Health Science

Communication

Biosci. Biotech. Res. Comm. 9(4): 833-840 (2016)

Facilitating and impeding factors in self-care of the

elderly referred to health care centers

Maryam Amin Nasab

, Beheshteh Tabarsi

and Mohammad Zare

Graduate Master of Nursing, School of Nursing and Midwifery, Tehran Medical Branch, Islamic Azad

University, Tehran, Iran

Instructor, Faculty of Nursing and Midwifery, Tehran Medical Branch, Islamic Azad University, Tehran, Iran

Faculty of Nursing and Midwifery, Tehran Medical Branch, Islamic Azad University, Tehran, Iran

ABSTRACT

The population of elderly has been increasing worldwide and the problems and diseases from this evolutionary stage

can incur huge costs on governments and cause numerous disabilities, thus they need attention and compliance with

effective self-care program in improvement of their health. The present research aims to determine on Facilitating

and impeding factors in self-care of the Elderly who referred to health care center of Kabudrahang city af liated

to University of Medical Sciences in 2015. This analytical-descriptive study was conducted using simple random

sampling, participated by 384 elderly referred to health care center of Kabudrahang city af liated to University of

Medical Sciences in 2015. The information was collected via the demographic questionnaire and questionnaire of

Facilitating and impeding factors in self-care of elderly. Data analysis of this research was made based on descriptive

statistics (frequency, mean, frequency percent, standard deviation). ndings of this study indicated that mental, physi-

cal and social factors with mean of 2.30, 2.02 and 1.63 had the most rate of signi cance in facilitating self-care for

the elderly. Among various impeding factors, physical, mental and social factors with mean of 1.42, 1.08 and 0.96

had the most rate of signi cance in impeding self-care for the elderly. Physical factor was recognized as the  rst and

the most important impeding factor in self-care of the elderly. The elderly believed that muscle weakness is the most

important physical impeding factor which impedes their self-care; mental factor is the second major impeding factor

in self-care in the elderly. Findings of this research indicated that facilitating factors in self-care of the elderly have

been in average level. Mental factor was recognized as the most important facilitating factor in the self-care of the

elderly. On the other hand, physical factor was recognized as the most important impeding factor in self-care of the

elderly. Thus the more improvement in factors affecting improvement in self-care in the elderly and the more reduc-

tion in impeding factors, it can help the elderly to have a huge self-care.

833

ARTICLE INFORMATION:

*Corresponding Author: m.aminnasab58@yahoo.com

Received 25

Oct, 2016

Accepted after revision 20

Dec, 2016

BBRC Print ISSN: 0974-6455

Online ISSN: 2321-4007

Thomson Reuters ISI ESC and Crossref Indexed Journal

NAAS Journal Score 2015: 3.48 Cosmos IF : 4.006

reserved.

Online Contents Available at: http//www.bbrc.in/

834 FACILITATING AND IMPEDING FACTORS IN SELF-CARE BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Amin Nasab, Tabarsi and Zare

INTRODUCTION

Elderly is a natural process of change by the passage

of time which starts at birth and continues throughout

life[Brunner and Suddarth 2014]. However the elderly

is the constant process in human life, it is not speci ed

exactly when it starts. As speci ed, 60-year-old people

and elder ones are recognized as the elderly of a country

[Shamloo, 2013] and in some sources 65-year-old people

have recognized as the elderly [WHO, 2014].

It is forecasted that number of elderly increases to

18 million people by 2051 and share of elderly popula-

tion reaches to 20% [Sadeghi, 2013]. Due to low birth

rates, increasing life expectancy in Iran, and population

movement to elderly population, the elderly have been

proposed as the largest demographic group [SCI, 2011].

The demographic crisis in Iran can be called elderly tsu-

nami that will have different social and health aspects.

The inability is of the consequences of elderly, de ned

as dysfunction in function of daily activities in form of

need to help in at least one of the activities of daily liv-

ing. This disorder causes the dependence of the elder and

his needing to increase care supports. Physical disability

of the elderly which is due to the disease can be followed

by disastrous consequences, such as hospitalization, the

increasing use of health care system and death. These

 ndings display the necessity to attention to the elderly

and the disabilities from it [Arshinji, 2010]. Adults natu-

rally have the ability to take care of themselves, but the

children and especially the elders need help in doing

their self-care activities [George, 2011].

Studies have shown that the elderly are persuaded

to the activities which cause improvement in level of

their health. However, chronic diseases and disability

in elderly cannot be resolved thoroughly, they can use

the activities which help them to maintain independ-

ence and reach the highest level of health and self-care.

The aim of self-care in elderly is to assist the elderly

to maintain the highest level of independence and their

self-esteem despite social, physical and mental disabili-

ties [Brunner and Suddarth, 2014].

The study by Hemmati et al. indicated that 80% of the

elderly have low self-care and 20% had high self-care

[Hemmati, 2013]. In a research by Abedi [2011] et al, the

results indicated that perceived health, lifestyle, spiritual

beliefs are the family factors and the medical insurance

and protection are the personal, social and economic

factors, found as the most important factors contributed

in self-care of the elderly. A variety of factors including

mental maturity, skills, values, knowledge, motivation

and health individuals in family affect extent of self-

care [Memarian, 2015].

Review on studies in the context of self-care in the

elderly indicates that barriers to optimal self-care have

been examined in various countries, but due to differ-

ences in cultural context in various countries including

Iran, the fact that to which extent the existing  ndings

can be generalized is not speci ed. As a result, the sig-

ni cance to recognize facilitating and impeding factors

in the elderly’s self-care by increasing the ability of self-

care can result in self-actualization in the elderly.

MATERIALS AND METHODS

The current research is an analytical-descriptive study

conducted among the elderly who referred to health care

center of Kabudrahang city af liated to University of

Medical Sciences in 2015. Data collection instruments

have been as follows:

1. The research made demographic information ques-

tionnaire under study included age, gender, edu-

cation level, marital status, employment status,

monthly income, source of income, satisfaction

with income, living conditions, housing status, in-

surance status, daily and personal activities, med-

ical history, medical checkup, history of participa-

tion in training related courses.

2. The facilitating factors questionnaire included 35

questions and the impeding factors questionnaire

included 28 questions in three physical, mental and

social dimensions, prepared using various sources

and articles and interviewing with a number of pa-

tients. Content validity of the questionnaire after

modi cations by 10 professors at Hamedan Uni-

versity of Medical Sciences was con rmed and the

reliability coef cient of the instruments was mea-

sured via Cronbach’s alpha(0.83). Both question-

naires were organized with the responses in terms

of 5-point Likert scale and given score with scores

ranging from 1-5 with very high, high, average,

low and never degrees. The sample size(384) was

estimated using statistical formula. The inclusion

criteria include awareness of place and time, not

having severe physical problems, lack of mental

problems such as Alzheimer. In compliance with

code of ethics in the research, the participants par-

ticipated in the study after awareness from aim

of research, informed satisfaction, con dentiality

of information and optional participation in the

study.

RESULTS

With regard to the obtained results in this research, the

highest (61.5%) and lowest (38.5%) percent of the units

under research included of women and men, respectively.

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS FACILITATING AND IMPEDING FACTORS IN SELF-CARE 835

Amin Nasab, Tabarsi and Zare

Table 1: Absolute and relative frequency distribution of the elderly who referred to health care center of

Kabudrahang city af liated to Hamedan University of Medical Sciences in 2015 in terms of demographic features

Frequency

Personal features

Highest(%) Least (%)

mean

standard

deviation

Age (5/56%)

60-70 years old

(2/5%)

81 years old and above

52/69 56/6

Gender (5/61%) woman (5/38%) man

Education level (8/57 %) illiterate (8/0%) high school

Marital status (2/55 %) married (6/1 %) divorce

Employment status (7/47 %) housewife (13 %) retired

Income source (1/34 %) family (6/7 %) Aid Committee

Extent of satisfaction with income (1/47 %) average satisfaction (6/3 %) very little satisfaction

Living condition (4/29 %) with spouse (8/0 %) with other individuals

Living status (6/96 %) personal house (4/3 %) rental house

Supplementary insurance status (1/71 %) lack of supplementary

insurance

(9/28%)supplementary insurance

Disease history (6/71 %) high blood pressure (6/0 %) Brain problems

Making personal and daily activities (8/88 %)by the person (2/11 %) by other’s help

Medical checkup (6/64 %) irregular (4/35 %) regular

The record of participation in Related

training courses

(3/51 %) participating in courses (7/48%) lack of participating in

the courses

Table 2: Status of physical facilitating factors in self-care of the Elderly who referred to health care center of

Kabudrahang city af liated to Hamedan University of Medical Sciences in 2015

physical facilitating factors in self-care Mean Standard

deviation

Least Highest Rank

Having good physical conditions helps me to take care of myself 19/2 86/0 0 4 3

Daily activity and sport help me to take care of myself 80/1 08/1 0 4 6

healthy diet helps me to take care of myself 93/1 95/0 0 4 4

Awareness on how to keep healthy assists me to take care of myself 63/1 26/1 0 4 7

I have suf cient energy to take care of myself 83/1 81/0 0 4 5

due to personal independence, I am able to have self-care 48/2 93/0 0 4 1

I feel healthy by self-care 26/2 83/0 0 4 2

physical impeding factors 02/2 67/0 29/0 86/3

The highest percent(56.5%) has been at age group(60-70

years old). 57.8% have been illiterate, 55.2% have been

married, 47.7% have been housewives, 71.1% had no

Supplementary insurance, 71.6% had high blood pres-

sure, 88.8% did their personal and daily tasks, 64.6%

had irregular medical checkup and 51.3% participated

in related training courses. Findings related to effective

physical factors in self-care of the elderly who referred

836 FACILITATING AND IMPEDING FACTORS IN SELF-CARE BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Amin Nasab, Tabarsi and Zare

Table 3: Status of mental facilitating factors in self-care of the Elderly who referred to health care center of

Kabudrahang city af liated to Hamedan University of Medical Sciences in 2015

mental facilitating factors in self-care mean standard

deviation

least highest rank

I know my self-care needs properly 13/1 98/0 0 4 20

I value myself 64/2 81/0 0 4 4

I take care of my health at any situation and take care of myself 35/2 82/0 0 4 11

I have sense of responsibility to maintain my health and self-care 47/2 83/0 0 4 9

I feel happy with all the tasks which cause maintenance of my health 50/2 74/0 1 4 6

I enjoy making my personal tasks 55/2 84/0 0 4 5

I put effort to maintain my health 26/2 86/0 0 4 13

I expect to achieve thorough health 66/1 98/0 0 4 18

I ensure that if I put huge effort to maintain my health, my efforts

will not remain fruitless

18/2 84/0 0 4 14

I should take care of myself so as not to get ill 50/2 79/0 1 4 7

health is the best blessing and I have to take care of myself to

maintain it

23/3 66/0 1 4 2

if I get ill, I should take care of myself again 25/3 85/0 1 4 1

I feel that I am an important person in family 15/2 99/0 0 4 15

I know that if I do not take care of myself, I might face problem 79/2 67/0 1 4 3

The elderly is not disability and I should take care of myself 40/1 92/0 0 4 19

If I do not take care of myself, I will be more likely taken to the

elderly house

42/2 43/1 0 4 10

I believe in myself and I know that I can take care of myself 28/2 72/0 0 4 12

If I have a good condition mentally, it can take care of myself better 01/2 11/1 0 4 16

I hope my future, thus I take care of myself 73/1 92/0 0 4 17

I have power of decision making in my personal and care affairs and

I can take care of myself

49/2 90/0 0 4 8

Mental facilitating factors in self-care 30/2 48/0 85/0 55/3

to health care center of Kabudrahang city af liated to

Hamedan University of Medical Sciences in 2015 have

been displayed in table 2. With regard to the obtained

results, the items “due to personal independence, I am

able to have self-care”, “I feel healthy by self-care”,

“having good physical conditions helps me to take care

of myself” had the highest signi cance.

Findings related to effective mental factors in self-

care of the elders referred to health care center of Kab-

udrahang city af liated to Hamedan University of Medi-

cal Sciences in 2015 have been displayed in table 3. With

regard to the obtained results, the items “if get ill, we

must be grateful and take care of myself”, “the health is

the best blessing and we should take care of ourselves to

maintain it”, “I know that if I do not take care of myself,

there would be problems”, have the highest signi cance

in terms of facilitating factors in self-care of the elderly.

Findings related to social factors affecting self-care

of the elderly referred to health care center of Kabudra-

hang city af liated to Hamedan University of Medical

Sciences in 2015 have been displayed in table 4. With

regard to the obtained results, items “having medical

insurance assists me to make my medical checkup regu-

larly so as to take care of myself”, “having care at house

assists me in making self-care” have the highest signi -

cance in facilitating self-care. Data of effective physical

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS FACILITATING AND IMPEDING FACTORS IN SELF-CARE 837

Amin Nasab, Tabarsi and Zare

Table 4: Status of social facilitating factors in self-care of the Elderly who referred to health care center of

Kabudrahang city af liated to Hamedan University of Medical Sciences in 2015

Social facilitating factors in self-care Mean Standard

deviation

Least Highest Rank

The government’s  nancial support assists me to take care

of myself

71/0 08/1 0 4 8

The family’s  nancial support assists me to take care of

myself

14/1 25/1 0 4 6

Part-time jobs well suited to age assist me to take care of

myself

95/0 20/1 0 4 7

If I have suf cient income, it can take care of myself 11/2 10/1 0 4 2

Special trainings to elderly assist me to take care of myself 93/1 52/1 0 4 4

Making more relationship with peers, friends and family

assist me to take care of myself

70/1 91/0 0 4 5

Having medical insurance assists me to make my medical

checkup so as to take care of myself

54/2 89/0 1 4 1

Having nurse at home assists me in making self-care 98/1 18/1 0 4 3

Social facilitating factors in self-care 63/1 65/0 50/0 25/3

Table 5. Status of physical facilitating factors in self-care of the Elderly who referred to health care center of

Kabudrahang city af liated to Hamedan University of Medical Sciences in 2015

Physical impeding factors in self-care mean standard

deviation

least highest rank

The limitations due to my disease have not caused me failing to

take care of myself

92/1 90/0 0 4 3

My vision weakness is a barrier to make my self-care activities 13/1 99/0 0 4 7

My hearing weakness is a barrier to make my self-care activities 07/1 12/1 0 4 8

My muscle weakness is a barrier to make my self-care activities 09/2 86/0 0 4 1

I have not suf cient energy to take care of myself 81/1 94/0 0 4 4

I have not suf cient time to take care of myself 63/0 94/0 0 4 11

motor disorder in my limbs is a barrier to make my self-care

activities

94/1 98/0 0 4 2

I have not suf cient power to take care of myself 81/1 99/0 0 4 5

Due to sleepless night and daytime sleepiness, I cannot take care

of myself

76/0 96/0 0 4 9

Due to fatigue, I cannot take care of myself 67/1 03/1 0 4 6

Due to effect of Medications such as drowsiness and weakness

and so on, I cannot take care of myself

76/0 00/1 0 4 10

Physical impeding factors in self-care 42/1 67/0 27/0 18/3

Amin Nasab, Tabarsi and Zare

838 FACILITATING AND IMPEDING FACTORS IN SELF-CARE BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Table 6: Status of mental facilitating factors in self-care of the Elderly who referred to health care center of

Kabudrahang city af liated to Hamedan University of Medical Sciences in 2015

mental facilitating factors in self-care mean standard

deviation

least highest rank

I do not need to make self-care 67/0 79/0 0 4 9

feeling of hopelessness in life impedes making self-care activities 61/1 09/1 0 4 2

Sense of belonging is a barrier to make self-care activities 03/1 89/0 0 4 5

I am bored and I cannot take care of myself 53/1 10/1 0 4 3

I have no motivation to make self-care 95M0 95/0 0 4 7

my children are assigned with taking care of me 61/1 23/1 0 4 1

As I live along, there is no possibility to self-care 59/0 02/1 0 4 10

As I have fear from failing to take care of myself, I do not make

self-care

03/1 87/0 0 4 4

I am indifferent to myself and self-care 77/0 78/0 0 3 8

Anxiety does not allow me to take care of myself 01/1 91/0 0 3 6

Mental impeding factors in self-care 08/1 63/0 00/0 80/2

Table 7: Status of social impeding factors in self-care of the elderly who referred to health care center of

Kabudrahang city af liated to Hamedan University of Medical Sciences in 2015

Social impeding factors in self-care Mean Standard

deviation

Least Highest Rank

Financial problems are barriers to make my self-care activities 72/1 18/1 0 4 1

no having supporting family is a barrier to make my self-care

activities

58/1 16/1 0 4 2

long distance from home to health center is a barrier to make my

self-care activities

65/0 04/1 0 4 5

unsuitable treatment of the personnel and physical at health center

are a barrier to refer for care

28/0 59/0 0 3 6

lacking special supports for the elderly such as transport systems

and motor equipment are barriers to make my self-care activities

75/0 91/0 0 4 4

my belonging to my family has impeded me to make my self-care

activities

78/0 93/0 0 4 3

social impeding factors in self-care 96/0 62/0 00/0 67/2

impeding factors in self-care of the elderly who referred

to health care center of Kabudrahang city af liated to

Hamedan University of Medical Sciences in 2015 are

shown in table 5. With regard to the obtained results,

items “muscle weakness impedes me to make my self-

care activities”, “motor disorder in my limbs impedes

doing my self-care activities” and “the barriers due to

my disease have caused failing to have self-care” had

the highest rate for effect of impedance in the elderly’s

self-care. The  ndings related to effective mental imped-

ing factors in the self-care of the elderly who referred

to health care center of Kabudrahang city af liated to

Hamedan University of Medical Sciences in 2015 have

been displayed in table 6.

With regard to the obtained results, the items “my

children are assigned with taking care of me”, “feeling of

hopelessness in life impedes making self-care activities”,

and “I am bored and I cannot take care of myself” have

Amin Nasab, Tabarsi and Zare

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS FACILITATING AND IMPEDING FACTORS IN SELF-CARE 839

the highest signi cance of impedance in self-care of the

elderly. Findings related to the effective social impeding

factors in self-care of the elderly who referred to health

care center of Kabudrahang city af liated to Hamedan

University of Medical Sciences in 2015 have been dis-

played in table 7. With regard to the obtained results, the

items “ nancial problems impede making my self-care

activities”, “lacking supporting family impedes mak-

ing self-care activities”, “my dependence on my fam-

ily impedes making self-care activities” had the highest

effect of impedance in self-care of the elderly.

DISCUSSION

Study by Tinda Rabie indicated that lacking self-care

information is the major barrier to self-care in the

elderly, which this is inconsistent with this study (Tinda

Rabie, 2015). In accordance with this study, the study by

Abedi et al indicated that the religious beliefs have been

the effective factors in self-care of the elderly, which this

is due to the Islamic and religious culture in our country

(Abedi et al 2010).

The study by Salimi et al indicated that the elderly

have not a good prospect to their health status in future

and have expected worsening their health status, which

this was consistent with this study (Salimi et al 2015).

The study by Sundsli Kari indicated that feeling of hap-

lessnesshas been a strong impedance in self-care which

this is consistent with this study [14]. The study by Azad

bakht et al in accordance with this study indicated that

however the elderly understand the consequences from

lack of making self-care behaviors such as dependence,

transfer of them to the elderly houses, heavy medical

costs and making health behaviors will increase in them

[Sundsli et al, 2012]. In the study by Azad bakht et al,

the economic status reported by the elderly associated to

the facilitating self-care behaviors in health, which this

is consistent with the results from this study [Azadbakht

et al, 2014]. Further, the study by Abedi et al indicated

that having the health services insurance and support-

ing area have been the most important effective fac-

tors in self-care of the elderly, which this has not been

consistent with the results from this study [Abedi et al,

2010]. The results from study by Yeon-Hwan Park et al

indicated that deterioration in physical condition has

been of the impeding factors in self-care, which this is

consistent with the present research (Yeon-Hwan et al

2015). In this ranking, the items “I have not suf cient

time for taking care of myself”, “due to effect of Medi-

cations such as drowsiness and weakness and so on, I

cannot take care of myself” and “due to sleepless night

and daytime sleepiness, it cannot take care of myself”

had the least degree of impedance which has not been

consistent with the study by Rabie et al., (Rabie et al.,

2015). According to their research, Lack of sleep and lack

of suf cient time have been among the major imped-

ing factors. Further, the study by Yeon-Hwan Park et

al (2105) indicated that lack of suf cient time has been

the barrier to the self-care in the elderly, which this was

inconsistent with the results from this study.

The study by Dale et al (2011) indicated that frustra-

tion, dissatisfaction with life, sense of belonging, lack

of mental health are the impeding factors in the self-

care, which the results from this study are consistent

with the results from the present research. The study by

Dale indicated that belonging to the family is the major

barrier to the self-care of the elderly, which this is con-

sistent with the results from this study (Dale et al 2011).

Findings from this research indicated that in general the

facilitating factors in self-care of the elderly have been

at average level in which the physical, mental and social

factors have been contributed.

Thus the more improvement in factors affecting

improvement in self-care in the elderly and the more

reduction in impeding factors, it can help the elderly

to have a huge self-care. The mental factor is the most

important facilitating factor in the self-care of the

elderly. Thus it should assist for increasing the feeling of

the elderly and remove the problems such as hopeless-

ness in them. Health care professionals should make the

required actions to increase self-esteem of the elderly.

ACKNOWLEDGEMENTS

Thanks to Chancellery for Research in Tehran Medical

Branch, Islamic Azad University, Tehran, Iran in approv-

ing this research project, to the professors and all the

elderly who collaborated in this study as well as our col-

leagues in the health care centres of Kabudrahang city

for their cooperation and help.

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