Introduction
With the gradual increase in the number of older people, their health and treatment needs also increase  [5]. However, many countries such as Iran, are not prepared to face the aging phenomenon and its health, social and economic consequences [5]. The health system of the country should consider the needs and expectations of the disabled elderly in the coming years and provide health and treatment services to them [7]. Moving towards age-friendly hospitals and preparing the health system for the growing aged population is one of the most important short-term challenges of the country [6, 10]. To create a suitable physical environment and provide quality medical services for the elderly, the present study aims to assess the compliance of the teaching hospitals in Khorasan Razavi Province of Iran with age-friendly hospitals.

Methods
This is a cross-sectional descriptive study that was conducted during the first six months of 2023. The study population included 16 teaching hospitals in Khorasan Razavi Province. They all were selected for the study using a census method. The data collection tool was the “age-friendly hospitals checklist,” developed by Ahmadi [10] using the age-friendly toolkit published by World Health Organization (WHO) and Rashmi’s checklist [18]. This questionnaire has 50 items answered by “yes” (2 points), “somewhat” (1 point), and “no” (0 points). The total score ranges from 0 to 100. A higher score indicates greater compliance with the age-friendly hospital criteria.
After obtaining permission from the ethics committee of Gonabad University of Medical Sciences and a written letter of introduction and coordination with the officials of each hospital, the researcher visited the hospital and completed the relevant checklist and recorded the observational data. The items related to the “physical environment” were completed by the observation method, and the items related to “information and training of service providers” and “management systems” were completed by observing and reviewing the documents of the quality improvement office and the training unit of the hospitals. Data analysis was done in SPSS software, version 23 using descriptive statistics such as Mean±SD, frequency, and percentage.

Results
As can be seen in Table 1, the mean score of the physical environment, staff training and information, management system, and the total score of the questionnaire were 26±8.28, 3.93±3.45, 4±3.79 and 33.93.11±75, respectively.


According to the observations, none of the hospitals had a dedicated parking lot for the elderly. However, more than 80% of the hospitals were near a bus station or metro station. Also, the floors of more than 80% of hospitals were slippery and not suitable for the elderly; 68% of hospitals had ramps for people with wheelchairs and railings for stairs. None of the hospitals had a separate entrance for the elderly; 56% had proper lighting, 68% had wide doors and rooms, and 68% had accessibility to elevators on each storey. In more than 80% of hospitals, signboards had been installed in all departments. However, 37% had used bold and clear letters and 100% were written in Farsi and English without using local language. More than 90% of the hospitals did not give priority to the elderly in admission and billing, and only 12% had a strong support system to reduce costs for the elderly. More than 90% of hospitals did not have protocols for screening the elderly, and more than 75% had not trained the staff regarding communication with the elderly, the four main diseases of the elderly (Alzheimer’s, falls, urinary incontinence, depression), preventive counseling, and warning of danger signs. Only 12% of hospitals had provided explanations about the prescribed drug and gave priority to the elderly in collecting drugs. Hospitals had no geriatric physician and no separate multispecialty clinic for seniors.

Discussion
Considering the problems observed in the physical environment of the study hospitals and the importance of their correction for improving the services to the elderly, the hospital managers and officials should take measures to eliminate the observed deficiencies. Although financial issues can be a serious obstacle in this field, but many of these deficiencies can be eliminated to a large extent by spending little money and with proper management. The service providers lacked information about the necessary instructions related to the diseases and conditions of the elderly, counseling issues, and how to properly interact with the elderly. Therefore, the training of service providers and related staff regarding these issues can be put on the agenda, and monthly or periodic workshops can be included in the educational programs of hospitals. Also, the recruitment of geriatric physicians or nurses should be considered by the hospitals.

Ethical Considerations
Compliance with ethical guidelines
The study was approved by the Ethics Committee of Gonabad University of Medical Sciences (1401.078IR.GMU.REC).

Funding
This article is the result of a master's thesis of Salehe Abasian, approved by Department of Ageing, Faculty of Nursing, Gonabad University of Medical Sciences and was done with the support of the Research Vice-chancellor of Gonabad University of Medical Sciences.

Authors' contributions
All authors equally contribute to preparing all parts of the research.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors would like to express their gratitude and appreciation to the respected vice-presidents of research and technology, as well as respected professors at the universities of medical sciences in Khorasan Razavi Province, the officials of the educational and therapeutic hospitals of Razavi Khorasan Province, the participants in this research and the referees of this article.

 

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