Background
Methods
Eligibility criteria
Search strategy
Population | Context | Phenomenon of Interest | Study Design |
---|---|---|---|
“Aged [Mesh]” OR“older adults” OR “older persons” OR “elderly individuals” OR “elderly people”OR “elderly residents” OR residents | (relocation OR transition OR admission)AND (“Residential Facilities”[Mesh]) OR “Homes for the Aged”[Mesh]) OR “Long-Term Care”[Mesh]) OR “aged care home” OR “long-term care facility” OR “LTC facilities” OR “residential aged care facility”) | “Social Adjustment”[Mesh] OR (adaptation OR adjustment OR “psychosocial changes” OR “psychosocial adjustment” OR adapt* OR adjust* | “nursing methodology” OR “case study” OR “constant comparison” OR “content analysis” OR “descriptive study” OR “discourse analysis” OR ethnography OR exploratory OR feminist OR “focus group” OR “grounded theory” OR hermeneutic OR interview OR narrative OR naturalistic OR “participant observation” OR phenomenology OR “qualitative method” OR “qualitative research” OR “qualitative study” OR “thematic analysis” |
Selection of articles
Quality appraisal of studies
Author(s)/year | Clear research aims | Qualitative methodology appropriate | Research design appropriate | Recruitment strategy appropriate | Data collection appropriate? | Participant Researcher relationship considered | Ethical issues considered? | Data analysis sufficiently rigorous | Clear statement of findings? | How valuable is the research? | CASP score |
---|---|---|---|---|---|---|---|---|---|---|---|
Tracy [17] | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
Wilson [7] | Yes | Yes | Yes | Yes | Yes | Can not tell | Yes | Yes | Yes | Yes | 9 |
Heliker [18] | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
Koppitz [19] | Yes | Yes | Yes | Yes | Yes | Can not tell | Yes | Yes | Yes | Yes | 9 |
Lee [10] | Yes | Yes | Yes | Yes | Yes | Can not tell | Yes | Yes | Yes | Yes | 9 |
Guevara [20] | Yes | Yes | Yes | Yes | Yes | Can not tell | Yes | Yes | Yes | Yes | 9 |
Iwasiw [9] | Yes | Yes | Yes | Yes | Yes | Can not tell | Yes | No | Yes | Yes | 9 |
Lee [21] | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
Kahn [22] | Yes | Yes | Yes | Yes | Yes | No | No | Can not tell | Yes | Yes | 7 |
Križaj [23] | Yes | Yes | Yes | Yes | Yes | Can not tell | Yes | Yes | Yes | Yes | 9 |
Salarvand [16] | Yes | Yes | Yes | Yes | Can not tell | Can not tell | No | No | No | Can not tell | 5 |
Data extraction
Authors | Country | Sampling | Research Purpose | Method | Collection | analysis | Classification of the Findings |
---|---|---|---|---|---|---|---|
Tracy [17] | USA | No.28, Gender:9 M/19F Age:68–93, | To explore feelings about their transitional experience and recall situations in their adjustment process | Hermeneutic phenomenology | Group interview | Van Manen’s method | 1Self-motivated move versus familial encouragement; 2Ties to the past versus starting a new; Independence versus dependence; 3Affection versus disdain; 4Adjustment versus maladjustment; |
Wilson [7] | USA | No.15, Gender:4 M/11F Age:76–97 | To identify variance in the initial responses of older adults whose move to a nursing home is either planned or unplanned | Grounded theory | In-depth semi-structure Interviews, observation | Constant comparative method | 1Overwhelmed phase 2Adjustment 3 Initial accept phase |
Heliker [18] | USA | No.10 Gender:Not describe Age: Not describe | To describe the phenomenon of being admitted and living in a nursing home;to explicating their experience of transition | Hermeneutic phenomenology | Interviews observation | Heideggerian | 1Becoming homeless; 2Getting settled and learning the ropes; 3Creating a place; |
Koppitz [19] | Switzerland | No.31 Gender:8 M/23F Age:83.1 ±6.2 | To examine the process of an uplanned admission into a nursing home and its impact on the individuals’ adaptation | Descriptive phenomenology | semi-structure Interviews | Mayring’s approach of content analysis | 1Being cared for; 2Moving on; 3Being cut off; 4Being restricted; |
Lee [10] | Hongkong China | No.18 Gender:9 M/9F Age:70–96 | To describe the process through which residents in Hongkong adjust nursing home placement | Grounded theory | In-depth Interviews | Constant comparative method | 1Orienting 2Normalizing 3Rationalizing 4Stabilizing |
Guevara [20] | Philippines | No.20 Gender:7 M/13F Age:69–84 | To examine the process of acclimatization of Filipino elderly in a nursing care facility | Grounded theory | In-depth unstructured Interviews | Constant comparative method | 1Reminiscing phase 2Recommencing phase 3Reinforcing phase 4Recapturing phase 5 Renewing 6Rekindling Phase |
Iwasiw [9] | Canada | No.12 Gender:2 M/10F Age:67–96 | To investigate the experience of this early phase of relocation | Not describe | interviews | Constant comparative method | 1Emotional reactions 2Transition activities 3Reflecting on their situation 4Connecting with a personal philosophy |
Lee [21] | UK | No.8 Gender:Not describe Age:65–97 | To explore old pepole’s experience of transition into residential care | Exploratory design | interviews | Narrative | 1Reflecting key plots of ‘control’, ‘power’, ‘identity’ and ‘uncertainty’ interwoven throughout their narratives; 2Experiencing some difficulties in incorporating this transition into their life stories.; 3Not feeling confident in their decision to move; 4Living in constant fear of losing their memory; 5Limited expectations for their future |
Kahn [22] | USA | No.21 Gender:2 M/19F Age:66–93 | To describe the process successfully used to adapt to nursing home environment | Ethographic study | interviews observations | Narrative | 1Recognizing the ambivalence 2Downplaying the negative 3No other Options 4An act of will |
Križaj [23] | Republic of Slovenia | No.6 Gender:3 M/3F Age:74–92 | To explore Slovenian older people’s experiences of transition into a care home | Phenomenological approach | Semi-structured, in-depth interviews | Interpretative Phenomenological Analysis | 1This is who I am, 2Adjusting my daily occupations, 3The value of health |
Data analysis
Results
Synthesized finding | Category | Finding | Illustration |
---|---|---|---|
Synthesized finding1: The impacts of culture on adaptation | Category1 religion and ‘God’ promoting adaptation | Finding1: Renewing | Filipino elderly expressed how a deeper relationship with God commenced as they journeyed through life in the nursing home: “I pray because I know that no one else will help me only God will Being prayerful helps me to adjust [20] |
Finding2: Connecting with a personal philosophy | I am a great believer in God’s plan and implied that they could influence their responses to this new life. They expressed tolerance and acceptance, starting ‘It’s God’s will’ [9] | ||
Category2: Collectivity and harmony as principles of relationship building | Finding3: Normalizing | Meeting collective needs was also discussed in relation to the Chinese culture of living and eating together as a big family.:If there is a vacancy in the bathroom, you can go ahead to take a bath. If the bathrooms are fully occupied, you have to wait until others had finished. It is the same as living at home—you also have to take turns for bathing. Now, you just live in a bigger room with more neighbors [10]. | |
Synthesized finding 2: The Transition process | Category3: The Decision-making Process | Finding4: Self-motivated move versus familial encouragement | 1We talked about moving before I broke my hip. I couldn’t do the work – snow and grass 2My daughter brought me here because I needed supervision. I had fallen at home, and I laid there for two days [17] |
Finding5: Not feeling confident in their decision to move; | Decision to move: I don’t know why I’m here vs. it was a difficult decision [21] | ||
Finding6: No other options | Oh, I get short of breath. I have to take pills in order to breathe. Sick most of the time. .. so this is the place to be. What can you do when you are alone. I was alone in the small apartment. And back and forth, back and forth to the hospital.. .. You know it was a bad life going back and forth. Now I’m here. And I stay here [22] | ||
Finding7: Experiencing some difficulties in incorporating this transition into their life stories. | Participants discussed health difficulties restricting their ability to cope alone, often justifying requiring extrafamilial support by highlighting that they would not need to be there if their health were better [21]. | ||
Category4: The Fluctuation Process | Finding8: Ties to the past | The pieces I wanted were brought up here. I knew everything would fit. So my apartment I am happy with. It is, to me, very attractive and has my own favorite things. It meant sorting out and getting rid of a lot and saving some that I did not have the heart to get rid of. But anyway, my apartment is very pretty and that has a lot to do with me being happy here [17]. | |
Finding9: Independence | They realized that while this transition involved giving up some of their independence such as driving and cooking, [17] | ||
Finding10: Overwhelmed phase | I get awful lonely and depressed. I wish I could be home. I forget a lot of things, my mind isn’t working the way it should. I go to a room and forget why I went there. I’m afraid if I leave my room. I’ll get lost and won’t find my way back. I don’t want to be a burden to my daughter and her husband [7] | ||
Finding11: Becoming homeless | Four months I was there, and loved every minute of it, except I was so busy trying to get everything settled. I don’t regret one minute being over there. I want to go back to my apartment; it’s a whole house full of memories. The only thing I’ve regretted is falling and being where I am now [nursing home]. You see the whole story is that if you can’t do for yourself, they have different places for you [18]. | ||
Finding12: Being cut off; | I always say that everything one possesses has its own story. It’s a memento for something. We’re forced to let go of the things we had before [19]. | ||
Finding13: Being restricted | It was only when I arrived here that I realised that I couldn’t cope anymore. I used to like to cook, to invite friends. I could no longer do any of that [19]. | ||
Finding14: Reminiscing phase | Each of the participants felt an urge to retell the story behind his present life in a nursing home.: All I can say I that I’m not satisfied because my family wasn’t here [20]. | ||
Finding15: Emotional reactions | I don’t sleep … I just stare at the wall. A feeling of shock was expressed [9]. | ||
Finding16:Reflecting key plots of ‘control’, ‘power’, ‘identity’ and ‘uncertainty’ interwoven throughout their narratives; | I miss the privacy and freedom of my own home. I used to control my pension [...] they take all that off you to come here you know Uncertainty: Then one day I had a stroke. Apparently () It never occurred to me that I had one [21]. | ||
Finding17: Living in constant fear of losing their memory | Participants’ fears around losing their memory appeared to impact on their behaviour, with individuals describing ‘clinging onto’ their memory [21] | ||
Finding18: Limited expectations for their future | Well, I’ll grow old here, people do die here, you know, every so often. I think they just take them out in the middle of the night and cremate them, you know [21] | ||
Finding19: This is who I am, | That is the only reason why I miss my car. If I was bored, I just sat in my car and went up there [to his weekend cottage] for a few days [23] | ||
Finding20: Disdain | There are a lot of people around here whose minds are not very good; they don’t belong in assisted living anymore. At the dinner table, they don’t mind their manners. One lady uses the tablecloth to wipe her nose [17] | ||
Finding21: Maladjustment | Although they didn’t miss the upkeep and repairs, it seemed so expensive to make monthly payments. They also found it difficult to adjust to paying for individual services such as medication distribution, assistance with personal hygiene, and bandage changing [17] | ||
Finding22: Recommencing phase | Instigation of a new phase of life in a nursing home is perceived by the participants as being Stressful: Here, I am not allowed to invite. There are many restrictions. You have to talk to the directors first. In my home I can do everything [20] | ||
Category5: The Adjustment Process | Result23: Affection | The help here is all very concerned for you and the people, the residents. If anyone hurts, the rest of the people feel it too [17] | |
Finding24: Adjustment | It is a matter of attitude. If you decide that it is an adventure, the next stage in life, then you accept it and go on from there [17]. | ||
Finding25: Getting settled and learning the ropes; | I’m acquainted with all these nurses down here. They like me and I like them. Cook’s the same way. She always has a little ice cream for me [18]. | ||
Finding26: Being cared for | They provide the meals and we get to choose what we want … I would give the meals four stars [19]. | ||
Finding27: Dependence | Many participants reflected on becoming increasingly dependent on others [17] | ||
Finding28: Orienting | They therefore used their own efforts to gain a realistic understanding of the dynamics of every aspect of nursing home life: Ms. Ho [the deputy superintendent] told me not to hang dry my clothes in the corridor. Yet, I saw a lot of others were doing this in the evening. I just informally checked this with Ah Mei. I now know that this rule is really not followed [10] | ||
Finding29: Rationalizing | They began to soften the blow by downplaying the negative so as to make day-to-day life easier within the limits of nursing home living.: Hey, you can just sit over here for a while and you can hear how some of them [other residents] are talking about missing who and who. We are all like that. It is only abnormal if you don’t miss someone or something [10] | ||
Finding30: Reinforcing phase | Numerous persons really dole out some goods... Every day, we receive visitors. They give us food so we never run out of food here. Eventually, I became a lot better and happy [20] | ||
Finding31: Recapturing phase | Respondent’s narrations, when asked about the similarities between their previous home and where they presently live, were often infused with a sense of contentment and ease: Yes, everything’s here, you can’t look for anything else—there are clothes, chairs, beds... you won’t look for anything [20] | ||
Finding32: Reflecting on their situation | Appraisals of facility and their experience in it ranged from disapproval to ringing endorsement [9]. | ||
Finding33: Downplaying the negative | There was evidence that minimizing negative aspects of their present situations was not only due to a reluctance to complain to an outsider [22] | ||
Finding34: Adjusting my daily occupations | I found it difficult to live because I didn’t have my own life … but I had to adjust to the extent … that it wasn’t possible [to live her own life]. And now it is, and that’s what matters [23]. | ||
Finding35: Recognizing the ambivalence | I don’t think there is any other place like this that’s any better as far as old people are concerned. It’s not like home. But then I don’t think there is any place that is a better home for old people my age [22]. | ||
Category6: The Acceptance Process | Finding36: Starting a new | Many participants agreed they had made new friends and felt “like a family in their new location. “We watch out for each other, and I try to hold the elevator for those who need more time [17] | |
Finding37: Initial accept phase | Nobody can help me but myself. You’ve got to pick up your boots and do it. As long as I can keep my sense of humour and keep walking it should be all right. It’s starting to be more like home [7]. | ||
Finding38: Creating a place | Creating a place was a constitutive pattern: “I’ve met a lot of people here...they treat you right.” This demonstrates the significance of creating a place by developing new memories, new friends, and new neighbors. Two residents who were asked to change their rooms declined and adamantly stated, “This is my place, and I’m not moving. My family knows where I am. I’m staying here [18] | ||
Finding39: Moving on; | It’s okay at this age and given my heart condition – things weren’t very good before. Yes, it’s okay. I’m in the right place, there’s care if I need it and I’m well looked after [19] | ||
Finding40: Stabilizing | The central theme thus identified was resignation from previous life: to be simple, peaceful, take things easy, eat, and rest more: It’s fate that brings us here—in this very same nursing home! I have to accept this [10]. | ||
Finding41: Rekindling Phase | Rekindling is demonstrated by the elderly when they restore a sense of being at home in the institution as acceptance and contentment is reached: Yes, it’s hard but after a long time of being here, we were able to adjust, we are able to recover. Whatever possession you have, be contented with it. That’s what I feel [20]. | ||
Finding42: An act of will | So I got in my mind that this is it. I’ve got to be here. I’ve got to live with it. I made out my mind no matter what, it’s all right, it’s good.. .. It depends upon the person [22]. | ||
Finding43: The value of health | Janez felt that the surroundings of his weekend cottage had positive health effects for him.at [the weekend cottage] I have pine trees, I have greenness around me and I can really say that I can see better. That air influences my eyesight [23]. |
Synthesized finding 1
Religion and ‘god’ promoting adaptation
The Canadians in one study thought moving to an RCF was God’s arrangement and tried to accept it, as a religious coping strategy. Their belief influenced their response to the new environment. The Canadians stated that their past, present and intended behaviours were congruent with their belief systems and expressed tolerance and acceptance [9].Being prayerful helps me to adjust.I feel light whenever I pray, while I feel burdened when I do not.
It is God’s willYou can not have everything.Life is what you make it.I am a great believer in God’s plan.
Collectivity and harmony as principles of relationship building
If there is a vacancy in the bathroom, you can go ahead to take a bath. If the bathrooms are fully occupied, you have to wait until others have finished. It is the same as living at home—you also have to take turns for bathing. Now, you just live in a bigger room with more neighbours.
Synthesized finding 2
The decision-making process
Participants emphasized their control over their relocation decision, evaluated their options, retained the right to return home, and questioned the decision with uncertainty [21]. Some had limited freedom to decide where or when to live and family members directly made decisions [21].We talked about moving before I broke my hip. I couldn’t do the work – snow and grass [17].Oh, I get short of breath. I have to take pills in order to breathe. Sick most of the time . . . so this is the place to be. What can you do when you are alone. I was alone in the small apartment. In addition, back and forth to the hospital. . . . You know it was a bad [22]
At the back of my mind was, I’m only coming here for six weeks and if it’s all right I’ll stay, if it isn’t, I’ll go back [21].My son made [the decision] for me [...] he put me in a care home [21].
The fluctuation process
Most residents experienced an emotional shock during the initial period of relocation. They felt overwhelmed, fearful, homeless, a loss of control, unhappy, resistant, and etc. [7, 9, 17, 21].The pieces I wanted were brought up here. I knew everything would fit. So my apartment I am happy with. It is, to me, very attractive and has my own favourite things. It meant sorting out and getting rid of a lot and saving some that I did not have the heart to get rid of. However, anyway, my apartment is very pretty and that has a lot to do with me being happy here [17]
Activities in nursing homes followed standardized procedures, which could constrain the residents [19]. Many complained about losing independence, such as driving and cooking [20, 23]. Some disdained social relationships because they were used to being alone or found it hard to interact with residents with dementia [17].I don’t sleep … I just stare at the wall [9].I get awful lonely and depressed. I wish I could be home. I forget a lot of things, my mind isn’t working the way it should. I go to a room and forget why I went there. I’m afraid if I leave my room. I’ll get lost and won’t find my way back. I don’t want to be a burden to my daughter and her husband [7].
The adjustment process
I’m acquainted with all these nurses down here. They like me and I like them. Cook’s the same way. She always has a little ice cream for me [18].They provide the meals and we get to choose what we want … I would give the meals four stars [19].I don’t think there is any other place like this that’s any better as far as old people are concerned. It’s not like home. But then I don’t think there is any place that is a better home for old people my age [22].
The acceptance process
So I got in my mind that this is it. I’ve got to be here. I’ve got to live with it. I made out my mind no matter what, it’s all right, it’s good. . . . It depends upon the person [22].Yes, it’s hard but after a long time of being here, we were able to adjust, we are able to recover. Whatever possession you have, be contented with it. That’s what I feel [20].