Michele A. Sinunu, MPH, Rollins School of Public Health, Department of International Health, Emory University, 2034 Desmond Drive, Decatur, GA 30033, 404-210-6916, msinunu@sph.emory.edu, Kathryn Yount, PhD, Department of International Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, and Nadia el-Afifi, MD, MPH, Geriatrics Department, Palestine Hosptial, 64 el-Thawra St., Cairo, Egypt.

Declines in fertility and increases in longevity in Egypt have led to increases in the proportion of Egyptians that are old and frail. The development of services to provide care for these older adults has lagged behind demographic change, and as a result, the family continues to be the major source of support for growing numbers of frail older adults. This paper summarizes the findings of a qualitative study exploring the processes by which family caretakers in Cairo decide to place their frail older relatives into longterm care in a setting where norms of filial obligation remain strong. Open-ended, semi-structured interviews were conducted over a four-month period with 18 "cases" (family caregivers who placed an older relative into the longterm care center in Palestine Hospital in Cairo) and 17 matched "controls" (family caregivers who care for their older relatives at home). Seven factors influenced decisions of adult caregivers about location of care: older adult's health status, availability of kin, filial obligation and ideals of reciprocity, characteristics of family caregivers and the quality of caregiver-older relative relationships, religious conviction, and a desire to do what is "best" for the older relative. Understanding how these themes affect the individual decision of family caregivers is vital to meeting the needs of both the older adults and those who care for them.

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