پدیدارشناسی تجربه جابجایی به آسایشگاه در سالمندان

Background: Older adults experience numerous life transitions. One of the most impactful is relocation from their previous residence. This study focused on a specific type of relocation, the transition from home to a residential care facility, and aimed to understand this transition as a phenomenon.
Method: A phenomenological approach was employed using semi-structured interviews. Data saturation was achieved through interviews with 13 individuals aged 60 and above, possessing the cognitive capacity to respond, and with lengths of stay ranging from one month to two years.
Results: Data were analyzed using Colaizzi’s seven-step method, resulting in the identification of five themes and fourteen concepts. These themes included a reduction in social networks, social withdrawal, engagement with depressive symptomatology, diminished control over life, and compromised physiological functioning. Findings indicated that individuals transitioning to residential care facilities experience a constellation of negative changes in their physical, psychological, and social well-being. Specifically, they experience psychological distress, including depression, sadness, and a loss of perceived control. Physiologically, sleep patterns and physical capabilities decline. Furthermore, relationships with their former social networks are significantly reduced, and they lose meaningful roles within their families and communities.
Conclusion: Relocation to a residential care facility appears to result in a loss of previous lifestyles, transforming individuals from multifaceted, socially engaged beings into individuals perceived as ill and requiring care. This transition is associated with consequences such as a decline in quality of life and, potentially, a reduced hope for the future.
EXTENDED ABSTRACT
 Introduction
Relocation is defined as a change in the environment in which an individual moves from one place to another. Relocation, especially relocation to a nursing home, is a stressful event in the lives of the elderly, accompanied by significant losses such as the loss of possessions, social support systems, and mobility. Some researchers have referred to it as "relocation stress syndrome," characterized by symptoms such as changes in eating habits, sleep patterns, depression, and weight changes. Others have conceptualized it as an adaptation process, introducing different stages for it. In the present study, considering that relocation from home to elderly nursing homes is experienced in various ways within the cultural contexts of different societies, and given that in Iran, nursing homes are the only available living options for elderly individuals who are relatively independent in terms of functionality but cannot be cared for by their families for any reason, and since other options such as short-term and long-term residential centers accompanied by assistance for independent living for the elderly are not available, we aim to answer the question: What experiences do the elderly have regarding relocation to nursing homes?
Method
The present study, conducted in 2023-2024 (1402-1403), utilized a qualitative approach, specifically descriptive phenomenology. The research population consisted of elderly residents in private nursing homes in Tehran. Thirteen elderly individuals were recruited using purposeful sampling until data saturation was achieved. Inclusion criteria were: 1) Cognitive ability enabling understanding and responding to questions, 2) Age over 60 at the time of entry to the centers, and 3) Willingness to participate. Exclusion criteria included: 1) Dementia and 2) Residency duration exceeding two years. To conduct the research, after obtaining necessary referral letters from the university and the Tehran Social Welfare Organization, researchers visited several nursing homes located in various areas of Tehran, ensuring socio-economic diversity within the target group. Semi-structured interviews were conducted after obtaining informed consent and explaining the purpose and other ethical considerations, such as confidentiality and the freedom to withdraw from the interview at any time. Interviews were transcribed and analyzed using Colaizzi's seven-step method. To ensure the credibility of the findings based on the four criteria of credibility, transferability, dependability, and confirmability, researchers consistently engaged with the research environment, carefully selecting the study site and participants. Furthermore, expert consultation and participant data verification methods were employed.
Results
The age of research participants ranged from a minimum of 65 to a maximum of 76 years. Most participants were widowed, and their education levels varied from secondary school to a bachelor's degree. The number of children ranged from zero to five. This esearch yielded 5 themes and 14 concepts, illustrated in Figure 1. Within Theme 1–Diminished Social Networks– older adults transitioning to residential care facilities experience alterations in their social networks in two distinct ways. Firstly, they lose contact with individuals outside of their immediate family with whom they previously maintained occasional interactions. Secondly, there is a reduction in contact with close relational networks, including children and siblings. Theme 2 – Social Disengagement– highlights the deprivation experienced by older adults of opportunities and resources typically available to the general population for full and effective participation in economic, political, social, and cultural life. This displacement from their former community and social context results in a sense of marginalization, which subsequently undermines self-esteem. Theme 3 – Engagement with Depressive Symptomatology – reveals that relocation is frequently associated with anxiety, psychological distress, and symptoms indicative of depressive disorder. This serious mood disorder significantly impacts decision-making processes, behavior, and cognitive patterns. Theme 4–Reduced Perceived Control– demonstrates various manifestations of diminished feelings of control. These experiences include uncertainty regarding their new situation, the delegation of personal affairs to others accompanied by a withdrawal from autonomy, and instances where, despite efforts to maintain control, decision-making authority is relinquished. Theme 5– Compromised Physiological Conditions– details the physical challenges encountered by older adults following relocation to residential care. Beyond basic needs such as hydration and nutrition, disruptions in sleep patterns, a crucial physiological requirement for this population, are also observed.
Conclusion
Older adults transitioning to nursing homes experience this event with a range of negative emotions, interpersonal disturbances, and behaviors, sharing similarities with aspects of the relocation syndrome. However, the relocation syndrome perspective primarily focuses on physical and clinical signs, neglecting other dimensions such as relational and social aspects. A significant concern is the reduction in social dimensions of life – loss of roles, social activities, and diminished networks – following the move. For Iranian older adults, within a family-centric and interaction-oriented culture, relocation represents a multifaceted crisis; it is accompanied by negative physical and psychological changes while simultaneously severing ties with their previous social lives, as if a new life with different parameters is imposed upon them, one that doesn't sustain their prior lifestyle. Considering that a significant proportion of residents in nursing homes still do not require constant, intensive care and maintain relatively good functional and cognitive status, relocation can lead to a decrease in their quality of life.
Ethical Consideration
Ethical Code
This research was conducted with the approval and coordination of Tarbiat Modares University and the Tehran Welfare Organization.
Financial Support
This study did not receive financial support.
Authors’ Contributions
E.M: Conceptualization, methodology, data curation, software, formal analysis, writing-original draft; Z.S: Conceptualization, methodology writing - review & editing, supervision
Conflict of Interest
The authors had no conflicts of interest.
Acknowledgments
We appreciate all the older adults who cooperated with us patiently throughout this research process.
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