PURPOSE: This study aimed to describe the real experiences and needs of stoma self-care in elderly colorectal cancer patients, providing a theoretical basis for healthcare professionals to develop effective intervention measures. METHODS: Semi-structured, in-depth interviews were conducted with the thirteen elderly colorectal cancer patients with stomas. These interviews were audio-recorded and transcribed verbatim. The interview data were then organized, analyzed, and thematically refined using Colaizzi's 7-step analysis method. RESULTS: This study extracted three overarching themes and seven corresponding sub-themes. Theme one, actively seeking help, encompassed pre-rehabilitation needs, social support needs, and continuity of care needs. Theme two, new challenges posed by stomas, included sub-themes related to changes in daily life and psychological burdens. Theme three, courageous acceptance and proactive coping, comprised cognitive changes and behavioral changes as its sub-themes. CONCLUSION: The study's findings suggest that inadequate in-hospital stoma care education and a lack of continuity of care at home can result in heightened challenges for elderly patients. Healthcare professionals should implement a personalized, full-process education program tailored to geriatric patients' specific needs, ensuring seamless care transition and coordinated management between hospital and home environments.