Introduction
In history, several threats, such as emerging infectious diseases, including COVID-19, have caused many global concerns and problems, especially for elderly people [2]. On the other hand, according to the estimations of the United Nations, the aging of Iran’s population in the coming decades will be an inevitable phenomenon [7]. To properly deal with these threats in the future and apply the experiences gained during the COVID-19 pandemic, the widely used and conventional model of the future wheel can be helpful by taking into account the social, psychological, health-related, economic, political, security, and environmental effects on the elderly [8]. More than three years have passed since the outbreak of COVID-19, but there are still many unknowns. In this research, with a prospective and systematic perspective and based on the perceptions of experts, the various effects of the pandemics on the elderly in Iran in 2022 are investigated using the future wheel model.

Methods
This qualitative and expert-oriented study was conducted using the second version of the future wheel [11]. To collect data, the opinions of three panels of experts were used and the study was done in three steps. In the first step, the first panel of experts listed 63 effects in 7 layers (9 effects in the first layer, 20 effects in the second layer, and 34 effects in other layers) by holding brainstorming sessions and searching for related information sources. Next, they specified the time horizon of the effects and listed 9 effects as opportunities and 5 effects as threats. Then, a meeting was held with the second panel of experts based on the nominal group method, and the effects of the pandemic were classified into six groups of social-psychological (n=23), technological (n=3), economic (n=5), environmental (n=1), political (n=2) and health (n=29) based on the STEEP analysis method.
In the second step, the list of effects, the table of opportunities and threats, and the time horizon of the effects were emailed to the third panel of experts. After collecting the opinions of experts, 81 effects (after removing 5 effects and adding 23 new effects) were classified into six groups of social-psychological (n=25), technological (n=3), economic (n=7), environmental (n=1), political (n=3) and health (n=38). After adding 2 opportunities and 5 threats to the initial table, 11 opportunities and 10 threats were finally identified. 
In the third step (consensus), the final future wheel was drawn using Photoshop software and emailed to the third panel of experts, along with the table of opportunities and threats and the time horizon of the effects. All effects were confirmed by experts, and only one opportunity and one threat were removed.

Results
In this study, 10 opportunities and 9 threats of the pandemics for the elderly and the time horizon of 81 effects were determined and the future wheel model was drawn. 

Social-psychological effects
Leaving the elderly alone at home leads to not meeting their basic needs, increasing the probability of an accident at home, and increasing depression, which increases the need to care for them and reduces their independence. On the other hand, the filial piety of the caregivers decreases, which increases the independence of the able-bodied elderly. Negative stereotypes about the health and performance of the elderly and the reduction of intergenerational solidarity can lead to an increase in the possibility of age discrimination. Also, quarantine and forced unemployment increase the possibility of elder abuse.

Technological effects
Quarantine causes the establishment of virtual counseling and support centers for the elderly, increasing remote care and the use of technologies related to the control, prevention, and treatment of diseases, such as the introduction of various drugs, medical equipment, and mobile applications.

Economic effects
Fear of contracting a disease can lead to increased stress, arbitrary consumption of unnecessary supplements, lack of routine visits to the doctor, increase in psychosomatic, digestive, and autoimmune diseases, Alzheimer’s disease, and the costs of the health system. However, this fear can increase self-care and reduce unnecessary visits to the doctor and the costs of the health system.

Environmental effects
Reduction in car traffic and the temporary closure of factories during the pandemic can help improve air quality and reduce air pollution in the short term.

Political effects
The risk of contracting infectious diseases such as COVID-19 and related death is higher in the elderly than in other age groups. It may cause policymakers to forget the importance of the elderly and disrupt the allocation of resources for them, such as the creation of elderly-friendly cities, etc.

Health effects
Inactivity caused by quarantine increases the possibility of contracting non-communicable diseases such as obesity, diabetes, high blood pressure, heart diseases, sleep disorders, digestive problems, and musculoskeletal diseases. On the other hand, the reduction in social gatherings due to the imposed restrictions can lead to the reduction of other infectious diseases, such as influenza in the elderly. The fear of getting sick leads the elderly to stay home, which increases the need for home care services such as sending a doctor, nurse, medical equipment, and physiotherapy.

Conclusion
The spread of emerging infectious diseases and its various effects on the elderly are not limited to one country or region, and it is a crisis that can affect all countries in the world. All-round programs should be formulated to face them tailored to the existing conditions. It seems that despite the special attention of the international community to the health of the elderly in recent decades, there is still no comprehensive and forward-looking plan regarding the health of the elderly in the face of pandemics in Iran. Since the future of the aging phenomenon in Iran is full of uncertainty in various social, economic, political aspects, continuous monitoring of the situation, detailed analysis of the dimensions and trends of this phenomenon to inform the senior planners of the country in advance should be prioritized in future studies of the Iranian health system.

Ethical Considerations
Compliance with ethical guidelines
This study has an ethical approval from kerman University of Medical Sciences (Code: IR.KMU.REC.1400.175)All ethical principles were observed in this study.

Funding
This article was extracted from a research project, funded by Kerman University of Medical   Sciences. (Grant Number: 99000336).

Authors' contributions
Zohreh Nejatzadegan Eidgahi: Conceptualization, initial draft preparation, Writing; Reza Dehnavieh: Funding acquisition, Supervision, Validation; Vahidreza Borhaninejad: Conceptualization, Methodology; Vajihe Rouhi and Alikhani Alireza: review & editing.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors would like to express their sincere gratitude to the Deputy for Research and the Institute of Future Studies in Health of Kerman University of Medical Sciences and the experts in geriatric health for their support and cooperation in this research.

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