Introduction
Despite the importance of the doctor-elderly patient relationship due to the impact of poor communication between them on the health and quality of life of the elderly, no research has been conducted ins this field in Iran, especially in Tehran city, which has the largest elderly population. On the other hand, there are differences in the doctor-patient relationship between young and older patients. Based on various studies, it has been found that the doctor-patient relationship has a special impact on the treatment costs, health, and compliance with treatment of the elderly [9]. However, there are inconsistencies among different studies regarding factors related to the doctor-patient relationship, such as age, gender, education level, and economic status of patients and gender of doctors [13, 16-18]. The present study aimed to determine the doctor-patient relationship status and factors related to the doctor-patient relationship from the perspective of older adults in Tehran, Iran.

Methods
This is a descriptive-analytical study with a cross-sectional design conducted on people aged ≥60 referred to governmental or private clinics in Tehran, Iran. Inclusion criteria were age 60 years or higher, consent to participate in the study, history of illness and doctor visits, and ability to communicate and answer questions. Exclusion criteria were unwillingness to continue participating in the study, developing an acute illness during the study, and the incomplete responses to questionnaires. Eligible individuals were selected using a multi-stage cluster random sampling method. Data were collected using a sociodemographic checklist and the doctor-patient communication (DPC) scale. Then, the collected data was analyzed using SPSS software, version 26. Descriptive statistics were presented using frequency, mean, standard deviation, and percentage. The Kolmogorov-Smirnov test was used to check the normality of the data, which showed that the data related to the doctor-patient relationship was not normal. Therefore, LG10 was used to correct the data. Then, Pearson’s correlation test, independent t-test, analysis of variance, and multiple linear regression were used.

Results
Participants were 382 older people, aged 60-91 years, with a mean age of 69.79±6.68 years. The highest number of participants was in the 60-74 age group (75.6%) and the lowest number of participants was in the >90 age group (0.3%). Among participants, 251 were women (65.7%) and 131 were men (34.3%). Most participants (88.2%) perceived their relationship with their doctor as good. There was a significant difference the doctor-elderly patient relationship based on educational level (P=0.032), autoimmune diseases (P=0.001) and other uncommon diseases in old age (P=0.043), gender of doctors (P=0.016), specialty of doctors (P=0.002), acceptance of insurance as one of criteria for choosing a doctor (P=0.012), duration of being under the doctor›s supervision (P=0.011) and duration of visit (P=0.001). Regarding the factors of age, gender, ethnicity, perceived economic status of patients, other criteria of physician choice, common diseases in old age, frequency of physician visits, and presence of a companion with the patient, no significant difference in doctor-elderly patient relationship was found (P>0.05). 
The results of multiple linear regression analysis showed that the doctor-elderly patient relationship was significantly predicted by the educational level of patients, duration of visit, and recommendation from another doctor to choose a doctor. These factors explained 19% of the variance in the doctor-elderly patient relationship (F (13, 368)=6.79, P=0.001, R2=0.19). The illiterate people (β=0.12, P=0.022) and those with primary and secondary education (β=0.15, P=0.003) were more satisfied with their relationship with the doctor. It was also found that the recommendation of another doctor leads to a decrease in the elderly patient›s satisfaction with the communication with the doctor (P=0.050, β=-0.09). Moreover, the longer the visit, the more satisfied the elderly were with their relationship with the doctor (P=0.001, β=0.30).

Conclusion
The results of the present study showed that most of the elderly patients in Tehran (88.2%) have a good relationship with their doctor. The doctor-elderly patient relationship can significantly be predicted by the educational level of patients, duration of visit, and recommendation from another doctor to choose the doctor, among which the visit duration has the greatest impact. Therefore, in order to improve the doctor-elderly patient relationship, it is necessary to consider the patients’ education level, recommendation from another doctor, and duration of visit.

Ethical Considerations

Compliance with ethical guidelines
This study was approved by the Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (Code: IR.USWR.REC.1402.020). All ethical principles were considered in this study.

Funding
This article was extracted from the master’s thesis of Hamideh Esmaeili at the University of Social Welfare and Rehabilitation Sciences. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for profit sectors.

Authors' contributions
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank all seniors who participated in this study for their cooperation.



 

1. Avazeh M, Babaei N, Farhoudi S, Kalteh EA, Gholizadeh B. [The study of self-care and related factors in the elderly with chronic diseases in 2018 (Persian)]. Journal of Health and Care. 2019; 21(2):135-44. [DOI:10.29252/jhc.21.2.135]
2. Pashazadeh H, Abolfathi Momtaz Y, Delbari A. [Prevalence of caregiver abuse by the elderly in nursing homes of Tehran and its related factors (Persian)]. Salmand: Iranian Journal of Ageing. 2022; 17(2):262-75. [DOI:10.32598/sija.2022.3191.1]
3. Pishkar Mofrad Z, Jahantigh M, Arbabisarjou A. Health promotion behaviors and chronic diseases of aging in the elderly people of Iranshahr*-IR Iran. Global Journal of Health Science. 2015; 8(3):139-45. [DOI:10.5539/gjhs.v8n3p139] [PMID] 
4. Rahimi AA, Ahmadi K, Asgharnejad Farid AA. [Assessing the status of mental health indices in Iranian eldery people (Persian)]. Journal of psychological Science. 2019; 18(77):529-38. [Link]
5. Qin Y, Li X, Wu J, Yu K. A management method of chronic diseases in the elderly based on IoT security environment. Computers Electrical Engineering. 2022; 102(14). [DOI:10.1016/j.compeleceng.2022.108188]
6. Sadeghiyan F, Raei M, Hashemi M, Amiri M, Chaman R. [Elderly and health problems: A cross sectional study in the Shahroud township (Persian)]. Salmand: Iranian Journal of Ageing. 2011; 6(2):26-30. [Link]
7. Turabian J. Doctor-patient relationship and multimorbidity: the more extraordinary a case seems, the easier it is to solve it. Archives of Family Medicine and General Practice. 2019; 4(1):82-9. [DOI:10.36959/577/487]
8. Turabian JL. Differential characteristics in communication and relationship of the general practitioner with the elderly patient. Journal of Family Medicine Forecast. 2019; 2: 1017. [Link]
9. Eskandari M, Hosseini F, Razjouyan K, Abadi A. Examining doctor-patient communication skills among senior medical students based on calgary cambridge observation guide. Medical Journal of the Islamic Republic of Iran. 2021; 35:122. [DOI:10.47176/mjiri.35.122] [PMID] 
10. Shakerinia I. [Physician-patient relationship and patient’s satisfaction (Persian)]. Iranian Journal of Medical Ethics and History of Medicine. 2009; 2(3):9-16. [Link]
11. Asemani O. [A review of the models of physician-patient relationship and its challenges (Persian)]. Iranian Journal of Medical Ethics and History of Medicine. 2012; 5(4):36-50. [Link]
12. Karami Z, Keyvanara M. [Models of relationship between physicians and patients referring to the clinic of Isfahan Shahid Beheshti Hospital 2007 (Persian)]. Strides in Development of Medical Education. 2010; 6(2):149-56. [Link]
13. Shantiaei M. Patient-physician communication during medical visits: Senior adults’ perspectives, expectations, and experiences. Fortune Journal of Health Sciences. 2021; 4(2):324-45. [DOI:10.26502/fjhs025]
14. Daba-Buzoianu C, Cârtită-Buzoianu C, Amalancei BM. Exploring physician-older patient communication. A qualitative analysis of communication between older patients and general practitioners. Romanian Journal of Communication Public Relations. 2018; 20(1):47-56. [Link]
15. Puscas L, Kogan JR, Holmboe ES. Assessing interpersonal and communication skills. Journal of Graduate Medical Education. 2021; 13(S 2):91-5. [DOI:10.4300/JGME-D-20-00883.1] [PMID] 
16. Williams SL, Haskard KB, DiMatteo MR. The therapeutic effects of the physician-older patient relationship: Effective communication with vulnerable older patients. Clinical Interventions in Aging. 2007; 2(3):453-67. [PMID]
17. Greene MG, Adelman R, Charon R, Hoffman S. Ageism in the medical encounter: An exploratory study of the doctor-elderly patient relationship. Language & Communication. 1986; 6(1-2):113-24. [DOI:10.1016/0271-5309(86)90010-8] [PMID]
18. Liang CY, Wang KY, Hwang SJ, Lin KC, Pan HH. Factors affecting the physician-patient relationship of older veterans with inadequate health literacy: An observational study. The British Journal of General Practice. 2013; 63(610):e354-60. [DOI:10.3399/bjgp13X667222] [PMID] 
19. Coats H, Downey L, Sharma RK, Curtis JR, Engelberg RA. Quality of communication and trust in patients with serious illness: An exploratory study of the relationships of race/ethnicity, socioeconomic status, and religiosity. Journal of pain and symptom management. 2018; 56(4):530-40.e6. [DOI:10.1016/j.jpainsymman.2018.07.005] [PMID] 
20. Akbarilakeh M, Shouaybi S. [Psychometric properties of Persian version of Doctor-Patient Communication (DPC) Scale for skill assessment in acute and critical conditions in Iran (Persian)]. Journal of the Iranian Institute for Health Sciences Research. 2021; 20(5):628-19. [DOI:10.52547/payesh.20.5.619]
21. Gashtasebi A, Montazeri A, Vahdani Nia MS, Rahimi Froshani A, Mohamad K. [Self-reported health and socioeconomic status: Results from a population-based study in Tehran, Iran (Persian)]. Payesh. 2003; 2(3):187-93. [Link]
22. Sustersic M, Gauchet A, Kernou A, Gibert C, Foote A, Vermorel C, et al. A scale assessing doctor-patient communication in a context of acute conditions based on a systematic review. PLoS One. 2018; 13(2):e0192306. [DOI:10.1371/journal.pone.0192306] [PMID] 
23. de Waard CS, Poot AJ, den Elzen WPJ, Wind AW, Caljouw MAA, Gussekloo J. Perceived doctor-patient relationship and satisfaction with general practitioner care in older persons in residential homes. Scandinavian Journal of Primary Health Care. 2018; 36(2):189-97.  [DOI:10.1080/02813432.2018.1459229] [PMID] 
24. Moin A, Davaty A, Jahangard Z. [Evaluation of patients’ satisfaction from patient-physician communication and factors influencing it among outpatients of Tehran’hospitals (Persian)]. Iranian Journal of Medical Ethics and History of Medicine. 2019; 12:276-86. [Link]
25. Greene MG, Adelman RD, Friedmann E, Charon R. Older patient satisfaction with communication during an initial medical encounter. Social Science & Medicine. 1994; 38(9):1279-88.[DOI:10.1016/0277-9536(94)90191-0] [PMID]
26. Peck BM. Age-related differences in doctor-patient interaction and patient satisfaction. Current Gerontology and Geriatrics Research. 2011; 2011:137492. [DOI:10.1155/2011/137492] [PMID] 
27. Williams A, Giles H. Sociopsychological perspectives on older people’s language and communication. Ageing & Society. 1991; 11(2):103-26. [DOI:10.1017/S0144686X00003962]
28. Adelman RD, Greene MG, Charont R. Issues in physician-elderly patient interaction. Ageing & Society. 1991; 11(2):127-48. [DOI:10.1017/S0144686X00003974]
29. Ishikawa H, Roter DL, Yamazaki Y, Takayama T. Physician-elderly patient-companion communication and roles of companions in Japanese geriatric encounters. Social Science & Medicine. 2005; 60(10):2307-20. [DOI:10.1016/j.socscimed.2004.08.071] [PMID]
30. Fan VS, Burman M, McDonell MB, Fihn SD. Continuity of care and other determinants of patient satisfaction with primary care. Journal of General Internal Medicine. 2005; 20(3):226-33. [DOI:10.1111/j.1525-1497.2005.40135.x] [PMID] 
31. Weiss LJ, Blustein J. Faithful patients: The effect of long-term physician-patient relationships on the costs and use of health care by older Americans. American Journal of Public Health. 1996; 86(12):1742-7. [DOI:10.2105/AJPH.86.12.1742] [PMID] 
32. Buller MK, Buller DB. Physicians' communication style and patient satisfaction. Journal of Health and Social Behavior. 1987; 28(4):375-88. [DOI:10.2307/2136791] [PMID]
33. Stevens L, Rodin I. Psychiatry e-book: An illustrated colour text. 2th ed. Philadelphia: Elsevier Health Sciences; 2010. [Link]