Extended Abstract
1. Objectives
The burden of chronic diseases increases with age, which subsequently calls for long-term care [1]. In most parts of the world, the aged women population is higher than that of men, and they are more likely to be sent to nursing homes compared to older men [2]. Moving to residential care homes has been reported as one of the hardest experiences of the elderly and their caregivers. Such transition can cause different degrees of depression and loss of social support in the elderly [3].
Nursing home is the most important residential area for some of the elderly groups. However, it is generally necessary to recognize the reason for choosing to live in these care homes. By this knowledge, we can use preventive and treatment methods and services to help the elderly women stay the longest possible in their own houses.

2. Methods and Materials
This qualitative research used content analysis approach. Samples were selected using purposeful sampling method among the elderly women living in nursing homes in Tabriz City, Iran. The study data were performed through semi-structured and face-to-face interview with the participants. Inclusion criteria were being ≥60 years old, having cognitive abilities according to a short cognitive test result, willingness to express attitudes about the research objective, and the having able to speak and participate in interviews. Those with cognitive problems and related diseases and younger than 60 years were excluded from the study.
The process of sample selection continued until the saturation of data. Eventually, 13 elderly women aged 60-91 years were selected. Duration of their stay in nursing homes ranged from 5 months to 10 years. Required descriptions of the goals and importance of the research were provided to the study participants. After obtaining consent forms, the time and place of the interview was determined by the subjects. The interview environment was comfortable enough for recording a high quality sound. The participants were assured of the confidentiality of their information. They were able to withdraw from the study as desired. This study was approved by the Ethics Committee of Tabriz University of Medical Sciences.

3. Results
Two main concepts were identified as key factors associated with the causes of elderly women living in nursing homes; “underlying factors” and “situational factors”. Elderly women reported several problems that deprived them of participation in the community and home chores. Such factors included financial problems, unwanted marriage, inconvenience, negligence, falls, accidents, illness, loneliness, and emotional problems.
Age, gender, career, and income level were considered as the demographic characteristics. Despite having different lifestyles, these factors almost had the same effect on the subjects. Considering these factors, the elderly prefer to live in nursing homes which can help reduce their stress. Family factors were related to the needs and conditions of the elderly in recent years. Living conditions and the unfulfilled needs of the elderly women through many years were the causes of staying in nursing homes. In other words, such conditions were the facilitators of living in nursing homes. But appropriate living conditions, family/children and even grandchildren support, a dynamic lifestyle, feeling of usefulness, self-care ability, lack of loneliness, attachment style, etc. were reasons for staying at their own homes.
This can increase their life satisfaction and their quality of life. On the other hand, lack of the aforementioned conditions along with unwanted marriage, inconvenience, and negligence were the reasons for staying in nursing homes. According to the obtained data, the subcategories of accidents, falls, and acute illnesses were extracted from the “accidental” dimension. In this regard, the most reported causes were the lack of caregiver and inability to self-care. Under “imposed” dimension, some subjects reported enforced factors and decisiveness as their reasons for living in nursing homes.
Enforced living in nursing homes was among the factors affecting their depression. With respect to “voluntary” dimension, the benefits of living in nursing homes were reported. Elderly women are transferred to nursing homes after years of living with family, friends or relatives. Soon after feeling lonely or experiencing emotional problems, the lack of partner or security, the lack of caregiver, inability to cook, self-care inability, etc., they were admitted to nursing homes. Such places can improve their physical conditions and their quality of life.

4. Conclusion
Lack of support, bio-psychological factors, low literacy and celibacy were among the main reasons of elderly women in Tabriz to live in nursing homes. It is necessary to empower the elderly in care centers and achieve the most possible healthy aging and maintaining the elderly’s contact with community. Thus, further studies on social factors and those introduced in this research at a national level and in different cultural contexts seems necessary. It also seems that the services needed to accommodate the elderly woman in the current and desired houses (such as home care services at different levels, supportive and social services, and companionship services) should be integrated with the health system.

Ethical Considerations
Compliance with ethical guidelines
This paper has been approved by Tabriz University of Medical University. The research goal and process were explained to the participants and they were assured of the confidentiality of their information. They were free to quit the study at any time.

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

Authors contributions
Conceptualization, validation: Hossein Matlabi, Mehdi Abbasian, and Mehdi Nakhodaeezah; Methodology: Reza Fadayevatan and Hossein Matlabi; Formal analysis: Hosein Matlabi and Mehdi Abbasian; Investigation, resources, and draft preparation: Mehdi Abbasian, Shamsedin Namjoo, and Mehdi Nakhodaeezah; Editing: Hossein Matlabi; Visualization, supervision, and project administration: Hossein Matlabi and Reza Fadayevatan; and Funding acquisition: Hossein Matlabi and Mehdi Abbasian.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgements
Authors would like to thank authorities and personnel of the study nursing home for their valuable cooperation.



 

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