Qualitative study on the experience and needs of social isolation in older adults with stroke

Based on the Social Ecological Theory framework, this study aims to explore the social isolation experiences and needs of older adults with stroke, providing an empirical basis for constructing multi-level, systematic clinical intervention strategies. Using an interpretive phenomenological approach, semi-structured interviews were conducted from September 2025 to November 2025 with older adults with stroke purposively sampled from a tertiary hospital in Shandong Province. Guided by Heidegger’s interpretive phenomenology, this study adopts NVivo 13.0 software to conduct coding and thematic analysis of interview data until the point of data saturation. A total of 15 participants were interviewed, with a total interview duration of 385 min, yielding 39,000 words of transcribed text. Three main themes and nine sub-themes were extracted: at the microsystem level, decline in physical and mental function and crisis of self-identity (activity restriction due to physical function limitations, internal friction of stigma and negative emotions, regression of social roles and loss of sense of worth); at the mesosystem level, disruption of social connections and fragility of support systems (imbalance and stress in family interaction patterns, structural atrophy of original social networks, barriers to interpersonal communication and social avoidance); at the macrosystem level, lack of environmental friendliness and lag in social support provision (inadequacy of age-friendly physical environments and barrier-free facilities, absence of community rehabilitation resources and continuity of care services, poor coordination between medical security policies and long-term care systems). The social isolation experience of older adults with stroke is influenced by the interaction of multiple factors at the individual, family, and social environmental levels. Future interventions should move beyond a singular physiological rehabilitation perspective to construct a cross-system comprehensive support system encompassing individual psychological empowerment, family resilience enhancement, and social environment optimization, in order to improve their social isolation status and enhance their quality of life.