Factors Related to the Dignity of Older People in Tehran in 2020

Abstract The elderly are the fastest growing segment of the population globally. This is also the case in developing countries such as Iran. The fear of aging and the refusal to accept older adults into the mainstream of society affects the dignity of older people. This study was conducted to describe factors and dignity of older people in Tehran, Iran. This descriptive, correlational study was conducted on a sample of 215 older people above age 60 in 10 public parks in five regions of Tehran in 2020. A socio-demographic questionnaire and patient dignity inventory were used for data collection. Content validity and Cronbach’s alpha were used for evaluating the validity and reliability of questionnaires. Data were analyzed with SPSS. 60% of subjects were male and 40% female with a mean age of 68(± 5.05) year. The mean scores for dignity domains ranged from 67.30 (±17.56) for symptom distress, to 93.01(± 10.90) for dependency on a 100-point scale. The scores of dignity domains were significantly associated with job status, housing status, income source, health insurance, chronic diseases, annual physician referral rates, and hospitalization in last year. The best predictors of dignity were health insurance and annual physician referral rates. The findings of this study showed that the dignity of older people is related to a number of factors. Monitoring modifiable factors such as health insurance and annual physician referral rates and non-modifiable factors such as chronic diseases will help us to preserve or improve the dignity of older people.

In this paper, we aim to clarify the cause of the difficulty in home modification. The aging society becomes larger where older people have difficulty in living home because of weakened body functions. To maintain quality of life, it is important to modify houses. In Japan, home modification is conducted by care managers, who are originally from nurses, helpers, and so on. However, to modify houses, we hypothesized that it is needed to have knowledge about not only body function but also architecture. Because of this, home modification should be difficult for care managers. For this problem, we aim to clarify the difficulty in home modification. In November 2018, we took part in the teaching course for care managers about home modification and asked care managers the number of home modification they conducted and what they have difficulty in. As a result, we asked for 57 care managers, who have experience as care managers for 39 months in average. Home modification was mainly conducted for setting handrails (four for a care manager in average). It was also revealed that experience of modification for handrails and doors are larger when the experience of care manager becomes longer, but other modification is not the case. The care managers told us that they cannot understand architecture. This result indicates that care managers cannot think of many options for modification because of their little knowledge about architecture. Therefore, it should be needed to combine the architects and care managers for appropriate home modification.

EFFECT OF PERCEIVED SOCIAL SUPPORT ON MORTALITY RATE AMONG OLDER CHINESE AMERICANS
Charu Verma, 1 Mengting Li, 2 and XinQi Dong, 2 1. Rutgers New Brunswick,New Jersey,United States,2. Rutgers University,New Brunswick,New Jersey,United States Most existing studies have examined the relationship between social support and health in cross-sectional data. However, the changing dynamics of social support over time and its relationship with all-cause mortality have not been well explored. Using data from the Pine Study (N = 3,157), this study examined whether social support was associated with time of death at an 8 years follow-up among older Chinese Americans. Social support from a spouse, family members and friend were collected at the baseline using an HRS social support scale. Perceived social support and time of death were ascertained from the baseline through wave 4. Cox proportional hazard models were used to assess associations of perceived support with the risk of allcause mortality using time-varying covariate analyses. Covariates included age, sex, education, income, and medical comorbidities. All study participants were followed up for 8 years, during which 492 deaths occurred. In multivariable analyses, the results showed that positive family support [HR 0.91; 95% CI (0.86, 0.98)] and overall social support [HR 0.95; 95% CI (0.92,0.98)] were significantly associated with a lower risk of 8-year mortality. Results demonstrate robust association in which perceived positive family and overall social support over time had a protective effect on all-cause mortality risk in older Chinese Americans. Interventions could focus on older adults with low social support and protect their health and well-being. Future studies could further explore why social support from family is different from social support from other sources regarding mortality risk in older Chinese Americans.

FACTORS RELATED TO THE DIGNITY OF OLDER PEOPLE IN TEHRAN IN 2020
Ali Darvishpoor Kakhki, Fereshteh Moradoghli, Roghayeh Esmaeili, and Ali Kakhki, Shahid Beheshti University of Medical Sciences, Tehran, Iran The elderly are the fastest growing segment of the population globally. This is also the case in developing countries such as Iran. The fear of aging and the refusal to accept older adults into the mainstream of society affects the dignity of older people. This study was conducted to describe factors and dignity of older people in Tehran, Iran. This descriptive, correlational study was conducted on a sample of 215 older people above age 60 in 10 public parks in five regions of Tehran in 2020. A socio-demographic questionnaire and patient dignity inventory were used for data collection. Content validity and Cronbach's alpha were used for evaluating the validity and reliability of questionnaires. Data were analyzed with SPSS. 60% of subjects were male and 40% female with a mean age of 68(± 5.05) year. The mean scores for dignity domains ranged from 67.30 (±17.56) for symptom distress, to 93.01(± 10.90) for dependency on a 100-point scale. The scores of dignity domains were significantly associated with job status, housing status, income source, health insurance, chronic diseases, annual physician referral rates, and hospitalization in last year. The best predictors of dignity were health insurance and annual physician referral rates. The findings of this study showed that the dignity of older people is related to a number of factors. Monitoring modifiable factors such as health insurance and annual physician referral rates and non-modifiable factors such as chronic diseases will help us to preserve or improve the dignity of older people. Nearly 3 million older Americans with low incomes live in subsidized housing. This population has disproportionate rates of functional impairment, cognitive impairment, and nursing home admission. Patient-centered interventions are needed to improve aging in place for this population, but little is known about resident perspectives on this topic. We interviewed 58 residents aged 62 or older and 8 caregivers from 7 housing sites. We analyzed transcripts using qualitative thematic analysis. Participants reported that several factors impacted their ability to age in place. First, most participants noted the importance of physical environment, including the design and location of their apartment building. Physical accessibility and proximity to community resources facilitated aging in place, while features such as heavy doors and smoke in communal areas posed challenges.

IF YOU DON'T USE IT, YOU LOSE IT: PERSPECTIVES OF OLDER ADULTS ON AGING IN PLACE IN SUBSIDIZED HOUSING
Second, most participants identified the importance of the building's social environment; support received from other residents and on-site staff facilitated aging in place, while gossip and unpleasant residents were barriers. Third, participants noted that health issues such as arthritis limited their ability to function independently, regardless of environment. Participants emphasized the importance of physical activity for preventing functional decline, stating, "if you don't use it, you lose it." Older adults living in subsidized housing view their environment as central to their ability to age in place. Our findings suggest that interventions to improve aging in place in these settings must focus not only on optimizing residents' physical function, but also on using the environment to promote resident independence and quality of life.

OLDER ADULTS' EXPERIENCE OF HEALTH AND LIFE EVENTS AS REPORTED ONLINE OVER 150 CONSECUTIVE WEEKS
Jeffrey Kaye, 1 Nora Mattek, 2 Zachary Beattie, 2 Nicole Sharma, 2 Thomas Riley, 2 and Hiroko Dodge, 3 1. Layton Alzheimer's Disease Center,Portland,Oregon,United States,2. Oregon Health & Science University,Portland,Oregon,United States,3. Pregon Health & Science University,Portland,Oregon,United States Key activities and life events that impact quality of life and health may be gleaned from cross-sectional annual surveys or for medical data, derived intermittently from electronic health records. These methods cannot reflect the day-to-day and week-to-week changes that typically occur in domestic life. To assess the frequency and types of major life activities and events occurring at finer-grained temporal scale, we queried online, every week, three domains of activity and function (life events such as having an overnight visitor, travel away from home; health-related events such as medication changes, falls, ER/hospital visits, health limitations; and internal states such as pain, mood, or loneliness). Over a mean assessment period of 2.9 ± 1.2 years, 16,738 online surveys were completed by 129 community-residing volunteers with mean age 84 years. Overall the most frequent events reported were physical health limitations (14%), travel away from home (12%) and overnight visitors (9%). Needing new in-home assistance for medication management, bathing, dressing or grooming was rare (1%). Accidents were also rare (1%). Low mood, pain ratings (0-10 scale) and loneliness were infrequently reported; 4% low mood, 8% pain rated > 5, 3% reporting loneliness. Low mood and increased pain intensity were highly correlated with health changes (medication changes, ER/hospital visits, health limitations, falls; all p<0.0001). Continuous home-based online assessment of life activities and health can provide a more detailed and timely characterization of older adult function. These data may be used to guide more timely and effective health maintenance programs and interventions.