With increasing life expectancy and a growing elderly population worldwide, elder care has become a major priority for health systems. These care services are accompanied by numerous ethical challenges, and neglecting them can negatively affect the dignity, rights, and quality of life of older adults. This study aimed to address the question: “What ethical challenges are faced in elder care?” Accordingly, a systematic review was conducted guided by PRISMA guidelines. To identify relevant studies, PubMed, Scopus, Web of Science, SID, and Google Scholar were searched for the period 2013–2025, using the keywords “Ethical Challenges”, “Elderly Care”, “Nursing”, and their Persian equivalents. Inclusion criteria were original articles (qualitative, quantitative, experimental, or quasi-experimental) with a direct focus on ethical challenges in elder care, written in Persian or English, and with full-text availability. Exclusion criteria included letters to the editor and conference abstracts. The quality of the studies was assessed using the appraisal tool proposed by Gifford. In total, 31 eligible articles were included in the final analysis. The results indicated that ethical challenges in elder care can be classified into four main categories, including autonomy, justice, beneficence, and non-maleficence. Subthemes included privacy preservation, shared decision-making, end-of-life care, equitable resource allocation, and the prevention of physical and psychological harm. The findings underscored the necessity of strengthening ethics education and informing policymaking in elder care.
