• Users Online: 277
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 3  |  Issue : 2  |  Page : 121-127

Impact of cultural factors on the elderly utilization from healthcare services provided by Isfahan University of Medical Sciences' Hospitals - 2014


Isfahan University of Medical Sciences, Faculty of Health Care Management and Information Science, Isfahan, Iran

Date of Web Publication26-Jul-2017

Correspondence Address:
Mahan Mohamadi
Isfahan University of Medical Sciences, Isfahan
Iran
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2395-2296.179074

Rights and Permissions
  Abstract 

Aim: As we know, due to the undesirable structural and functional changes arise from aging, old people need more healthcare services than other groups in society. Many factors affect utilization of health services in this age group. Cultural factors can be named as the most important since they play a basic role in determining people's lifestyle and ultimately in the health protection behaviors. Therefore, this paper is aimed at investigation of cultural factors, affecting old people benefit of health services in Isfahan province in 2014. Methods: This study was descriptive analytic, conducted in later 2014. The research population consisted of people aged over 60 years who had been admitted in 12 hospitals affiliated to Isfahan University of Medical Sciences. Two hundred seventy-five people were selected and entered into the research using random sampling method. Data gathering tool was a researcher-made questionnaire in three scopes, and finally the data analyzed at two levels of descriptive level (including frequency, percentage, mean and standard deviation (SD) and inferential level (including statistical tests comparing independent group means, correlation coefficient test, and multivariable regression) in SPSS 22 software. Result: The results showed that the level of utilization for people who had routine exercises and jugging was 0.3 units of SD upper than others. Meanwhile, by increasing exercise frequency, level of religious beliefs and opinions and the having a proper and healthy diet, the utilization of healthcare services decreases by −0.198, −0.150 and −0.196, respectively. In fact, 5.5% of changes in health services utilization variable are explained by the research independent variables. Conclusion: The study showed that doctors' recommendations on physical activities, reasonable increase in exercise frequency, access to rich and healthy food, and religious beliefs can affect old people's utilization of health services; but they cannot explain all variances of it. Therefore, according to complexity of health related issues, other involved variables should be identified and investigated.

Keywords: Cultural factors, elderly people, hospitals, utilization of health services


How to cite this article:
Keyvanara M, Karimi S, Mohamadi M, Bahrami S. Impact of cultural factors on the elderly utilization from healthcare services provided by Isfahan University of Medical Sciences' Hospitals - 2014. Int J Educ Psychol Res 2017;3:121-7

How to cite this URL:
Keyvanara M, Karimi S, Mohamadi M, Bahrami S. Impact of cultural factors on the elderly utilization from healthcare services provided by Isfahan University of Medical Sciences' Hospitals - 2014. Int J Educ Psychol Res [serial online] 2017 [cited 2017 Sep 21];3:121-7. Available from: http://www.ijeprjournal.org/text.asp?2017/3/2/121/179074


  Introduction Top


Today, senility has become a major global challenge because of the world's growing aged population; so that according to the World Health Organization (WHO) statistics in 2000, number of the elderly in Southwest Asian countries like Iran was about 7% of their population and this number will increase by 15% until 2030.[1] Based on the ageing proportion index in 2011, Iran's old urban and rural population was estimated about 4.35% and 4.34%, respectively.[2] Also, the amount of population aging index in Iran's urban and rural areas was estimated 4.5% and 51.6%.[3] According to the provincial level report of United Nations Population Fund regional office in Iran, 6.5% of Isfahan population was considered old, in year 2011.[4] A population index states that if more than 12% of a population is over 60 years, it will be considered as a graying population.[5]

Aging process is a series of undesirable structural and functional changes that will get worse by passing years. These undesirable changes prevent performing motor skills, decrease people adaption to the surrounding environment, and also make changes in people's social and mental life.[6] So it is clear that people's need for healthcare services will raises with aging; in fact, it can be stated that elderly is one of the predisposing factors to benefit health services. In all countries, there are several unmet needs around the health related problems, and understanding the reasons for healthcare services utilization or lack of utilization can help responsible organizations to find the ways for improving people's quality of life.[7]

Utilization of healthcare services can be considered in two dimensions:First one is service recipient point of view (patients) and the other one is service providers' dimension. It can be stated that the second dimension is more objective and tangible because it is evaluated based on the volume of provided services; while the first dimension is more subjective and is based on service recipients' opinions.[8] This paper investigates the utilization, based on the second dimension (utilization or nonutilization and its frequency).

Various models have been traced to explain utilization of healthcare services. Andersen described the basic model of healthcare services utilization in the form of a behavioral model.[9] According to Andersen's behavioral model,[10] using health services can be affected by the three sets of factors: Predisposing factors (such as illness, aging, etc.), features providing benefit conditions (such as insurance, etc.), and ultimately needs (such as sense of inability).[10],[11]

Among all complex dimensions of healthcare services utilization, culture can be considered as one of the most effective factors and in many cases, as a barrier to this utilization. In fact, culture is a set of beliefs and opinions that affects people's lifestyle and knowledge and redirect their behaviors related to illnesses and treatments.[7] In fact, culture plays an important role, as a base in determining of everyday life and people's lifestyle.[12]

Cultural differences can be due to the races, geographical distances, and various climate regions, economic factors, religions, languages-dialects, educational levels, and etc. In our country, culture is also affected by emigration strongly. Over past three decades, on average, one million people have moved within the country borders (and more frequent from rural to urban areas) annually. Tehran, Isfahan and Khorasan Razavi provinces were the host of most Iranian immigrants in these years.[4] Regardless to emigration reasons, cultural differences resulted from emigrations have a considerable impact on people's access to public services such as health-related services.

In addition to mentioned cultural variety factors; beliefs, attitudes, and knowledge can affect people's lifestyle.[13] In general, lifestyle can affect peoples' health statues strongly. The lifestyle improving health causes promoting health and well-being and further sense of satisfaction, personal persuasion, and self-actualization.[14] Lifestyle importance is because of its effect on life quality and diseases prevention.[15] A study conducted by the WHO about health behaviors in 35 countries showed that about 62% of life quality and people's health depended on life style and personal behaviors.[16] Health promotion and health supply of society people are one of the important elements of communities' development. Health professions which previously focused on diseases treatment, now pay attention to prevention and health supply through lifestyle improvement and eliminating the factors which somehow have a negative effect on human health level.[17]

Variables such as physical activity level, religious beliefs, and nutrition are directly affected by people's lifestyle and consequently by their culture. Considering the importance of nutrition, exercise, and religious beliefs in old people's physical and mental health promotion.[18],[19],[20] This paper investigates cultural factors, affecting old people utilization of health services (based on the volume and frequency), provided in Isfahan University of Medical Sciences' hospitals in 2014. The reason for selecting Isfahan as the sampling location was its high rate of immigration from neighbor provinces.


  Methods Top


The present research was a descriptive analytic study that determined cultural factors effect old people's utilization of health services in Isfahan province as a destination for within country emigrants (such as people from Chaharmahal vs. Bakhtiari, Yazd, Kohgiluyeh vs. Boyer Ahmad, Lorestan, Khuzestan). The research population was the elderly, who had been hospitalized at university hospitals of Isfahan (Al Zahra, Ayatollah Kashani, Feyz, Jesus son of Mary, Ayatollah Beheshti, Hazrat Nor and Ali Asghar, Imam Musa Kazem, Amin, Hazrat, Sydalshhda, Shahid Chamran, and Farabi; - Imam Hossein Hospital was eliminated from the statistical population because of its specialty in the field of children and infants) in second half of 2014. Two hundred seventy-five people were selected as the sample and entered the research using random sampling method. Inclusion criteria were being 60-year-old and more, hospitalized in one of the hospitals affiliated to Isfahan University of Medical Sciences and their willingness to participate in the present research; and exclusion criteria were people's disability in answering the questions, even with telephone follow-up after discharging and unwillingness to participate in the research.

Data collection tools were researcher-made questionnaires, designed in the three subsets applying both Andersen's behavioral model [1] and nutritional model of National Health and Nutrition Examination Survey.[21] The first part of these questionnaires was related to background variables; second part includes cultural variables (such as nationality, dialect, language, religion, resident place, emigration, smoking, exercise, diet, traditional medicine, and home remedy); and finally the third part includes dependent variables (such as utilization of hospital services, clinical or diagnostic services and physician visits, and their frequency). The tool reliability was confirmed by 15 experts and professors, and its validity was estimated by Cronbach's alpha test (α = 0.74). The gathered data entered in the SPSS 22 software (IBM Company), and then the analysis was performed at two levels of descriptive level (including frequency, percentage, mean and standard deviation [SD]) and inferential level (including statistical tests comparing independent group's means, correlation coefficient test and multivariable regression).


  Findings Top


According to demographic data, 46.2% of respondents were women and 53.8% were men. Regarding marital status, 0.7%, 72%, and 1.1% were respectively single, married, widow, and divorced. Most of them had between 2 and 5 children and 72% were elderly couples. Considering employment status, 56.4% of respondents were unemployed and 17.1% employed.

A comparison between means of dependent variables based on cultural predictive variables showed that there is no significant difference between utilization and its frequency regarding to the cultural variables such as immigration and smoking at confidence level of 95% (0.05<significance level). In other words, the percentage utilization and its frequency will not be different among those who immigrate and those who do not immigrate as well as those who smoke and those who do not smoke at the confidence level of 95%. The observed difference in these two sample means may reflect high variance in one of the groups. But the results show that the mean of utilization and its frequency regarding to the exercise is statistically significant at a confidence level of 95%. It means that elders who exercise more are not the same as their peers with less or no physical activity in utilization and its frequency; in the other hand aged people with physical activities are more fortunate to use healthcare services than others who have scheduled and frequent plan for doing physical activities[Table 1].
Table 1: Comparison of services utilization and its frequency among elders considering predictive variables

Click here to view


The results of Spearman test show that there is not a significant statistical relationship among the predictive cultural variables (familiarity with Persian language, role of religious beliefs in life, rate of feeling comfort in community, proper daily diet, and use of traditional and herbal medicine) and healthcare services utilization as the dependent variable at confidence level of 95%. These relations are also true for utilization frequency except having a proper daily diet with a coefficient of −0.190 [Table 2].
Table 2: Correlation between predictive cultural variables and healthcare services utilization

Click here to view


According to research findings, the most important independent variables (cultural factors) which have a significant relationship with dependent variable (healthcare services utilization) include doing sports, having religious beliefs, and the frequency of exercise in the week. Based on [Table 4], adjusted determination coefficient is 0.055; in fact, 5.5% of changes in healthcare services utilization can be explained by dependent variables of the research. Other changes of healthcare services utilization are not investigated due to its complex and multidimensional nature health-related behaviors which are influenced by other factors. In addition, explained regression model being done based on variance analysis test is linear and significant, because the amount of F-test for significance of the effect of independent variables on healthcare services utilization equals 6.248 with significance level of P = 0.000. Also, the amount of significance of each variable's effect and coefficient sign (positive-negative) was investigated for this effect (increase or decrease) using standard β coefficient. The results of multivariable regression analysis in [Table 3] shows that variables such as doing exercise, having religious beliefs in life, and number of times allocated to sports have entered into equation with beta coefficient of 0.324, −0.150, and −0198. Regarding beta coefficients, it can be observed that exercise and walking variables explain the most and variable of religious beliefs explain the least changes on healthcare services utilization; the effects of these two dependent variables are respectively, increasing and decreasing. Since exercise has been evaluated nominally, it was changed into a dummy variable before entering into regression equation; therefore, the results show that services utilization of those who walk and exercise is 0.3 SD units more than those who do not; but an increase in the number of times allocated to exercise during the week leads to less services utilization frequency. This amount equals −0.198 in regression equation. As a result, two variables of religious beliefs in life and the number of times allocated to exercise have a weakening (decreasing) effect on dependent variable, while exercise (not as a planned and scheduled one) has an increasing effect.
Table 3: Statistical determinants of the amount and direction of effects in each independent variable on utilization of healthcare services and the this utilization frequencies (n=275)

Click here to view
Table 4: Results of multivariable regression model evaluation using stepwise method for determination of effective factors on utilization of healthcare services

Click here to view


In addition, the results show that the most important independent variables (cultural factors) which have a significant relation with a dependent variable (frequency of healthcare services) include having proper daily diet and exercise. According to [Table 4], adjusted determination coefficient equals 0.060; in fact 6% of changes in the frequency of healthcare services can be explained by the research independent variables. In addition, explained regression model being done based on variance analysis test is linear and significant, because the amount of F-test for significance of the effect of independent variables on healthcare services utilization equals 9.618 with significance level of P = 0.000. The results of multivariable regression analysis in [Table 3] shows that variables of proper and adequate daily diet, as well as exercise, have entered into equation with beta coefficient of −0.196 and −0.138 with proper and adequate daily diet having the most significant role in explaining dependent variable. Moreover, these two variables have a decreasing effect on dependent variable; in other words, having an appropriate daily diet and doing exercise and walking will decrease the frequency of healthcare services proportionately.


  Discussion Top


Results show that the healthcare services utilization of those who walk and exercise is 0.3 SD units more than those who do not. This can be explained by the chronic diseases the elderly face with, specialists' recommendations for increasing mobility, and also fear from deterioration. In fact, the elderly try to avoid worsening health statue through disease management methods such as temporal physical activities, while they are have to use healthcare services regularly in order to maintain their existing health statue. Buchner's study also showed that although exercise plays a protective role for risks of falling in aged people, but it does not improve their walking ability, balance, and physical conditions. In fact, beside the positive effects of physical activities on decreasing services utilization by some groups of elderly; in aged people with middle to acute disease, short-term physical activities do not reduce their healthcare services utilization.[22] Moreover, Holland et al. in their 12 months survey found out that physical activity had a positive effect on health of those who suffered mild depression at lower ages; however, evidence of health promotion in aged people with more acute disease was not remarkable.[23]

On the other hand, the frequency of times allocated to sports during the week can decrease service utilization between the elderly which shows the better health conditions in people who do physical activities weekly and regularly. The results of this research are consistent with Wolin et al. study on the role of physical activities and sports on individual perception from quality of life;[24] as well as The American College of Sports Medicine [3] surveys which have identified the important role of sports and active life style in improved mobility, positive participation to life, and prevention of different diseases in the elderly.[25]

According to Cyarto et al., physical activity is an important factor in functional capacity improvement of the elderly.[26] Since paresis, lack of flexibility and motor control problems are effective factors on poor balance and consequently falling, implementation of a physical readiness program can be effective in prevention of falling, because of exercise and physical activity impact on muscle strength, flexibility, and motor control which consequently decreases individuals' therapeutic needs.[27] Duncan et al. study shows that active elders perform better than their inactive peers in controlling balance during functional or experimental tests.[28] Even, elders with good and optimal physical readiness were similar to youth in pattern of muscle activation at the time of confusion or imbalance.[18] The results of this research also show that walking has a direct effect on health in older ages. A meta-analysis research performed by De Vries et al. showed that physical therapy has a positive effect on mobility and physical function of elderly patients with disabilities. In the mentioned study, researchers referred to the effects of short-term and long-term exercise interventions on physical function.[29] Moreover, two surveys obtained significant results and stated that long-term multidimension interventions can be the best methods for improvement of mobility and increasing physical function in elderly patients with disabilities.[30],[31] Increasing the level of physical activity as an underlying factor for promotion of general health in communities and decreasing health problems such as cardiovascular diseases, osteoporosis, and etc, can be recommended.[32] Results of present study are consistent with the above mentioned studies.

Also results show that the frequency of utilization will decrease 0.1 unit of SD by rasing in the level of religious beliefs which can be explained regarding to religious people's beliefs about faith to divine destiny even in disease and their effort to relief through praying which will consequently bring more mental relaxation. Reyes-Ortiz et al. found that 62% of people pray in critical and stressful situations and mentioned religious healing and relief as an important factor.[33] In Salehi et al. study, people with higher religious practices represented better mental health.[34] According to a study by Paragament, religion can have positive effects in filling life gaps and making a sense of life.[19] Results of a research performed by Pardini et al. confirm the positive relationship between religious faith and health conditions.[35] Our results are consistent with the above-mentioned studies.

Moreover, the findings show that the most important independent variable which has a significant relationship with dependent variable (frequency of health services utilization) is having a proper daily diet. Nutrition is an important determining factor in elder patients' health and therefore, nutritional interventions and programs are essential for this group.[36],[37] Furthermore, Eshaghi et al. referred to nutritional disorders in their study and recommended more investigations as well as proper programs for improvement of nutritional status of elders.[38] Numerous studies have confirmed the role of nutrition on health problems such as cancers, cardiovascular diseases, and dementia.[39] Our results are in common with studies done regarding elders' nutrition.


  Conclusion Top


Given that there is a significant relation between physical activities and utilization of healthcare services, it can be said that medical recommendations by physician on physical activities will have positive effects on elders' sensitivity to have higher mobility. Moreover, reasonable increase of the frequency of sport activities as well as having a proper diet will decrease elders' need to use health services. Improving elders' access to rich nutrients and strengthening their religious beliefs can decrease their use of health services. Of course, it should be noted that given the complexity of healthcare topics, investigation of other factors such as economic, social, structural (centralization or decentralization), and so on can predict elders' utilization of healthcare services in a more consideration.

Acknowledgment

The author would like to thank for all the Management and Health Information School professors of Isfahan University of Medical Sciences.

Financial support and sponsorship

It is driven from a master thesis titeled “factors affecting elderly people utilization of health care services provided by Isfahan University of Medical Sicences.” Its also aproved as a research project and was supported financilay.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Namadian M, Ghobadi S. Evaluation of Mental Status in Old Ages- Zanjan 2001. Tehran: Ashena Press; 2006.  Back to cited text no. 1
    
2.
Iranian center of Statistics. National Population and Housing Census; 1335-1390. Available from: http://amar.org.ir/english/. [Last retrieved on 2015 Jan to Mar 21].  Back to cited text no. 2
    
3.
Presidency of the Islamic Republic of Iran Management and Planing Organization. Iranian Population and Housing Census In Autumn (24 October – 13 November); 2011.  Back to cited text no. 3
    
4.
United Nations Population Fund- I.R of Iran Branch. Analitic View to Urbenization and within Borders Migration in Islamic Republic of Iran; 2011.  Back to cited text no. 4
    
5.
Hajiebrahimi MH, Qandehari A, Charkazi A, Mirnejad M, Behnampour N. Comparing Socio-economic Variables and Life Satisfaction among the Elder People in Gorgan, Iran, During 2004-2009. Salmand Iranian Journal of Ageing 2014:9;168-78.  Back to cited text no. 5
    
6.
Candeloro JM, Caromano FA. Effects of a hydrotherapy program on flexibility and muscular strengthin elderly women. Rev Bras Fisioter São Carlos 2007;11:267-72.  Back to cited text no. 6
    
7.
Rebhan DP. Health Care Utilization: Understanding and applying theories and models of health care seeking behavior. Case Western Reserve University; 2009.  Back to cited text no. 7
    
8.
Da Silva RB, Contandriopoulos AP, Pineault R, Tousignant P. A global approach to evaluation of health services utilization: Concepts and measures. Healthc Policy 2011;6:e106-17.  Back to cited text no. 8
    
9.
Nouraei MN, Saber MA, Barouni M, Asadi LM, Vaez MM, Hadian M. investigating the effective factors on health care services utilization in Tehran. Razi Med J 1393;21:61-72.  Back to cited text no. 9
    
10.
Andersen RM. Revisiting the behavioral model and access to medical care: Does it matter? J Health Soc Behav 1995;36:1-10.  Back to cited text no. 10
    
11.
Aroian KJ, Khatutsky G, Tran TV, Balsam AL. Health and social service utilization among elderly immigrants from the former Soviet Union. J Nurs Scholarsh 2001;33:265-71.  Back to cited text no. 11
    
12.
Nourian M, Seyedghorab M. The Role of Pucblic Culture on Revelutionary Life Style. Available from: http://www.borhan.ir/NSite/FullStory/News/?Id=5985. [Last acessed on 2015 April 12].  Back to cited text no. 12
    
13.
Lannin DR, Mathews HF, Mitchell J, Swanson MS, Swanson FH, Edwards MS. Influence of socioeconomic and cultural factors on racial differences in late-stage presentation of breast cancer. JAMA 1998;279:1801-7.  Back to cited text no. 13
    
14.
Tavakoli M, Emadi Z. The relationship between health-promoting lifestyle, mental health, coping styles and religious orientation among Isfahan university students. J Res Behav Sci 2015;13:481-95.  Back to cited text no. 14
    
15.
Lee RL, Loke AJ. Health-promoting behaviors and psychosocial well-being of university students in Hong Kong. Public Health Nurs 2005;22:209-20.  Back to cited text no. 15
    
16.
Walker SN, Sechrist KR, Pender NJ. The Health-Promoting Lifestyle Profile: Development and psychometric characteristics. Nurs Res 1987;36:76-81.  Back to cited text no. 16
    
17.
Phipps C. Fundamental of Nursing. Philadelphia: Lippincott; 2001.  Back to cited text no. 17
    
18.
Spiriduso W. Physical Dimention of Aging. Champaign, Illinoise: Human Kinetics; 1995. p. 30-90.  Back to cited text no. 18
    
19.
Hess RE, Maton KI, Pargament K. Religion and Preventionin Mental Health. New York: Harworth Press Inc.; 1992.  Back to cited text no. 19
    
20.
Ghorbani A, Karimzadeh T, Azadmanesh Y. Nutritional assessment in elderly hospitalized patients in Qazvin Teaching Hospitals in 2011. Iran J Ageing 2013;8:33-40.  Back to cited text no. 20
    
21.
U.S. Department of Health and Human Services. The National Health and Nutrition Examination Survey 2008. National Center for Health Statistics. Centers of Disease Control and Prevention; 2007-2008.  Back to cited text no. 21
    
22.
Buchner DM, Cress ME, de Lateur BJ, Esselman PC, Margherita AJ, Price R, et al. The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults. J Gerontol A Biol Sci Med Sci 1997;52:M218-24.  Back to cited text no. 22
    
23.
Holland SK, Greenberg J, Tidwell L, Malone J, Mullan J, Newcomer R. Community-based health coaching, exercise, and health service utilization. J Aging Health 2005;17:697-716.  Back to cited text no. 23
    
24.
Wolin KY, Glynn RJ, Colditz GA, Lee IM, Kawachi I. Long-term physical activity patterns and health-related quality of life in U.S. women. Am J Prev Med 2007;32:490-9.  Back to cited text no. 24
    
25.
American College of Sports Medicine, Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, et al. American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc 2009;41:1510-30.  Back to cited text no. 25
    
26.
Cyarto EV, Brown WJ, Marshall AL, Trost SG. Comparison of the effects of a home-based and group-based resistance training program on functional ability in older adults. Am J Health Promot 2008;23:13-7.  Back to cited text no. 26
    
27.
Aslankhani M, Shams A, Shamsipour P. Effect of mental and physical practices on static and dinamic blance anoung healthy elders. J Iran Ageing 1387;3:9-22.  Back to cited text no. 27
    
28.
Duncan PW, Weiner DK, Chandler J, Studenski S. Functional reach; a new clinical measure of balance. J Gerontol 1999;45:192-197.  Back to cited text no. 28
    
29.
De Vries NM, Van Ravensberg CD, Hobbelen JS, Rikkert MO, Staal JB, Nijhuis-van der Sanden MW. Effects of physical exercise therapy on mobility, physical functioning, physical activity and quality of life in community-dwelling older adults with impaired mobility, physical disability and/or multi-morbidity: A meta-analysis. Ageing Res Rev 2012;11:136-49.  Back to cited text no. 29
    
30.
Chin A Paw MJ, van Uffelen JG, Riphagen I, van Mechelen W. The functional effects of physical exercise training in frail older people: A systematic review. Sports Med 2008;38:781-93.  Back to cited text no. 30
    
31.
Theou O, Stathokostas L, Roland KP, Jakobi JM, Patterson C, Vandervoort AA, et al. The effectiveness of exercise interventions for the management of frailty: A systematic review. J Aging Res 2011;4:194.  Back to cited text no. 31
    
32.
Stürmer T, Günther KP, Brenner H. Obesity, overweight and patterns of osteoarthritis: The Ulm Osteoarthritis Study. J Clin Epidemiol 2000;53:307-13.  Back to cited text no. 32
    
33.
Reyes-Ortiz CA, Rodriguez M, Markides KS. The role of spirituality healing with perceptions of the medical encounter among Latinos. J Gen Intern Med 2009;24 Suppl 3:542-7.  Back to cited text no. 33
    
34.
Salehi L, Soleymanizadeh L, Bagheri Yazdi SA, Abbaszadeh A. The relationship between religious beliefs and locus of control with mental health. J Qazvin Univ Med Sci 2011;11:50-55.  Back to cited text no. 34
    
35.
Pardini DA, Plante TG, Sherman A, Stump JE. Religious faith and spirituality in substance abuse recovery: Determining the mental health benefits. J Subst Abuse Treat 2000;19:347-54.  Back to cited text no. 35
    
36.
Wells JL, Dumbrell AC. Nutrition and aging: Assessment and treatment of compromised nutritional status in frail elderly patients. Clin Interv Aging 2006;1:67-79.  Back to cited text no. 36
    
37.
Salehi S, Naajee A, Sargazi M. The amount of consumption of fruits and vegetables and related factors in the hospitalized elderly in Zahedan in 1389. Iran J Ageing 2012;6:30-6.  Back to cited text no. 37
    
38.
Eshaghi SR, Babak A, Manzori L, Merasi MR. Nutritional status of elderly in elderly nutritional status in elderly' Isfahan. Salmand Iran J Ageing 2007;5:340-5.  Back to cited text no. 38
    
39.
Oliveira MR, Fogaca KC, Leandro-Merhi VA. Nutritional status and functional capacity of hospitalized elderly. Nutr J 2008;54:1-8.  Back to cited text no. 39
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Methods
Findings
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed1112    
    Printed44    
    Emailed0    
    PDF Downloaded51    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]