988368

Introduction
The global population is rapidly aging [1]. Between 2000 and 2050, the global population of older adults is projected to double, increasing from 11% to 22% [2]. The Asian population is aging faster than other regions [3]. The Asian Development Bank reported that by 2030, the Asian continent will have the world’s largest older population, exceeding 4.9 billion people [4]. Iran has experienced this trend [5]. According to the 2016 census results in Iran, individuals aged >60 years account for over 9%, encompassing approximately 7 million people [6]. They are projected to reach 11% and 17% of the total population by 2036 and 2051, respectively [7]. Aging often changes family structure, living arrangements, work patterns, retirement, health, and identity [8]. Some older individuals adjust well to changes and have a successful aging experience. However, some struggle to cope with these transitions, leading to various physical, mental, and social health issues [9].
A new and positive perspective on aging is known in several terms, including healthy, productive, active, and successful aging [10]. Encouraging active aging enhances older adults’ quality of life by promoting health, engagement, and safety [11]. The term “active” covers ongoing physical activity, workforce involvement and sustained engagement in society, politics, culture, spirituality, and civic affairs [12]. The participation of elderly in volunteer activities keeps them active and contributes to their social, physical, and psychological well-being [13]. Additionally, active aging significantly influences older adults’ quality of life [14].
According to the World Health Organization (WHO), social support, social capital and contextual variables affect active aging [15] (Figure 1). Social support and social capital are crucial factors associated with active aging [16]. Social support includes emotional support, informational support, companionship, and perceived support [17]. Emotional support, which includes love, trust, intimacy, and encouragement from social networks, gives older adults a sense of value as members of society [18]. Informational support involves providing older adults with helpful information, guidance, and suggestions [19]. Companionship support motivates older adults to participate in groups and social activities [20]. Perceived support refers to financial assistance and access to social amenities and services. Social support is associated with reduced psychological problems among older adults [21]. Social support increases positive thoughts and self-confidence in older adults, contributing to active engagement. Older individuals receiving care from family or friends tend to engage in higher physical activity levels [18].
Disability is another factor that can significantly impact active aging. Disability refers to an older person’s need for assistance from others in carrying out daily activities [22]. Disability results in higher dependence on nursing homes [2, 18], increased caregiving expenses, and financial stress on the healthcare system and families [19]. The number of older individuals experiencing disability is increasing, potentially because more individuals survive multiple diseases, leading to sedentary lifestyles and lack of social support [23]. Prompt identification and management of disabilities can help reverse this trend and enhance the well-being of older individuals [24, 25]. 
Conflicting findings have been reported regarding the influence of demographic characteristics on active aging in older adults. For example, Shavaki and Salehi [26] indicated that older men are more active than older women, whereas Ayoubi-Mahani et al. [27] found the opposite. Moreover, Movahed and Majidi [28] reported a significant relationship between educational level and active aging, whereas Tajvar et al. [29] did not observe such a relationship.
Considering the increasing number of older adults, focusing on physical and social activities is critical. Various factors influence the level of active ageing. By identifying these factors, we can make suitable decisions and implement targeted interventions to elevate the activity levels of older adults, ultimately enhancing their overall quality of life. However, due to limited research and conflicting results on the factors affecting older adults’ activity, this study aimed to determine active aging status and identify predictive factors among the elderly in Qazvin City, Iran.

Materials and Methods
This descriptive study, conducted in 2023, included 289 participants aged >60 years living in Qazvin City. Older individuals were selected using cluster sampling. Therefore, Qazvin City was divided into three municipal zones and several parks were randomly chosen from each zone based on population density. Eligible older adults were selected from each park.
The inclusion criteria included individuals aged 60 years or over willing to participate in the study and capable of answering questions. The exclusion criteria included older adults diagnosed with a mental illness (according to their self-report).
The sample size was calculated using α=0.05, β=0.05, and the correlation coefficient (r) of -0.7 between active aging and intergenerational social support [9]. This calculation resulted in a sample size of 240 individuals. Considering a 20% probability of non-response, 289 individuals were included in the study (Equation 1).



Instruments
Data were collected using a demographic information checklist, an Iranian active aging questionnaire, a multidimensional scale of perceived social support (MSPSS), and the WHO disability assessment schedule (WHODAS 2.0). 
A 10-point Likert item assessed the perceived health status: “How do you evaluate your health status?” It was rated from poor to excellent.

Iranian active aging questionnaire
Mohammadi et al. developed an Iranian active aging questionnaire to assess active aging. This questionnaire comprises 40 items evaluated on a 5-point Likert scale (0=none, 1=little, 2=some extent, 3=greatly, 4=very highly). It covers six subscales: Social institutional participation (four items), active mind maintenance (six items), social contact (seven items), agent attitude (seven items), productive engagement (eight items), and physical functional activity (eight items). The scores range from 0 to 160, with higher scores indicating more active aging. Mohammadi et al. evaluated and confirmed its content validity, internal consistency, and test-retest reliability by Cronbach’s α of 0.876, Pearson’s correlation coefficient of 0.951, and the inter-cluster correlation coefficient of 0.996 [30].

MSPSS
The MSPSS was created to assess perceived social support. Each dimension of social support included four items, resulting in 12 items. The items were rated on a 7-point Likert scale, ranging from one (completely disagree) to seven (completely agree). Scores ranged from 12 to 84. Higher scores indicate more excellent social support [31]. The validity and reliability of the Persian version have been confirmed by Bagherian-Sararoudi et al. [32]. Ezati et al. [33] found that the questionnaire had a Cronbach’s α of 0.82 when used with older adults.

WHODAS 2.0
The WHODAS 2.0 assesses disabilities in older adults. The questionnaire contains 12 items evaluated on a 5-point Likert scale, ranging from “without difficulty” to “extreme difficulty.” Scores ranged from 12 to 60. The questionnaire assessed disability in six domains: Communication, mobility, self-care, interpersonal relationships, life activities, occupational activities, and participation in social and family activities. Higher scores indicated higher levels of disability [34, 35]. The questionnaire was validated by older Iranians [36].

Data analysis
The data were analyzed using R software, version 4.2.3 Descriptive statistics, such as Mean±SD, were used to summarize quantitative variables. Frequency and percentage distributions were utilized for qualitative/nominal variables. A multiple regression model was used to detect the predictors of active aging. A stepwise algorithm, guided by the Akaike information criterion, was utilized to choose the most suitable predictive model. A P<0.05 was considered to be statistically significant.

Results
Table 1 presents the characteristics of older individuals.


The mean age was 66.78±6.22, ranging from 60 to 93. 
According to Table 2, the older participants showed a mean score of 109.18±24.15 for active aging.


Physical functional activity had the highest active aging, with a weighted mean of 3.08, followed by social contact, with a weighted mean of 2.94. The lowest level of active aging was found for social institutional participation, with a weighted mean of 1.84.
The mean disability and social support for older participants were 21.77±9.03 and 59.08±16.95, respectively. Friends reported the highest level of social support (21.35±6.15), followed by family (20.73±6.26), while others observed the lowest level (16.97±7.11).
The multivariate regression model results indicated that sex, marital status, employment, educational level, disability, economic situation, perceived health, and perceived social support were the most significant predictors of active aging. Older adults were more active if they were women (B=7.92, P=0.007), widowed (B=16.40, P=0.001), employed (B=8.30, P=0.020), or retired (B=8.04, P=0.016), had secondary (B=9.08, P=0.017) or academic (B=14.81, P=0.002) educational level, average (B=8.67, P=0.027), and good (B=14.18, P=0.001) or excellent (B=11.84, P=0.037) economic situations. Older adults with better-perceived health (B=2.14, P<0.001), higher social support (B=0.38, P<0.001) and lower disability (B=-0.72, P<0.001) had significantly higher levels of active aging (Table 3). 



Discussion
This study was conducted to identify predictive factors for active aging in older individuals living in Qazvin City. The results showed that active aging among older adults was moderate. Additionally, the results revealed statistically significant relationships between sex, marital status, educational level, economic situation, employment, perceived health, disability, perceived social support and active aging.
We found that older adults had moderately active aging. However, previous studies have reported different results. For example, Movahed and Majidi [28] found moderate active aging among older adults in Shiraz City. Tajvar et al. [29] reported that active aging among older adults in Tehran City, Iran, was below average. Additionally, Seyedjavadi and Pakfar [37] estimated the activity levels of older patients to be unsatisfactory. Asadi Shavaki and Salehi [26] also reported low physical activity among approximately half of the older participants. Most studies’ low to moderate levels of active aging can be attributed to barriers, such as age-related disabilities, fear of falling, decreased energy levels, musculoskeletal pain, costs, and limited access to social activities [38].
Our results indicated that older women exhibit significantly more active aging than older men. This outcome can also be explained by the fact that, at older ages, men may reduce their physical and social activities due to retirement. At the same time, women continue to be involved in household responsibilities and caring for family members. Additionally, this result suggests that the women in this sample prioritize their health by remaining active. Previous studies have presented conflicting findings on sex differences in activity levels [26, 27, 39], potentially due to cultural variations among older populations. 
We found that older adults with secondary and academic education demonstrated a significantly higher level of active aging than illiterate adults. Ayoubi-Mahani et al. [27] concluded that lack of knowledge is a barrier to active aging. Likewise, Lin et al. [40] identified high literacy levels as an influential factor in active aging among elderly people in Taiwan. Furthermore, Khazaeepool and Naghibi [41] stated that older adults with higher educational levels were more engaged in social participation. Higher education is associated with better socioeconomic status and enhanced communication skills, which can result in increased social involvement. Education can also lead to a healthier lifestyle, improved job prospects, and higher socioeconomic standing, all of which increase social engagement. Additionally, higher levels of education are associated with improved health literacy, which may explain why individuals with higher education are more physically and socially active [42].
In this study, older individuals with poor economic status tended to have lower levels of active aging, consistent with previous studies [27-29]. For instance, Movahed and Majidi [28] identified that a high-income level predicts active aging among older adults in Shiraz City. Ayoubi-Mahani et al. [27] also concluded that low income is a barrier to active ageing. Older people with better financial status access social and health services better and have more opportunities for social interaction [43]. High inflation, financial constraints, and increased expenses in old age can marginalize older individuals [27]. Income and additional earnings are vital aspects of security during active ageing. They contribute to financial well-being and participate fully in society [44, 45].
Our results indicated that employed and retired older individuals were significantly more active than housewives. Consistent with this result, Asadi Shavaki and Salehi [26] found that vigorous physical activity was significantly higher in employed older adults (workers and self-employed) than housewives. In addition, KhazaeePool and Naghibi [41] reported that employed older individuals had higher social participation. Occupation and income are factors that support increased social interaction among older adults. Employed older adults have more opportunities for social interactions due to their exposure to the outside environment and regular interactions with friends and colleagues at work. Retired older adults may also have higher levels of social activity owing to reduced job-related stress and more time for social interactions.
According to our results, divorced older adults were significantly more active than married adults. This is inconsistent with previous studies showing that married older adults tend to be more active than their unmarried counterparts. For example, Tajvar et al. [29] found that unmarried women scored lower on measures of active aging than married women. The discrepancy observed in this study could be attributed to the significant percentage of divorced older individuals employed, resulting in elevated scores for active aging.
Our results showed that older individuals with a better understanding of their health tended to score higher on measures of active aging. Smith et al. [17] found that self-assessed health strongly correlated with physical activity. Health status plays a significant role in enabling or hindering participation in social activities [46]. As demonstrated by Vaartio-Rajalin et al., older adults participating in activities outside their homes reported better-perceived health than those engaging in activities at home or not participating [47].
Our results revealed that elderly individuals with higher disability levels scored lower in active aging. Ayoubi-Mahani et al. [27] also showed that disability is a significant barrier to active ageing. In older adults, disability can result in limitations or loss of ability to engage in work-related activities, fulfill social roles, and maintain independent living [48]. Aging-related physical problems can significantly impede previous social activities, leading individuals to rely more on others and have limited participation in various social situations [49]. Furthermore, physical disability among the elderly is commonly correlated with feelings of loneliness and isolation, increased dependence on others, and reduced social interactions [50].
Our results showed that social support predicted higher active aging in the elderly, consistent with other studies. For example, Movahed and Majidi [28] found that social support was one of the most significant predictors of active aging in Shiraz City. Jokar et al. [51] also observed a positive and significant correlation between social support and the ability to carry out daily activities in rural areas. Social support is an effective indicator of the consequences of ageing [52]. Having a strong social support system is directly connected to active coping with reduced functioning and disability. Support networks are crucial in older adults’ overall health and daily activity performance [36]. Social participation is a key element in active aging [53]. Social support is vital for sustaining and enhancing physical and cognitive health by encouraging participation various activities [51]. Older individuals can rediscover purpose through social and emotional support and engaging in educational and social activities with loved ones [54].

Conclusion
Our research suggests that older adults engage in moderate physical activity. Interventions aimed at promoting active and healthy aging should focus on older men, people with disabilities, lower-income seniors and people dealing with health issues. Additionally, our study found that social support influences active ageing. Establishing support from family, companions and healthcare providers can help older adults gain confidence in starting and maintaining physical and social activities.

Limitations
This study was conducted on older adults in Qazvin City, which limits its generalizability to older adults in other Iranian cities or institutionalized older adults. Another limitation is the self-report nature of the questionnaires; some participants refrained from providing accurate responses. We encouraged them to provide honest and truthful answers by explaining the study’s objectives. Additionally, numerous factors could affect the level of active aging; however, it was infeasible to consider all these factors due to time constraints. Future studies should focus on these factors.

Ethical Considerations
Compliance with ethical guidelines
The Ethics Committee of Qazvin University of Medical Sciences approved this study, Qazvin, Iran (Code: IR.QUMS.REC.1401.231). Older participants received thorough information about the study’s goals and were assured that their data would remain confidential. Consent forms were collected from the participants to ensure full compliance with the study requirements

Funding
The project was supported by the research Council of Qazvin University of Medical Sciences, Qazvin, Iran. 

Authors' contributions
Data collection: Zahra Shirshekan; Statistical analysis: Ahad Alizadeh; Methodology and writing  the original draft: Zahra Shirshekan, Seyedeh Ameneh Motalebi and Fatemeh Mohammadi; Review and editing: Zahra Shirshekan, Seyedeh Ameneh Motalebi, Fatemeh Mohammadi and Mohammad Amerzadeh; Final approval: All authors.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors thank the Vice-Chancellor for Research at Qazvin University of Medical Sciences and extend our most profound appreciation to all older people who participated in this research. Consent and cooperation were essential for the study’s success.


References

1. Tchkonia T, Palmer AK, Kirkland JL. New horizons: Novel approaches to enhance healthspan through targeting cellular senescence and related aging mechanisms. The Journal of Clinical Endocrinology & Metabolism. 2021; 106(3):e1481-7. [DOI:10.1210/clinem/dgaa728] [PMID]
2. Sadri Damirchi E, Ghomi M, Esmaeli Ghazi Valoii F. [Effectiveness of life review group therapy on psychological well-being and the life expectancy of elderly women (Persian)]. Salmand: Iranian Journal of Ageing. 2017; 12(3):312-25. [DOI:10.21859/sija.12.3.312]
3. United Nations Economic and Social Commission for Asia and the Pacific. Addressing the challenges of population ageing in Asia and the pacific: Implementation of the Madrid international plan of action on ageing. New York: United Nations; 2017. [Link]
4. Asian Development Bank [Internet]. 2022. Available from: [Link]
5. Hekmati pour N, Taheri N, Hojjati H, Rabiee S. [Evaluation of the relationship between social support and quality of life in elderly patients with Diabetes (Persian)]. Journal of Diabetes Nursing. 2015; 3(1):42-50. [Link]
6. Taraghi Z, Ilali ES. [A comparison of older adults’ and managers’ attitudes towards age-Friendly City indexes (Persian)]. Salmand: Iranian Journal of Ageing. 2018; 13(2):236-49. [DOI:10.32598/sija.13.2.236]
7. Mosadeghrad AM. [The futurology of aging population in Iran (Persian)]. Tehran University of Medical Journal. 2021; 79(3):248-9. [Link]
8. Forster P, Morris M. Successful transition to retirement in Australia. Social Sciences Directory. 2012; 1(1):4-12. [Link]
9. Razeghi Nasrabad HB, Alimondegari M, Rezvanian Z. [Demographic-social and economic determinants of active aging among retirees of some government offices in Babol (Persian)]. Strategic Research on Social Problems. 2020; 9(4):51-76. [DOI:10.22108/srspi.2020.124440.1601]
10. Wongsala M, Anbäcken EM, Rosendahl S. Active ageing-perspectives on health, participation, and security among older adults in northeastern Thailand-a qualitative study. BMC Geriatrics. 2021; 21(1):41. [DOI:10.1186/s12877-020-01981-2] [PMID]
11. Ayoubi-Mahani S, Eghbali-Babadi M, Farajzadegan Z, Keshvari M, Farokhzadian J. Active aging needs from the perspectives of older adults and geriatric experts: A qualitative study. Frontiers in Public Health. 2023; 11:1121761. [DOI:10.3389/fpubh.2023.1121761] [PMID]

12. Barbaccia V, Bravi L, Murmura F, Savelli E, Viganò E. Mature and older adults’ perception of active ageing and the need for supporting services: Insights from a qualitative study. International Journal of Environmental Research and Public Health. 2022; 19(13):7660. [DOI:10.3390/ijerph19137660] [PMID]
13. Principi A, Jensen PH, Lamura G. Active ageing: Voluntary work by older people in Europe. Bristol: Policy Press; 2014. [DOI:10.1332/policypress/9781447307204.001.0001]
14. Davodi SR, Zendehtalab H, Zare M, Behnam Vashani H. Effect of health promotion interventions in active aging in the elderly: a randomized controlled trial. International Journal of Community Based Nursing and Midwifery. 2023; 11(1):34-43. [doi:10.30476/IJCBNM.2022.96246.2117] [PMID] [PMCID]
15. Won CW, Ha E, Jeong E, Kim M, Park J, Baek JE, et al. World health organization integrated care for older people (ICOPE) and the integrated care of older patients with frailty in primary care (ICOOP_frail) study in korea. Annals of Geriatric Medicine and Research. 2021; 25(1):10-6. [DOI:10.4235/agmr.21.0025] [PMID]
16. Boerio, P., Garavaglia, E., Gaia, A. Active ageing in Europe: Are changes in social capital associated with engagement, initiation and maintenance of activity in later life? Ageing and Society. 2023; 43(5): 1122-40. [DOI: 10.1017/S0144686X21001021]
17. Smith GSE, Moyle W, Burton NW. The relationship between social support for physical activity and physical activity across nine years in adults aged 60-65 years at baseline. International Journal of Environmental Research and Public Health. 2023; 20(5):4531. [DOI:10.3390/ijerph20054531] [PMID]
18. Possmark S, Berglind D, Sellberg F, Ghaderi A, Persson M. To be or not to be active-a matter of attitudes and social support? Women’s perceptions of physical activity five years after Roux-en-Y Gastric Bypass surgery. International Journal of Qualitative Studies on Health and Well-being. 2019; 14(1):1612704. [DOI:10.1080/17482631.2019.1612704] [PMID]
19. Böhm AW, Mielke GI, da Cruz MF, Ramirez VV, Wehrmesister FC. Social support and leisure-time physical activity among the elderly: A population-based study. Journal of Physical Activity and Health. 2016; 13(6):599-605. [DOI:10.1123/jpah.2015-0277] [PMID]
20. Stoeckel KJ, Litwin H. The impact of social networks on the relationship between functional impairment and depressive symptoms in older adults. International Psychogeriatrics. 2016; 28(1):39-47. [DOI:10.1017/S1041610215000538] [PMID]
21. Loprinzi PD, Joyner C. Source and size of emotional and financial-related social support network on physical activity behavior among older adults. Journal of Physical Activity and Health. 2016; 13(7):776-9. [DOI:10.1123/jpah.2015-0629] [PMID]
22. Mouchaers I, Verbeek H, Kempen GIJM, van Haastregt JCM, Vlaeyen E, Goderis G, et al. The concept of disability and its causal mechanisms in older people over time from a theoretical perspective: A literature review. European Journal of Ageing. 2022; 19(3):397-411. [DOI:10.1007/s10433-021-00668-w] [PMID]

23. Yu R, Wong M, Chong KC, Chang B, Lum CM, Auyeung TW, et al. Trajectories of frailty among Chinese older people in Hong Kong between 2001 and 2012: an age-period-cohort analysis. Age and Ageing. 2018; 47(2):254-61. [DOI:10.1093/ageing/afx170] [PMID]
24. Woo J. Designing fit for purpose health and social services for ageing populations. International journal of Environmental Research and Public Health. 2017; 14(5):457. [DOI:10.3390/ijerph14050457] [PMID]
25. Dent E, Lien C, Lim WS, Wong WC, Wong CH, Ng TP, et al. The Asia-Pacific clinical practice guidelines for the management of frailty. Journal of the American Medical Directors Association. 2017; 18(7):564-75. [DOI:10.1016/j.jamda.2017.04.018] [PMID]
26. Asadi Shavaki M, Salehi L. [The study of physical activity among elderly of Karaj city and its relationship with some the demographic factors (Persian)]. Alborz University Medical Journal. 2016; 5(4):259-66. [DOI:10.18869/acadpub.aums.5.4.259]
27. Ayoubi-Mahani S, Eghbali-Babadi M, Farajzadegan Z, Keshvari M. [Facilitators and Barriers to Active Aging in Iran: A Gualitative Study (Persian)]. Salmand: Iranian Journal of Ageing. 2023; 18(3):438-59. [DOI:10.32598/sija.2023.3604.1]
28. Movahed M, Majidi M. [Active Aging Index and related factors among aged people in Shiraz in 1397 (Persian)]. Journal of Fasa University of Medical Sciences. 2020; 9(4):1819-28. [Link]
29. Tajvar M, Yaseri M, Mahmoudi R, Karami B. [Active aging index and its individual determinants in Tehran, Iran (Persian)]. Journal of School of Public Health & Institute of Public Health Research. 2020; 18(2):139-57. [Link]
30. Mohammadi E, Allahyari T, Darvishpoor Kakhaki A, Saraei H. [Determining psychometric properties of Iranian active aging measurement instrument (Persian)]. Salmand: Iranian Journal of Ageing. 2018; 12(4):414-29. [DOI:10.21859/sija.12.4.414]
31. Denis A, Callahan S, Bouvard M. Evaluation of the French version of the multidimensional scale of perceived social support during the postpartum period. Maternal and Child Health Journal. 2015; 19(6):1245-51. [DOI:10.1007/s10995-014-1630-9] [PMID]
32. Bagherian-Sararoudi R, Hajian A, Ehsan HB, Sarafraz MR, Zimet GD. Psychometric properties of the persian version of the multidimensional scale of perceived social support in iran. International journal of preventive medicine. 2013; 4(11):1277-81. [PMID] [PMCID]
33. Ezati E, Hosseinikoukamari P, Karimy M, Rawlins J, Akbartabar F, Khalvandi P. The role of spirituality and social support in Iranian elderly happiness: A cross-sectional study. Journal of Education and Community Health. 2023; 10(1):16-22. [DOI:10.34172/jech.2023.1856]
34. Üstün TB. Measuring health and disability: manual for WHO disability assessment schedule WHODAS 2.0. Geneva: World Health Organization; 2010. [Link]

35. Carlozzi NE, Kratz AL, Downing NR, Goodnight S, Miner JA, Migliore N, et al. Validity of the 12-item World Health Organization disability assessment schedule 2.0 (WHODAS 2.0) in individuals with Huntington disease (HD). Quality of Life Research. 2015; 24(8):1963-71. [DOI:10.1007/s11136-015-0930-x] [PMID]
36. Adib-Hajbaghery M, Akbari H. [The severity of old age disability and its related factors (Persian)]. Feyz Medical Sciences Journal. 2009; 13(3):225-34. [Link]
37. Seyedjavadi M, Pakfar Z. [The relationship between active aging and mental health in the elderly patients (Persian)]. Middle Eastern Journal of Disability Studies. 2021; 11:18. [Link]
38. Hosseini Afroozi SM, Zameni L, Asadi SY. [The determinants of physical activity in the older adults with and without experience of falling: Examination an extended health belief model (Persian)]. Iranian Journal of Motor Behavior and Sport Psychology. 2022; 2(3):12-25. [Link]
39. Ahmadi B, Amini Sanii N, Bani F, Bakhtari F. Predictors of physical activity in older adults in northwest of Iran. Elderly Health Journal. 2018; 4(2):75-80. [DOI:10.18502/ehj.v4i2.260]
40. Lin WI, Chen ML, Cheng JC. The promotion of active aging in Taiwan. Ageing international. 2014; 39(2):81-96. [DOI:10.1007/s12126-013-9192-5]
41. KhazaeePool M, Naghibi SA. [Correlates and barriers of social participation in elderly living in Mazandaran, Iran (Persian)]. Payesh. 2022; 21(2):183-96. [DOI:10.52547/payesh.21.2.183]
42. Verney SP, Gibbons LE, Dmitrieva NO, Kueider AM, Williams MW, Meyer OL, et al. Health literacy, sociodemographic factors, and cognitive training in the active study of older adults. International Journal of Geriatric Psychiatry. 2019; 34(4):563-70. [DOI:10.1002/gps.5051] [PMID]
43. Rezapour A, Mahmoudi M, Gorji H, Faradonbeh S, Asadi S, Zadeh N, et al. [A survey of Unmet health needs and the related barriers to access them (Persian)]. Journal of Health Administration 2014; 17(57):87-98. [Link]
44. Zacher H, Sagha Zadeh R, Heckhausen J, Oettingen G. Motivation and healthy aging at work. The Journals of Gerontology. Series B, Psychological Sciences and social sciences. 2021; 76(S 2):S145-56. [DOI:10.1093/geronb/gbab042] [PMID]
45. Kobayashi E, Sugawara I, Fukaya T, Okamoto S, Liang J. Retirement and social activities in Japan: does age moderate the association? Research on Aging. 2022; 44(2):144-55. [DOI:10.1177/01640275211005185] [PMID]
46. Townsend BG, Chen JT, Wuthrich VM. Barriers and facilitators to social participation in older adults: A systematic literature review. Clinical Gerontologist. 2021; 44(4):359-80. [DOI:10.1080/07317115.2020.1863890] [PMID]
47. Vaartio-Rajalin H, Snellman F, Gustafsson Y, Rauhala A, Viklund E. Understanding health, subjective aging, and participation in social activities in later life: A regional Finnish survey. Journal of Applied Gerontology. 2024; 43(6):638-49. [DOI:10.1177/07334648231214940] [PMID]
48. Mehrabian F, Aminian MR, Heidarzadeh A. [Study of age at onset and causes of disability of elderly people in hospice (nursing home) of disabled and elderly people of Rasht (Persian)]. Journal of Guilan University of Medical Sciences. 2017; 26(101):46-57. [Link]
49. Heravi Karimloo M, Anoosheh M, Foroughan M, Sheykhi MT, Hajizade E, Seyed Bagher Maddah MS, et al. [Loneliness from the perspectives of elderly people: A phenomenological study (Persian)]. Salmand: Iranian Journal of Ageing. 2008; 2(4):410-20. [Link]
50. Mikaeili N, Rajabi S, Abbasi M. [A comparison of loneliness, mental health and self-efficacy of the elderly (Persian)]. Journal of Social Psychology. 2012; 7(22):73-81. [Link]
51. Jokar F, Asadollahi AR, Kaveh MH, Ghahramani L, Nazari M. [Relationship of perceived social support with the activities of daily living in older adults living in rural communities in Iran (Persian)]. Salmand: Iranian Journal of Ageing. 2020; 15(3):350-65. [DOI:10.32598/sija.10.15.3.2773.2]
52. Khodaparast S, payandeh M, Isazadeh S, Abdi H. [Comparing the quality of life, support and social isolation of active and inactive elderly during the Covid 19 pandemic (Pesian)]. Medical Journal of Mashhad University of Medical Sciences. 2022; 65(3):1328-35. [DOI:10.22038/mjms.2022.21718]
53. Portegijs E, Lee C, Zhu X. Activity-friendly environments for active aging: The physical, social, and technology environments. Frontiers in Public Health. 2023; 10:1080148. [DOI:10.3389/fpubh.2022.1080148] [PMID]
54. Chang YT, Yu CW, Chao CM, Chen RJ. Relationship between degree of exercise participation and active aging among older adults. Advances in Public Health. 2021; 2021:3418568. [DOI:10.1155/2021/3418568]