giving an average of 3.73±2.24 drugs per patient (ranging of 1-15). Polypharmacy was noticed in 32.4% patients. Cardiovascular drugs accounted for 20.8% of the prescriptions, antidiabetics 8.8%, nutritional agents and vitamins 7.6%, and analgesics, anti-inflammatory drugs and antipyretics accounted for 7.5%. Conclusion Developing educational programs on geriatric pharmacology general practitioners and more supervision among community-dwelling older adults might have effects on prescription pattern. There is a need for prescriber training and retraining with emphasis on the geriatric population.

Prevalence and associated factors of potentially inappropriate medications among Iranian older adults.

Aim Potentially inappropriate medications (PIMs) in older people are associated with the increased use of health care services. The aim of this study was to investigate the prevalence of PIMs among the elderly being referred to pharmacies in Tehran using the Beers criteria of 2012, and identify factors related to PIMs. Methods This cross-sectional study was conducted on elderly patients (60 years and above) referred to pharmacies in Tehran, in 2017. The Beers' criteria 2012 were used to evaluate PIMs. The logistic regression analysis was used to find sociodemographic predictors of PIMs. Results The mean age of 1591 patients was 70.51 years. The overall prevalence of PIMs was 26.0%. The most frequent PIMs, in order of frequency, included diclofenac (13.5%), alprazolam (9.3%), and chlordiazepoxide (9.1%) and clonazepam (8.4%). The pain medications were found to be most common PIMs (37.6%). Polypharmacy (OR=3.64, CI 95%: .81-4.70; p<0.001), number of chronic disease (OR=2.371, CI 95%:1.71-3.28; p<0.001) insomnia (OR=1.45, CI 95%: 1.13-1.87; p<0.01) and type of specialists were found as PIMs risk factors. Internal medicine specialists prescribed PIMs significantly fewer times than other specialists(OR=0.59, CI 95%: 0.40-0.88; p<0.01, and the orthopedic specialists prescribed PIMs significantly more times than other physicians (OR=3.23, CI 95%: 5.76-1.81; p<0.001). Conclusion High prevalence of PIMs among Iranian elderly patients implies a need for the development and operationalization of scientific guidelines for the use of medicines. It is also necessary to hold training courses for physicians to be educated in such cases.

The Vulnerability of the Iranian Elderly in Disasters: Qualitative Content Analysis.

BACKGROUND: Elderly people are among the most vulnerable groups in natural disaster events. Although old age is responsible for them becoming unequally vulnerable, understanding the different aspects of vulnerability can help health care providers, especially nurses, to manage disaster risk for this increasing number of people. This study intended to explore disaster-related vulnerability and its contributing factors based on older adults' perceptions and experiences. MATERIALS AND METHODS: This qualitative content analysis study was performed in Iran in 2016. The study was conducted by semi-structured interviews of 24 participants, and purposeful sampling with maximum variation continued until data saturation. RESULTS: By analyzing primary codes two main themes were extracted through content analysis, namely personal factors and social factors, from experiences of two experts in the field of health in emergencies and disaster management among 22 Iranian elderly participants. CONCLUSIONS: This study indicated that age is not the only criteria that makes an elderly person vulnerable, but their lifetime achievements and experiences can determine their level of vulnerability. The results of this study will help health service providers as well as disaster nurses to identify and moderate the factors affecting the vulnerability of the elderly, and by using their rich experience, enhance senior citizens' resilience to disasters.

Urinary incontinence and sleep complaints in community dwelling older adults.

Sleep disorder is associated with poor quality of life in old age. Therefore, it is imperative to identify contributing factors leading to sleep disorder. The current study aimed to examine the impact of urinary incontinence on sleep complaint after controlling for potential sociodemographic and health covariates. Materials and Methods: A cross-sectional study was conducted on a sample of 184 community dwelling older adults 60 years and older in Yazd, Iran, 2016. In order to obtain the sample a multistage proportional random sampling technique was employed. Sociodemographic characteristics, sleep complaint, and urinary incontinence were collected from medical records. Statistical analyses were performed using SPSS version 24. A multiple logistic regression analysis was used to examine the impact of urinary incontinence on sleep complaint after controlling for potential covariates. Findings: A total of 184 respondents with a mean age of 68.48±6.65 years (age range, 60-87 years) were included in the study. About 70% of the respondents were women, 72.8% were married, 68.5% were not formally educated, and 21.7% were living alone. The prevalence of sleep complaint and urinary incontinence were 27.2% (95% CI: 21-34) and 22.3% (95% CI: 17-29), respectively. The results of the multiple logistic regression analysis revealed respondents with urinary incontinence were four times more likely to suffer from sleep complaint than those without urinary incontinence after adjusting for potential covariates (AOR=4.04, 95% CI: 1.74-9.35, p<0.001). Conclusion: Based on the results of this present study, which showed that urinary incontinence independently contributed to sleep complaint among older adults, it is necessary to employ effective interventions for controlling urinary incontinence to reduce sleep complaints.

How did older adults respond to challenges after an earthquake? Results from a qualitative study in Iran.

OBJECTIVES: In many areas, natural disasters are a major challenge for life and property of people. Earthquake is one of the most devastating natural disasters. This study aimed to explore how older adults responded to challenges after the earthquake in Iran. METHODS: This study was based on qualitative analysis. Data were collected through in-depth and semi-structured interviews. 29 participants including 18 older adult survivors of the earthquake-stricken areas, four lay caregivers, and three health professionals in disasters, one social worker, two relief worker and one disaster psychologist were interviewed. The interviews were recorded and transcribed. The transcribed texts were analyzed using inductive qualitative content analysis recommended by Graneheim and Lundman (2004). RESULTS: The study explored two main categories regarding older adults' responses to challenges after the earthquake: adaptive and maladaptive responses. Adaptive response has been developed by four factors including; religious coping, sharing feelings and information, coping with new activities, roles and place. Also, maladaptive response was included; the lack of motivation to search for relief supplies, undue dependency, and decrease of social activities. CONCLUSION: Service providers are recommended to identify the patterns of vulnerability and cultural sensitivities in older adults' responses to manage the negative consequences of disasters on older adults. Furthermore, older adults can make a substantial contribution in recovery programs based on the adaptive responses, such as helping in the rescue efforts and psychological support from family and community after disasters.

The Persian Version of the "Life Satisfaction Scale": Construct Validity and Test-Re-Test Reliability among Iranian Older Adults.

After forward-backward translation, the LSS was administered to 334 Persian speaking, cognitively healthy elderly aged 60 years and over recruited through convenience sampling. To analyze the validity of the model's constructs and the relationships between the constructs, a confirmatory factor analysis followed by PLS analysis was performed. The Construct validity was further investigated by calculating the correlations between the LSS and the "Short Form Health Survey" (SF-36) subscales measuring similar and dissimilar constructs. The LSS was re-administered to 50 participants a month later to assess the reliability. For the eight-factor model of the life satisfaction construct, adequate goodness of fit between the hypothesized model and the model derived from the sample data was attained (positive and statistically significant beta coefficients, good R-squares and acceptable GoF). Construct validity was supported by convergent and discriminant validity, and correlations between the LSS and SF-36 subscales. Minimum Intraclass Correlation Coefficient level of 0.60 was exceeded by all subscales. Minimum level of reliability indices (Cronbach's α, composite reliability and indicator reliability) was exceeded by all subscales. The Persian-version of the Life Satisfaction Scale is a reliable and valid instrument, with psychometric properties which are consistent with the original version.

Grandparents - Grandchildren Relationship in Iran, 2017.

INTRODUCTION: With the continuing growth of aged populations, it is imperative to find ways to maintain and improve the quality of life in old age. It has been documented that grandparents-grandchildren relationship is significantly contributed to quality of life of older adults. This study was conducted to identify the status and associated factors of grandparents-grandchildren relationship in a sample of Iran. METHODS: This cross-sectional study was conducted on 377 community dwelling older adults 60 years and over living in Kashan, Iran. A multistage proportional random sampling technique was applied to obtain the sample. The grandparent -grandchildren relationship was measured by a researcher-developed 16-item scale. The data were analyzed using SPSS version 23 and AMOS 23. RESULTS: The mean age of the respondents was 70.42(SD = 8.20) years. About 62% of the respondents were female and 60.7% were married. The average score of grandparents-grandchild relationship was 67.60(SD = 12.47). The multiple linear regression analysis revealed a significant model (F (11, 365) = 19.05, P < 0.001), where information communication technology of grandparents, geographical distance between grandparents and grandchildren, and the quality of relationship between grandparents and parents of grandchildren were the most important predictors of the grandparents-grandchildren relationship. CONCLUSION: The findings from the current study showed that status of grandparents-grandchildren relationship is moderate to high and influenced by some factors. It is, therefore, suggested that policymakers pay more attention to strengthening grandparent-grandchild relationship by providing educational programs for families and encouraging the elderly to learn and use information communication technology.

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.

The Attitudes of Rural Community Health Workers Towards Older Adults in Kermanshah, Iran.

BACKGROUND: Studies have shown that the quality of elderly care is substantially influenced by the attitudes of healthcare staff. The present study aimed to assess the attitude of rural community health workers towards elderly people. METHODS: A cross-sectional design was employed in this study, which was conducted among all health workers of Harsin city (province of Kermanshah - Iran). The Kogan's Attitudes towards Older People Scale (KOPS) was used to measure data. The statistical program SPSS, version 22 was used to perform the data analysis. RESULTS: The mean age of the participated health workers was 37.59 ± 4.48, about 85% were married and 76% were diploma holders. The average score of attitude was 150.60 ±15.31. About 15% of rural community health workers had negative attitude towards older adults. No significant relationships were observed between age, gender, marital status, work experience and educational status with attitudes toward aging. CONCLUSION: The findings of this study showed that rural community health workers do not have strong positive attitude towards the elderly. Therefore, it is imperative to develop efforts to improve positive attitudes of rural community health workers towards older adults and aging process.

Uncertainty, the Overbearing Lived Experience of the Elderly People Undergoing Hemodialysis: A Qualitative Study.

BACKGROUND: The chronic kidney disease is a major health concern. The number of the elderly people with chronic renal failure has increased across the world. Dialysis is an appropriate therapy for the elderly, but it involves certain challenges. The present paper reports uncertainty as part of the elderly experiences of living with hemodialysis. METHODS: This qualitative study applied Max van Manen interpretative phenomenological analysis to explain and explore experiences of the elderly with hemodialysis. Given the study inclusion criteria, data were collected using in-depth unstructured interviews with nine elderly undergoing hemodialysis, and then analyzed according to Van Manen 6-stage methodological approach. RESULTS: One of the most important findings emerging in the main study was "uncertainty", which can be important and noteworthy, given other aspects of the elderly life (loneliness, despair, comorbidity of diseases, disability, and mental and psychosocial problems). Uncertainty about the future is the most psychological concerns of people undergoing hemodialysis. CONCLUSION: The results obtained are indicative of the importance of paying attention to a major aspect in the life of the elderly undergoing hemodialysis, uncertainty. A positive outlook can be created in the elderly through education and increased knowledge about the disease, treatment and complications.

Validity and Reliability of Health Promoting Lifestyle Profile II in the Iranian Elderly.

BACKGROUND: With increasing age, the prevalence of chronic diseases increases. Since health-promoting behaviors (HPB) are considered a basic way of preventing diseases, especially chronic diseases, it is important to assess HPB. This study examines the validity and reliability of the Health Promoting Lifestyle Profile II (HPLP-II). METHODS: This is a cross-sectional study which is conducted on 502 elderly individuals aged 60 and over in Tehran, Iran. In order to determine the validity, content and construct validity were used. The content validity index (CVI) was used to assess the content validity and to assess construct validity, confirmatory factor analysis (CFA), and item-total correlations were employed. For reliability, test-retest analysis was used, and the internal consistency of the HPLP-II was confirmed by Cronbach's alpha. For data analysis, SPSS-18 and Amos-7 software was used. RESULTS: The mean age of the subjects was 66.3 ± 5.3 years. The CVI for the revised HPLP-II and all its subscales was higher than 0.82. The CFA confirmed a six-factor model aligned with the original HPLP-II. Pearson correlation coefficients between the revised HPLP-II and their items were in range of 0.27-0.65. Cronbach's alpha of the revised HPLP-II was obtained as 0.78 and for their subscales were in the range of 0.67-0.84. Intraclass correlation coefficient was obtained 0.79 (95% confidence interval: 0.59-0.86, P < 0.001). CONCLUSIONS: The Iranian HPLP-II scale is an appropriate tool for assessing HPBs of the Iranian elderly.

Bitter experiences of elderly parents of children with intellectual disabilities: A phenomenological study.

BACKGROUND: It is predicted that over the next 30 years, there will be a significant increase in the number of elderly parents who care for their children with intellectual disability. This paper is part of a larger qualitative study which investigated the unpleasant experiences of these parents. MATERIALS AND METHODS: A phenomenological approach was adopted and data were collected through unstructured in-depth interviews with elderly parents of children with intellectual disability. The data were analyzed using Colaizzi's seven-step method. RESULTS: "Bitterness" is one of the four emergent themes extracted in this study which has five theme clusters: inappropriate behavior toward the child in the society, the society's failure to support the child with intellectual disability, sorrows experienced by parents, the child's problems, and barriers in the care of the child with intellectual disability. One significant barrier in the last theme cluster is limitations due to aging. CONCLUSIONS: The findings of this study suggest that the elderly parents of children with intellectual disability experience many sorrows and unpleasant feelings, but they mostly consider the social factors as the cause of problems and not the presence of the child. The results also indicate that older parents cannot look after the child as before in their old age; so, future well-designed studies are required for identification of the process of supporting them.

Prevalence of Types of Cancers in the Elderly Covered by Insurance of the Islamic Republic of Iran Broadcasting Company in 2015 - Comparison with Younger Groups.

Presently, the world population of the elderly is growing. By improving health hygiene and welfare indicators, mortality and birth rates decrease and life expectancy increases, making the present century the century of elderly. Aging is one of the main risk factors for development of cancer, which itself is the second cause of death in old people. This study was conducted to assess the prevalence of cancer in the elderly covered by the Islamic Republic of Iran Broadcasting (IRIB) insurance program and to obtain suitable programs for cancer screening and early detection, increase patient survival, improve elderly care and to reclaim the cost of treatment in comparison to the national and international statistics. This is a cross-sectional study conducted on all elderly patients diagnosed with malignancy based on their pathology reports. In this study, of the total 75,500 patients covered by IRIB insurance, 17.2% belonged to the elderly group, males accounting for 53.3%. The most common cancers in old men were prostatic cancer (61.3%), colon cancer (10.3%) cancer of the hematologic system, bladder cancer (9.6%), lung cancer (9.1%), thyroid cancer (3.9%) and brain tumors (1.3%). In the elderly women, the most common cancers were breast cancer (80.1%), colon cancer (5.1%), thyroid cancers (4.4%), bladder and hematologic system malignancies (3.6), lung cancer (2.9%) and brain tumors (0.7%). In addition, the prevalence of cancer was almost the same as national and international statistics. With the exception of non-melanoma skin cancer no difference was shown in prevalence of cancer between IRIB elderly patients and the other groups of cancer patients in Iran.

Emergency room (ER) referrals and health insurance in the United States.

This article aims to determine how various health insurance policies affect the rate of emergency room (ER) referrals in the United States. The secondary data, gathered in National Health Measurement Study (NHMS) in 2008 and 2010, was used. The authors identify the relationships between health insurance and ER referrals by using zero-inflated binomial and zero-inflated Poisson regression. About 17% (2008) and 20% (2010) of the respondents had one or more ER referrals in the 2 years; those who were under coverage of governmental health insurance are more likely to refer ER than uninsured group. The differences in ER referrals that ended with hospital admission across different insurance policies are not significant. Health insurance is a remarkable factor in ER referrals; the coverage of health insurance plans can affect consuming the services provided in ER. Governmental insurance plans can increase ER referrals.

Activities of daily living independence in Iranian blind war survivors: a cross sectional study, 2008.

AIM: Assessment of activities of daily living (ADL) can be helpful for designing individualized rehabilitation programs for disabled individuals. Measuring and comparing the basic ADL (BADL) and instrumental ADL (IADL) independence between middle aged and senior Iranian blind war survivors (IBWS) was the aim of this study. METHODS: This cross-sectional study assessed BADL and IADL of 312 blind war survivors, using the Barthel Index and the Lawton-Bordy scale. Data collection was carried out in a recreational event for the blind war survivors in Mashhad, Iran, 2008. RESULTS: The majority of the participants were male (99%), and more than 80% had multiple injuries. None of them were independent in all BADL and IADL. Older groups were more dependent in IADL such as telephone use, drug management, financial management, and BADL such as walking on uneven surfaces, bed/chair transfer and using stairs. The functional status and activities' level differences between those aged younger than 50 years and those aged older than 50 years were significant (P<0.05). DISCUSSION: In the present study, all the IBWS were dependent in at least one ADL. Multiple physical injuries could be one of the main reasons for the dependency in this group. IBWS aged older than 50 years were considerably more dependent in their BADL and IADL than the younger group. It appears that starting the fifth decade of age in IBWS might cause some considerable decrease in their function. Training and individualized rehabilitation programs are warranted.