Background: Knee osteoarthritis is a prevalent condition among the elderly, often necessitating total knee replacement surgery, which can impact psychological well-being and resilience during recovery. Understanding the trajectory of these psychological factors is essential for optimizing postoperative care and promoting successful aging. Objectives: This longitudinal study aimed to evaluate trends in self-assessed psychological well-being and resilience among elderly patients following knee replacement surgery. Methods: This research is a longitudinal study. A total of 432 elderly adults (aged 60-74 years) undergoing unilateral or bilateral knee replacement surgery at Shafa Yahyaian Hospital, Iran, were assessed at discharge, one month, and three months post-surgery. Psychological well-being was measured using the Reef Psychological Well-being Questionnaire, and resilience was assessed by the Brief Resilience Scale. Data were analyzed using repeated measures ANOVA and other appropriate statistical tests. Results: Psychological well-being significantly improved from discharge to one month and three months post-surgery (P < 0.001), with no significant difference between the one-and three-month assessments. All six dimensions of psychological wellbeing (autonomy, environmental mastery, personal growth, positive relationships, purpose in life, and self-acceptance) demonstrated significant positive changes over time, except for purpose in life, which showed a different pattern. Resilience scores also increased significantly over time, peaking at three months post-surgery (P < 0.001). No significant associations were found between psychological measures and demographic characteristics such as age, gender, or education. Conclusions: Psychological well-being and resilience improve significantly during the first three months following knee replacement surgery in elderly patients. These findings underscore the importance of integrating psychological assessments and resilience-building strategies into postoperative nursing care and discharge planning to support holistic recovery and healthy aging.

Introduction: The physiological changes with increasing age make older adults more prone to acquiring chronic diseases, and their treatment needs multiple drug regimens. However, the extensive use of medications is accompanied by an increased risk of adverse drug reactions (ADRs), partly due to polypharmacy (concomitant use of multiple drugs). Both polypharmacy band medication adherence are considered major public health concerns, which are growing worldwide. Objective: This study was conducted to determine drug adherence in older adults with polypharmacy referred to selected educational medical centers of Iran University of Medical Sciences, Tehran City, Iran, in 2021. Materials and Methods: The present study is a descriptive cross-sectional analytical study. The sample consisted of 243 older people. The participants were selected using a non-probability sampling method (continuous method with categorical proportional allocation). The inclusion criteria were older adults taking polypharmacy (five or more prescribed drugs). Data collection tools were a demographic personal and clinical characteristics form, a drug compliance questionnaire, and a 10-point visual analog scale (VAS) of self-perception of health. After the participants had completed the questionnaires, the raw data were analyzed using descriptive and inferential statistics methods, including analysis of variance, independent t-test, and the Pearson correlation coefficient. The significance level was considered P<0.05. Results: The mean age of the subjects was 69.38±6.6 years; their mean perception of health was 5.83±2.33, and the mean number of underlying diseases was 2.3±1.19. The study participants showed moderate drug adherence, which was insufficient. No significant relationship was found between demographic and clinical variables with drug adherence. The Pearson correlation test results showed a weak correlation between age and medication adherence (r= 0.029, P=0.001), as well as age and number of underlying diseases (r=0.031, P=0.001). Conclusion: This study demonstrated moderate drug adherence in older adults with polypharmacy, which is not optimal. Healthcare professionals involved in patients’ medication use play a key role in providing essential education to older adults with polypharmacy to improve drug adherence.

Background: After being discharged from the hospital, some people recovering from COVID-19 may suffer complications and problems. This study was conducted to determine the sleep quality in the survivors of COVID-19 discharged from the hospital. Methods: This descriptive cross-sectional study was conducted in Imam Khomeini Sarab Hospital in East Azerbaijan Province, Iran, in 2022. The study sample was 222 survivors of COVID-19, discharged from the hospital for at least a month. The subjects were recruited by continuous sampling method. The data were collected by a demographic and disease-related questionnaire and the Pittsburgh sleep quality index (PSQI). The collected data were analyzed by the independent t-test, analysis of variance, and Scheffé post-hoc test in SPSS software, version 20. The significance level was set at P≥0.05. Results: Among the subjects, 94(42.3%) were men, and 128(57.7%) were women. The age of the respondents was 50.32±16.75 years. About 84.2% of the study subjects obtained a total sleep quality score of more than 5, which s poor sleep quality. Also the mean sleep quality score of the research subjects was 9.19±3.68, indicating poor sleep quality. Significant relationships existed between sleep quality and most demographic and disease characteristics (P<0.001). Conclusion: Considering the poor quality of sleep of the survivors of COVID-19 after discharge from the hospital, it is suggested to give sufficient training to these patients before discharge to help them sleep comfortably, and if necessary, plan to refer them to a doctor.

Background & Aims Aging is associated with decreased physical and psychological functions. This study aims to investigate the ability to perform basic and instrumental activities of daily living (ADL) in elderly women with osteoporosis in Tehran, Iran. Materials & Methods This is a cross-sectional study conducted on 130 elderly women over 60 years of age referred to selected hospitals affiliated to Iran University of Medical Sciences in 2019-2020, who were selected by a consecutive sampling method. The data collection tools were a demographic form, the Barthel index for ADL, and the Lawton-Brody Instrumental ADL scale. The data was statistically analyzed in SPSS software, version 20. Results The mean age of the women was 67.5±5.7 years. None of them had dependency for performing ADLs such as eating. The highest dependence was for urination (54.62%). Regarding instrumental ADLs, the highest inability was related to shopping (60.77%), and the lowest inability was related to managing one's own medication use (0.77%). The scores of basic and instrumental ADLs were significantly related to age and educational level (P<0.001). Conclusion More governmental, family and social support is needed for elderly women with osteoporosis (with older age and educational level) who have lower ability to perform their basic and instrumental ADLs.

Background & Aims The present study aims to determine the fear of COVID-19 in the elderly newly diagnosed with cancer referred to selected hospitals affiliated to Alborz University of Medical Sciences. Materials & Methods In this longitudinal study, 174 elderly people newly diagnosed with cancer referred to the selected hospitals participated, who were selected using a continus sampling method. To collect data, a demographic form, the Abbreviated Mental Test, and the 7-item fear of COVID-19 scale were used before diagnosis, one month after, and two months after. The data were analyzed in SPSS software, version 22. Results Fear of COVID-19 level at the time of cancer diagnosis was moderate (mean score: 17.69±4.74). In the second stage (one month after the diagnosis), the mean score was 14.26±4.09. In the third stage (two months after diagnosis), the mean score was 11.81±4.13. Fear of COVID-19 at the time of cancer diagnosis was significantly different based on marital status (P=0.049), underlying diseases (P=0.014), and perception of health (P=0.004). Conclusion Fear of COVID-19 can disrupt the process of treatment and chemotherapy in elderly patients with cancer. It is recommended to develop interventions to improve the mental health of the elderly with cancer during the pandemic.

Introduction: Cardiovascular disease (CVD) is a prevalent condition among older adults' hospitalizations leading to psychological complications. Nursing care is the longest intervention the patient receives. This study evaluated the relationship between nursing care quality and anxiety and depression among old patients with CVD. Methods: This is a descriptive cross-sectional correlational study that included 250 old patients with CVD admitted to an 'age-friendly hospital'. Using the convenience sampling method. The data collection tools included the Hospital Anxiety and Depression Scale (HADS) and the Quality Patient Care Scale (QUALPACS). Data were collected through conducting interviews and analyzed in SPSS ver.13 via statistical tests such as correlation coefficients, independent t-test, and ANOVA. Results: Overall, 229 (91.6%) of patients received the desired nursing care quality. The mean (SD) scores for anxiety were 1.52 (1.14) and depression 2.18 (1.51), indicating a less than average hospital anxiety and depression. There was an inverse correlation between anxiety and nursing care quality. Conclusion: A combination of high-quality nursing care and clinical governance criteria in an age-friendly hospital can reduce anxiety in old patients.

Background & Aims: Peripheral neuropathy due to chemotherapy is one of the serious complications of chemotherapy and its negative effects on various aspects of patients' lives can not be denied. The aim of this study was to determine the quality of life of the elderly with peripheral neuropathy due to chemotherapy in selected educational and medical centers of Iran University of Medical Sciences in 2016. Materials & Methods: The present study was a cross-sectional (descriptive) study. The study population was the elderly with chemotherapy-induced peripheral neuropathy referred to the educational and medical center of Iran University of Medical Sciences. 170 people were selected by continuous sampling method. Data collection tools included demographic characteristics form and Lipad quality of life questionnaire (LEIPAD) and research data were completed during 3 months (from September 1399 to November 1399). Data were analyzed using descriptive and inferential statistics using SPSS software version 16 at a significant level (P<0.05). Results: The average quality of life of the elderly based on the total score was 59.37 14 14.29 (high quality of life) and based on zero to one hundred was equal to 63.84 15 15.37. The highest score was related to the mental function dimension with a score of 86.06 19 18.19 and the lowest score was related to sexual function with a score of 9.5 18 18.11. The results showed that the quality of life of most elderly people was at a high level (81.8%). Quality of life of the elderly with gender (P=0.003), comorbidities (P=0.045), income adequacy (P=0.002), employment status (P<0.001) and duration of illness (P=0.019) had a statistically significant relationship. The results of linear regression showed that the variables of employment status (unemployed) (P=0.041), duration of illness (P=0.033) and comorbidities (P=0.030) significantly affected the quality of life of the elderly Has had an impact. Findings showed that 0.22% of changes in quality of life can be explained by independent variables. Conclusion: Considering that the research samples were more than the young elderly group, ie between 60 and 74 years old, and were not very old and disabled, and a significant percentage of them were married and benefited from family support, far from It was not expected that their quality of life would not be overshadowed and assessed as desirable, despite facing a cancer crisis, chemotherapy intervention, and neuropathic symptoms. However, the quality of life in the sexual dimension was poorer, which requires counseling interventions and more attention from health planners.

Background & Aims: The emerging diseases such as coronavirus disease 2019 (COVID-19) can cause a serious stress, fear, and anxiety in the elderly. This study aims to determine the perceived stress and fear of COVID-19 in the elderly referred to comprehensive health centers in Tehran, Iran. Materials & Methods: In this descriptive cross-sectional study, 260 older people aged >60 years referred to two comprehensive health centers (130 from each center) in the west of Tehran participated, who were selected by cluster and stratified sampling methods. Data collection tools were a demographic form, the Perceived Stress Scale, and the Fear of COVID-19 Scale. Descriptive and inferential statistics were used to analyze the collected data in SPSS Software, version 20. Results: The mean score of perceived stress was 41.5±10.19, indicating high level of stress in the elderly. This variable had a statistically significant relationship with age, underlying disease, and self-perceived health (P<0.001). The results of the Scheffe post hoc test showed that perceived stress was significantly lower in married subjects, those with no underlying disease, and those with self-perceived health score of 5 or higher. Fear of COVID-19 with a mean score of 23.45±9.35, was also higher among the elderly. Conclusion: The perceived stress and fear of COVID-19 are high among the elderly in Tehran, Therefore, a proper planning by the health system policymakers for this group is necessary during the pandemic.

Background: Chronic pain is one of the most common and serious problems in old age that if not controlled, leads to reduced daily activities. The aim of this study was to determine the effect of acupressure on pain and daily activities in elderly women. Methods: This was a quasi-experimental study with a pre-test and post-test design, which was conducted on 80 elderly women who were referred to the health centers of Qazvin, Iran. The subjects were randomly assigned to the experimental (n=40) and control (n=40) groups. The data were collected by visual analogue scale (VAS) and barthel index (BI). The experimental group received ten sessions of acupressure for three consecutive weeks on the related acupoints (LIV3, UB62, SP9, GB34, UB17, GB30, UB (UB25-UB11), GB20, GB21). Each acupoint was massaged for one minute in a circular motion until the elderly could bear it. The control group received sham acupressure. Post-test was performed one week after the end of ten intervention sessions. The data were analyzed by Chi-square test and independent t-test using SPSS software v. 20. The significance level was set at P<0.05. Results: Before the intervention, there was no statistically significant difference in the level of pain intensity (P=0.352) and daily activities (P=0.420) between the groups. After the intervention, the pain intensity of the subjects in the intervention group decreased (P<0.001) and their daily activities improved compared to the control group (P<0.001). Conclusion: According to the findings, acupressure is an affordable, low-cost, easy, and non-invasive complementary therapy, which is recommended to reduce pain intensity and promote activities of daily living in older women.

Background: The most common aging change is increased arteriosclerosis, which can prone the elderly to heart attacks. Physiological and psychological changes deteriorate the health-related quality of life (QoL) of the survivors of heart attacks. However, gender differences may affect the health-related QoL of the survivors. The present study aimed to compare the health-related QoL of elderly men and women after a heart attack in selected educational-therapeutic centers of Iran University of Medical Sciences in 2020. Methods: This was a cross-sectional study with descriptive comparative design conducted on 196 elderly patients (98 men and 98 women in each group) who were referred to the heart clinics of selected educational-therapeutic centers of Iran University of Medical Sciences in Tehran, Iran in 2020. The subjects were selected through continuous sampling. Data were collected by abbreviated mental test (AMT) and MacNew Heart Disease health-related QoL (HRQoL) questionnaire and analyzed by Chi-square test, independent t-test, analysis of variance, Pearson correlation coefficient, and multiple linear regression using SPSS software, version 26. The significance level was set at P≤0.05. Results: The Mean±SD age of elderly women and men was 72.59±7.87 and 69.6±8.24 years, respectively. The Mean±SD health-related QoL of the elderly women was 3.89±0.58 and that of elderly men was 4.16±0.82. The results of the independent t-test showed that the scores of health-related QoL and its dimensions were significantly higher in men than in women (P<0.001). The results of the Pearson correlation coefficient revealed a negative and significant correlation between age and health-related QoL in elderly men (r=-0.253, P=0.012). The results of simultaneous multiple linear regression revealed that 26.8% of the changes in men’s health-related QoL were explained by their individual characteristics. Conclusion: Considering the lower health-related QoL of women compared to men after a heart attack, more support for women after a heart attack seems necessary. Further research is also recommended to find out the causes of this difference.

Objectives: Old age is associated with various health threats, including falls which have psychological, physical, and social consequences. One of these consequences is the fear of falling especially after orthopedic surgery. This study aims to evaluate the fear of falling and anxiety in older adults with a history of fall-related orthopedic surgery. Methods & Materials: In this descriptive-correlational study with cross-sectional design, 280 older people with a history of fall-related orthopedic surgery referred to the selected hospitals affiliated to Iran University of Medical Sciences were selected using a convenience sampling method. Data collection tools were a demographic form, the Abbreviated Mental Test (AMT), the Fall Efficacy Scale-International (FES-I), and the subscale of Anxiety from the Depression, Anxiety and Stress Scale-21 (DASS-21). Data were analyzed using descriptive and inferential statistics such as independent t-test, Pearson correlation test, one-way ANOVA, and linear regression analysis in SPSS v. 20 considering a significance level of P≤ 0.05. Results: The Mean±SD age of participants was 69.50±4.29 years and 65% were female. Most of them (99%) reported a high fear of falling level; 47.9% reported moderate anxiety and 26% reported severe to very severe level of anxiety. Their Mean±SD anxiety score (11.88±4.18) was higher than the cut-off point (10). Anxiety was significantly correlated with gender, educational level, marital status, history of fallinh, and history of chronic diseases (P<0.05). According to the results of Pearson correlation test, There was a statistically significant direct correlation between fear of falling and anxiety (r= -0.254, P=0.001). According to the results of linear regression analysis, being female had the greatest effect on anxiety (β=0.183), while being female and single, having good economic status, and living with spouse had the greatest effect on the fear of falling (β=0.236, 0.545, 0.047, and 0.545, respectively). Conclusion: Fear of falling seems to be high in older adults with a history of fall-related orthopedic surgery. Given the adverse consequences of the fear of falling and the high prevalence of anxiety in these people, it is recommended that counseling programs be provided for them at the time of discharge from the hospital.

Loneliness and the Contributing Factors in the Elderly Patients with Type II Diabetes: A Descriptive Cross-sectional Study

Background & Aims: Along with the growth of the aging population, there are several challenges for this population group as well as for caregivers and health policymakers. One of the most important challenges is the increase in care needs due to the increased suffering of the elderly from chronic and malignant diseases and disabilities. Therefore, due to the high prevalence of cancer and also the growth of the aging population, palliative care appears to be one of the important priorities of the health system. Palliative care has been identified as an important and ongoing part of cancer care. Palliative care is an approach that improves the quality of life of the patient and his family in the face of problems related to life-limiting diseases by preventing the patient's suffering and improving the patient's symptoms and other physical, mental, spiritual, and social problems. In fact, palliative care alleviates the disease-related pain and its effects on the patient and her family from the diagnosis of the disease to the control of pain and other symptoms. Studies have shown that there is a significant relationship between palliative care received and the quality of life in patients with chronic diseases such as cancer. Quality of life is also a multidimensional concept and nurses have an important role in improving the quality of services and care by considering the physical, mental, spiritual, religious, cultural, and social aspects of the patients. Therefore, it is necessary to first investigate the existing conditions and the quality of palliative care in the health centers and then take effective measures to improve them. Therefore, this study was conducted to determine the quality of palliative care from the perspectives of the elderly with cancer admitted to Firoozgar Educational and Medical Center in 2019. Materials & Methods: This was a cross-sectional study. A total of 123 elderly patients with cancer admitted to Firoozgar Hospital in 2019 (November to January 2019) were selected through continuous sampling procedure. Inclusion criteria were informed consent to participate in the study, no cognitive impairment (a minimum score of 7 out of 10 based on AMT test) in the elderly, the ability to communicate and answer the items of the questionnaire, no known mental illness (based on the patient's medical record), confirmed cancer (according to the medical diagnosis and medical record). The exclusion criteria were no consent to participate in the study, noncooperation in each stage of completing the questionnaire (AMT, demographic form, palliative care quality tools). Data collection tools included the short-form anxiety management training (AMT) to analyze the elderlies' mental health status and cognitive system, demographic form, and quality end of life questionnaire (QEOLC-10) which were completed through face-to-face interviews with the samples. The palliative care quality questionnaire assesses the quality of palliative care provided from the perspectives of patients with chronic diseases. This questionnaire includes 10 items with different dimensions of staff communication skills, patient-centered care system, symptom reduction management, staff emotional skills, and care based on patient values which are rated on an 11-point scale (range: 0-10). Data were analyzed using descriptive and inferential statistics such as independent t-test and ANOVA using SPSS Software version 16 at the significance level of P≤0.05. Results: The mean age of the elderlies was 65.55 ± 4.12 years. The highest frequency was related to the age group of 60-64 years, which shows that the subjects were classified as young-old. Among them, 76 (61.8%) cases were male and 47 (38.2%) were female. Almost all samples in these studies were married (95.9%), retired and . MS Geriatric Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran . Department of Community Health Nursing and Geriatric Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran. (Corresponding author) Tel: 02143651820 Email: bastani.f@iums.ac.ir . Department of Biostatistics, School of Health, Iran University of Medical Sciences, Tehran, Iran D ow nl oa de d fr om ij n. iu m s. ac .ir a t 2 :2 8 IR S T o n S un da y N ov em be r 28 th 2 02 1 ناریا یراتسرپ هیرشن هرود 4 3 هرامش / 30 1 / ریت هام 400 1 unemployed elderly had the highest frequency with (47.2%) and (41.5%), respectively. More than half of the study samples, about (56.9%), had a history of hospitalization, among which (47.1%) declared that they were hospitalized for one to two weeks and (48%) of the elderly were suffering from gastrointestinal cancer, which was more common than other types of cancer. In this study, the quality of palliative care in various dimensions (patientcentered care system, personnel communication skills, symptom reduction management, personnel emotional skills, patient values) was at the desired level. (54.5%) of the elderly reported the quality of palliative care to be desirable. The mean and standard deviation of palliative care quality was 65.55 ± 4.12. In all dimensions of quality of care, the two variables of the current hospitalization period (P=0.012) and nursing skills (P<0.001) had the most statistically significant relationship with the quality of palliative care. The quality of palliative care in pain management had a statistically significant relationship with gender (p = 0.047), current hospitalization period (P=0.015), and nurses' skills (P<0.001), which was significantly higher in men than women, and had the highest frequency during 3-4 days of hospitalization, and nursing skills had a significant role in all the aspects. Conclusion: In general, the results of this study showed that relief from physical, psychosocial, social, and spiritual problems through palliative care is possible for more than 90% of patients at the advanced stages of cancer. Palliative care to treat and alleviate the cancer-related symptoms and improve the quality of life of patients and their families can help people live more comfortably. It is especially true in places where there is a large number of patients with advanced cancer and there is little chance of treatment. In this study, the quality of palliative care from the perspective of the studied elderly was rated as desired, which is one of the reasons for providing such services in the special palliative care ward of Firoozgar Medical Center with experienced and trained caregivers. However, the main problem of the nursing system in Iran regarding palliative care for patients with cancer is that this type of care does not have a specific framework for nurses and is not seriously included in the formal curriculum.

Background & Aims: Successful aging is a positive inner feeling and satisfaction from the past and present life. The subjective meaning of successful aging focuses on the inner dimensions of the aging experience such as happiness, self-fulfillment, emotions, perceived social support, satisfaction, and vitality in life. Perceived or subjective social support refers to individual's cognitive evaluation of their relationships, and studying and evaluating perceived social support is closely related to self-assessment of health, and paying attention to its understanding is of utmost importance in health care. One of the variables that effect successful aging, and improves health and quality of life of the elderly, is mental vitality which is somehow tied to the concept of psychological well-being and this concept refers to being positive, full of energy and cheerful. In other words, there is a very close relationship between mental vitality and happiness and social interactions. All of these states are positive and favorable concepts and are therefore associated with positive emotions and mood, which are very important in old age. Today, with the increase in the number of the elderly and the prolongation of life and life expectancy, efforts are being made to identify the components and factors associated with successful aging that guarantee a better quality of life, to provide an accurate sociological picture for proper health planning for the elderly. Therefore, the aim of this study was to determine successful aging in the dimensions of perceived social support and mental vitality in the elderly referred to the health centers of Iran University of Medical Sciences in 2020. Materials & Methods: This is a descriptive cross-sectional study. The research samples included 245 elderly people referring to the health centers of Iran University of Medical Sciences (in Tehran) in 2020 who were selected by continuous sampling method and entered the study after obtaining informed written consent. Data collection tools included Abbreviated Mental Test form (AMT), elderly demographic characteristics form, Multidimensional Scale of Perceived Social Support developed by Zimmet, and Mental Vitality questionnaire developed by Ryan & Frederick. The questionnaires were completed in person and by interview (conducted by the researcher) during three months. Data were analyzed using descriptive statistics (frequency distribution tables and numerical indices) and inferential statistics (independent t-test, variance, Pearson correlation coefficient, and regression) in SPSS 16 at the significance level of p ≤0.05. Results: The results of the present study showed that the mean age of the elderly was 68.18 ± 6.25 years. In total, (55.5%) of the subjects were women. Most of them were literate with undergraduate and postgraduate education and about (76.5%) were married and over (80%) had social security insurance. More than half of the surveyed elderly (53.4%) considered their current health status better than their peers and (96.8%) stated that they were able to perform their daily tasks and activities independently without the help and supervision of others. (66.8%) of the elderly surveyed considered religion to play a significant role in reducing stress and 51.4% stated that they were very satisfied with their lives. Perceived social support was at a high level for (65.6%) of the studied units. This component was the highest in the family dimension with an average of 22.76 and the lowest in the friends . Master of Geriatric Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran. . Department of Community Health Nursing and Geriatric Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran (Corresponding author) Tel: 09821-43651820 Email: bastani.f@iums.ac.ir . Department of Community Health Nursing and Geriatric Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran D ow nl oa de d fr om ij n. iu m s. ac .ir a t 3 :5 5 IR S T o n S at ur da y O ct ob er 1 6t h 20 21 [ D O I: 10 .5 25 47 /ij n. 34 .1 31 .5 5 ] ناریا یراتسرپ هیرشن هرود 4 3 هرامش / 31 1 / رویرهش هام 400 1 dimension with an average of 16.24 among the dimensions of perceived social support. Also, education at the diploma level with a standard coefficient of -0.261 had the greatest effect on perceived social support. Regarding the mental vitality variable, 76.1% of the studied units were at the average level. The results showed that satisfaction with the insurance situation in terms of coverage of medical expenses with a standard coefficient of 0.232 and poor economic status with a standard coefficient of -0.235 had the highest direct and inverse effect on mental vitality. Conclusion: Perceived social support and high mental vitality in the elderly can pave the way for achieving a successful aging phenomenon. This concept includes the recognition of various components of successful aging such as perceived social support and mental vitality, longevity, independence in life, and other factors in health and social planning. According to the results, more than half of the studied elderly had high perceived social support, which can be considered as a positive factor affecting successful aging, because perceived social support decreased with age of the participants in this study. Also, perceived social support in the family dimension with the highest average among its dimensions showed the impact and importance of family relationships in successful aging. However, most of the elderly participated in this study were "young seniors" who were between 60 and 75 years old, and therefore it is possible that the high perceived social support in the samples be related to their young age, their independence, and their living with a spouse and family. Also, a significant percentage of the samples in this study had moderate and high mental vitality, which was influenced by their independence and satisfaction and benefiting from the insurance covering medical expenses. A better understanding of the two concepts of perceived social support and mental vitality can be the basis for successful aging-related interventions. It seems that the Holistic Care approach in modern nursing can empower the elderly with lower education and income and those who are single, unmarried, incapable, and independent in carrying out daily activities of life, and with an unfavorable understanding of their health status by performing health interventions, feeling of vitality and having perceived social support, and take an effective step towards achieving successful aging. One of the important goals of this study is to use its results to increase the quality of services and solve existing problems. The researcher hopes that the findings of this study can be useful in improving the goals of healthy, successful, and active aging in society in the following areas. Due to the descriptive cross-sectional nature of this study and the fact that in the studies conducted in the world, perceived support and mental vitality, two components of successful aging are influenced by several factors, it is suggested that future studies evaluate the longitudinal and trend of these two indicators in the elderly to get more accurate results from these two components.

Background & Aims: The world's population is ageing, and the elderly constitute large number of the world's population. With ageing, the health status undergoes certain changes, and the risk of developing chronic diseases and disabilities increases in the final years of life. Given the increased index of life expectancy and the subsequent increase in the number of the elderlies in the world, the number of diabetic patients in this population also increases. Diabetes is an important health issue and a common physical illness, which causes numerous complications in old age. Type II diabetes has no definite diagnosis and requires long-term care and proper self-management. Since diabetes has no definite treatment, the early identification of the suspected cases could prevent and delay the associated complications through proper self-management. The self-management of diabetes is complex and may go beyond blood sugar control, requiring the balancing of multiple metabolic and lifestyle factors and helping the patients to discover and exploit their capabilities in this regard. If patients with chronic diseases refrain from self-management and do not actively partake in self-care, positive clinical outcomes will be hard or impossible to achieve. Self-management is a rehabilitative method in which the care activities mainly depend on the patient, and the aim is to attain maximum independence, decision-making, and health improvement based on the abilities and lifestyle of the patient. Therefore, self-management must be evaluated in vulnerable and targeted populations, such as the elderly. Due to the chronic nature of diabetes, the patient must follow a special, long-term medication regimen that is prescribed by the treatment team, which is only possible with the active participation of the patient in the treatment and implementation of the recommendations of the treatment team members; this is referred to as treatment adherence. One of the main concerns and clinical problems that is frequently faced by healthcare providers is the problems associated with the lack of adherence to the prescribed treatment, particularly in the with antihypertensive drugs a minimum of six months, and no impairment with the score of ≥7 in the abbreviated mental test (AMT). Data were collected using the short-form AMT, a demographic form, diabetes self-management questionnaire (DSMQ), and drug adherence questionnaire (MMAS). After the completion of the questionnaires by the researcher, the data were coded, and the analysis of the raw data was performed using descriptive statistics (adjusting frequency distribution tables, calculating frequency indices, and frequency numerical indices) for the qualitative variables. In addition, the minimum, maximum, mean, and standard deviation were determined using inferential statistics and Chi-square, independent t-test, analysis of variance (ANOVA), Pearson' correlation-coefficient, Scheffe post-hoc test, and regression analysis at the significance level of P≤0.05. drug adherence, self-management multivariate other domains. Self-management had a significant correlation with education level (P=0.017) and income adequacy (P=0.01). The results of independent t-test also showed that self-management was significantly lower in the unmarried patients (single/widowed/divorced) compared to the married elderlies (P=0.003). Drug adherence was significantly lower in men compared to women (P=0.015) and had significant correlations with education level (P=0.001), employment status (P=0.013), and income adequacy (P=0.019). Conclusion: According to the results, self-management and drug adherence were generally satisfactory in the elderly patients with type II diabetes. However, self-management was significantly lower in the patients who were illiterate, unmarried (single/widowed/divorced), and had an insufficient income, regarded as the vulnerable segment of the society. Therefore, this group of elderlies needs more attention from the health system and healthcare planners, as well as educational-counseling interventions based on the empowerment of vulnerable elderlies in order to promote self-management behaviors, minimize the complications of diabetes, and experience a healthy, active, and successful aging.

Background: Anxiety in orthopedic surgeries, especially knee replacement, is one of the most common complaints of the elderly. Aromatherapy with Damask Rose (Rosa damascena Mill.) can be one of the non-pharmacological methods in complementary medicine to control anxiety. Objectives: The present study aimed to determine the effect of aromatherapy with R. damascena on elderly anxiety after knee replacement surgery. Methods: In this quasi-experimental study, 80 elderly patients (60 to 90 years old) undergoing knee replacement surgery according to inclusion criteria were selected by convenience sampling method randomly from Moheb Mehr and Shafa Yahyaian hospitals of Tehran, Iran, and were divided into two groups of case and control. The case group was exposed to aromatherapy intervention at four intervals of 30 minutes. The instrument for measuring anxiety was the Visual Analogue scale for anxiety (VAS-A). Results: The results showed that the study elderly were homogeneous in terms of demographic variables in both case and control groups, except for two variables of education level and consumption of analgesics, which were also determined by two-way ANOVA. These parameters (education level, P = 0.54, and consumption of analgesics, P = 0.661) were not confounding variables. Significant differences were observed in the anxiety of the case group before and after the intervention (P < 0.001), while this difference was not significant in the control group (P = 0.304). Moreover, the difference in anxiety scores was significantly decreased after the intervention compared to before intervention in both case and control groups (P < 0.001). Probably Damask Rose aroma molecules produce and secrete neurotransmitters such as endorphins and encephalin, thereby reducing pain and anxiety. Conclusions: According to the findings of the study, the aromatherapy with R. damascena seems to be effective in reducing postoperative anxiety in these elderly patients.

Background : A coronary heart disease (CHD) is one of the causes of frequent elderly hospitalizations that are associated with psychological complications such as "hospital anxiety and depression". Furthermore, there needs to be a paradigm shift beyond routine programs toward innovative approaches such as clinical governance (CG) to improve the quality of care. This study aimed to investigate the association between Nursing Care Quality integrated with CG to Hospital Anxiety and Depression among Elderly Patients. Methods : In this descriptive correlational study, 250 elderly patients with CHD admitted to a large teaching hospital in Tehran, Iran as “Aging Friendly Hospital” selected by consecutive sampling method. The data collection instruments included the Quality Patient Care Scale (QUALPAC) and The Hospital Anxiety and Depression Scale (HADS). Data were collected by face to face interviews. Data were analyzed using descriptive and inferential statistics such as independent t-test, ANOVA and correlation coefficients in SPSS v.16 software . Results : Overall, 91.6 % of the subjects perceived the quality of nursing care integrated with CG desirable. The mean score of HADS in the subscales of anxiety and depression were (1.52 ± 1.14 and 2.18 ± 1.51) respectively which indicates hospital anxiety and depression were less than the average level. There was a negative significant correlation between the subjects’ hospital anxiety and quality nursing care (P< 0.01). Conclusion : The findings showed there is an association between perceived quality of nursing care and hospital anxiety among elderly patients. It is recommended that Managers of healthcare services should take into account CG seriously to paradigm shift beyond routinely care program toward innovative approaches of health policy.

Introduction: Elderly people are exposed to potential threats, such as physical and mental disabilities, which overwhelm their functional independence and their daily activities. Therefore, the purpose of this study was to determine the functional independence of elderly patients referred to West Health Center in Tehran, Iran. Materials and Methods: This descriptive-cross sectional study was conducted on 200 elderly people referred to West Health Center in Tehran during 2017. The participants were selected using the convenience sampling method. The data were collected utilizing an Abbreviated Mental Test, a demographic form, and the Barthel index to investigate the elderly functional independence. The data were analyzed in SPSS software (version. 20) through one way ANOVA, independent t-test, and Pearson correlation coefficient. P-value less than 0.05 was considered statistically significant.  Results: According to the results, the mean±SD age of the elderly participated in this study was (64.53±3.95), and 51 of the participants were female. About 95.5 of the elderly had complete independence for their daily activities. However, 4 and 0.5 of them had partial and moderate dependencies, respectively. Moreover, there was a reverse relationship between age and functional independence (P<0.001, r=-0.345). However, functional independence correlated significantly with educational level, marital status, hypertension, and joint pains (P<0.05). Conclusion: According to the results, a majority of the elderly people has been independent in their daily activities; however, aging correlated with reduced levels of independence. Therefore, regarding holistic care in clinical nursing services, it is necessary to pay attention and develop programs to support the elderly in order to promote their health and provide the concept of healthy and active aging.