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Mohd Mydin FH, Mikton C, Choo WY, Shunmugam RH, Murray A, Yon Y, Yunus RM, Hairi NN, Hairi FM, Beaulieu M, Phelan A. Psychometric properties of instruments for measuring abuse of older people in community and institutional settings: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1419. [PMID: 39211334 PMCID: PMC11358705 DOI: 10.1002/cl2.1419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 09/04/2024]
Abstract
Background The examination of psychometric properties in instruments measuring abuse of older people (AOP) is a crucial area of study that has, unfortunately, received relatively little attention. Poor psychometric properties in AOP measurement instruments can significantly contribute to inconsistencies in prevalence estimates, casting a shadow of uncertainty over the magnitude of the problem at national, regional, and global levels. Objectives This review rigorously employed the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guideline on the quality of outcome measures. It was designed to identify and review the instruments used to measure AOP, assess the instruments' measurement properties, and identify the definitions of AOP and abuse subtypes measured by these instruments, ensuring the reliability and validity of the findings. Search Methods A comprehensive search was conducted up to May 2023 across various online databases, including AgeLine via EBSCOhost, ASSIA via ProQuest, CINAHL via EBSCOhost, EMBASE, LILACS, ProQuest Dissertation & Theses Global, PsycINFO via EBSCOhost, PubMed, SciELO, Scopus, Sociological Abstract via ProQuest, Chinese National Knowledge Infrastructure (CNKI), Google Scholar and WHO Global Index Medicus. Additionally, relevant studies were identified by thoroughly searching the grey literature from resources such as Campbell Collaboration, OpenAIRE, and GRAFT. Selection Criteria All quantitative, qualitative (addressing face and content validity), and mixed-method empirical studies published in peer-reviewed journals or grey literature were included in this review. The included studies were primary studies that (1) evaluated one or more psychometric properties, (2) contained information on instrument development, or (3) examined the content validity of the instruments designed to measure AOP in community or institutional settings. The selected studies describe at least one psychometric property: reliability, validity, and responsiveness. Study participants represent the population of interest, including males and females aged 60 or older in community or institutional settings. Data Collection and Analysis Two reviewers evaluated the screening of the selected studies' titles, abstracts, and full texts based on the preset selection criteria. Two reviewers assessed the quality of each study using the COSMIN Risk of Bias checklist and the overall quality of evidence for each psychometric property of the instrument against the updated COSMIN criteria of good measurement properties. Disagreements were resolved through consensus discussion or with assistance from a third reviewer. The overall quality of the measurement instrument was graded using a modified GRADE approach. Data extraction was performed using data extraction forms adapted from the COSMIN Guideline for Systematic Reviews of Outcome Measurement Instruments. The extracted data included information on the characteristics of included instruments (name, adaptation, language used, translation and country of origin), characteristics of the tested population, instrument development, psychometric properties listed in the COSMIN criteria, including details on content validity, structural validity, internal consistency, cross-cultural validity/measurement invariance, reliability, measurement error, criterion validity, hypotheses testing for construct validity, responsiveness, and interoperability. All data were synthesised and summarised qualitatively, and no meta-analysis was performed. Main Results We found 15,200 potentially relevant records, of which 382 were screened in full text. A total of 114 studies that met the inclusion criteria were included. Four studies reported on more than one instrument. The primary reasons for excluding studies were their focus on instruments used solely for screening and diagnostic purposes, those conducted in hospital settings, or those without evaluating psychometric properties. Eighty-seven studies reported on 46 original instruments and 29 studies on 22 modified versions of an original instrument. The majority of the studies were conducted in community settings (97 studies) from the perspective of older adults (90 studies) and were conducted in high-income countries (69 studies). Ninety-five studies assessed multiple forms of abuse, ranging from 2 to 13 different subscales; four studies measured overall abuse and neglect among older adults, and 14 studies measured one specific type of abuse. Approximately one-quarter of the included studies reported on the psychometric properties of the most frequently used measurement instruments: HS-EAST (assessed in 11 studies), VASS-12 items (in 9 studies), and CASE (in 9 studies). The instruments with the most evidence available in studies reporting on instrument development and content validity in all domains (relevance, comprehensiveness and comprehensibility) were the DEAQ, OAPAM, *RAAL-31 items, *ICNH (Norwegian) and OAFEM. For other psychometric properties, instruments with the most evidence available in terms of the number of studies were the HS-EAST (11 studies across 5 of 9 psychometric properties), CASE (9 studies across 6 of 9 psychometric properties), VASS-12 items (9 studies across 5 of 9 psychometric properties) and GMS (5 studies across 4 of 9 psychometric properties). Based on the overall rating and quality of evidence, the psychometric properties of the AOP measurement instruments used for prevalence measurement in community and institutional settings were insufficient and of low quality. Authors' Conclusions This review aimed to assess the overall rating and quality of evidence for instruments measuring AOP in the community and institutional settings. Our findings revealed various measurement instruments, with ratings and evidence quality predominantly indicating insufficiency and low quality. In summary, the psychometric properties of AOP measurement instruments have not been comprehensively investigated, and existing instruments lack sufficient evidence to support their validity and reliability.
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Affiliation(s)
| | - Christopher Mikton
- Department of Social Determinants of Health, Division of Healthier PopulationsWorld Health OrganizationGenevaSwitzerland
| | - Wan Yuen Choo
- Department of Social & Preventive Medicine, Faculty of MedicineUniversiti MalayaKuala LumpurMalaysia
| | - Ranita Hisham Shunmugam
- Department of Library & Information Science, Faculty of Arts & Social SciencesUniversiti MalayaKuala LumpurMalaysia
| | - Aja Murray
- Department of PsychologyUniversity of EdinburghEdinburgUK
| | - Yongjie Yon
- World Health Organization Regional Office for EuropeCopenhagenDenmark
| | - Raudah M. Yunus
- Public Health MedicineUniversiti Teknologi MARASungai BulohMalaysia
| | - Noran N. Hairi
- Department of Social & Preventive Medicine, Faculty of MedicineUniversiti MalayaKuala LumpurMalaysia
| | - Farizah M. Hairi
- Department of Social & Preventive Medicine, Faculty of MedicineUniversiti MalayaKuala LumpurMalaysia
| | - Marie Beaulieu
- École de travail social, Faculté des lettres et sciences humainesUniversité de SherbrookeSherbrookeQuébecCanada
| | - Amanda Phelan
- School of Nursing, Midwifery & Health Systems, National Centre for the Protection of Older PeopleUniversity College Dublin, BelfieldDublinIreland
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Turner R, Glue P, Barak Y. Effects of changing criteria on improving interRAI assessment for elder abuse: analysis of a national dataset from Aotearoa New Zealand. BMJ Open 2024; 14:e081791. [PMID: 38960466 PMCID: PMC11227781 DOI: 10.1136/bmjopen-2023-081791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 06/11/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVES Globally, one in six older adults in the community will be a victim of abuse (elder abuse; EA). Despite these horrific statistics, EA remains largely undetected and under-reported. Available screening methods and tools fail to accurately identify the phenomenon's true prevalence. We aimed to test assessment capture rates by altering the criteria for suspicion of EA in the interRAI-HC (International Resident Assessment Instrument-Home Care) in a large national dataset. DESIGN We employed secondary analyses of existing data to test a methodology to improve the detection of older adults at risk of EA using the interRAI-HC, which currently underestimates the extent of abuse. SETTING The interRAI is a suite of clinical assessment instruments. In Aotearoa New Zealand, interRAI is mandatory in aged residential care and home and community services for older people living in the community. They are designed to show the assessor opportunities for improvement and any risks to the person's health. OUTCOME MEASURE Capture rates of individuals at risk of EA when the interRAI Abuse-Clinical Assessment Protocol (A-CAP) is changed to include the unable to determine abuse (UDA) group shown in a pilot study to increase capture rates of individuals at risk of EA. RESULTS Analysis of 9 years of interRAI-HC data (July 2013-June 2022) was undertaken, encompassing 186 713 individual assessments consisting of 108 992 women (58.4%) and 77 469 men (41.5%). The mean age was 82.1 years (range: 65-109); the majority 161 378 were European New Zealanders (86.4%) and the most common minority ethnicity was Māori (6.1%). Those at high risk of abuse (A-CAP) tended to be male (2402; 51.0%), were 79.2 years old on average (range 65-105), with 49.6% (2335) living alone, 39.4% (1858) suffering from depression and a majority were assessed as not having independent decision making (2942; 62.5%). In comparison, the UDA group showed similar characteristics to the A-CAP group on some measures. They were slightly younger than the general sample, with a mean age 80.1 years (range 65-107), they had higher rates of depression (2123; 33.5%) compared with the general sample (25 936; 14.8%) and a majority were assessed as not having independent decision-making (3855; 60.9%). The UDA group is distinct from the general sample and the UDA group broadly has similar but less extreme characteristics to the A-CAP group. Through altering the criteria for suspicion of EA, capture rates of at-risk individuals could be more than doubled from 2.5% to 5.9%. CONCLUSIONS We propose that via adapting the interRAI-HC criteria to include the UDA category, the identification of older adults at risk of EA could be substantially improved, facilitating enhanced protection of this vulnerable population.
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Affiliation(s)
- Robin Turner
- Biostatistics Centre, University of Otago, Dunedin, Otago, New Zealand
| | - Paul Glue
- Psychological Medicine, School of Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Yoram Barak
- Psychological Medicine, School of Medicine, University of Otago, Dunedin, Otago, New Zealand
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Santos-Rodrigues RCD, Brandão BMLDS, Araújo-Monteiro GKND, Marcolino EDC, Moraes RMD, Souto RQ. Assessment tools for elder abuse: scoping review. Rev Esc Enferm USP 2022; 56:e20220115. [PMID: 36490228 PMCID: PMC10081593 DOI: 10.1590/1980-220x-reeusp-2022-0115en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 10/17/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE to map assessment tools for elder abuse and determine the psychometric properties of each one. METHOD scoping review developed according to recommendations of the JBI Institute Reviewer's Manual in databases and gray literature. RESULTS seventeen tools were identified for measuring situations of elder abuse. They were categorized into 1) Tools for assessment of risk for abuse, and 2) Tools for identification of abuse. According to risk for abuse, Vulnerability to Abuse Screening Scale was the most prevalent in the literature, with factorial analysis acceptable through four domains, and good internal reliability (0,74). Therefore, Assessment Tool for Domestic Elder Abuse comprises the assessment of six types of elder abuse; however, the study shows psychometric limitation since the internal structure was not evaluated by validity evidences. CONCLUSION seventeen tools to determine the occurrence or risk for elder abuse were identified with different psychometric properties. We recommend the use of more than one of the tools identified for an appropriate measurement of elder abuse situations given the complexity of the phenomenon and the lack of a single instrument that contemplates all its consequences and forms of expression.
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Affiliation(s)
| | | | | | | | - Ronei Marcos de Moraes
- Universidade Federal da Paraíba, Centro de Ciências Exatas e da Natureza, Departamento de Estatística. João Pessoa, PB, Brazil
| | - Rafaella Queiroga Souto
- Universidade Federal da Paraíba, Centro de Ciências da Saúde, Programa de Pós-Graduação em Enfermagem, João Pessoa, PB, Brazil
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Jacobs R, Farina N, Schneider M. Cross-cultural adaptation of the EAST and CASE screening tools for elder abuse in South Africa. J Elder Abuse Negl 2022; 34:369-392. [PMID: 36734135 DOI: 10.1080/08946566.2023.2176393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Elder abuse is globally considered a hidden problem with great variations in its conceptualization across cultures, non-uniformity in understanding, and manifestations of abuse and neglect. Currently, there are no validated or culturally adapted screening measures for elder abuse in South Africa. The aim of this study was to test the cultural appropriateness of the Elder Abuse Screening Tool (EAST) and the Caregiver Abuse Screen (CASE) in two regions and four languages in South Africa. Using a cognitive interviewing methodology, 23 carers and 19 older adults were interviewed. Findings show that questions in the EAST and CASE are generally well understood, but that adaptations of both tools are necessary for use within South Africa. Fear, knowledge, and experience of crime also showed that strangers, like family, deliberately use deception to build trust and abuse. Further validation is needed to determine suitable scoring and use by health and social care practitioners.
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Affiliation(s)
- Roxanne Jacobs
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Nicolas Farina
- Community and Primary Care Research Group, University of Plymouth, Plymouth, UK
| | - Marguerite Schneider
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Khan A, Adil A, Ameer S, Shujja S. Caregiver abuse screen for older adults: Urdu translation, validation, factorial equivalence, and measurement invariance. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-020-00894-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Melchiorre MG, Di Rosa M, Macassa G, Eslami B, Torres-Gonzales F, Stankunas M, Lindert J, Ioannidi-Kapolou E, Barros H, Lamura G, J. F. Soares J. The prevalence, severity and chronicity of abuse towards older men: Insights from a multinational European survey. PLoS One 2021; 16:e0250039. [PMID: 33852624 PMCID: PMC8046244 DOI: 10.1371/journal.pone.0250039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/29/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Elder abuse is a growing public health question among policy makers and practitioners in many countries. Research findings usually indicate women as victims, whereas male elder abuse still remains under-detected and under-reported. We aimed to investigate the prevalence, severity and chronicity of abuse (psychological, physical, physical injury, sexual, and financial) against older men, and to scrutinize factors (e.g. demographics) associated with high chronicity of any abuse. METHODS Randomly selected older men (n = 1908) aged 60-84 years from seven European cities (Ancona, Athens, Granada, Kaunas, Stuttgart, Porto, Stockholm) were interviewed in 2009 via a cross-sectional study concerning abuse exposure during the past 12 months. RESULTS Findings suggested that prevalence of abuse towards older men varied between 0.3% (sexual) and 20.3% (psychological), with severe acts between 0.2% (sexual) and 8.2% (psychological). On the whole, higher chronicity values were for injury, followed by psychological, financial, physical, and sexual abuse. Being from Sweden, experiencing anxiety and having a spouse/cohabitant/woman as perpetrator were associated with a greater "risk" for high chronicity of any abuse. For men, severity and chronicity of abuse were in some cases relatively high. CONCLUSIONS Abuse towards older men, in the light of severe and repeated acts occurring, should be a source of concern for family, caring staff, social work practice and policy makers, in order to develop together adequate prevention and treatment strategies.
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Affiliation(s)
- Maria Gabriella Melchiorre
- Centre for Socio-Economic Research on Ageing, National Institute of Health and Science on Aging, IRCCS INRCA, Ancona, Italy
| | - Mirko Di Rosa
- Laboratory of Geriatric Pharmacoepidemiology, National Institute of Health and Science on Aging, IRCCS INRCA, Ancona, Italy
| | - Gloria Macassa
- Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
- Division of Public Health Sciences, Department of Health Sciences, Mid Sweden University, Mittuniversitetet, Sundsvall, Sweden
| | - Bahareh Eslami
- Division of Public Health Sciences, Department of Health Sciences, Mid Sweden University, Mittuniversitetet, Sundsvall, Sweden
| | | | - Mindaugas Stankunas
- Department of Health Management, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Health Service Management Department, School of Medicine, University of Griffith, Gold Coast, Queensland, Australia
| | - Jutta Lindert
- Department of Public Health, University of Emden, Emden, Germany
- Women’s Studies Research Center, Brandeis University, Waltham, MA, United States of America
| | | | - Henrique Barros
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Giovanni Lamura
- Centre for Socio-Economic Research on Ageing, National Institute of Health and Science on Aging, IRCCS INRCA, Ancona, Italy
| | - Joaquim J. F. Soares
- Division of Public Health Sciences, Department of Health Sciences, Mid Sweden University, Mittuniversitetet, Sundsvall, Sweden
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Zahed S, Emami M, Bazargan-Hejazi S, Eslami AA, Barekatain M, Zamani-Alavijeh F. What motivates informal caregivers of people with dementia (PWD): a qualitative study. BMC Palliat Care 2019; 18:105. [PMID: 31779612 PMCID: PMC6883577 DOI: 10.1186/s12904-019-0491-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 11/18/2019] [Indexed: 11/26/2022] Open
Abstract
Background The burden of caring for People with Dementia (PWD) is heavy; identifying incentives that motivate them in providing care is essential in facilitating and optimizing care. This study aims to explore and describe these motivating factors. Methods We conducted this qualitative study between January 2016 and January 2017 in Isfahan, Iran. Data were extracted through in-depth, semi-structured interviews with 19 caregivers of PWD. These data were then examined through thematic content analysis. Results We identified four categories of psychological motives based on the caregivers’ feedback and experience. These include 1) Moral-based motives, 2) Religious, and spiritual motives; 3) Financial motives, and 4) Wicked motives. Conclusions Our results revealed several aspects of caregivers’ motives. They include moral, religious, and spiritual aspects; sharing housing accommodations, and the likelihood of inheriting a portion of the patient’s assets based on unspoken rules and informal arrangements in the family, and wicked and immoral aspects. These findings can inform future efforts in enhancing the experiences of caregivers of PWD, and subsequently, the quality of care these patients receive. It further suggests that family members, members of a religious and spiritual organization, as well as social media, could play important roles in setting the stage.
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Affiliation(s)
- Shakiba Zahed
- Candidate in Health Education and Health Promotion, Student Research Committee, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Emami
- Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahrzad Bazargan-Hejazi
- Department of Psychiatry, College of Medicine, Charles Drew University of Medicine and Science, and David Geffen School of Medicine, the University of California at Los Angeles (UCLA), Los Angeles, USA
| | - Ahmad Ali Eslami
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Barekatain
- Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Zamani-Alavijeh
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
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Sakar H, Mahtab AK, Farshad S, Fahimeh T, Mirzadeh FS, Hossien F. Validation Study: The Iranian Version of Caregiver Abuse Screen (CASE) among Family Caregivers of Elderly with Dementia. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2019; 62:649-662. [PMID: 31314705 DOI: 10.1080/01634372.2019.1640824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 07/03/2019] [Accepted: 07/03/2019] [Indexed: 06/10/2023]
Abstract
Since abuse screening is difficult among the elderly with dementia, detection of elder abuse is a serious issue; meanwhile, the number of available tools to assess elder abuse by caregivers is limited. The aim was to evaluate validity and reliability of the Iranian version Caregiver Abuse Screen (CASE) tool. After the translating process of the tool to the Farsi language for 236 dementia participants ≥60 years old and their informal caregivers' from outpatient' clinics, in a cross-sectional method then the validity, reliability and factorial structure of the CASE was evaluated. The translated Iranian version CASE reveals a good psychometric property (α = 0.868) with strong internal consistency and reliability. Some variables (depression, burden, dementia intensity, and ADLs) were associated with abuse in dementia elderly. The two-factor structure was obtained in exploratory factor analysis labeled interpersonal abuse and neglect. Generally, the Iranian version of CASE approved with sufficient validity and reliability as a suitable instrument to find the risk of elder abuse among dementia caregivers.
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Affiliation(s)
- Hormozi Sakar
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences , Tehran , Iran
| | - Alizadeh-Khoei Mahtab
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences , Tehran , Iran
- Gerontology & Geriatric Department, Medical School, Tehran University of Medical Sciences , Tehran , Iran
| | - Sharifi Farshad
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences , Tehran , Iran
| | - Taati Fahimeh
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences , Tehran , Iran
| | - Fatemeh Sadat Mirzadeh
- Gerontology & Geriatric Department, Medical School, Tehran University of Medical Sciences , Tehran , Iran
| | - Fakhrzadeh Hossien
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences , Tehran , Iran
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