Iran Journal of Nursing

Introduction
Aging can cause a decrease in physical and psychological health, which has a negative impact on the quality of life and functional independence. Osteoporosis is a chronic and metabolic bone disease that is very common in older adults, especially in women. Osteoporosis causes bones to become weak and brittle and limits the activities of daily living (ADL) in the elderly. Considering that women are central to the health of their families, and osteoporosis is more common in women, this study aims to investigate the ability to perform basic and instrumental ADL in elderly women with osteoporosis in Tehran, Iran.

Methods
This is a descriptive cross-sectional study. Participants were 130 elderly women over 60 years of age with osteoporosis referred to the selected hospitals affiliated to Iran University of Medical Sciences in 2019-2020, who were included by a consecutive sampling method and based on the inclusion criteria. The sampling process lasted for four months, from July to November 2020. Data collection tools were the abbreviated mental test, a demographic form, the Barthel index for ADL, and the Lawton-Brody Instrumental ADL scale. After completing the questionnaires by interviewing the women, the data were analyzed in SPSS software, version 20. The significance level was set at 0.05.

Results
The mean age of women was 67.5±5.7 years. Regarding the level of education, 31.54% were illiterate, 49.23% had lower than higher school education, 14.62% had a diploma, and the rest (4.62%) had university degree. The majority of women (72.4%) were married and housekeeper (89.2%). Also, 97.7% were living in the city, and 70% were living with their husbands. Regarding the characteristics of the disease, 96.9% had a history of osteoporosis, and the most common type of osteoporosis was osteopenia (63.8%). The duration of osteoporosis in most women was more than 5 years (65.9%), and 67.7% had no history of hospitalization due to bone fracture. Regarding the ability to perform basic ADL, none of the women needed help for feeding, and their most dependency was in urinating (45.4%). In the case of ability to perform instrumental ADL, The most inability was in financial management (77/60) and the lowest inability was related to the responsibility for own medications (0.77%). The ability to perform basic ADL was significantly related to women’s age (P=0.024) and level of education (P=0.024). The ability to perform instrumental ADL had a statistically significant relationship with age (P=0.013), education level (P=0.001), and occupation (P=0.001).

Conclusion
According to the results of this study, more family and social support from the society is needed old women with osteoporosis, with older age and low ability to perform basic and instrumental ADL. Based on nursing care with a “holistic approach”, to support very old people with a serious disease such as osteoporosis, policy making and effective health planning with coordination between the government sector and voluntary and charity organizations are needed. This can play a decisive role in reducing the problems of elderly women in various basic and instrumental ADLs and pave the way for improving their health, realizing the concept of “active aging”, and improving their quality of life.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Iran University of Medical Sciences (Code: IR.IUMS.REC.1398.1228)

Funding
The study was extracted from the master’s thesis of Zohre Dolatabadi, funded by Iran University of Medical Sciences . 

Authors' contributions
Conceptualization, editing & review: Farideh Bastani; Writing initial draft and resources: Zohre Dolatabadi; Dataanalysis: Hamid Haghani; Coordination and writing initial draft: Farzaneh Mehdipour and Hossein Jahani.

Conflict of interest
The authors declare no conflicts of interest.

Acknowledgments
The authors would like to thank the Deputy for Research of Iran University of Medical Sciences  for their financial support, and all the women participated in this study.


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