Presenting Approaches to Stress Management in the Elderly in Qazvin

Background: Based on the opinions of the World Health Organization (WHO), the elderly period begins at the age of 60 in third world countries. During this period the amount of social activities are reduced and as a result of which, the person is far more exposed to solitude and physical problems (i.e. high blood pressure, diabetes, etc.) and mental illnesses (i.e. depression etc.). Therefore, considering the continuous growth in the population of the elderly in Iran, management of stress is crucial in order to lengthen their quality life-time, and reduce direct and indirect compensations to the government and also to families. Methods: This survey was conducted in a descriptive- analytical method in Qazvin in 2019, and the questionnaires were filled by eligible participants after reforming the questionnaire twice based on 0.71 (Cronbach’s alpha) confirmation. In order to prove the validity and reliability of the data, mentioning any personal information were strictly avoided, and later 30 participants were taken part in the research. Results: Considering the fact that in order to manage the stress, the participants’ mental conditions need to be mainly addressed, which are indeed source of numerous diseases, conducting daily activities, trusting families and societies is very effective in their self-acceptance. Addressing personal requirements including: 1. Individual quality life-time. 2. Medical facilities and services, 3. Public transportation services, and self-care, are potentially the most important issues to the elderly. Conclusion: Based on the conducted survey, many activities have been done to help the elderly manage their stress. However, considering the increasing population of the elderly, there are many more activities yet to be done operationally and tangibly. Although holding training sessions might be promising and motivating, but as a result of countless social difficulties, caused by lack of facilities, and lack of positive or supportive view by the community, the role of such phenomenon will most probably be passive and fleeting. Doing physical exercise can be an effective and cheerful element, and also preventive to the occurrence of many physical and mental illnesses. It should also be noted that many of the current problems are actually caused by urban factors (e.g. sidewalks, sport centers, etc.) which need to be immediately addressed by the government.


Introduction
The decreasing trend in the birth rate will lead to increasing the population age group and as a result turns the society into old population. Based on the findings of the world health organization, agedness begins at the age of 60 in third world countries will have to cope with physiological alternations including muscular disorders,

Presenting Approaches to Stress Management in the Elderly in Qazvin
Tayyebeh Jaddi Madarsara 1 , Saeed Yari 2 , Navid Ahmadian Kudakan 3 , Hamzeh Saeidabadi 4 increasing physical, mental, and social illnesses among which the physical and mental illnesses are the most challenging situations for them [1][2][3][4]. Based on the public census conducted in 2011, the number of elderlies in Iran was 6,459,676 which equates 8.23% of the total population. It is anticipated that this number will have increased to 10,000,000 (over 25%) [5], and by the end of 2050 it will have reached the remarkable number of apjec.waocp.com Tayyebeh Jaddi Madarsara, et al: Presenting Approaches to Stress Management in the Elderly in Qazvin 25,000,000 which is way more than the trend in other countries [6]. By beginning the old ages, the persons physical and social activities will gradually decrease. This will lead to some issues such as depression, anxiety, despair, losing self-esteem, or even death [7][8].based on the existing researches and statistics, there will be a certain increase in the population of Iran followed by concerns regarding health and self-care [3][4][5][6][7][8][9]. What attracts the attention of the modern science today, is not only lengthening the life-time, but also adding quality life-time for the elderly, including welfare and wellbeing as well as pleasant physical and mental conditions. If we fail to do so, all efforts regarding lengthening human beings' lifetime will confront devastating consequences [10]. Based on recent studies, the most important factor effecting the health state of the elderly, is stress and anxiety [11][12][13][14][15][16][17][18][19]. on the other hand stress is one of the most important risk factor that due to cancer [20][21][22][23][24][25][26][27][28]. In order to mitigate his issue, the causes of stress need to be identified, and counter measures need to be determined to improve their level of life expectancy and health. Taking the mentioned issues into account, neglecting the state of the elderly, can result in heavy direct and indirect compensations for the societies and families. Therefore, through implementing an adequate management system, these costs could be saved and later spent on the quality of their life styles.

Materials and Methods
In order to conduct this descriptive-analytical survey, a questionnaire was firstly deigned with the title of "effective methods to manage stress in the elderly and the disabled people". This questionnaire was later filled by eligible participant, and after correction its reliability and observability were increased to 71%. In order to realize the honesty of the answers given to the questionnaire, mentioning names and personal intel of the participant were avoided, so they may take part in the research with no worries. This questionnaire was later distributed among 30 old and disabled people. 9 items were mentioned in the questionnaire as follows: 1. Life quality 2. Energy and happiness 3. The viewpoint of the society to old people 4. The elderly's true feelings at the time of their presence in the society.
5. Convenience equipment in parks 6. Facilities including public transportation 7. Sport equipment and facilities 8. The condition of side walks 9. Medical services Below the form, and additional section was allocated to mention their opinions and suggestions if needed.
Participants were asked verbally about their self-care activities including: constantly eating healthy breakfast, adding fruits and vegetable to their regular diet, controlling their weight, abstaining fatty or sweet foods, avoiding salt and salty foods, drinking minimum 8 glasses of water, using diaries regularly.

Results
According to the analysis of the data: 1. Individual life-time quality 2. Medical services and facilities, and 3. Public transportation services were mentioned in the most frequently suggestions. In order to overcome these issues, we can ask for more support on behalf of their families, society, and also social service organizations, since the root cause of all their issues which will eventually lead into anxiety and distress, are mental discomfort. The important point is that we can train self-care in order to manage or even reduce their mental distress. Based on observed cases, not only hasn't self-care been taken into consideration, but also it can be mentioned as the missing element in managing stress, which is indeed one of the most critical aspects of stress management, and also requires further investigations and control measures. There have been numerous valid actions conducted in case of public transportation. However, it should also be noted that more convenient buses, specifically designed for the elderly can be allocated to the public transportation system to improve their wellbeing.

Discussion
Considering the conducted assessment, activities planned for the wellbeing of the elderly have to be more practical and tangible within a community. Although training plans can be promising, inspiring, and motivating, but considering current social difficulties, especially for this stratum, the role of training program will be passive and temporary, since there is deficit in the level of the allocated facilities. On the other hand, keeping the useful effect of sports on health and the commercial aspect, including: • preventing depression and living a happy and joyous life • Increasing the life expectancy in the elderly • Trying to communicate with people in the same age group in sport centers • Improving social skills and self-confidence • Informing people of sport activities done by old people • allocating a certain location for sports • Asking for their advice and experience in different cases These factors are expected to promote their motivation, morale, and presence in the community and lead into creating a better social relation among all citizens. The most important point in this regard is the supportive role of the government. Many of their civil problems must be taken into account and executed by municipalities. Based on the anticipations made of the population growth in Iran, the rules regarding their health and wellbeing must be executed more rapidly. Their needs must be identified by the house of representatives and executed by the government.
Keeping the mentioned points in mind, the below suggestions are presented: 1. Seeking advice from the elderly in order to promote the quality of life in due organizations (municipality, etc.) 2. Initiating urban system for receiving old people's advice in terms of: 2.1 reforming and regularizing sidewalks. 2.2 allocating buses specifically designed for the use of the elderly.
2.3 allocating taxies in interstate transportation specifically designed for the use of the elderly.
2.4 rebuilding park entrances, and preferably creating theme parks.
2.5 reforming bank entrances, shopping centers, and pharmacies.
3. Train Iranian and Islamic culture to all citizens, in order to honor the elderly.
4. Supportive role of the family to create a peaceful and stress-free environment.
5. Setting strict rules for enrolling them in elders' house, so that families might reconsider abandoning this attention-seeking stratum.
6. Paying special attention to sports and holding competitions, to promote their courage.
7. Initiating an official TV program to reflect the activities conducted in this field, and expressing suggestions and future plans.
8. Allocating medical and pharmaceutical services in order to facilitate their treatment.
9. Creating housing with the specific requirements for the elderly 10. Controlling their unhealthy eating habits.