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
1
, Beheshteh Tabarsi
2
and Mohammad Zare
3
1
Graduate Master of Nursing, School of Nursing and Midwifery, Tehran Medical Branch, Islamic Azad
University, Tehran, Iran
2
Instructor, Faculty of Nursing and Midwifery, Tehran Medical Branch, Islamic Azad University, Tehran, Iran
3
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
th
Oct, 2016
Accepted after revision 20
th
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
© A Society of Science and Nature Publication, 2016. All rights
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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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