Introduction
In late 2019, the number of COVID-19 cases and deaths increased significantly in Iran. Therefore, the Ministry of Health and Medical Education decided on nationwide quarantine and lockdown of the country in 2020 and 2021 [1-4]. One of the vulnerable groups during the Covid-19 pandemic was the elderly. Since a very large population of Iran are aged people and considering that restrictions made by the government for various periods subjected them to additional mental, psychological and physical pressures, this study aims investigate the lived experiences of the elderly during the COVID-19 pandemic in Iran in 2021-2022.

Methods
This study was conducted from October 1, 2021 to January 30, 2022 in Fars, Kermanshah and Tehran provinces of Iran. The information was collected through in-depth semi-structured interviews with the elderly about their experiences in facing COVID-19 and staying at home. Questions were: “How was your experience in facing with pandemic and quarantine?” and “what problems did you face during the pandemic?” Based on their answers, follow-up questions were also asked. The sampling method was purposive. Older people who were rich in the information were selected. In this regard, 16 interviews were conducted. To ensure the strength of qualitative data, Lincoln and Guba’s criteria (trustworthiness, transformability, dependability, and confirmability) were used [1]. The data were analyzed by using Smith’s interpretative phenomenology analysis.

Results 
Of 16 participants, 9 were male and 7 were female with a mean age of 73 years, ranged 65-82 years. The lived experiences of the elderly during the pandemic in Iran were presented in three main themes: Psychological tensions, resilience (healing), and economic tensions (Table 1).


Psychological tensions included Sadness, feeling the end of life, fear, stress, pessimism, use of sleeping pills, insomnia, denial of illness, loneliness, anger, fear of what people say, despair, and confusion. A 62-year-old woman expressed her discomfort during the pandemic: “I was very sad those days. I kept saying to myself why is it like this? I wished to see my children. When my children were at work, I was worried that they might not be careful and get coronavirus. I was very sad that people were dying all over the world”. A 65-year-old woman expressed her feelings of fear and despair: “I was thankful that my children were healthy and calling me. I was hopeful! I didn’t say that there is no coronavirus, but I know that life and death are in the hands of God. No one will die unless God wills it. My son-in-law was a worker and had financial problems in those days! I was very sad for him”. A 74-year-old woman expressed her feelings of fear: “Every morning when I woke up, I thought I got coronavirus! At first, I had a fear to go to our own yard. I could sleep at night only after using sleeping pills. I don’t like to think about those days! it was like a prison! I was always praying that a medicine would be found soon and the disease would go away”.

Conclusion
The results of this study showed that the lived experiences of the elderly during the COVID-19 epidemic in Iran fall into the three main themes of psychological tensions, resilience (healing) measures, and economic tensions. It is recommended to provide information and motivation to the elderly through telephone counseling. The families who have elderly people should be given the necessary information regarding their care and maintenance during this period. Given that severe restrictions such as social distancing and quarantine measures increased concerns about the mental health of the elderly, it is very important to analyze and identify psychological concepts and protective factors and develop practical guidelines to protect the mental health of the elderly during the pandemic. 

Ethical Considerations
Compliance with ethical guidelines
This project is approved by Shiraz University of Medical Sciences (Code: IR.SUMS.REC.1401.036).

Funding
This project was partly supported by Shiraz University of Medical Sciences (Grant No.: 24402).

Authors' contributions
Conceptualization and study design: Rita Rezaee and Milad Ahmadi Marzaleh; Drafting the manuscript, analysis of the data, supervision and final approval: All authors

Conflicts of interest

Acknowledgements
The authors would like to thank Afsaneh. Keivanshekouh at the Research Consultation Center (RCC) of Shiraz University of Medical Sciences for her invaluable assistance in editing the manuscript.

References

1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020; 395(10223):497-506. [DOI:10.1016/S0140-6736(20)30183-5] [PMID]
2. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. The Lancet. 2020; 395(10223):507-13. [Link]
3. Peyravi M, Soltani A, Ahmadi M, Marzaleh MA. Iran coping experiences with covid-19: Strategies and recommendations. Disaster Medicine and Public Health Preparedness. 2022; 16(3):845-6. [DOI:10.1017/dmp.2020.441] [PMID] [PMCID]
4. Peyravi M, Dehbozorgi M, Ahmadi Marzaleh M. Two-week lockdown in iran due to COVID-19: Impacts, challenges, and recommendations. Disaster Medicine and Public Health Preparedness. 2022; 16(4):1313-4. [DOI:10.1017/dmp.2021.28] [PMID] [PMCID]
5. Cravello L, Martini E, Viti N, Campanello C, Assogna F, Perotta D. Effectiveness of a family support intervention on caregiving burden in family of elderly patients with cognitive decline after the covid-19 lockdown. Frontiers in Psychiatry. 2021; 12:590104. [DOI:10.3389/fpsyt.2021.590104] [PMID] [PMCID]
6. Pisula P, Salas Apaza JA, Baez GN, Loza CA, Valverdi R, Discacciati V, et al. A qualitative study on the elderly and mental health during the COVID-19 lockdown in Buenos Aires, Argentina-Part 1. Medwave. 2021; 21(4):e8186. [PMID]
7. Loza CA, Baez G, Valverdi R, Pisula P, Salas Apaza J, Discacciati V, et al. A qualitative study on the elderly and accessibility to health services during the COVID-19 lockdown in Buenos Aires, Argentina-Part 2. Medwave. 2021; 21(4):e8192. [PMID]
8. Sayin Kasar K, Karaman E. Life in lockdown: Social isolation, loneliness and quality of life in the elderly during the COVİD-19 pandemic: A scoping review. Geriatric Nursing (New York, N.Y.). 2021; 42(5):1222-19. [PMID]
9. Larkin M, Flowers P, Smith JA. Interpretative phenomenological analysis: Theory, method and research. Newcastle upon Tyne: Sage; 2021. [Link]
10. Jeong H, Othman J. Using interpretative phenomenological analysis from a realist perspective. The Qualitative Report. 2016; 21(3):558-70. [DOI:10.46743/2160-3715/2016.2300]
11. Schwandt TA, Lincoln YS, Guba EG. Judging interpretations: But is it rigorous? Trustworthiness and authenticity in naturalistic evaluation. New Directions for Evaluation. 2007; 2007(114):11-25. [DOI:10.1002/ev.223]
12. Banerjee D. The impact of Covid‐19 pandemic on elderly mental health. International Journal of Geriatric Psychiatry. 2020; 35(12):1466-7. [DOI:10.1002/gps.5320] [PMID] [PMCID]
13. Naeim M, Rezaeisharif A, Kamran A. COVID-19 has made the elderly lonelier. Dementia and Geriatric Cognitive Disorders Extra. 2021; 11(1):26-8. [DOI:10.1159/000514181] [PMID] [PMCID]
14. Girdhar R, Srivastava V, Sethi S. Managing mental health issues among elderly during COVID-19 pandemic. Journal of Geriatric Care and Research. 2020; 7(1):32-5. [Link]
15. Yildirim H, Işik K, Aylaz R. The effect of anxiety levels of elderly people in quarantine on depression during covid-19 pandemic. Social Work in Public Health. 2021;36(2):194-204. [DOI:10.1080/19371918.2020.1868372] [PMID]
16. Lee K, Jeong GC, Yim J. Consideration of the psychological and mental health of the elderly during COVID-19: A theoretical review. International Journal of Environmental Research and Public Health. 2020; 17(21):8098. [DOI:10.3390/ijerph17218098] [PMID] [PMCID]
17. Naghavi A. [The opporttunity and threats of COVID-19: Lessons from the perspective of older adults (Persian)]. Journal of Family Research. 2021; 16(4):439-52. [Link]
18. Moradi M, Navab E, Sharifi F, Namadi B, Rahimidoost M. [The effects of the covid-19 pandemic on the elderly: A systematic review (Persian)]. Salmand: Iranian Journal of Ageing. 2021; 16(1):2-29. [DOI:10.32598/sija.16.1.3106.1]
19. Cohen G, Russo MJ, Campos JA, Allegri RF. COVID-19 epidemic in Argentina: Worsening of behavioral symptoms in elderly subjects with dementia living in the community. Frontiers in Psychiatry. 2020; 11:866. [DOI:10.3389/fpsyt.2020.00866] [PMID] [PMCID]