Introduction
The gradual decline in birth rates and the expansion of primary health care have led to a relative increase in human life expectancy and an increase in the population of people over 60 years of age [1]. Being single increases loneliness. Loneliness can occur in any age group, but it is more common in older adults [9]. Loneliness is a feeling of lack of social contact or an undesirable social relationship [10]. Several factors, including socioeconomic status, being female, older age, and not having children, are significantly associated with feelings of loneliness [15]. Studies show that one of the major social issues is the growing number of single women [18]. To our knowledge, the is lack of studies in Iran on the experiences of loneliness in older women remained permanently single, as one of the most vulnerable groups. In this regard, this qualitative study aimed to explore the experience of loneliness in single older women living in Tehran, Iran.
Furthermore, the researchers have noted a significant gap in studies exploring the experiences of elderly women living alone and the consequences they encounter. Therefore, this study aims to investigate the experience of loneliness from the perspective of elderly single women in Tehran City, Iran.

Methods
This qualitative study was conducted in Tehran, Iran, during 2020–2021. The participants were 23 older women aged 60–70 years, who had never been married and had lived alone for at least one year. Sampling was carried out using the snowball method. The women were recruited from the acquaintances, colleagues (at Iran University of Medical Sciences), and neighbors of the researchers, who met the inclusion criteria. Data were collected through in-depth, semi-structured individual interviews and the collected were analyzed using the conventional content analysis method. The duration of each interview was between 15 to 25 minutes. Data analysis began immediately after each interview, and sampling continued until data saturation was achieved.

Results
After analyzing and coding the data, three main themes emerged. The first main theme was “coping with loneliness”, which had two categories: Using adaptive coping strategies (e.g. seeking support from family members and friends, using social media, shopping, exercise, praying) and using maladaptive coping strategies (e.g. becoming accustomed to loneliness, social isolation, self-blame, and negative thoughts). The second main theme was “the consequences of living alone”, which included two categories: Perceived benefits (e.g. a sense of independence, lack of marital challenges, and peace of mind) and perceived disadvantages of loneliness (difficulties in renting houses as a single woman, feelings of being a burden to family, insomnia and reliance on sleep pills, fear particularly at night; emotional and psychological distress, headaches, and lack of partner support). The third main theme was “the mediators of coping with loneliness”, which had three categories: Social factors, physiological factors, and socioeconomic factors. Social factors included societal attitudes towards unmarried women, continued employment, and concerns about the security of residential buildings. The physiological factors included age and chronic diseases. The socio-economic factors included income level, occupation, and type of home ownership.

Conclusion
Understanding the lived experience of loneliness in older women In Iran remained single can significantly help with identifying their needs and developing appropriate plans to address their concerns and challenges. Interventions should focus on educating them about effective ways to spend their leisure time and using adaptive coping strategies for dealing with loneliness. Emphasizing active aging from an early stage is essential to prevent chronic illnesses in these women. Additionally, greater attention should be given to the economic status of these older women, including the adjustment of their pensions and wages based on the annual inflation rates. Efforts to reduce social stigma and negative attitudes toward older women who remained unmarried for any reason are also crucial.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Iran University of Medical Sciences, Tehran, Iran (Code: IR.IUMS.REC.1399.423). Written informed consent was obtained from all participants, covering the study’s objectives, methodology, permission to record and transcribe interviews, and the right to withdraw at any time. Confidentiality was maintained by replacing names with codes and making results available to participants upon request.



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

Authors' contributions
Conceptualization: Tahereh Dehdari and Hajar Karami Agh Ghaleh; Methodology: Tahereh Dehdari, Hajar Karami Agh Ghaleh, and Avasadat Hosseini; Validation: Tahereh Dehdari and Hajar Karami Agh Ghaleh; Research and review: Hajar Karami Agh Ghaleh; Data Analysis: Tahereh Dehdari, Hajar Karami Agh Ghaleh, and Avasadat Hosseini; Funding: Hajar Karami Agh Ghaleh; Project supervision and management: Tahereh Dehdari; Writing the original draft: Hajar Karami Agh Ghaleh and Avasadat Hosseini; Review and editing: Tahereh Dehdari, Avasadat Hosseini, and Hajar Karami Agh Ghaleh.

Conflicts of interest
The authors declared no conflict of interest.


References

1. Russell J, Flood V, Yeatman H, Mitchell P. Prevalence and risk factors of food insecurity among a cohort of older Australians. The Journal of Nutrition, Health & Aging. 2014; 18(1):3-8. [DOI:10.1007/s12603-013-0339-6]
2. OECD. OECD economic surveys: Belgium 2013. Geneva: United Nations; 2013. [DOI:10.1787/eco_surveys-bel-2013-graph13-en]
3. Abbasian M, Nakhodaeezah M, Namjoo Sh, Khalili Z, Jahangiry L, Fadayevatan R, et al. [Reasons for nursing home placement of older women in Tabriz, Iran: A content analysis (Persian)]. Salmand. 2019; 13(4):406-17. [DOI:10.32598/SIJA.13.4.406]
4. Zanjari N, Sasanipour M. Changes in cause of death among the older adults and its effect on increasing life expectancy in Iran. Iranian Journal of Epidemiology. 2022; 18(1):33-44. [Link]
5. Sharafuddin SH. [A reflection on the issue of women’s celibacy in Iran (Persian)]. Bi-Quarterly Journal of Islamic Studies on Social Injuries. 2020; 1(2):1-22. [Link]
6. Talebpour A, Beiranvand M. [Qualitative study of the consequences of definite celibacy in girls (Persian)]. The Journal of Woman and Family Studies. 2022; 10 (1):10-35. [DOI:10.22051/jwfs.2022.38040.2783]
7. Talebpour A, Beiranvand M. [Investigating the lived experience of permanent celibacy from the perspective of single girls (Persian)]. Quarterly Journal of Women and Society. 2022; 13(51):95-114. [DOI:10.30495/jzvj.2022.30184.3807]
8. Widhowati SS, Chen CM, Chang LH, Lee CK, Fetzer S. Living alone, loneliness, and depressive symptoms among Indonesian older women. Health Care for Women International. 2020; 41(9):984-96. [DOI:10.1080/07399332.2020.1797039]
9. Afshari A, Hashaemi Z. [The relationship between religious exposure and psychological wellbeing with loneliness in the elderly (Persian)]. Aging Psychology. 2019; 5(1):65-75. [DOI:10.22126/jap.2019.1180]
10. Sardollahi A, Khalili Z, Ahmadi khatir M, Mahdavi Shahri M. [Psychology of elderly (Persian)]. Tehran: Jameenegar Publication; 2015. [Link]
11. Heravi Karimooi M, Anoosheh M, Foroughan M, Sheykhi MT, Hajizadeh E, Seyed Bagher Maddah M, et al. [Loneliness from the perspectives of elderly people: A phenomenological study (Persian)]. Iranian Journal of Ageing. 2008; 2(6):410-20. [Link]
12. Dong X, Chen R. Gender differences in the experience of loneliness in US Chinese older adults. Journal of Women & Aging. 2017; 29(2):115-25. [DOI:10.1080/08952841.2015.1080534]
13. Salehi Tilaki E, Ilali ES, Taraghi Z, Mousavinasab N. [The comparative of Loneliness and its related factors in rural and urban elderly people in Behshahr city (Persian)]. Journal of Gerontology. 2019; 4(1):52-61. [DOI:10.29252/joge.3.4.6]
14. Hosseini MR, Hoseynizadeh Arani SS, Mohamadi M. Loneliness in the city: Exploring the lived experience of loneliness and its relation with life satisfaction among adult residents of Tehran city (Persian)]. Urban Studies. 2019; 9(29):26-51. [Link]
15. Vozikaki M, Papadaki A, Linardakis M, Philalithis A. Loneliness among older European adults: Results from the survey of health, aging and retirement in Europe. Journal of Public Health. 2018; 26(6):613-24. [DOI:10.1007/s10389-018-0916-6]
16. Mirdrikvand F, Panahi H, Hoseyni Ramaghani N. [Loneliness of the elderly: The role of communication skills, social support and functional disability (Persian)]. Aging Psychology. 2016; 2(2):103-13. [Link]
17. Cohen-Mansfield J, Eisner R. The meanings of loneliness for older persons. Aging & Mental Health. 2020; 24(4):564-74. [DOI:10.1080/13607863.2019.1571019]
18. Alikarami K, Maleki A, Abdollahyan H, Rezaei M. [Phenomenology of the lived experiences of lonely aged women from abandonment and rejection (Persian)]. Social Welfare Quarterly. 2021; 21(80):231-60. [Link]
19. Sheikholeslami F, Masouleh SR, Khodadadi N, Yazdani MA. Loneliness and general health of elderly. Journal of Holistic Nursing and Midwifery. 2012; 21(2):28-34. [Link]
20. Eman MT, Noushadi MR. [Qualitative content analysis (Persian)]. Pazhuhesh. 2011; 3(2)-15-44. [Link]
21. Shahini N, Asayesh H, Ghobadi M, Sadeghi J. [Correlation between perceived social support and loneliness with life satisfaction among students of Golestan University of Medical Sciences (Persian)]. Pejouhandeh. 2013; 17(6):302-6. [Link]
22. Shahriyari Ahmadi M, Pazoki L, Poor Sadr N. [Relationship between sense of loneliness as well as marital commitment and extent of use of social media in women (Persian)]. The Women and Families Cultural-Educational. 2019; 14(46):95-114. [Link]
23. Nguyen TT, Lee EE, Daly RE, Wu TC, Tang Y, Tu X, et al. Predictors of loneliness by age decade: Study of psychological and environmental factors in 2,843 community-dwelling Americans aged 20-69 years. The Journal of Clinical Psychiatry. 2020; 81(6):15111. [DOI:10.4088/JCP.20m13378]
24. Arslantaş H, Adana F, Abacigil Ergin F, Kayar D, Acar G. Loneliness in elderly people, associated factors and its correlation with quality of life: A field study from Western Turkey. Iranian Journal of Public Health. 2015; 44(1):43-50. [PMID] [PMCID]
25. Jafari A, Behboodi M. [The efficacy of aerobic exercises in reducing loneliness and promoting happiness in elderly (Persian)]. Iranian Journal of Psychiatric Nursing. 2017; 5(5):9-17. [DOI:10.21859/ijpn-05052]
26. Kalantari A, Hoseynizadeharani SS. [City and social relationships: a study of the relationship between social isolation and level of received social support with the experience of loneliness (case study: Tehran residents) (Persian)]. Urban Studies. 2015; 5(16):87-118. [Link]
27. Shamsaei F, Cheraghi F, Esmaeili R, Mohsenifard J. [Explanation of loneliness in the elderly and comparison with psychosocial development theory: A quantitative study (Persian)]. Journal of Education and Community Health. 2014; 1(2):30-8. [DOI:10.20286/jech-010230]
28. Hosseini SH, Izadi Z. [The phenomenology of lived experiences of women over 35 years of age who have never married in Tehran (Persian)]. Women’s Studies Sociological and Psychological. 2016; 14(1):41-72. [DOI:10.22051/jwsps.2016.2332]
29. Imanzadeh A, Alipoor S. [Examining the elderly women’s experiences of loneliness: A phenomenological study (Persian)]. Aging Psychology. 2017; 3(1):31-43. [Link]
30. Vakili M, Mirzaei M, Modarresi M. Loneliness and its related factors among elderly people in Yazd. Elderly Health Journal. 2017; 3(1):10-15. [Link]
31. Macdonald SJ, Nixon J, Deacon L. ‘Loneliness in the city’: Examining socio-economics, loneliness and poor health in the North East of England. Public health. 2018; 165:88-94. [DOI:10.1016/j.puhe.2018.09.003]
32. Yousefzadeh P, Bastani F, Haghani H, Hosseini R. [Loneliness and the contributing factors in the elderly patients with type II diabetes: A descriptive cross-sectional study (Persian)]. Iran Journal of Nursing. 2021; 33(128): 27-39. [DOI:10.52547/ijn.33.128.27]