Home-based supportive and health care services based on functional ability in older adults in Iran.

BACKGROUND: Home-based care is affordable due to population aging, increased chronic disease, and higher hospitalization costs. The objective was to evaluate home-based supportive and health care services provided to older adults and identify possible associations between activities of daily living (ADLs), instrumental ADL (IADLs) classifications, sociodemographic variables, clinical characteristics, and perceived social support among older adults. MATERIALS AND METHODS: In this cross-sectional study, 700 people aged 60 years and older were selected by stratified cluster sampling. Areas of Tabriz City were selected as clusters, and 55 comprehensive urban health centers were selected as stratifies. Chi-square, Pearson's and Spearman's tests, and multiple linear regression were used for statistical analyses. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS 24.0, SPSS Inc., Chicago, USA). The study instrument included demographic characteristics of older adults and caregivers, health services provided at home, and two valid questionnaires, including the KATZ index of independence in (instrumental) activities of daily living and a multidimensional scale of perceived social support. Scores on scales and demographic variables were collected during telephone interviews. The study lasted from April 25, 2022, to October 30, 2022. RESULTS: A high level of perceived social support was 56.6%. The study found that 51.3% of participants had family caregivers. Most participants had ADL independence (85.4%), while 22.9% and 24.3% were dependent and needed assistance with IADL, respectively. Women had a lower ADL score and a higher IADL score than men (P < 0.05). The obtained results of multiple regression analysis revealed a negative and significant association between unemployment, illiteracy, increasing age, five and more medications, and ADL and IADL dependency (P < 0.05). CONCLUSION: Empowering older adults to reduce dependency, and designing a formal home-based care system is recommended.

Developing a comprehensive model of home-based formal care for elderly adults in Iran: A study protocol.

BACKGROUND: Due to the increasing Iran's aging population, designing a home care model is necessary. However, the data on designing the home care model for elderly adults among developing countries are limited. This study will be carried out to develop a formal home-based care model for elderly adults in Iran. METHODS: This multi-method study will include three phases: First, Mixed-methods sequential explanatory study including two steps: One, survey to determine the prevalence of dependence on formal and informal caregivers among people aged ≥ 60 years living in Tabriz metropolis; and two, content analysis approach includes face-to-face, semi-structured interviews with the older adults receiving formal care at home, their caregivers and relevant key informants on the characteristics of care and caregiver, challenges and expectations of standard care. In phase 2, a scoping review will be used to find out the components of home care in other countries, such as care provider organization, caregivers training, and financing. PubMed, Scopus, Web of Science, EMBASE, Google scholar databases and grey literature will be run to retrieve relevant evidence using proper MeSH terms. In phase3, the triangulation method (using the results of the previous phases, reviewing national upstream documents and the focus group discussion) will be done to reach consensus and design the initial model for the Iranian context. In the following, a Delphi study will be conducted on the validation and feasibility of the developed model. DISCUSSION: The current health infrastructure in Iran is focused on caring for younger people, despite the near future population aging. Most studies have addressed the challenges of geriatric care, but no study has addressed the various dimensions of home care in Iran and how to provide this service to elderly adults. Providing a comprehensive model of home care for the elderly can improve the quality of life and satisfaction of the elderly and their caregivers.

Factors Affecting Health Policies for Older People in Iran.

Globally, the number and proportion of people aged 60 years and older is growing fast. As people age, health needs become more complex, and the health system's responsiveness to older people's needs requires evidence-informed policies. Hence, this study explores the factors affecting the health policy development process for older people in Iran. We conducted 32 interviewers with people aged 60 years and older and 21 interviews with key informants involved in policy making related to older people. Qualitative data were analyzed using thematic analysis. Actors and stakeholders, policy structure, selected health policy processes, the health care service delivery system, government financial support, and community and culture building are the most influential factors in health policy making for older people. Government policies and health priority interventions are needed to address these influential factors for older people to ensure healthy aging over the life course.

Marriage survival in new married couples: A competing risks survival analysis.

BACKGROUND AND AIM: Marriage is one of the most important phenomena in human life. The survival of the marriage and the impact of various competing factors on the survival is of high importance. This study aimed at utilizing competing risks survival analysis to investigate the marriage survival of new couples in Tabriz. METHODS: In this longitudinal study, a number of 386 individuals who were married and divorced from 1991 to 2017, were selected by random sampling. The registered information was attained from the general registry office of Tabriz. Data analysis was carried out using the Lunn-McNeil procedure and the results were presented using an adjusted hazard ratio (AHR). RESULTS: The average age of marriage was about 23.9 (SD 6.6) years. The results of multivariate Lunn-McNeil models indicated that for the competing cause of having a relationship with another person (AHRs range: 1.12 to 2.03), the traditional mode of being familiar (AHRs range: 1.55 to 3.39), family weak role in choosing a wife/spouse (AHRs range: 0.25 to 3.25) and the role of moral-religious commitment (AHRs range: 0.37 to 0.47), along with other causes severed the risk of marriage survival reduction. CONCLUSION: According to the results of this study in assessing competing risks, we conclude that the decline in marriage survival is a multifactorial phenomenon. Examining the survival of marriage in order to better understand all the dimensions and factors affecting this phenomenon and providing information to counselors and officials can play an important role in increasing marriage survival.

Illness acceptance, medication adherence and the quality of life in patients with heart failure: A path analysis of a conceptual model.

Heart failure (HF) is a chronic disease that negatively affects different aspects of the patients' lives, diminishing their quality of life. This research studied factors that impact the health-related quality of life (HRQoL) of patients with HF, particularly medication adherence and acceptance of illness. In this cross-sectional study, data were collected from 273 patients admitted to a tertiary hospital with the diagnosis of HF. Participants' level of illness acceptance, medication adherence, and HRQoL were assessed using validated questionnaires, and data were analyzed using the regression path analysis. There was found a moderate level of acceptance of illness (24.9 ± 6.79) and low levels of medication adherence (3.44 ± 3.15) and HRQoL (53.81 ± 17.99) among participants. Gender, education, income, history of coronary artery bypass (CABG), the New York Heart Association (NYHA) class, acceptance of illness, and medication adherence were statistically significantly associated with HRQoL. Patients with diminished HRQoL were more likely to be female, less educated, have lower income, higher NYHA class, no prior CABG, low medication adherence, and low level of acceptance of illness. The final path model demonstrated a good fit with the data (χ^2/df = 1.70, CFI = 0.92, RMSEA = 0.05, and p = 0.01). Health care providers should target and promote medication adherence and the acceptance of illness as modifiable factors to help improve the HRQoL of patients with HF.

The effects of Huperzine A on dementia and mild cognitive impairment: An overview of systematic reviews.

Cognitive impairments are a part of the neurocognitive disorders which deteriorate the normal cognitive function. An overview of systematic reviews (SRs) was conducted to summarize the findings of SRs and meta-analyses on the effectiveness of Huperzine A (Hup A) in dementia and mild cognitive impairment (MCI). A literature search was conducted since inception to December 2020. We used the AMSTAR tool to assess the methodological quality of SRs. The quality of evidence of primary studies was evaluated according to the SRs authors' assessment. Six SRs met our inclusion criteria. The results showed that Hup A has beneficial effects on cognitive function and Activities of Daily Living (ADLs) in Alzheimer's disease, but in vascular dementia and MCI, there was little or no evidence to conclusion. There is insufficient evidence of the effectiveness of Hup A on the quality of life and global clinical assessment. None of the SRs reported any serious side effects. Despite the promising effects of Hup A on cognition and ADLs, there is insufficient evidence to support the effectiveness of Hup A in cognitive impairments due to the high heterogeneity of SRs and the low quality of primary studies. High-quality, large multicenter RCTs with long-term follow-up in different settings are warranted.

Nursing process from theory to practice: Evidence from the implementation of "Coming back to existence caring model" in burn wards.

AIM: To develop the caring model and utilize and evaluate the effect of the model in the nursing student's learning process in burn wards. DESIGN: A longitudinal multiphase study. METHODS: In the first phase, "Coming back to existence caring model" was developed, in the second phase, to evaluate the program, 35 students in the first semester and 31 students in the second semester of the 2017-2018 academic year were selected randomly, and their logbooks were analysed. RESULTS: Components of the nursing process, based on the model, were wound management, care and documentation, early mobilization, discharge planning and patient education. The lowest nursing process utilization in both semesters was in the sexuality domain. The most nursing diagnosis was a risk for infection. In the discharge plan, education about how the patient communicates with others in the second semester was less than other educational content (61/3%). However, empowering students was remarkable.

The Main Issues and Challenges Older Adults Face in the SARS-CoV-2 Pandemic: A Scoping Review of Literature.

BACKGROUND: The Severe Acute Respiratory Syndrome Coronavirus Disease 2019 (SARS-CoV-2) severely affects those above the age of 60 yr and those with other conditions. This study aimed to review the available evidence on older adult's issues in facing the COVID-19 pandemic. METHODS: The framework is based on scoping review of literature published from Jan 10 to Jul 31, 2020. Medline, Scopus, Web of Science, and Google Scholar databases and other sources of information, to identify grey literature, were selected for data collection. Two researchers independently screened all studies and extracted data. All types of studies published about SARS-CoV-2 and related to older adults' issues were eligible. RESULTS: Overall, 210 documents were included in the final analysis. Letter to the editor was the most frequent article format (20.95%). Most of the papers were from the United States (38.09%) and published in Jun 2020 (29.52%). After content analysis, six following themes were extracted: Supporting and information sources, e-health services, access to essential supplies, Long Term Care Facilities (LTCFs), physical and mental consequences of self-isolation, neglect of older adults, ageism and age discrimination. CONCLUSION: In the pandemic, there is an urgent need for interventional research and innovational implementations to address issues related to providing services for older adults. This can help older adults to maintain their physical and mental health, and reduce the spread of infection in nursing homes. Further studies focusing on the rights of the older adults are needed on all issues associated with COVID-19.