Caregiving experiences of left-behind elderly who raise their grandchildren in rural China: a descriptive qualitative study

As a key group that is involved in intergenerational childrearing, the caregiving experiences of left-behind rural elderly individuals directly impact the physical and emotional well-being of their grandchildren, family stability, and the process of achieving active aging. However, existing research has primarily focused on the health and development of left-behind children, resulting in an insufficient understanding of the caregiving experiences of left-behind elderly and how these experiences impact this latter group. In this study, we explored the caregiving experiences of left-behind rural elderly in raising their grandchildren and provided a scientific basis for improving their quality of life and enhancing related social support. A descriptive qualitative study was conducted. From February 5 to 15, 2026, purposive and snowball sampling were used to recruit 16 left-behind elderly who were engaged in grandparenting in rural areas of Zhanjiang City, Guangdong Province, China. Data were collected through semi-structured interviews and subsequently analyzed using thematic analysis to identify key themes. Six themes and 17 sub-themes were identified: (a) emotional burdens of caregiving; (b) positive emotional rewards and fulfillment; (c) objective stressors in the caregiving context; (d) caregiving motivations rooted in intergenerational ethics; (e) internal resources for psychological adaptation; and (f) external resources and institutional support. These themes collectively depict a complex caregiving landscape in which grandparents simultaneously navigate burdens and rewards, drawing on culturally rooted internal resources that remain insufficient to compensate for fragmented external support. This study reveals the multifaceted nature of grandparenting among rural left-behind older adults. The findings underscore the need for comprehensive assessment of their caregiving burden and well-being risks, alongside coordinated support from healthcare services, families, and communities to improve grandparents’ caregiving conditions and quality of life.