Introduction
Intergenerational relationships are an integral part of the culture in a society. These relationships are defined and valued by the society’s culture and are referred to interactions between individuals or groups with different ages that may be family or social members. These relationships are not limited to the family; they have spread to other social structures. In nursing homes, intergenerational relationships are of particular importance because people of different ages and generations interact with each other. Studies indicate that positive intergenerational relationships have many health and social benefits. Healthcare workers, including nurses, can greatly cover intergenerational relationships in the form of care provided to the elderly. Despite the importance of intergenerational relationships in the elderly, their challenges in nursing homes have not been well studied. This study aims to identify the process of intergenerational relationships in nursing homes in Iran.
Methods
This is an applied exploratory study that was conducted in three nursing homes in Tehran, Iran using the grounded theory method. The participants were 13 elderly residents (8 men and 5 women) and 8 employees working in nursing homes (5 nurses, 1 supervisor, 1 psychologist and 1 nursing home manager) who were selected using a purposive sampling method. The data were collected using semi-structured interviews until data saturation and sorted by constant comparative method. Data analysis was done concurrently with data collection by the main researcher (first author) through the stages of open coding, axial coding and selective coding.
Data analysis was done using the qualitative content analysis method of Graneheim and Lundman [23]. In this way, each interview was first transcribed and read several times and analyzed before conducting the next interview. During open coding, the researchers identified, labeled and conceptualized the phenomena experienced by the participants by reading the transcribed data line by line. The researchers then classified the data according to their similarities and dissimilarities. During axial coding, the relationship between classes resulted from open coding was developed in terms of dimensions and features and then conceptualized. In selective coding, hypothetical statements were collected to comprehensively explain the process of intergenerational relationships between the nursing home staff and elderly residents.
Results
The results of analysis using Strauss and Corbin’s grounded theory led to the identification of 5 categories. “Intergenerational tensions” was the first and main category. This variable reflects the views of the participants about the process of intergenerational relationships in nursing homes. The causal condition for this variable was titled “Tensions based on psychological factors” which included: Neglecting individual identity, contradictory behaviors of professional ethics, values affected by the dominant value system in a society, and ageist attitudes. The “defective platform of intergenerational relationships” was the title of contextual factors provided the necessary background for establishing relationships between nursing home residents and staff which included: challenging nature of geriatric care, conflicting characteristics of the caregiver, static culture of the nursing home, and maladaptive traits. Intervening factors that affected the process of intergenerational relationships and facilitated it were communication and support networks for the elderly, organizational policies, and individual components while the intervening factors that limited intergenerational relationships were the non-productive functioning of the society and lack of support by the organization. The elderly used strategies to relieve tension and preserve their existence in the nursing home which was titled “Efforts to preserve existence” and included: Developing and strengthening peaceful interactions and withdrawal/isolation. Consequences of intergenerational relationships in the elderly and staff was titled “Living with insecurity” and included: Improved quality of life (QoL) and social isolation.
Discussion
Data analysis showed that the main concern of the elderly in nursing homes was intergenerational tensions. Preservation of existence was the starting point of the process of intergenerational relationships in the elderly. Hence, it can be said that the nursing home older residents try to build and establish relationships with the staff with the belief in preserving existence. Generational differences between nursing home residents and staff make it difficult to establish effective relationships between them leading to poor quality care. The findings of the present study can help better understand the factors affecting the process of intergenerational relationships in nursing homes and help nursing home managers to use strategies to remove barriers and improve these relationships and create greater cohesion between generations so that it can lead to the possibility of better care and subsequently improved QoL. 

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of the University of Social Welfare and Rehabilitation Sciences (Code: IR.USWR.REC.1397.003). Informed consent was obtained from the participants and they were free to leave the study at any time and were assured of the confidentiality of their information.

Funding
This study was extracted from a PhD thesis in nursing.

Authors' contributions
Conceptualization: Mahboubeh Dakhteh Harouni; investigation: All authors; editing & review: All authors.

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgements
The authors would like to thank the Vice-Chancellor for Research of the University of Social Welfare and Rehabilitation Sciences, the staff of nursing homes, and all seniors participated in this study for their support and cooperation

References

1. Muia DM, Maina LW, Mwangi SM. Changing intergenerational relationships and their implications on family structure and functioning in Africa. International Journal of Education and Research. 2013; 1(10):1-10. [Link]
2. De Jager HA. A group of adolescents’ experiences of care in relationships with older people in a resource-constrained environment [PhD dissertation]. North-West: North-West University; 2014. [Link]
3. Nortje D. Young people’s perceptions of older people before and after an ethnodrama presentation [PhD dissertation]. North-West: North-West University; 2013. [Link]
4. Spangenberg M. Older people’s experiences of the Grandparent-Grandchild (GP-GC) relationship in the contemporary South African context. North-West: North-West University; 2018. [Link]
5. Santini S, Tombolesi V, Baschiera B, Lamura G. Intergenerational programs involving adolescents, institutionalized elderly, and older volunteers: Results from a pilot research-action in Italy. BioMed research international. 2018; 2018:4360305. [DOI:10.1155/2018/4360305] [PMID] [PMCID]
6. Lipscomb VG. Intergenerational issues in nursing: Learning from each generation. Clinical Journal of Oncology Nursing. 2010; 14(3):267-9. [DOI:10.1188/10.CJON.267-269] [PMID]
7. Lee DT, Yu DS, Kwong AN. Quality of life of older people in residential care home: A literature review. Journal of Nursing and Healthcare of Chronic Illness. 2009; 1(2):116-25. [DOI:10.1111/j.1752-9824.2009.01018.x]
8. Custers AF, Westerhof GJ, Kuin Y, Gerritsen DL, Riksen-Walraven JM. Relatedness, autonomy, and competence in the caring relationship: The perspective of nursing home residents. Journal of Aging Studies. 2012; 26(3):319-26. [DOI:10.1016/j.jaging.2012.02.005]
9. Bell JA. Five generations in the nursing workforce: Implications for nursing professional development. Journal for nurses in professional development. 2013; 29(4):205-10. [DOI:10.1097/NND.0b013e31829aedd4] [PMID]
10. Venter E. Bridging the communication gap between Generation Y and the Baby Boomer generation. International Journal of Adolescence and Youth. 2017; 22(4):497-507. [DOI:10.1080/02673843.2016.1267022]
11. Drury L, Abrams D, Swift HJ, Lamont RA, Gerocova K. Can caring create prejudice? An investigation of positive and negative intergenerational contact in care settings and the generalisation of blatant and subtle age prejudice to other older people. Journal of Community & Applied Social Psychology. 2017; 27(1):65-82. [DOI:10.1002/casp.2294] [PMID] [PMCID]
12. Ahmadi Y, Hamed B. [The study of situation of differences between generations on relationship’s generation continuum (case study Kermanshah city) (Persian)]. Journal of Applied Sociology, 2011; 22(2): 185-208. [Link]
13. Njuguna V, Kariuki D. Role of communication competence in elderly care: A carers’ perspective [MSc. thesis]. Helsinki: Arcada University; 2012. [Link]
14. Gallagher S, Bennett KM, Halford JC. A comparison of acute and long‐term health‐care personnel’s attitudes towards older adults. International Journal of Nursing Practice. 2006; 12(5):273-9. [DOI:10.1111/j.1440-172X.2006.00582.x] [PMID]
15. Kydd A, Wild D. Attitudes towards caring for older people: literature review and methodology. Nursing Older People. 2013; 25(3):22-7. [DOI:10.7748/nop2013.04.25.3.22.e769] [PMID]
16. Williams K, Kemper S, Hummert ML. Improving nursing home communication: An intervention to reduce elderspeak. The Gerontologist. 2003; 43(2):242-7. [DOI:10.1093/geront/43.2.242] [PMID]
17. Riedl M, Mantovan F, Them C. Being a nursing home resident: A challenge to one’s identity. Nursing research and practice. 2013; 2013:932381. [DOI:10.1155/2013/932381] [PMID] [PMCID]
18. Jadidi A, Farahaninia M, Janmohammadi S, Haghani H. [Quality of life for elderly residents in nursing home (Persian)]. Iran Journal of Geriatric Nursing. 2015; 2(1):9-18. [Link]
19. Nejati V, Ashayeri H. [Health related quality of life in the elderly in Kashan (Persian)]. Iranian Journal of Psychiatry and Clinical Psychology. 2008; 14(1):56-61. [Link]
20. Habibi S, Nikpour S, Sohbatzadeh R, Haghani H. [Quality of life in elderly people of west of Tehran (Persian)]. Iranian Journal of Nursing Research. 2008; 2(6-7):29-35. [Link]
21. Vanderven K. Intergenerational theory in society: Building on the past, questions for the future. Journal of Intergenerational relationships. 2004; 2(3-4):75-94. [DOI:10.1300/J194v02n03_07]
22. Polit DF, Beck CT. Essentials of nursing research: Appraising evidence for nursing practice. Philadelphia: Lippincott Williams & Wilkins; 2009. [Link]
23. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse education today. 2004; 24(2):105-12. [DOI:10.1016/j.nedt.2003.10.001] [PMID]
24. Speziale HS, Streubert HJ, Carpenter DR. Qualitative research in nursing: Advancing the humanistic imperative. Philadelphia: Lippincott Williams & Wilkins; 2011. [Link]
25. Paddock K. The impact of the transition to a care home on residents’ sense of identity [PhD dissertation]. Manchester: The University of Manchester; 2016. [Link]
26. Wahab P, Din SU, Pasha K, Ahmed M, Hussain M, Khan J. A generation gap between children and their parents in Pashtun community Buner District, Khyber Pakhtunkhwa, Pakistan. Masyarakat, Kebudayaan dan Politik. 2022; 35(1):1-13. [DOI:10.20473/mkp.V35I12022.1-13]
27. Najafiasl Z. [Intergenerational gap: An emerging phenomenon in Iran (Persian)]. International Journal of Social Sciences. 2015; 5(1):59-70. [Link]
28. Ocakli BÖ, Yalçin B. Perception of intergenerational conflict in Turkey. OPUS International Journal of Society Researches. 2021; 17(33):67-94. [DOI:10.26466/opus.818458]
29. Arani MM, Aazami S, Azami M, Borji M. Assessing attitudes toward elderly among nurses working in the city of Ilam. International Journal of Nursing Sciences. 2017; 4(3):311-3. [DOI:10.1016/j.ijnss.2017.06.009] [PMID] [PMCID]
30. Cooper SA, Coleman PG. Caring for the older person: an exploration of perceptions using personal construct theory. Age and Ageing. 2001; 30(5):399-402. [DOI:10.1093/ageing/30.5.399] [PMID]
31. Ben-Harush A, Shiovitz-Ezra S, Doron I, Alon S, Leibovitz A, Golander H, et al. Ageism among physicians, nurses, and social workers: Findings from a qualitative study. European journal of Ageing 2017; 14(1):39-48. [DOI:10.1007/s10433-016-0389-9] [PMID] [PMCID]
32. Paddock K, Brown Wilson C, Walshe C, Todd C. Care home life and identity: A qualitative case study. Gerontologist. 2019; 59(4):655-64. [DOI:10.1093/geront/gny090] [PMID] [PMCID]
33. Sun C, Ding Y, Cui Y, Zhu S, Li X, Chen S, et al. The adaptation of older adults’ transition to residential care facilities and cultural factors: a meta-synthesis. BMC geriatrics. 2021; 21(1):64. [DOI:10.1186/s12877-020-01987-w] [PMID] [PMCID]
34. Ball MM, Whittington FJ, Perkins MM, Patterson VL, Hollingsworth C, King SV, et al. Quality of life in assisted living facilities: Viewpoints of residents. Journal of Applied gerontology. 2000; 19(3):304-25. [DOI:10.1177/073346480001900304]
35. Vitorino LM, Low G, Vianna LAC. Linking spiritual and religious coping with the quality of life of community-dwelling older adults and nursing home residents. Gerontology and geriatric medicine. 2016; 2:2333721416658140. [DOI:10.1177/2333721416658140] [PMID] [PMCID]
36. Malone J, Dadswell A. The role of religion, spirituality and/or belief in positive ageing for older adults. Geriatrics. 2018; 3(2):28. [DOI:10.3390/geriatrics3020028] [PMID] [PMCID]
37. Kwame A, Petrucka PM. Communication in nurse-patient interaction in healthcare settings in sub-Saharan Africa: A scoping review. International Journal of Africa Nursing Sciences. 2020; 12:100198. [DOI:10.1016/j.ijans.2020.100198]
38. Strauss A, Corbin JM. Basics of qualitative research: Techniques and procedures for developing grounded theory. New York: Sage; 1998. [Link]
39. Monnapula-Mazabane P. Young adult males’ experiences of relationships with older persons in an economically deprived community in the North West Province [MSc. thesis]. Washington: NorthWest University; 2014. [Link]
40. Kimondo J. Benefits and challenges experienced by elderly living in nursing homes. Helsinki: Arcada-Nylands svenska yrkeshögskola; 2012. [Link]
41. Babaei S, Taleghani F. Compassionate care challenges and barriers in clinical nurses: A qualitative study. Iranian journal of nursing and midwifery research. 2019; 24(3):213-9. [DOI:10.4103/ijnmr.IJNMR_100_18] [PMID] [PMCID]
42. Okoye UO, Obikeze DS. Stereotypes and perceptions of the elderly by the youth in Nigeria: Implications for social policy. Journal of Applied Gerontology. 2005; 24(5):439-52. [DOI:10.1177/0733464805278648]
43. Mendonça J, Marques S, Abrams D. Children’s attitudes toward older people: Current and future directions. In: Ayalon L, Tesch-Römer C, editors. Contemporary perspectives on ageism. Cham: Springer; 2018. [DOI:10.1007/978-3-319-73820-8_30]
44. Hwang EH, Kim KH. Quality of gerontological nursing and ageism: What factors influence on nurses’ Ageism in South Korea? International Journal of Environmental Research and Public Health. 2021; 18(8):4091. [DOI:10.3390/ijerph18084091] [PMID] [PMCID]
45. Robinson T, Callister M, Magoffin D, Moore J. The portrayal of older characters in Disney animated films. Journal of Aging Studies. 2007; 21(3):203-13. [DOI:10.1016/j.jaging.2006.10.001]
46. Oosterveld-Vlug MG, Pasman HRW, van Gennip IE, Willems DL, Onwuteaka-Philipsen BD. Nursing home staff’s views on residents’ dignity: A qualitative interview study. BMC health Services Research. 2013; 13:353. [DOI:10.1186/1472-6963-13-353] [PMID] [PMCID]
47. Rule BG, Milke DL, Dobbs AR. Design of institutions: Cognitive functioning and social interactions of the aged resident. Journal of Applied Gerontology. 1992; 11(4):475-88. [DOI:10.1177/073346489201100407] [PMID]
48. Grenade L, Boldy D. Social isolation and loneliness among older people: issues and future challenges in community and residential settings. Australian Health Review. 2008; 32(3):468-78. [DOI:10.1071/AH080468] [PMID]
49. Lindbloom EJ, Brandt J, Hough LD, Meadows SE. Elder mistreatment in the nursing home: A systematic review. Journal of the American medical directors association. 2007; 8(9):610-6. [DOI:10.1016/j.jamda.2007.09.001] [PMID]
50. Simkins CL. Ageism’s influence on health care delivery and nursing practice. Journal of Student Nursing Research. 2007; 1(1):5. https://repository.upenn.edu/josnr/vol1/iss1/5/
51. Hyun Shin J. Relationship between nursing staffing and quality of life in nursing homes. Contemporary Nurse. 2013; 44(2):133-43. [DOI:10.5172/conu.2013.44.2.133] [PMID]
52. Banaszak-Holl J, Castle NG, Lin MK, Shrivastwa N, Spreitzer G. The role of organizational culture in retaining nursing workforce. The Gerontologist. 2015; 55(3):462-71. [DOI:10.1093/geront/gnt129] [PMID] [PMCID]
53. Herold-Majumdar A, Marijic P, Stemmer R. Organizational culture empowering nurses and residents in nursing homes. Advances in Social Sciences Research Journal. 2020; 7(10):590-611. [DOI:10.14738/assrj.710.9291]
54. Kariuki JW. Quality of life among the elderly in nursing homes: A literature review [MSc. thesis]. Helsinki: Arcada; 2019. [Link]
55. Kang B, Scales K, McConnell ES, Song Y, Lepore M, Corazzini K. Nursing home residents’ perspectives on their social relationships. Journal of clinical nursing. 2020; 29(7-8):1162-74. [DOI:10.1111/jocn.15174] [PMID] [PMCID]
56. Chuang YH, Abbey JA, Yeh YC, Tseng J, Liu MF. As they see it: A qualitative study of how older residents in nursing homes perceive their care needs. Collegian. 2015; 22(1):43-51. [DOI:10.1016/j.colegn.2013.11.001] [PMID]
57. Sarin K, Punyaapriya P, Sethi S, Nagar I. Depression and hopelessness in institutionalized elderly: A societal concern. Open Journal of Depression. 2016; 5(3):69767. [DOI:10.4236/ojd.2016.53003]
58. Palacios‐Ceña D, Losa‐Iglesias ME, Gómez‐Calero C, Cachón‐Pérez JM, Brea‐Rivero M, Fernández‐de‐las‐Peñas C. A qualitative study of the relationships between residents and nursing homes nurses. Journal of Clinical Nursing. 2014; 23(3-4):550-9. [DOI:10.1111/jocn.12202] [PMID]
59. Dickens AP, Richards SH, Greaves CJ, Campbell JL. Interventions targeting social isolation in older people: a systematic review. BMC Public Health. 2011; 11(1):1-22. [DOI:10.1186/1471-2458-11-647] [PMID] [PMCID]
60. Šare S, Ljubičić M, Gusar I, Čanović S, Konjevoda S. Self-esteem, anxiety, and depression in older people in nursing homes. Healthcare. 2021; 9(8):1035. [DOI:10.3390/healthcare9081035] [PMID] [PMCID]
61. Gurková E. Issues in the definitions of HRQoL. Journal of Nursing, Social Studies, Public Health and Rehabilitation. 2011; 3(4):190. [Link]
62. Adra M. Generating a model of quality of life for older nursing home residents in the Lebanon: A grounded theory study [PhD dissertation]. Manchester: University of Manchester; 2012. [Link]