نرجس قاسم نیاعربی

Objective : The global increase in the elderly population has heightened the need for coordinated, tailored healthcare services that address the complex needs of older adults. This study aims to conceptualize the elderly healthcare ecosystem by identifying its key actors, classifying their roles, and examining the nature of their interactions. Methodology: A multi-stage methodological approach was employed. First, an extensive literature review—focusing on healthcare ecosystems and ageing studies—was conducted to develop an initial analytical framework. Based on this, ecosystem actors were identified and categorized using Mitchell et al.’s Stakeholder Salience Model. An expert panel was then consulted to validate actor attributes and refine classifications. To analyze interdependencies and determine influential actors, a Fuzzy Cognitive Map was constructed, enabling the assessment of causal relationships and the dynamic positioning of stakeholders within the ecosystem. Results : The analysis identified seven groups of actors within the healthcare ecosystem. FCM findings reveal that the elderly, families, and medical centers are the most influential actors. At the same time, the Ministry of Health and Medical Education, insurance and pension funds, and the Ministry of Cooperatives, Labor, and Social Welfare emerge as the most influential and central stakeholders in advancing ecosystem objectives. Conclusion : The study demonstrates that the elderly healthcare ecosystem is inherently dynamic, and stakeholder classifications should not be viewed as static. Attributes such as power, legitimacy, and urgency are fluid and context-dependent. The FCM results further highlight this dynamism by illustrating how shifts in causal relationships can reposition actors across stakeholder categories, underscoring the need for adaptive policymaking.