Introduction
Today, a large part of people with schizophrenia have family caregivers. Stressful factors in caregivers of patients with schizophrenia are different and more than in caregivers of patients with other chronic diseases. Elderly parents often take care of adult patients with schizophrenia. These parents, who are in charge of taking care of their family members and managing their health, cannot take good care of their children with schizophrenia due to their age and physical conditions. Therefore, they have to carry a high care burden, which can lead to their poor health. Constant parenting exposes elderly parents to health risks, social exclusion and mental care burden. The present study aims to investigate the lived experiences of Iranian elderly parents having an adult child with schizophrenia.

Methods
This is a qualitative, descriptive, phenomenological study. Sixteen parents of adults with schizophrenia were selected using a purposive sampling method from the Association for the Support of Patients With Schizophrenia (AHEBBA) and Razi Psychiatry Hospital in Tehran, Iran in 2020-2021. Inclusion criteria were at least 60 years of age, willingness to participate in the research, providing childcare for at least one year, and not having a severe mental disorder at the time of the study. In-depth and semi-structured interviews were conducted for 60-90 minutes to identify the main concepts and themes. The interviewer had no contact with the participants before the research. The interview was conducted face-to-face and individually. Each interview was recorded and transcribed verbatim. In the transcriptions, numerical codes were used instead of participants' names to record data. The initial coding was done by the interviewer and the first author and the classification and checking of the codes was done by two members of the research team. Data collection continued until reaching data saturation. Colaizzi's 7-step approach was used in the analysis process. The four criteria of credibility, confirmability, dependability, and transferability proposed by Lincoln and Guba were used to evaluate the accuracy and strength of the data.

Results
The age range of parents was 60-79 years and their mean age was 66.75 years. The results of the analyzing the interviews led to the extraction of four main themes and 11 sub-themes which are listed in Table 1. 



Emotional burden 
The theme of emotional burden included the sub-themes of “endless fear and worry”, “regret and shame”, and “sadness and anger”. The sub-theme endless fear and worry included the concepts of "fear of harming the patient", "worry about the child's future" and "feeling of danger and insecurity". The sub-theme " regret and shame" included three concepts: "Feeling sorry for the child’s conditions", "guilt and regret" and "embarrassment and shame". Finally, the sub-theme "sadness and anger" included four sub-categories: "Sad and angry about the child's illness", " annoyance about the reactions of people and society", "sad and angry about the child's behaviors" and " frustration of incurability and inconclusiveness".

Caring burden
The theme of caring burden included the sub-themes of “impaired social and family relationships”, “helplessness and ineffective support”, and “challenges of the healthcare system”. The sub-theme of impaired social and family relationships included three concepts: "Conflict of family members and caregivers with the patient", "conflict between caregivers and family members" and "limited interactions of caregivers with family and relatives". The sub-theme of helplessness and ineffective support included the two concepts of "insufficient support from governmental institutions" and "insufficient support from family and relatives". Finally, the sub-theme of challenges of the healthcare system included three concepts: "Poor knowledge of caregivers", "limited access to services" and "inefficient services of specialists".

Optimal and effective care
The theme of optimal and effective care included the sub-themes of “purposeful effort for the child's recovery” and “commitment and responsibility”. The sub-theme of the purposeful effort for the child's recovery included the two concepts of "regular follow-up of the treatment for the child" and "paying attention to the child's activity and free time". The sub-theme of commitment and responsibility included the two concepts of "performing caring duties" and "caregiver’s sacrifice and dedication".

Coping strategies
The theme of coping strategies included the sub-themes of “spiritual coping strategy”, “adaptive psychological strategies”, and “maladaptive psychological strategies”. The sub-theme of spiritual coping strategy included the three concepts of "performing religious rituals", "trusting and maintaining the relationship with God" and "believing in fate and destiny". The sub-theme of adaptive psychological strategies included three main concepts: "Doing daily activities", "acceptance of the child’s disease and tolerancing it" and "positive attitude and hope for the child's recovery". The sub-theme of maladaptive psychological strategies included three concepts: "Complaining about people and officials", " complaining about God" and "ineffective comparison".

Conclusion
For elderly parents, caring for an adult child with schizophrenia is burdensome and have adverse psychological consequences such as fear and worry, regret and shame, and sadness and anger. Family conflicts, social isolation, not receiving support from the government and relatives, having to tolerate the care burden alone, problems with insurance and treatment, the inefficiency of health facilities, and the low knowledge of specialists are among the other experiences of elderly parents in caring for their adult children with schizophrenia. Elderly parents have an effective role in helping treatment and recovery of children, paying attention to the children’s work and sports activities, having a committed behavior in performing care duties, and sacrifice in meeting their own needs and the needs of their children. These parents use both adaptive and maladaptive psychological strategies, as well as spiritual coping strategy to cope with the caring problems. Compared to the family caregivers of other patients, elderly parents, due to their age and physical conditions, need more organized attention in terms of assessing their physical and psychological condition, financial support, and addressing their needs and expectations.

Ethical Considerations

Compliance with ethical guidelines
The present study was approved by the Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (Code: IR.USWR.REC.1398.122). Elderly parents participated in the study by signing an informed consent form. Informing the participants about the goals of the research, confidentiality of identity information, having the right to withdraw from the research and other ethical requirements related to the research were fully observed.

Funding
This article is a part of the findings of the PhD dissertation of Mehdi Sharifi, approved by Department of Counseling, University of Social Welfare and Rehabilitation Sciences.

Authors' contributions
All authors participated in the preparation and writing of the article.

Conflicts of interest
The authors declared no conflicts of interest.

Acknowledgements
The authors would like to sincerely appreciate the efforts of the University of Social Welfare and Rehabilitation Sciences, the Association for the Support of Patients With Schizophrenia (AHEBBA), Razi Psychiatric Hospital in Tehran and elderly parents for their collaboration.