Mahtab Alizadeh-Khoei

Increasing life expectancy leads to more cancer incidence in older people, consider that preservation and improvement of Quality of Life (QoL) is a major goal of geriatric oncology and examining the factors affecting QoL is very important, this study aimed to explore the relationship between social support and hospital anxiety-depression with QoL in the geriatric cancer outpatients under oncology treatments. This cross-sectional study was conducted from June to September 2023, on 300 elderly aged 60 ≥ and over, who received at least two sessions of chemotherapy or radiotherapy and or both, selected from a cancer institute of a general hospital in Tehran, Iran. Data sampling was collected by demographic/clinical questionnaires (need help in doing ADLs (Activities of Daily Living), number of comorbidities, cancer types, and stage), and tools (MSPSS (Multidimensional Scale of Perceived Social Support ), HADS (Hospital Anxiety and Depression Scale), and EORTC QLQ-C30 (EORTC QLQ C-30, European Organization of Research and Treatment of Cancer Quality of Life Questionnaire)) to analyze. Significant positive relationships between social support with global health status/QoL scale (P < 0.0001) and functional scales (P < 0.001) were observed, but a negative relationship between social support and symptom scales (P < 0.05) was noted. Also, significant negative relationships between hospital anxiety (P < 0.001) and depression (P < 001) with global health status/QoL scale (P < 0.001) and functional scales (P < 0.001) were observed, but there was a significant positive relationship between hospital anxiety (P < 0.05) and depression (P < 0.05) with symptom scales. So, more social support and less anxiety and depression were related to better global health status/QoL scale, better functional scales, and lower symptoms/problems. Considering the positive role of social support and mental health in improving QoL, carrying out interventions to increase better social support sources (family, friends, and other important people) and preventing or reducing anxiety and depression could be effective in improving QoL in cancer geriatric outpatients.

Background: Hospital Elder Life Program (HELP) provides protocols based on factors for reducing delirium. Due to the lack of geriatric wards and aged care teams in Iran, it seems that some of the original HELP interventions need to be modified through a trial study. Hence, this study was conducted to determine whether the Iranian modified HELP could reduce delirium in geriatric hospitalized patients. Methods: This double-blind randomized controlled trial was designed and conducted in a hospital at Kashan University of Medical Sciences in Iran. A total of 195 hospitalized patients aged ≥70 years, were 84 in the Intervention Group (IG) and 111 in the Control Group (CG). After assessing delirium risk factors, participants in the IG group received interventions based on the cognitive, vision/hearing, sleep, mobility, feeding, and hydration protocols by nursing students and the CG group received routine care. Delirium incidence was assessed by the Confusion Assessment Method. Delirium incidence, cognitive and functional abilities, frailty, fall, and length of stay were outcomes. Results: The mean age of the patients was 78.53(Standard Deviation = 5.87) years. Delirium incidence was higher in the CG comparing to IG (14.71% vs 3.66%).Significant reduction observed in risk incidence of delirium because of interventions [Odds Ratio:0.124, Confidence Interval: 0.03–0.48]. Conclusion: The modified HELP effectively reduced delirium rates in geriatric hospitalized patients. Trial registration: This study was registered at the Iranian Registry of Clinical Trials IRCT20180910040995N1.

Frailty is associated with an increased risk of negative short-term and long-term hospital outcomes. This study aimed to evaluate the role of frailty in predicting readmission, length of stay, and quality of life in the hospitalized older adults. This observational study was conducted at Ziaiyan Hospital, Tehran, Iran. 304 participants (65-85 years), were enrolled through the inclusion criteria from August to December 2019. The Frailty Index (FI) was assessed by the Minimum Data Set-Home Care. Readmission was obtained through telephone interviews. The length of stay was gathered by the patient?s hospital records, and the EuroQol questionnaire was used for assessing the quality of life. Data were collected by a researcher nurse at the admission time, 30, 60, and 90 days after discharge. The logistic regression model and repeated measures ANOVA were employed to analyze the association between frailty and outcomes. According to FI, 102 (33.55%) participants were pre-frail, whereas 35 (11.51%) were frail. In the fully-adjusted model for readmission, the pre-frail participants had a higher risk of readmission at the hospital in comparison with the non-frail and frail groups (OR=1.88, 95% CI =1.90?3.26), and also for GP visits, frail patients showed nearly signi?cant differences (OR =2.45, 95% CI =0.99?6.06) but there were no differences between frail and pre-frail patients in readmissions in the emergency ward. In a fully-adjusted prolonged stay model, pre-frail patients had a higher probability to stay longer in hospital (OR =2.28, 95% CI: 1.24 - 4.18). The fully-adjusted model for QoL showed, frail patients were more prone to the declined levels of QoL in comparison with pre-frail patients (OR =10.77, 95% CI: 3.97 - 29.18). The findings indicated that frailty worsened negative outcomes and declined QoL. Early diagnosis in hospital settings could be beneficial for designing optimal care plans for the frail and pre-frail patients.

A validation study the Iranian Modified Barthel Index (MBI) in hospitalized acute stroke elderly by classical test theory approach and investigate Rasch analysis for both Iranian version MBI and BI and compare the hierarchical item difficulty of them. Face-to-face interview with 100 geriatric stroke inpatients 60+ or their caregivers was done in a cross-sectional study. First, construct validity of MBI analyzed by the classical test theory, then Rasch analysis were done for BI and MBI. The reliability of the Iranian MBI was significant at 0.955. One factor achieved by the variance of 83.2%. In Rasch analysis for MBI, the most difficult item was stair climbing, whereas the simplest items were bowel and bladder control. In BI, the most difficult items were toilet use and ambulation. The Iranian MBI is very accurate and reliable; therefore the use of MBI to measure better outcomes in stroke elderly inpatients is recommended comparing with BI.

The Short Portable Mental Status Questionnaire is a brief cognitive tool designed to screen cognitive impairment in geriatric inpatients and outpatients. The validity and reliability of this tool have not been studied in Iran so far. Therefore, this study was conducted to assess the diagnostic properties of the SPMSQ for detection of cognitive disorders in elderly and determine an appropriate cutoff point based on respondents’ level of education. This cross-sectional study was conducted through face to face interviews on a sample of 156 patients (≥60 years) referred to neurology and geriatric clinics of Ziaiyan hospital, Tehran University of Medical Sciences. Regarding the type of cognitive impairment, Participants were divided into two groups; those with cognitive disorders (n = 96) and healthy (n = 60). The level of literacy was also considered in each of the groups. The Cronbach's alpha coefficient for the SPMSQ was 0.88. In terms of the concurrent validity, a correlation coefficient between SPMSQ and GDS was higher in the literate group compared to the illiterate patients, while in the illiterate group, the SPMSQ had a higher correlation with AMT compared to the other tools. Based on DSM-5, the cutoff point of SPMSQ was 4 in the illiterate elderly patients and the sensitivity and specificity of the tool were at 86.4 and 88.2%, respectively. However, in the literate patients, the cutoff point was 3 and the sensitivity and specificity were 83 and 93.7%, respectively. Also, two components, namely orientation and long-term memory/concentration were determined for the SPMSQ using the factor analysis. The Iranian version of SPMSQ has a favorable validity and reliability for diagnosing cognitive disorders and can be used for cognitive screening of illiterate older adults.

The present research seeks the notion of the appropriateness of “Hwalek-Sengstock Elder Abuse Screening Test (H-S/East)”, and psychometric properties to analyses cultural aspects of elder abuse in the Iranian community dwellers referred to clinics. In this cross-sectional validation study 364 participants, 60 years and over were selected from outpatient’ clinics. The SF-36, GDS-15, and AMT scores were used for concurrent validity. The Brief Abuse Screen for the Elderly (BASE) scale was examined to determine the sensitivity and specificity of the Iranian version H-S/East. The elder abuse rate in participants was 29.4% based on cutoff ≥4, while a significant correlation was found in Iranian version H-S/EAST with depression and SF-36 subscale MCS at P < .01, and four factors observed. Optimal cutoff ≥4 obtained with 82.8% sensitivity and 84.5% specificity. It seems the Iranian version of H-S/East demonstrates concurrent validity and fair reliability in elderly outpatients, while construct validity should be carried out in the Iranian elder illiterate population and other languages/cultures.

Background: Some dementia patients can self‐report pain although the reports are not valid in severe dementia. Observational scales have been developed for pain assessment in these patients. This study aimed to assess the psychometric properties of the Persian version of Pain Assessment Checklist for Seniors with Limited Ability to Communicate‐II (PACSLAC‐II).Methods: This validation study was conducted on 138 older adults with dementia suffering from chronic pain who lived in nursing homes. The PACSLAC‐II Persian version was applied through observations during activity and rest. Reliability of the PACSLAC‐II was evaluated by Cronbach's alpha and intra‐class correlation coefficients. Construct validity was determined by confirmatory factor analysis, divergent and convergent validity. The Spearman's rank correlation between PACSLAC‐II scores and Faces Pain Scale was calculated for concurrent validity. Known‐group validity during activity and rest was calculated by Wilcoxon signed ranks test.Results: Cronbach's alpha coefficient for facial expression (0.82), verbalisation (0.72), and body movement (0.84) subscales indicated good internal consistency. The intra‐class correlation coefficients between two raters was 0.76 and in three times evaluation, the value was 0.76. Convergent validity with Iranian Brief Pain Inventory and divergent validity with 15‐item Geriatric Depression Scale confirmed the construct validity of PACSLAC‐II. Three factors structure of PACSLAC‐II was approved, and most of the variance was explained by facial expressions. The PACSLAC‐II can discriminate between pain and non‐pain events and has a moderate correlation with Faces Pain Scale (r = 0.33).Conclusions: PACSLAC‐II Persian version is a valid and reliable scale for pain assessment in older adults with dementia.

Since abuse screening is difficult among the elderly with dementia, detection of elder abuse is a serious issue; meanwhile, the number of available tools to assess elder abuse by caregivers is limited. The aim was to evaluate validity and reliability of the Iranian version Caregiver Abuse Screen (CASE) tool. After the translating process of the tool to the Farsi language for 236 dementia participants ≥60 years old and their informal caregivers’ from outpatient’ clinics, in a cross-sectional method then the validity, reliability and factorial structure of the CASE was evaluated. The translated Iranian version CASE reveals a good psychometric property (α = 0.868) with strong internal consistency and reliability. Some variables (depression, burden, dementia intensity, and ADLs) were associated with abuse in dementia elderly. The two-factor structure was obtained in exploratory factor analysis labeled interpersonal abuse and neglect. Generally, the Iranian version of CASE approved with sufficient validity and reliability as a suitable instrument to find the risk of elder abuse among dementia caregivers.