Iranian Journal of

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Background: Although there is increasing evidences that vitamin D is related to the occurrence of diabetes mellitus, its relation to glucose metabolism in pregnancy is not well studied. This study investigated 25-hydroxyvitamin D deficiency status in GDM pregnant women.
Methods: As a cross sectional study we recruited 741 pregnant women referred to five university educating hospital clinics. The universal screening was performed with a GCT-50g and those with plasma glucose level ≥130mg/dl, were diagnosed as GDM, if they had an impaired GTT-100g based on Carpenter and Coustan criteria. The levels of insulin was studied during OGTT-100g. Serum concentrations of 25-hydroxy vitamin D was measured too.
Results: Univeriate analysis revealed that 25 (OH) vit D concentrations were positively correlated with HOMA and ISOGTT index. Subjects with hypovitaminosis D (<12.5nmol/dl) had greater prevalence of GDM than others.
Conclusion: The results reveal a positive association between 25(OH) vit D concentrations and insulin sensitivity. Vit D deficiency is more prevalent in patients with GDM than normal pregnant women, So vit D supplementation may control glucose levels and improves outcome of pregnancy.

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Background: Few studies have investigated maternal leptin concentrations in women with pregnancies complicated by gestational diabetes mellitus (GDM), and these published results are conflicting. We examined the association between plasma leptin concentration and GDM risk.
Methods: As a cross-sectional study 741 pregnant women that referred to five university hospital clinics were recruited. The universal screening was performed with a GCT-50g and those with plasma glucose level ≥130mg/dl, were diagnosed as GDM if they had an impaired GTT-100g based on Carpenter and Coustan criteria. The level of insulin was measured during OGTT-100g. Also maternal plasma leptin concentrations were measured.
Results: GDM patients had higher age, parity, BMI, and serum leptin concentration as compare with normal pregnancies. In logistic regression model serum leptin levels were independent factor for GDM.
Conclusion: Serum leptin concentrations can predict GDM.

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Introduction: The height measurements in the elderly are associated with several problems. In this study we used a model to predict of the Iranian people aged height from age, shin length and forearm length. Methods: A total 165 aged people ≥60 years were randomly selected based on medical record number of about 800 eligible older people who lived in Kahrizak Charity Foundation. Standing height, shin length and forearm length were measured. Data from 99 participants were used to creat a predicting multivariate linear regression model for estimation of standing height of older men and women. The data of the rest 66 participants were used for models testing. Result: The following equations were created: Men height = 78.928+ (1.430× shin length) + (0.817×forearm length)-(0.176×age) The height of women = 71.694+ (1.414×shin length) + (1.084× forearm length)-(0.277× age) R2 were calculated as 0.63 for men and 0.52 for women. Error of estimation was +0.44 cm and it was - 0.16cm and +1.09cm for men and women respectively. Estimated heights were not significantly different from standing statures. Conclusion: height was predictable from shin length and for forearm lengths and also age with a relatively small error in the estimation among Iranian older people. The error of model is more in women than men.

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Introduction: Aspects of social and economic development in ICT has led to new applications of these technologies. Using the portal geriatrics’ is an access point to a wide range of resources and information in the content for geriatric medicine specialists, physicians and other health care workers, elderly and their families. It provides integrated information on the sources and applications of heterogeneous. The National Portal of Geriatric Medicine is the best solution to resolve this problem.This study compares the experience of few developed countries and offer the geriatrics’ portal. Methods: This paper is based on valid studies, library and internet searches in databases like as science directly, Springer, Proquest, and advanced search in Google to review the literature on the geriatrics portal in selected the countries. Findings: Developing a portal is a strategy to support the development and maintenance of all the desirable features of the portal and user needs’ analysis. It could also, characterize the structure and integrated system of geriatric care. It makes the integrity to fulfill of the main condition portal services and the content that offer to the elderly.

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Objective: The present study describes assessing physical health status of old people in different age groups in Tehran metropolitan area. The outcomes of this study could help to health policy makers to develop of better health policy in gerontology field by determine of priorities of care in different age groups of old people and effect of socio-economic components on elder’s’ physical health. Method: This was a cross sectional study in 2010. The participants were (N=402) aged 60 years old and over which have underrepresented from Shahid Beheshti university. The survey methods were via face- to-face interviews, and just in a few cases as telephone interviews. The instrument to data collection included demographic questionnaire, SF-36 short form and ADL tools. Data analyzed by Stata and SPSS Ver.15 through t-test, one-way ANOVA. Regression models applied as well. Findings: Based on the results 45% of elderly were in (60-69) years old, 36.5% were in (70-79) years old, and 18.5% were 80+ years old. The median age was 71.5±8.9 years. Regarding ADL, 18.2% of elderly were dependent 22.3% were semi dependent, and 59.5% of participants were independent to do activity of daily living. Regarding physical functioning, 29.6% of elderly had severe limitation 32.6% had moderate limitation, and 37.8% had no limitation in their physical function. Components of age, sex, marital status, education, job, income, insurance, housing, and living with whom had significant association with physical health status in old people. Although based on regression model and considering in effect of conflict variables, age and sex had more effect to predict of activity of daily living in old people. Age, sex, to be alone, and financial problems were the most predictors on physical function in aged people. Conclusion: The important components that effect on physical health of elderly related to fragile elderly from aspect of socio economic factors. Based on the results of this study aged elderly and old women were more disable to do Activity of Daily Living (ADL). Regarding physical function age, sex, living with whom, and financial dependency were significant components in relation with physical function. In other words, older people, women, elderly who did not live with their spouse, and elderly who were dependent in financial aspect to others had more difficulty in physical function.

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Introduction: Mental disorders are common in the elderly.The purpose of this study was to assess the general health status and its related factors among people ≥ 65 years in different districts of Tehran. Methods: This study has used data of the participants ≥ 65 years old in urban health equity and response tool (Urban-HEART) study. Finally the data of 1313 elderly were considered for this study. Variables included demographic characteristics (gender, age, education level, family size, marital status and employment status) and mental health using the Persian GHQ -28 questionnaire (domains: somatic, depression, insomnia and anxiety) and quality of life using the SF12. Results: The mean age of participants was 73.68 (5.91) (women=627 and men=686). GHQ-28 median of scores the participants were 24.00 (22.00)[20.00 (27.00) in women and 19.00 (19.00) in men (P<0.01)].Based on GHQ-28 cut-point 23, 50.2%of the participants had mental health problems, [61.2% women and 40.1% men (P<0.01)].The residents of third municipality districts had the best mental health (26.3% of men and 38.5% of women had mental health problems) and the aged of 20th municipality district had the worst health status (65.7% of males and 84.2% of women had mental health problems).In multivariable logistic regression model, for each year of increment age, 2.9% chance of mental health problems increased (P<0.01). With increasing level of education, mental health status was improved (P trend < 0.01). The relationship between family size and mental health was not significant (P =0.06). Conclusion: Mental health status of the elderly in Tehran was worse than the many other countries. The elderly lived in 20th municipal district, had the worst and the dwellers in the 3th district had the best mental health status.

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Background: Falling is one of the health problems among aged population. Elderly living in institutions are at greater risk of falling than those dwellings in the community, due to their health status and environmental conditions. This study was designed and conducted aimed to address the factors affecting falls in Kahrizak Charity Foundation (KCF). Methods: This is a prospective longitudinal study, which 194 of residents of KCF were participating in it with inclusion criteria were selected by Random Cluster sampling. They were enrolled after signing an informed consent. At baseline the data of demographic, lifestyle, past medical history and visual ability were collected by interviewing. The anthropometric measurements were performed as well. Cognitive status data were collected using abbreviated mental test (AMT) questionnaire and mini mental state examination (MMSE), balance status was assessed using the Tinetti mobility test (TMT) and its balance and gait sub- scores, depression was detected using the geriatric depression scale-15 (GDS-15). The participants were monitored for the falls occurrence its complications by daily call with caregivers and filling out the special forms for the recording of the falls occurrence by the head nurse. Data were analyzed using univariate and multivariable Cox-regression models. Results: The mean age of the participants was76.02 (8.82) years and the mean follow-up days was 754.40±189.26 days. 44 cases of falls were recorded during follow-up (over two years). The fall rate was 22.7 subjects per 100 participants per year. History of stroke, Parkinson's disease, visual loss, taking antidepressants, TMT score and TMT balance sub-score after adjustment (for age, sex, body mass index and survival time) were associated with falls. Conclusion: The falls among nursing home elderly residents were associated with a history of chronic diseases such as stroke and Parkinson's diseases, visual acuity, use of antidepressants and the TMT and its balance sub score.

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Background: Because of various health problems, the risk of the death in the elderly is higher than adults. The purpose of this study was to investigate the causes of the death, and comparing the cause of death that recorded on the death certificates and those were extracted from the medical records review. Methods: Variables included the demographic characteristics (age and sex), time of death and the cause of death were recorded in the death certifies and those were extracted from the medical records. Results: The mean of death age was 83.8 (8.50) years and in women and men were 84.2 and 81.5 years, respectively, (P < 0.01).The most prevalent cause of death was sudden cardiac death based on both death certificates recorded and review of medical records were 42.5% and 25.9% respectively. Sudden cardiac death in both methods was higher in women than men. Using the kappa, the highest degree of correspondence about the cause of death between two method was about gastrointestinal bleeding (K = 0.76) and then the cancers (K = 0.71) and respiratory infections (K =0.67). Total Kappa of two methods for causes of mortality was 0.50. The most cases of death were reported during 12:00 – 13:59 and 8:00 – 9:59am, time period (16.2 % and 14.1% respectively). Conclusion: the causes of deaths, which are recorded in the elderly nursing homes, do not have enough accuracy. Due to the high incidence of sudden cardiac death in elderly in nursing homes, resuscitation facilities and teams may be helping to reduce these types of death.

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Background: One of the common problems of the elderly, which increase of its prevalence with aging is the dementia and the cognitive impairment. We can help the involved patients to have a better quality of life with early diagnosis of the cognitive impairment. The aim of this study was an assessment of the validity and reliability of the Persian version of the abbreviated mental test (AMT) among the older people in a nursing home setting. Methods: 176 eligible elderly people aged ≥ 60 years living in KahrizakCharity Foundation (KCF), were selected randomly based on medical record number. Demographic information and past medical history of the participants were collected. Geriatric depression scale 15 (GDS-15), global deterioration scale (GDS) forms and also the Persian version of the abbreviated mental test (AMT) were administered. The participants were assigned to two groups the normal and impaired cognitive groups, based on DSM-IV diagnostic criteria. The GDS cut-points were used for assessment of validity, sensitivity and specificity of the Persian version of AMT. Results: The mean age of the participants was 77.30 (7.94) years. The Persian version of AMT had good discriminated validity in diagnosis of normal and impaired cognitive participants (7.35 ± 2.33 and 5.99 ± 2.29, P < 0.01 respectively) and at cut-point AMT< 8,(based on GDS cut-point) it had a sensitivity and specificity 92.15 % and 81.50% respectively. The sensitivity and specificity based on theism IVcriteriawere 64.9% and 64.0% at cut-off point equal to 7, respectively. The internal consistency of the Persian version of AMT was acceptable (Cronbach’salpha coefficient =0. 76). As well as the external reliability (intra-rater) of this instrument was good inter-class correlation coefficient (ICC) = 0.89) Conclusion: The Persian version of the AMT has appropriate validity and reliability in Iranian older people.

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Background: Older people are vulnerable in terms of health status. The elderly`s Khuzestan due to the very warm weather of this region are more at risk for health problems. This study is a report on the health status of the elderly in Khuzestan province in 2012.
Methods: This is a Cross-sectional study, with multi-level proportional cluster Random sampling among people aged ≤ 60 years of Khuzestan province. Nutritional status was assessed by Mini Nutritional Assessment (MNA), depressed mood screening was conducted with Geriatric Depression Scale-15 questionnaire, activities of daily living was evaluated using KATZ ADL and Lawton Instrumental ADL tools.
Results: In this study, 387 people participated. The prevalence of hypertension, diabetes mellitus, depressed mood, and anxiety in the participants, were 38.8%, 28.6%, 34.9 and 38.7, respectively. Hearing loss reported in 33.9% and vision impairment was in 62.2% of the participants. Memory impaired founded in 14.9% of the participants.  4.3% of the elderly suffered from malnutrition and 48.3% were at risk of malnutrition. Dysfunction in ADL were existed in 13.9% and 30.3% of the participants had some degrees of dysfunction in IADL.
Poly pharmacy (consumed more than 3 medications) was observed in 36.5% of older adults in this province. The most common health services need was medical services at home and then transport services.
Conclusion: Although the health status of the elderly in Khuzestan province  generally was not worse than the average of Iran, it needs that a special pay attention in some areas, such as hypertension, diabetes, nutritional status and lack of independence in activities of daily living in this age group.
 

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Background: Although several tools for evaluating and screening of cognitive status have been introduced, most of them are not applicable in Iranian elderly population because of cultural differences and high illiteracy rate. This study is report of "Brief Cognitive Assessment Tool"(BCAT) was developed as a cognitive status-evaluating test and reported psychometric characteristics.
Methods: the BCAT tool includes memory assessment using three words recall test with a rating similar to Mini-Cog and the functional status including "ability to dress", "ability to use the phone," " ability to manage own medications", among both two sexes and financial management capabilities in men and ability to prepare food in women. Functional rating is different in educated and non-educated people. Diagnosis of dementia is considered, when memory impairment is accompanied by the dysfunction. Eighty-six residents of a nursing home (41 men and 45 women) among who had inclusion and no had exclusion criteria also consent to participate were randomly enrolled. Concurrent validity was shown as correlation coefficient between the BCAT categorization and score of mini meAntal state examination (MMSE). Criterion validity, sensitivity and specificity of BCAT were evaluated based on global deterioration scale (GDS). Reliability of two raters results within two weeks was indicated by Kappa coefficient.
Results: The sensitivity and specificity and accuracy rate of the BCAT based the GDS was 88.6%, 82.6%, and 84.9%, respectively. The correlation between the MMSE score and results of the BCAT classifying was significant. The Kappa coefficient between the results of two raters was 81.1%.
Conclusion: It seems that the BCAT has good psychometric properties to recognize cognitive impairment among Iranian older adults.

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Background: The aging of the population is a great challenge of the public health in this century. The health promotion of the elderly people requires a comprehensive and accurate understanding of their health status.
Methods: This cross-sectional study has assessed the health status of 191 old people ≥ 60 in Sistan and Balouchestan province that selected by a multi-level cluster random sampling. General health data was collected using SF-36 questionnaire, nutrition status was assessed using Mini Nutritional Assessment (MNA), depression status was detected by the geriatric depression scale-15 (GDS-15), functional status was assessed using the activity daily living (ADL) and instrumental activity daily living (IADL) questionnaires, as well as, the information about demographic, history of diseases, vaccination, participation in social activities, and the utilization of elderly care services were evaluated by an approved questionnaire. History of hypertension was asked from the participants. Moreover the blood pressures of them were twice measured.
Results: The mean age of the participants was 69.81 (8.32) years. The health status was reported excellent and bad by 4.2% and 9.4% of the participants, respectively. The prevalence of fall in recent year, memory disorder, hearing and visual impairment, and malnutrition were 35.3%, 15.6%, 30.3%, 56.6%, and 8.9%, respectively. The prevalence of dependency in "activity of daily living" and "instrumental activity of daily living" were 25.8% and 58.2%, respectively.
Conclusion: It seems that the prevalence of malnutrition, impaired ADL and IADL, and memory impairment in the older population of Sistan and Baluchestan are above the national and global averages.
 

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Background: Elderly people need more receiving health services. Planning to provide services at regional and national levels requires information about the health status of the elderly. This study was performed to assess the health status of East Azarbaijan province.
Methods: In this cross-sectional study, 436 subjects were enrolled (180 men and 258 women) aged ≥ 60 years using multi-level proportioned cluster Random sampling from 19 cities of the province.
Data was collected by a demographic questionnaire , measuring  anthropometric characteristics, and blood pressure and  using "Mini  Nutritional Assessment" ,”Geriatric Depression Scale-15 ", “Katz’s Activity of daily living”,  and "Lawton’s Instrumental activities of daily living”.
Results: The mean age of the participants was 69.31 years.  The self-reported prevalence of diabetes was 34.2%. The prevalence of hypertension in the elderly was 52.5%. The most common complaint of the participants was pain (60.9%). Totally, 46.9% had a difficulty in walking, 44.3% visually impaired, and 26.4% suffered from hearing impairment. Moreover, 44.8% of sleep disorders was found. Also 26% of the participants had depressed mood.
Conclusion: Elderly residents of East Azerbaijan province, has probably a better health status than the average Iranian elderly. However, there is a high prevalence of hypertension and diabetes among older adults of this province that need to more pay attention.

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Background: Alborz Province is one of the provinces that accepted immigrants. Immigration has a profound effect on physical and mental health in elderly. This study was performed to assess the health status of Alborz province older population.
Methods: In this cross-sectional study, 235 subjects were enrolled (113 men and 122 women) aged ≥ 60 years using multi-level proportionated cluster random sampling that selected from 19 cities of this province. Data was collected by a demographic questionnaire, measuring anthropometric characteristics, and blood pressure and using "Mini Nutritional Assessment", ”Geriatric Depression Scale-15 ", “Katz’s Activity of daily living”, and "Lawton’s Instrumental activities of daily living”. Data was analyzed with spss21.
Results: The mean age of the participants was 68(6.00) years.  The prevalence of anxiety and depression among the participants was as 51.5% and 34%, respectively. At risk or malnutrition was observed in 27% of the participants and 54.5% had suffered dental problems and 49.8% also had problem in walking.
Conclusion: Overall, the health status of elderly people in the Alborz, perhaps slightly better than the national average, but the high prevalence of metabolic disorders also the high prevalence of depression and anxiety require serious intervention by policy makers to promote the health in elderly.

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Background: Identifying the risk factors for the health of the elderly and designing interventions to improve the health of the elderly is one of the priorities of the health care system in the world today. This first requires the promotion of scientific knowledge in the field of health problems of the elderly.
Methods: In this review conducted in 1399, all studies with the keyword of aging or age-related diseases such as atherosclerosis, osteoporosis, diabetes, dementia, frailty, cognitive impairment, daily life function, nutritional status with organizational affiliation of the Endocrinology and Metabolism Research center or the Elderly Health Research Center of Tehran University of Medical Sciences were reviewed without time limit in databases, PubMed, Web of Science, Scopus and Google Scalar search engines.
Results: A total of 115 studies were found with these keywords. By examining the sampling, method, data analysis and also the removal of similar data, 63 articles were reviewed.
Conclusion: In this regard, the Elderly Health Research center has conducted several studies to localize tools for assessing the health of the elderly, identifying common diseases of the elderly, the prevalence of diseases and syndromes of the elderly and designing several interventional studies in the form of three large studies Kahrizak elderly study, Bushehr elderly health study and Birjand elderly longitudinal study has been discussed in this review.