1. Introduction
According to the World Health Organization (WHO), the aged population in developing countries, including Iran, has had the fastest growth compared to other population groups [1]. By 2050, the percentage of elderly population in Iran will reach 31.2%, which is higher than in the world and Asia [2]. Due to higher life expectancy and lower mortality among women, the percentage of elderly women is higher in Iran [3, 4]. Economic, social, demographic and health indicators of elderly women are in a more unfavorable situation [5]. Despite the deteriorating health status of older women and the prediction of the feminization of aging in Iran, the country’s aging programs have not been gender sensitive. Implementing appropriate and comprehensive strategies for managing the geriatric services is important. The purpose of this study is to gain a deeper understanding of the concept of health in older women and how to achieve health in them. The questions are:
1. What is the concept of aging and its process and effects on societies?
2. What are the effective factors in the health of older women?
3. How can the health goal for older women be achieved?
2. Methods
This is a review study with an ethical approval (Code: IR.IAU.TNB.REC.1398.002). The search for literature and factors affecting the health of older women and achieving aging health was conducted in PubMed, Scopus, Elsevier, MagIran, SID, IranDoc, NoorMags, and websites of WHO and the United Nations Population Fund on studies published until June 2020 using the keywords: Elderly, aged, healthy aging, older women, health services, and health care in Persian and English. Initial search yodeled 600 articles. After initial screening, 111 articles related to the objectives of the study were selected. By studying the content, 60 were selected for deeper review. Criteria for inclusion were the study on aging and its trend in Iran, the effects of aging, health status and factors affecting the health of older women, strategies and policies, planning and providing health services for the elderly and older women worldwide including Iran. Duplicate articles, and those on a specific group of the elderly, such as the elderly with a specific disease, and those conducted at the provincial level, were excluded from the study.
3. Results
Biological, social, political, economic and environmental factors are effective in the difference between the health status of older men and women. According to “biological”, “psychosocial”, “behavioral” and “mental-cultural” theories, effective factors are physiology, biological experiences of life periods, lifestyle and social activities, values, norms, and expectations of society from the individual [6, 7]. The World Health Assembly considers physiological factors, behavior, gender, living environment and race to be effective, and suggests the formation of healthy aging from birth [8, 9, 10]. Studies in Iran suggest individual, family, social, and religious factors that affect older women’s health [7, 11, 12, 13]. Older women had poor status in the indicators of literacy, income, poverty, dependence, loneliness, celibacy, housing, living in nursing homes, insurance, disability, chronic diseases, mental health, and use of assistive devices compared to older men. Despite the need for more services, the number of needed referral and annual referral for outpatient services, self-medication and not referral due to financial reasons are more [14, 15] and are among the “vulnerable elderly” [16]. For ensuring the health of the elderly, there were following approaches: “health care”, “public health care”, “social care and support”, “biopsychological and social” and “integrated care older people” [9, 17, 18, 19].
Integrated care included: management and provision of ongoing health promotion services, prevention, diagnosis, treatment, rehabilitation, palliative care, comprehensive assessments, supervision, monitoring, sustainable financial and human resources, integrated information system, infrastructure development, multi-sectoral activities to prevent the reduction of inherent capacity and improve the functional abilities of the elderly [9]. The National Program for the Improvement of the Health, Welfare and Dignity of the Elderly 2012 has three sections: health promotion, dignity promotion and welfare promotion for the elderly [20] which has been taken from the integrated care model. Institution building in Iran is the result of the implementation of the Article 192 “Organization and Rehabilitation of Chronic Mental Patients and the Elderly” of the Third National Development Plan in 2004, which was established by the “National Council of the Elderly”. Due to the multi-part nature of the issue, the “National Document for the Elderly” was prepared in 2017 with the cooperation of stakeholders and managers of the Program and Budget Organization, and its final version in 2020 was communicated to the executive organizations [16]. In 2017, the Supreme Council for Health and Food Safety approved the implementation of the national program for the elderly [21]. Provision of integrated care services is only at the first level of health and government services and lacks a strategic approach, gender sensitiveness, and inter-sectoral integration. The following conceptual model is presented with an integration approach for “Iranian older women’s health”.
4. Discussion and Conclusion
Older women’s health is obtained by the interaction of individual, behavioral, economic, social, physical environment, and socio-health services in the context of gender and culture. So far, geriatric programs in Iran have been at the clinical level without integration requirements. The title “elderly” is mentioned in upstream laws and care centers with illness, mental and physical disability, and social ills. To achieve the health of older women, a systemic approach to management and implementation, overseeing legislation, and institutionalization in the context of gender and national and regional culture is needed. Moreover, interventions should also be elderly-oriented, interactive, multidisciplinary, continuous, participatory, and integrated at the clinical, organizational, and governance levels, along with program analysis in the feedback cycle. IT networking, sustainable financial resources, and research and development are essential (Figure 1).

Training and employing specialized and multi-skilled manpower considering the different needs of older women are recommended.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of the Islamic Azad University Tehran North Branch (Code: IR.IAU.TNB.REC.1398.002). 

Funding
The study was extracted from the Phd. dissertation of the first author in the Department of Health Sevices Management, North Tehran Branch, Islamic Azad University, Tehran.

Authors' contributions
All authors equally contributed to preparing this article.

Conflicts of interest
The authors declared no conflict of interest.