Identifying and evaluating the challenges of geriatric healthcare service provision in Iran: evidence from a mixed-methods study.

The increase in the elderly population is associated with an increase in the demand for healthcare services (HCSs). It is, therefore, crucial to gain an in-depth insight into the geriatric healthcare services (GHCSs) provided for older adults in order to improve such services and tailor them to the needs of this age group. This study aimed to identify and assess the challenges of GHCS provision in Iran. This is a mixed-methods study conducted in 2024 in three phases: (1) a qualitative study to explore key challenges, (2) the fuzzy Delphi method (FDM) to validate and prioritize the challenges identified in the qualitative phase, and (3) the fuzzy Failure Modes and Effects Analysis (FMEA) to assess the severity, occurrence, and detectability of these challenges. Data were collected using semi-structured interviews and questionnaires. The study population consisted of 22 geriatric healthcare experts, 10 elderly individuals, and 3 caregivers, selected through purposive and snowball sampling. Experts contributed to all three phases of the study, while elderly participants were included in the qualitative phase to provide firsthand experiences of GHCSs. Data were analyzed using latent content analysis, FDM, and FMEA approaches. The findings of the first phase were extracted using MAXQDA2020 software, while the second and third phases were analyzed using Excel 2016. Content analysis of interviews in the first phase led to the extraction of six main themes and 47 sub-themes, including: (1) educational challenges, (2) challenges related to facilities, infrastructure, and workforce capacity (3) financial challenges, (4) supervision-related challenges, (5) challenges related to the personal problems of the elderly, and (6) service-related challenges. Based on the findings of the FDM and FMEA phases, the most critical challenges include: limited insurance coverage, lack of coordination between the Ministry of Health and Medical Education and the State Welfare Organization, inadequate budget allocation, workforce shortages and unequal distribution, insufficient facilities for geriatric care, lack of a practical model for primary healthcare, and non-implementation of the National Policy Document on Ageing, among others. The geriatric healthcare system in Iran is facing a wide range of interconnected and systemic challenges. This study provides an evidence-based prioritization of these challenges using FDM and FMEA, highlighting the area's most in need of reform. Policymakers should use these findings to design targeted strategies that address structural, financial, and operational deficiencies in elderly care services.