علل سالمند سپاری به مراکز سالمندان از منظرسالمندان و فرزندان شان: یک مطالعه کیفی

Background: Older adulthood is one of the stages of human development and is accompanied by physiological, psychological, and social changes that may increase individuals’ need for care and support from others. The present study aimed to qualitatively explore the reasons for nursing home placement from the perspectives of older adults and their children.
Method: The study employed a qualitative phenomenological design and thematic analysis. The study population consisted of older adults residing in nursing homes in Baghdad and their children. Participants were selected through purposive sampling, and sampling continued until data saturation was reached. In total, eight older adults residing in nursing homes and their children participated in the study. Data were collected through semi-structured interviews with the older adults and their children and analyzed using Braun and Clarke’s six-phase approach to thematic analysis.
Results: Findings from the interviews with the older adults showed that, from their perspective, the reasons for nursing home placement fell into three subcategories: limited resources among children for caring for the older adult, including factors such as inadequate housing and inability to meet caregiving expenses; inability to maintain respect for the older adult, reflected in behaviors such as disrespect and withholding information from the older adult; and financial hardship of the older adult, including limited financial means and lack of adequate housing. Analysis of the interviews with the children also identified six subcategories: the older adult’s mood and behavioral problems, with examples such as irritability, conflict, and aggression; age-related problems, including medication nonadherence and the need for frequent medical visits; lack of cooperation from other family members in caregiving, including a spouse’s unwillingness to provide care and lack of cooperation from other children; family members’ physical inability to provide care, with examples such as illness and physical limitations among caregivers; inability to meet the costs of caring for the older adult, including housing-related difficulties and occupational demands; and painful past experiences with the older adult, with examples such as past mistreatment and current feelings of aversion
Conclusion: Overall, the findings showed that although older adults and their children differed in their perceptions of some reasons for nursing home placement, there were also considerable areas of convergence between their perspectives. These findings highlight the need to design and implement supportive and preventive programs aimed at reducing factors that contribute to nursing home placement.
EXTENDED ABSTRACT
 
Introduction




A




   ging is a natural and universal process and one of the developmental stages of human life. It is accompanied by gradual changes in physiological functioning, cognitive abilities, psychomotor performance, and social roles, which may negatively affect older adults’ individual, family, and social functioning. As these changes progress, older adults may become increasingly dependent on others for care, emotional support, and assistance with daily living. Caring for older adults requires specific competencies and an understanding of their biological, psychological, social, and cultural needs. Respectful care can contribute to older adults’ sense of dignity, security, and psychological well-being. At the same time, caregiving may impose substantial demands on family members. Previous studies have shown that family caregivers may experience time constraints, emotional strain, physical health problems, financial difficulties, occupational disruption, and reduced control over their personal lives. In some cases, inadequate caregiving resources and prolonged caregiver burden may also expose older adults to neglect or abuse. Within cultures in which family-based care of older parents is highly valued, placement in a nursing home may be viewed negatively and may generate considerable emotional and interpersonal conflict. Nevertheless, some families experience difficulties that make continued home-based care increasingly challenging. Understanding the reasons for nursing home placement therefore requires consideration of both older adults’ experiences and the perspectives of the children involved in the caregiving and placement process. Accordingly, the present study aimed to explore the reasons for nursing home placement from the perspectives of older adults and their children in Baghdad.
Method
The present study was conducted in Baghdad in 2023 and employed a qualitative phenomenological design with thematic analysis. The study population consisted of older adults residing in nursing homes and their children who had been involved in the decision to place their parents in institutional care. Participants were selected using purposive sampling, and recruitment continued until data saturation was achieved. Data saturation was reached after interviews with eight older adults and their children. The inclusion criteria for older adults were: residence in a nursing home for at least three months, ability to remember the circumstances leading to nursing home placement, ability to communicate and recount personal experiences, having at least one child, and participation of the child responsible for the placement decision. Exclusion criteria included having no children, dementia or delirium, and the presence of an acute physical illness that prevented participation. The sample included eight older adults, four women and four men, aged 63 to 76 years, together with one participating child for each older adult. The participating children were between 33 and 45 years of age. Data were collected through semi-structured interviews. Each interview lasted approximately 45 to 60 minutes and was conducted in a quiet room in the nursing home at a time agreed upon by the participant and the researcher. Interview questions focused on the circumstances, experiences, family conditions, and personal factors that contributed to nursing home placement. A pilot study was conducted with three participants, and some interview questions were revised based on their feedback. Follow_up questions were also used during the interviews to explore participants’ experiences in greater depth. The interview data were analyzed using the six-phase thematic analysis procedure, including familiarization with the data, generation of initial codes, searching for themes, reviewing themes, defining and naming themes, and preparing the final report. To enhance the credibility of the analysis, coding and interpretation involved the researcher, the supervisor, and a specialist in qualitative coding. Participant confidentiality was protected through the use of identification codes.
Results
Analysis of the interview data resulted in two main perspective-based categories, nine subcategories, and 33 concepts. The two main categories represented the reasons for nursing home placement from the perspectives of older adults and their children. From the perspective of the older adults, three subcategories were identified. The first was limited resources among children for caring for the older adult. This subcategory included forgetting parental affection and sacrifices, inadequate housing facilities, children’s reluctance to spend money on the older adult, and inability to afford caregiving expenses. Some participants believed that their children lacked the financial or residential resources required to continue caring for them at home. The second subcategory was inability to maintain respect for the older adult. This included disrespectful behavior by grandchildren, conflict or mistreatment involving sons- or daughters-in-law, and concealment of information from the older adult. Some older participants described feeling unwanted or viewed as an obstacle to the family’s comfort and everyday life. The third subcategory was financial poverty of the older adult. The underlying concepts included limited financial means, lack of inheritance or dowry-related assets, and lack of independent housing. Some participants reported that financial dependence contributed to their perception of themselves as a burden on their children and influenced the decision to enter a nursing home. From the children’s perspective, six subcategories were identified. The first was mood and behavioral problems of the older adult, including verbal hostility, irritability, repeated conflicts with family members, physical aggression, stubbornness, poor impulse control, and excessive talking.
The second was age-related problems, including refusal to take medication, repeated demands for medical visits, and difficulty maintaining standards of personal or religious cleanliness. The third subcategory was lack of cooperation from other family members in caregiving, including a spouse’s unwillingness to live with the older adult, fear that caregiving might disrupt the nuclear family, lack of support from siblings, and being an only child. The fourth was physical inability of family members to provide care, particularly when the caregiver or other family members were themselves affected by illness or reduced physical capacity. The fifth subcategory involved inability to meet the practical and financial demands of caring for the older adult, including unsuitable housing, being the sole caregiver, employment-related demands, and inadequate financial resources. The final subcategory was painful past experiences with the older adult, including previous mistreatment of family members, abuse of the other parent, and current feelings of aversion or resentment toward the older adult.



Conclusion
The findings indicate that nursing home placement is a complex and multidimensional phenomenon shaped by financial, relational, behavioral, physical, and caregiving-related factors. Older adults primarily emphasized their children’s limited caregiving resources, loss of respect within the family, and their own financial vulnerability. In contrast, children more frequently referred to the older adult’s behavioral and age-related difficulties, lack of cooperation among family members, physical limitations of caregivers, financial and practical caregiving pressures, and unresolved painful experiences in the parent–child relationship. Despite these differences, the two perspectives also converged in important areas, particularly regarding financial limitations, caregiving capacity, and difficulties within family relationships. The findings suggest that reducing unnecessary nursing home placement requires attention to both older adults and their family caregivers. Families may benefit from psychological preparation for later-life caregiving, greater sharing of caregiving responsibilities among family members, financial planning for old age, and improved access to supportive and home-based services. The findings also highlight the importance of preparing individuals for old age before significant dependency develops. Educational and supportive programs for older adults and their children may improve mutual
understanding, increase caregivers’ resilience, and reduce family tensions associated with long-term care. At the social level, policies that provide financial, psychological, and healthcare support to older adults and family caregivers may help reduce some of the pressures that contribute to nursing home placement.
Ethical Consideration
Ethical Code
Permission to conduct the study was obtained from Islamic Azad University, Khorasgan Branch. Before the interviews, the purpose of the study was explained to the participants, and their consent to participate was obtained. Participant confidentiality was maintained by using identification codes rather than personal information.
Funding
This study received no external funding.
Authors’ Contributions
Z.Y: Project administration, supervision, conceptualization, methodology, and validation. A.M: Formal analysis, data collection, and data curation. F.D: Conceptualization, methodology, formal analysis, data collection, and software.  Z.K.P: Methodology, writing-original draft, and writing-review and editing.
Conflict of Interest
The author had no conflicts of interest.
Acknowledgments
The authors sincerely thank all participants and the nursing home staff who contributed to the completion of this study.
 
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