Correspondence
4 Laufs J, Waseem Z. Policing in pandemics: abuse of older people, the estimated
a systematic review and best practices for
police response to COVID-19.
Int J Disaster Risk Reduct 2020; 51: 101812.
Policies to address the
impact of an ageing
population in Iran
Iran is experiencing an acceleration in
population ageing, such that in 2022,
the proportion of people older than
60 years in Iran exceeded 10% of the
total population. At the same time,
the population growth rate in Iran is
0·7, the lowest rate during the past
25 years.1 From 2000 onwards, Iran’s
fertility rate seems to have stabilised
and, based on the demographic
transition theory, it is not expected
to see many changes in the coming
years.2 At the top of the challenges
related to population, ageing in Iran
is the concern of lonely or unmarried
older people who live in families
with a small household dimension.
Currently, about 30% of older people
who live alone are aged 80 years and
older.3 The only-child phenomenon in
those of middle-age, the high rate of
immigration among young people, a
decreasing marriage rate, permanent
celibacy, divorce (especially among
those of middle age), and death of
a spouse are among the factors that
might contribute to loneliness among
the older population in the near
future.
80% of people older than 65 years,
in Iran’s capital, are estimated to have
at least one chronic disease, and 50%
have two chronic conditions.4 Also,
during the COVID-19 pandemic, the
prevalence of depression in the older
population increased substantially.5
About 10% of the country’s older
population has obvious disabilities,
which has led to much higher
rehabilitation expenditure in older
individuals compared with other
age groups. Abuse of older people
is another challenge. Although
there is no common definition of
1078 www.thelancet.com Vol 401 April 1, 2023
Department of Health Policy & Management, Tabriz
prevalence in Iran is about 48·3%
(95% CI 28·6–68·6).6 This challenge
calls for additional attention and
requires the involvement of families,
society, and related organisations
to appropriate actions to tackle this
issue.
The ageing of the population
brings concerns about the speed of
economic growth of the country,
increasing health system costs, the
quality performance of the health-
care system, the financial resilience
of the pension system, and the
wellbeing and quality of life of older
people. To address the challenges
facing older people in Iran, policy
makers need to carry out evidence-
informed policy interventions.
Targeted measures are needed, such
as setting healthy ageing as a priority
for the government, developing a
health-care delivery model for the
ageing population, increasing the
executive power of the National
Council on Ageing, and using the
potential of academic graduates
such as in gerontology or geriatric
medicine. Modifying the retirement
system to ensure long-term financial
and social security for older people
is also necessary. Making policies to
facilitate the use of voluntary services
and the provision of home caregiving
is recommended. It is necessary to
strengthen the performance and
funding of day-care centres and
retirement homes for older people,
provide long-term health-care
insurance plans tailored to the needs
of older people, invest in palliative
care, and increase awareness of
health-promoting behaviours of self-
care and healthy nutrition for older
people, as well as provide equal access
and equitable benefits supported by
timely and appropriate interventions
targeted at older people.
We declare no competing interests.
*Leila Doshmangir, Roghayeh Khabiri,
Vladimir Sergeevich Gordeev
doshmangirl@tbzmed.ac.ir
Health Services Management Research Center,
School of Management and Medical Informatics
(LD, RK) and Social Determinants of Health Research
Center (LD), Tabriz University of Medical Sciences,
Tabriz 5166614711, Iran; Department of Infectious
Disease Epidemiology, London School of Hygiene &
Tropical Medicine, London, UK (VSG)
1 The World Bank. Population growth (annual
%)—Iran, Islamic rep. 2022. https://data.
worldbank.org/indicator/SP.POP.
GROW?locations=IR (accessed Jan 2, 2023).
2 Fathi E. The phenomenon of population aging
in Iran. Iran J Off Stat Stud 2020; 30: 387–413.
3 Shams Ghahfarokhi M. Rising living alone
among the elderly in Iran: prevalence and
associated factors. BMC Geriatr 2022; 22: 622.
4 Mohaqeqi Kamal SH, Basakha M. Prevalence of
chronic diseases among the older adults in
Iran: does socioeconomic status matter?
Salmand Iran J Ageing 2022; 16: 468–81.
5 Doshmangir L, Gholipour K, Gordeev VS. Policy
changes needed to address the mental health
impact of COVID-19 in Iran. Lancet Psychiatry
2022; 9: e35.
6 Abdi A, Tarjoman A, Borji M. Prevalence of
elder abuse in Iran: a systematic review and
meta-analysis. Asian J Psychiatr 2019;
39: 120–27.
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