Introduction
Two earthquakes with magnitudes of 7.7 and 7.6, centered in Kahramanmaraş, devastated much of Turkiye on February 6, 2023.1 An earthquake is a disaster caused by geological/geophysical hazards that has an immediate impact on residents of 11 provinces and an indirect impact on people of all ages nationwide.2 Therefore, even people who were not directly affected by the earthquake were indirectly impacted by what they witnessed in the media, the losses, or the tangible effects.Reference Oz and Cona3
The older people, a vulnerable group, are among those most affected by the effects of the earthquake. The extent of the impact, however, differs based on people’s living circumstances and availability of support networks. Older people in nursing homes, for instance, are more distant from their family members than those who live at home, which can have serious psychological, social, and physical effects. Chronic illnesses, despair, and anxiety can all be brought on by loneliness.Reference Trybusińska and Saracen4, Reference Petitte, Mallow and Barnes5
The transfer of older residents from severely damaged nursing homes in Malatya, Gaziantep, and Hatay to Antalya after the Kahramanmaraş earthquake created a stressful process that made it difficult for older adults to adjust to their new surroundings; the physical and psychological effects of the earthquake, along with pre-existing illnesses, increased vulnerability and decreased well-being.Reference Çakır and Atalay6–Reference Matsuoka, Haseda and Kanamori8 In a similar vein, a qualitative study conducted in Iran found that older people experienced mental distress, insecurity, cruel treatment, and service errors.Reference Ardalan, Mazaheri and Naieni9
Older people who lost their homes after the 2011 earthquake and tsunami in Japan were found to suffer from post-traumatic stress disorder. Older people and their caregivers who were evacuated during the New Zealand earthquake reported anxiety, diminished cognitive function, and communication issues.Reference Heppenstall, Wilkinson and Hanger10 It was reported daytime sleepiness, mistrust of society, diminished social belonging, depressive symptoms, hopelessness, and elevated body mass index.Reference Shiba, Hikichi and Okuzono11 Rather than the severity of the disaster, the effects of earthquakes on older people can vary based on the social, cultural, and economic conditions of the countries.
The physical state of the nursing home, regional and climatic variations, injuries, the extent of damage, and the older residents’ personal values all influence this process. Research on the specific psychological, social, and health effects on older people is scarce, despite the existence of studies in the literature that discuss the experiences of those impacted by earthquakes.Reference Ardalan, Mazaheri and Naieni9–Reference Shiba, Hikichi and Okuzono11 The experiences of older people residing in a nursing home following the New Zealand earthquake are being studied.Reference Heppenstall, Wilkinson and Hanger10 By closely examining the emotional reactions, challenges with adaptation, and access to care/health and sociomedical support processes of older people who were compelled to relocate to a nursing home following the 2023 earthquake in Turkiye, this study seeks to close this gap.
Methods
Study Design and Study Setting
This study employed a qualitative, hermeneutical phenomenological approach to examine the lived experiences of nursing home residents who were uprooted after the 2023 earthquake. Hermeneutical phenomenology, which focuses on understanding experience as it is reflected in consciousness before conceptualizing it, is based on lived experience.Reference van Manen12 Participants were selected from among those who were relocated from these provinces’ nursing homes to one in Antalya due to the February 6, 2023, earthquake that destroyed 11 provinces and damaged nursing homes to varied degrees. Data was collected through in-depth interviews with residents of nursing homes impacted by the June-July 2023 earthquake. The study report was prepared in accordance with the Consolidated criteria for reporting qualitative research (COREQ) checklist (Supplementary file 2).Reference Tong, Sainsbury and Craig13
The city-centered, free-of-charge nursing homes are where the earthquake occurred and where the residents were moved. The relocation city has a Mediterranean climate in the south, while the earthquake zone has a continental climate in the east. The state had designated only one nursing home for rapid evacuation, as other public nursing homes did not have sufficient capacity to accommodate these individuals. Therefore, the residents had no other option for a nursing home to be relocated to. The 2 facilities are more than 900 kilometers apart, despite the fact that the new nursing home’s rooms are double occupancy and the building is brand-new and well-equipped. The relocated province is warmer and more humid than the earthquake zone, and is more crowded year-round. Although the 2 nursing homes are similar in terms of staff and facilities, the food cultures of the provinces differ. The relocated one places more emphasis on a Mediterranean diet than the first, which is dominated by red meat.
Sample
The population of the research consists of individuals aged 65 and over who came to the Nursing Home in Antalya from 3 nursing homes in the earthquake zone. In the qualitative research, if is tried to obtain a sample that can represent all the possible diversity and richness in the universe as much as possible.Reference Creswell and Creswell14 It is stated that the most appropriate sampling approach for phenomenological research is the purposeful sampling method.Reference Willis, Sullivan-Bolyai and Knafl15 Individual interviews were continued until data saturation was reached for the sample size of the study, and the study was conducted with 26 participants.Reference Glaser and Strauss16 Purposive sampling method was used in this research. People who met the inclusion criteria and were suitable for the purpose of the study were included in the study sample. The inclusion criteria were: (i) Older people living in nursing homes in the provinces affected by the earthquake in February 2023 and transferred to the Nursing Home in Antalya, (ii) able to communicate in Turkish, (iii) being 65 years or older, and (iv) volunteering to participate in research. Although 3 of the participants experienced physical injuries, they did not have any physical trauma that would affect their daily activities. No participants declined to participate in the study.
Data Collection
Data was collected through face-to-face individual interviews by the researchers at a nursing home in Antalya. Individual interviews were held in a quiet, well-lit area of the nursing home where individuals could express themselves comfortably. The interviews lasted an average of 45-60 minutes.
The questions were developed using studies in the literature, and similar questions from the literature were translated from English to Turkish using a professional translator. The interviews were conducted in Turkish, and both the questions and answers were in Turkish. They were then translated back into English by a different translator during the manuscript writing phase.
The questionnaire, which included open-ended questions based on the literature and a semi-structured form containing sociodemographic information, was created by researchers through in-depth individual interviews.Reference Heppenstall, Wilkinson and Hanger10, Reference Khosravi, Xosravi and Ziapour17, Reference Koppitz, Dreizler and Altherr18 Participants were able to describe their post-earthquake experiences and perceptions in detail thanks to the semi-structured approach. These interviews included the journey to Antalya, current nursing home experiences, problems encountered, and post-earthquake service access (Supplementary file 1).
Data Analysis
In phenomenological research, data analysis involves describing and explaining experiences and revealing themes. Data were analyzed using “content analysis” suggested by the Graneheim and Lundman-proposed method.Reference Graneheim and Lundman19 Both deductive and inductive methods were used in qualitative content analysis. This study used a deductive (theory-based) analytical technique to understand the experiences of older adults placed in care homes outside the affected area following the earthquake. This method makes use of pre-existing conceptual models and theoretical frameworks from the literature on data analysis. The researcher used predefined concepts, categories, or topics to investigate the data in deductive analysis. The analysis approach in this study was driven by theoretical concepts from the literature, namely those pertaining to post-traumatic recovery and growth, adaptability to environmental change, adaptation and coping in aging, and psychological resilience.Reference Kulakçı-Altıntaş and Ayaz-Alkaya20–Reference McCall, Gibb and Wang23 Additionally, this study used an inductive (data-driven) analysis methodology. The data spontaneously revealed new concepts and themes during the coding process. The analysis was founded on internal patterns that emerged from the experiences of the participants rather than the presumptions of an external theory. The emotional and social aspects of older people’s lived experiences adjusting to their new living situation following the earthquake were initially explored thanks to this method.
In the present study, since audio and video recording were not allowed with institutional permission, 2 researchers took notes of what was said, and the other researcher conducted the interviews in Turkish. At the end of the day after each meeting, what was written was reviewed again and transferred to a Word file. Then, the data were coded separately by 2 independent researchers, and themes and sub-themes were created (AI and YDA). These researchers came together and reviewed the codes, themes, and subthemes. The written text was then reviewed again and examined for the presence of codes that needed to be added. After this stage, 3 researchers in the research team came together, discussed the codes, subthemes, and themes, reached a consensus, decided on the themes and sub-themes, and the names of the main themes and sub-themes were finalized.
Reflexivity
The study was conducted by 3 female researchers specializing in public health nursing. The first 2 researchers hold doctoral degrees and have 13 years of academic experience. The third researcher has 20 years of experience as a professor. All researchers are experienced in collecting and analyzing qualitative and quantitative data in geriatric health.
Ethical Consideration
Permission for the research was obtained from Akdeniz University Clinical Research Ethics Committee (no.70904504, date: 20.03.2023). Institutional permission was obtained to conduct the research in a nursing home. Participants received thorough written and verbal explanations of the study’s purpose and the voluntary nature of their involvement, any possible risks or advantages, and the confidentiality of their data. Prior to data collection, written informed consent was acquired from every participant. The freedom to leave the study at any moment without facing any repercussions was also emphasized to the participants. The researchers adhered to the Declaration of Helsinki throughout the research process.
Results
The sociodemographic characteristics of the participating individuals in the study are presented in Table 1. A total of 26 participants were interviewed, 20 males (76.9%) and 6 females (23.1%). The average age of the participants was 73.5 ± 7.0. Of the participants, 65% (n = 17) had chronic illnesses, specifically diabetes, hypertension, and asthma, and 15.4% (n = 4) could walk with support (a cane). Other descriptive characteristics of the participants are presented in Table 1.
General characteristics of the participants
During the earthquake, 11.5% (n = 3) of participants were physically injured, 42.3% (n = 11) had a relative who died, and 80.8% (n = 21) experienced financial loss. The majority of participants (n = 23; 88.5%) were moved from Malatya to an Antalya nursing home, while others were moved from state-run facilities in Hatay and Gaziantep (Table 1). Four main themes were identified in this study: (a) feelings and attitudes after the earthquake, (b) problems experienced due to location change, (c) post-earthquake support, and (d) suggestions of earthquake survivors. The main themes and sub-themes are shown in Table 2 along with illustrative quotes.
The main themes, subthemes with illustrative quotations
Main Theme 1: Feelings and Attitudes After the Earthquake
Two sub-themes were identified under the main theme of feelings and attitudes after the earthquake: (a) trust and satisfaction, and (b) persistent fear and anxiety. Participants did not experience fear during the earthquake and felt secure because they believed the government building would not collapse. One participant stated that their religious beliefs provided comfort and reassurance, saying, “I read three prayers. A matter of faith, I was never afraid” (P9, 60 years). Participants also expressed happiness at moving to a nursing home with a sea view due to the relocation. One participant explained, “We felt like we had come to paradise” (P4, 63 years). Similarly, another participant emphasised the beauty of their current location and the value of life, saying, “Life is beautiful wherever there is a sea. I do not want to go back to Malatya” (P7, 73 years). Another participant stated, “I have diabetes and high blood pressure. I was happy that I didn’t have any problems obtaining medication or accessing a doctor during and after the earthquake, and also when we moved to the new nursing home” (P13, 89 years).
The participants also experienced persistent fear and loss. They were still frightened after the earthquake, and many spoke of the ongoing psychological effects of the event. According to several participants, they experienced intense anxiety and panic every day. For example, one participant said, “I get scared and cry every time a plane passes by. It was like we came out of a nightmare … There are people left behind. We thought about them” (P4, 63 years). Another participant similarly expressed the lasting pain and feelings of helplessness left by the earthquake with these words: “It was like the end of the world. The earthquake messed up everyone is psychology … There was no chance to escape. Earthquakes destroy everything. I did not leave my room for the entire day. I’m still scared” (P5, 70 years).
Main Theme 2: Problems Experienced Due to Location Change
Participants experienced some problems due to the change of location. Four sub-themes were identified within this main theme. (a) inability to get used to/like the food culture, (b) inability to adapt to the climate, (c) social isolation, and (d) limitation of living space. Almost all of the male participants stated that they could not get used to the food culture, did not like it, and could not eat it. Male participants were typically reluctant to eat, so it’s noteworthy that nearly all of them said they had trouble adjusting to food culture. One participant explained as follows: “The food is not suitable for us at all. There were meat dishes in Malatya. Vegetable dishes are always served here” (P1, 73 years). Almost all female participants, in comparison, did not have any issues because they are less particular about what they eat.
Nearly half of the participants said that they could not adapt to the climate in the transferred province. Some participants stated that the weather in the province they were brought to was very humid and extremely hot, and that they could not tolerate this heat and had difficulty breathing. One participant said, “I have asthma. The humid air is not good for me, I have difficulty breathing” (P8, 77 years). The other participant stated that he had to use air conditioning due to the air temperature, saying, “The air here is very humid, I didn’t like it at all. I can’t move my waist because of the air conditioner” (P1, 73 years).
Some of the participants experienced social isolation due to the change of location. Participants did not leave the nursing home because they did not know people or relatives in the city they came from, or because they did not know the way. Additionally, there were participants who stated that they could not go to social areas in the transferred province due to economic reasons. One participant explained this situation as follows: “I was leaving in the morning and coming in the evening. I was bored, there were many relatives, many friends, there was a coffee and tea place. I was talking to at least 50 people a day. This place is very expensive. The food I eat there for 50 Turkish Liras is here for 150 Turkish Liras. That’s why I can’t go out” (P1, 73 years). Another participant shared this: “I couldn’t go to the city center. Because I don’t know the way. Because there is no one I know” (P9, 60 years).
Most of the participants stated that their living space was restricted after the displacement due to the earthquake. They said that they stayed in a single room in the nursing home they came to, but now they had to stay in double rooms (P2, 74 years; P3, 60 years). Participants who said that they got used to a single room and loneliness stated that they could not get along when 2 people stayed together (P4, 63 years; P8, 77 years). One participant explained the difficulty of staying with 2 people in the room as follows: I want to watch TV, but my roommate doesn’t want it. Or my roommate watches the TV at a very high volume, which bothers me. Another problem mentioned was the air conditioning: “I want to turn it on, but my roommate doesn’t want it” (P11, 78 years).
Main Theme 3: Post-Earthquake Support
After the earthquake, support services were provided to all older people by professionals and volunteers. Two subthemes were identified within this main theme: (a) psychosocial support and (b) health services support. Participants stated that volunteer individuals and the state provide clothing and food support. It was also stated that health care professionals and volunteers provided psychological support. One participant said that “they gave them clothes, slippers and sneakers” (P10, 65 years). Another participant explained that psychological support was provided by saying, “The volunteers held our hands, stood by us, gave us morale” (P11, 78 years).
Post-earthquake health care support was provided to participants. Chronic disease management was provided to participants with chronic illnesses, who were contacted by the Family Health Center near the nursing home where they had recently come, since they had medication records. Participants stated that they were supported in obtaining medicines and making appointments. In addition, some participants stated that health checks were carried out and that they did not have problems in prescribing and taking medications and accessing health services. One participant explained that he had a heart condition and that they supported him in taking medication and making a hospital appointment (P2, 74 years).
Main Theme 4: Suggestions of Earthquake Survivors
Participants made recommendations regarding current and potential future disasters caused by geological/geophysical hazards. Two sub-themes were created within this main theme: (a) providing earthquake preparedness training and (b) organizing sociocultural activities. Some of the participants wanted training to be provided for earthquake preparation. Explaining what to do in trainings and preparing earthquake suitcases are other suggestions given by the participants. One participant stated that one should not panic, that he/she wanted to receive training regarding earthquakes, and that one should be told where to be and where not to be during an earthquake (P4, 63 years).
Some of the earthquake survivors suggested organizing sociocultural activities in the nursing home to which they were newly transferred. It was stated that such organizations were held in the province where the participants came from, and therefore, people who wanted to help or hotel owners invited them and wanted to socialize. One participant expressed his wishes by saying, “If there was a shuttle to the city center, for example, they would take it to Güllük. If only there was social communication with people. For example, if they take us on a picnic or a trip one day” (P4, 63 years). Another participant shared, “A mayor, member of parliament, or another person would visit every day … They organized activities like trips and picnics for us” (P23, 76 years).
Limitations
There are some limitations. Despite note-taking efforts, the inability to record audio or video due to institutional constraints may have limited data depth. The results are less generalizable due to the study’s restriction to a single public nursing home. While hermeneutical phenomenology offers rich insight into lived experience, it is limited by its interpretive subjectivity, lack of standardization, restricted generalizability, and dependence on researcher skill. Findings are context-bound, non-replicable, and require careful reflexivity to ensure credibility. Recall bias may be more likely if interviews are conducted months after the earthquake. Furthermore, the linguistic and cultural contexts unique to the older Turkish community limit the applicability of the results to other nations and cultures.
Discussion
This study revealed the effects of forced displacement after the earthquake among older people through in-depth interviews with them. While some participants felt safe and satisfied in their new environments, they also reported experiencing fear, grief, and anxiety. The adaptation process was particularly hampered by difficulties adapting to food culture and climate, social isolation, economic constraints, and cramped living spaces. However, psychosocial and health support contributed to recovery and adaptation. To better assist older people in adjusting to life after earthquakes, sociocultural activities should be expanded, and earthquake preparedness training should be organized.
Participants experienced negative emotions like fear, anxiety, loss, and longing both during and after the earthquake, even though they felt safe and content afterward, thinking they had relocated to stronger buildings and a safer city. Some people lost loved ones, experienced the earthquake directly in nursing homes, and this had a detrimental effect on their mental health. According to the literature, victims of earthquakes may also show signs of depression, emotional stress, fear or shock, and post-traumatic stress disorder.Reference Santos-Reyes and Gouzeva24–Reference Sasaki, Aida and Tsuji27 As a result, following an earthquake, the psychological well-being of older adults, a vulnerable population, should be routinely assessed.
Older people who were displaced after the 2023 earthquake in Turkiye are facing issues related to cultural differences, climate, social environment, and economic conditions. These issues include social isolation, limited living spaces, high living costs, and difficulty adjusting to food culture and climate. Studies and reports conducted after the earthquake highlight the need for regular screening and support for basic needs (food, shelter, health, social support), weakened social networks, and food provision in shelters that does not meet the nutritional needs of older people.Reference Sakamoto, Asano and Miyata28–30 The majority of participants said they intended to return to their former nursing homes after reconstruction because of nostalgia and maladjustment; they also asked for a meal plan in the nursing home that was suitable to their culture and took into consideration their needs. Consequently, it is advisable to establish designated social areas (e.g., retirement/older people’s cafes) that provide reasonably priced and culturally relevant menus.Reference Ardalan, Mazaheri and Naieni9, Reference Sakamoto, Asano and Miyata28–30
Psychosocial and health services support was provided to participants after the earthquake. With the support of primary care health care professionals and nursing home nurses and doctors, older people with and without chronic illnesses navigated this process smoothly. Preparation of health systems is important to reduce the negative effects of earthquakes on health. The comprehensive treatment provided by medical specialists can help manage mental health issues and chronic illnesses.Reference Koksal, Mert and Aslan31, Reference Pourhosseini, Ardalan and Mehrolhassani32 These results demonstrate the efficacy of team-based and integrated care approaches in preserving the health of older people during the post-earthquake phase. Following an earthquake, health services must continue without interruption. As a crucial component of health, humanitarian requirements for social assistance must be identified and satisfied.
Participants suggested providing earthquake preparedness training and organizing sociocultural activities against a possible earthquake. There should be educational programs suitable for the participants, understandable and accessible. Topics such as emergency procedures, safe shelters, emergency kits, and first aid should be included in these programs.33 In a study conducted in Iran, the effect of a risk reduction initiative given to the participants on earthquake preparedness was examined. There was an increase in all sub-dimensions of the earthquake preparedness scale (communication, environment) during and after the earthquake, and the preparation programs for disaster risk reduction positively affected the preparedness of the older people.2, 33, Reference Nourozi, Saeli and Khankeh34 In addition to risk reduction preparedness interventions, age-appropriate and accessible programs that cover fundamental subjects like emergency procedures, safe shelters, emergency kits, and first aid can improve older adults’ preparedness for earthquakes (including communication and environment).Reference Nourozi, Saeli and Khankeh34
Social and cultural activities for the older people who have relocated after the earthquake may be important to reduce their social isolation, adapt to their new communities, and increase their psychological resilience.Reference Hall, Wehling and Stansfield35 Participants expressed a desire for more sociocultural activities; outings and picnics were more common in prior care facilities. Even though there are more options for activities like painting, music, and ceramics in new care facilities, the majority of these activities take place inside the facility. It is believed that expanding the number of events hosted by non-governmental organizations in various locations could improve the health of older people, since they also wish to engage in social activities outside of the institution.Reference Petitte, Mallow and Barnes5
Conclusion
This study found that after being forced to relocate, older people impacted by the earthquake faced a variety of emotional, social, and physical difficulties. While many participants continued to experience fear, sadness, longing, and anxiety related to separation from family and familiar surroundings and displacement, some felt happiness, contentment, and security as a result of improved living conditions and trust in the state. Significant stressors for older people included social isolation, limited living areas, and trouble adjusting to new foods and temperature conditions. Support from psychosocial and health services, however, was essential in fostering their rehabilitation and general well-being.
Supplementary material
The supplementary material for this article can be found at http://doi.org/10.1017/dmp.2026.10322.
Data availability statement
The data supporting the findings of this study are available from the corresponding author.
Acknowledgment
The authors express their gratitude to the older adults and the professionals working in the nursing home.
Author contribution
Study design: AI, YDA, SG; Data collection: AI, YDA; Data analysis: AI, YDA; Study supervision: AI, YDA, SG; Manuscript writing: AI, YDA; Critical revisions for important intellectual content: AI, YDA, SG;
Funding statement
No funding has been received for this research.
Competing interests
None.
Ethical approval and informed consent statements
In order to conduct the research, approval was obtained from the Clinical Research Ethics Committee of Akdeniz University (Ethics committee Approval No.70904504, date:20.03.2023). Written and verbal informed consent were obtained from the older adults, and institutional approval was also secured.
