Journal of Education and Health Promotion

Abstract BACKGROUND: Potentially inappropriate medication (PIM) prevalence in older adults is increasing
day by day due to lack of knowledge among medical students and professionals.
OBJECTIVE: To determine the knowledge of medical students toward American Geriatric
Society (AGS) Beers criteria for PIM prescribing.
MATERIALS AND METHODS: This cross‑sectional study employed a self‑administered questionnaire
which was validated and designed to assess the knowledge, attitude, and practice of medical interns
and postgraduate residents on Beers criteria for PIMs in older adults. The study was conducted
in Faridkot region of Punjab in 2019. This study will utilize a purposive sampling strategy and a
convenience sampling of up to 183 participants. Mann–Whitney U or Kruskal–Wallis tests were used
to compare different issues as appropriate. P values of <0.05 were considered significant.
RESULTS: Out of 183 questionnaires distributed, only 155 participants (response rate 84.6%) had
filled the survey and were included in the study. 61.3% (n = 95) of the respondents were males. The
mean knowledge score of 155 participants was (5.16 ± 1.56), where the highest score was 9 and the
lowest score was 2 out of 10. 15.5% (n = 24) of the participant strongly agreed that Beers criteria use
is necessary in clinical setting and would be very helpful. While 22.5% (n = 35) of the participants
strongly agreed that PIMs cause adverse drug event (ADE) and drug‑related problems (DRPs) in
older adults. Age of the participant had a significant effect on the knowledge score (p = 0.009), and
participant aged between 31 and 40 years had significantly higher knowledge scores compared with
participants falls under 20–30 years.
CONCLUSION: Medical students and postgraduate residents had average knowledge of PIMs and
are unaware of the standard guidelines in older adults such as the Beers criteria. Lack of formal
education or training about Beers guidelines was the main reason responsible for average knowledge
among participants.

Abstract BACKGROUND: The outbreak of COVID‑19 pandemic has made it difficult for older adults to utilize
ordinary elder services. This cross‑sectional study investigated the status of feeling the need, seek,
and utilization of health promotion services among older adults in Ardabil, Iran, covered by the
country’s comprehensive health system during the pandemic.
MATERIALS AND METHODS: This descriptive‑analytical and cross‑sectional study was conducted
on 739 elderly people in Ardabil province. Cluster random sampling method was used for sampling.
Data were gathered by referring trained individuals to the place of residence of the selected older
adults Questionnaires were consisted of three parts: demographic information, household’s economic
status, and feeling the need, seek, and utilization from health promotion services. Multivariate logistic
regression was used to separately model the need, seeking for, and utilization of health promotion
services in STATA ver. 14.
RESULTS: The mean age of the older adults in this study was 68.88 ± 4.72 years. The results
indicate that men showed significantly greater need, seek for, and utilization of health promotion
services during COVID‑ 19 than women. According to the results, people over the age of 80 had
4.08 times (95% confidence interval [CI]: 1.99–12.60) more need and utilization of health services
than the older adults under 65 years. The results also indicate that use of health promotion services
was significantly associated with being married (3.74, 95% CI: 1.22–2.62), having primary insurance
and supplementary insurance (1.92, 95% CI: 1.21–3.12), and obesity (2.05, 95% CI: 1.13–3.76) in
P < 0.05 level. Based on the results, people with chronic disease and obesity were more likely to
utilize health promotion services.
CONCLUSION: Findings suggest that the access and utilization of inpatient and outpatient health
services by the elderly in the COVID‑19 pandemic has somewhat decreased, which could be due
to the fear of the disease being referred to health centers by the elderly. Hence, enabling conditions
such as parental health care were major factors affecting health‑seeking habits among the Iranian
elder population.

Abstract BACKGROUND: This study aimed to identify the quality of life (QoL) and its predictive factors based
on the Andersen’s behavioral model among the elderly in Iran.
MATERIALS AND METHODS: A quantitative cross‑sectional study was conducted on 400 people
aged 60+ resident in Zanjan, Iran, in 2019. Data were collected based on the Andersen’s behavioral
model constructs by the questionnaires. Path analysis was used to determine both direct and indirect
effects of variables and also for estimating the values of coefficients in the underpinning linear model.
RESULTS: In this study, 50% of the participants were female, and 83% were married. The participant’s
QoL was 37.4 (9.8). The results confirmed that financial level and physical activity were the most
significant predictor of the elder’s QoL. Chronic diseases and activities of daily living as need factors
affect the QoL of participant indirectly.
CONCLUSION: The results showed that the participant’s QoL was at a moderate level. Utilizing of
primary health‑care services was the weakest predictors of QoL. Sex, marital status, and education
level were not reliable predictors of QoL in elders. Other predisposing, enabling, and need factors
should be investigated to find the main determinants to improve elder’s QoL.

Abstract BACKGROUND: Loss of physical function during the process of aging might affect the quality of life.
Physical function assessment tests predicts outcomes such as falls, institutionalization, and death.
Studies assessing the association of physical function with quality of life and physical activity level of
elderly population in India is scarce. Hence we aimed to assess the physical function of community
dwelling older adults and to determine its association with physical activity levels and quality of life.
MATERIALS AND METHODS: This was a cross‑sectional analytical study. 89 community dwelling
older adults between 60 and 80 years of age were recruited. Physical function was assessed by
standing balance, walking speed, and grip strength. Quality of life was assessed by WHO QOL BREF
questionnaire and physical activity level was assessed by International Physical activity Questionnaire.
RESULTS: Standing balance was reduced in 24% and walking speed was decreased in 33% of the
participants. Males had higher walking speed, and grip strength. Quality of life was better among
males. Standing balance, walking speed and grip strength was significantly higher in moderate – heavy
activity levels. There was positive correlation between physical function and quality of life. There was
also positive correlation between physical activity level and quality of life.
CONCLUSION: Physical function, quality of life and physical activity level were decreased. Males had
better physical function and quality of life. Physically active individuals had better physical function
and quality of life. Early detection of decreased physical function and increase in physical activity
level could result in better quality of life among elderly.

Abstract INTRODUCTION: The main aim of this study was to explore the socioeconomic determinants of
health‑care and emotional needs among older adults.
MATERIALS AND METHODS: In this cross‑sectional study, 350 older adults were randomly selected
from five geographical regions in Isfahan, 2016. A self‑administered checklist was employed to
collect health‑care and emotional need data among older adults residing day‑care centers. Data
were analyzed using logistic regression through STATA/SE (version 14).
RESULTS: The highest proportion of older adults lived with income 285–855 USD monthly and
insured by social security insurance. Illiteracy, loneliness, and low level of income were more
prevalent among female older adults than male ones. The emotional needs of single/widow (odds
ratio [OR] = 0.299), divorced (OR = 0.133) older people, not having children (OR = 0.811) or
grandchildren (OR = 0.684), and illiterates (OR = 0.689) were discovered to be lower than their
counterpart groups. As the elderly got older, their health‑care needs were met more. Older adults
covered by military insurance have their health‑care needs met as much as 21% (OR = 1.215)
greater than social security insurance.
CONCLUSIONS: Regarding health‑care needs, economic and monetary factors are still important
in meeting this type of needs as well as education and social insurance. While regarding emotional
needs, nonmonetary and noneconomic factors, including social network, are important determinants
for the satisfaction of emotional needs.

Abstract Background: Health literacy is a measure of individual’s ability to read, comprehend, and act
on medical instructions. Older adults are one of the most important at risk groups affected
by the impact of inadequate health literacy. Health promoting behaviors in older adults have
potential impact on their health and quality of life and reduce the costs incurred to health care.
Given the paucity of information health literacy and health promoting behavior, the purpose
of this study was to examine health literacy level in older adults and the relationship between
health literacy and health promoting behaviors. Materials and Method: A cross‑sectional survey
of 354 older adults was conducted in Isfahan. The method of sampling was clustering. Health
literacy was measured using the Test of Functional Health Literacy in Adults (TOFHLA). Data
were collected via home interviewing. Health promoting behaviors were measured based on
self‑reported smoking status, exercise, and consumption of fruit and vegetables. The collected
data were analyzed using descriptive statistics and one‑way ANOVA and χ2 tests under SPSS
18 software. Results: The sample group averaged 67 ± 6.97 years in age. Approximately 79.6%
of adults were found to have inadequate health literacy. They tended to be older, have fewer
years of schooling, lower household income, and being female Individuals with inadequate
health literacy were more likely to report limitations in activity and lower consumption of fruit
and vegetables (P < 0.001). No significant association was found between health literacy
and smoking status. Conclusion: Considering high prevalence of inadequate health literacy
among older adults, and its inverse relationship with some health promoting behaviors. Simple
educational materials and effective interventions for low health literacy people can improve
health promotion in society and mitigate the adverse health effects of low health literacy.

Abstract Background: Health literacy is a measure of an individual’s ability to read, comprehend, and act on
medical instructions. Limited health literacy can reduce the adults’ ability to comprehend and use
basic health-related materials, such as prescription, food labels, health education pamphlets, articles,
appointment slips, and health insurance plans, which can affect their ability to take appropriate and
timely health care action. Nowadays, low health literacy is considered a worldwide health threat. So,
the purpose of this study was to assess health literacy level in older adults and to investigate the
relationships between health literacy and health status, health care utilization, and health preventive
behaviors. Materials and Methods: A cross-sectional survey of 354 older adults was conducted
in Isfahan. The method of sampling was clustering. Health literacy was measured using the Test of
Functional Health Literacy in Adults (TOFHLA). Data were collected using home interviewing. Health
status was measured based on self-rated general health. Health care utilization was measured
based on self-reported outpatient clinic visits, emergency room visits, and hospitalizations, and
health preventive behaviors were measured based on self-reported preventive health services
use. Results: Approximately 79.6% of adults were found to have inadequate health literacy. They
tended to be older, had fewer years of schooling, lower household income, and were females.
Inadequate health literacy was associated with poorer general health (P < 0.001). Health literacy
level was negatively associated with outpatient visits (P = 0.003) and hospitalization (P = 0.01).
No significant association was found between health literacy level and emergency room utilization.
Self-reported lack of PSA (Prostate-Specific Antigen) test (P < 0.001) and fecal occult blood test
(FOBT; P = 0.003) was higher among individuals with inadequate health literacy than those with
adequate health literacy. No significant association was found between health literacy level and
mammogram in the last 2 years. Conclusion: Low health literacy is more prevalent in older adults.
It indicates the importance of health literacy issue in health promotion. So, with simple educational
materials and effective interventions for low health literacy group, we can improve health promotion
in the society and mitigate the adverse health effects of low health literacy.