Population ageing is among the most critical global transformations. China is one of the fastest ageing countries and has the largest ageing population in the world. According to the latest report of the National Bureau of Statistics of China, older people aged over 60 accounted for 18.1% of the total population, and those over 65 represented 12.6% of the population by the end of 2019; this percentage is expected to rise to 26.9% of the total population by 2050 [
1]. It was reported that there were nearly 30,000 aged care facilities and more than 7.46 million beds for aged care services in July 2019 [
2]. The acceleration of population ageing will increase the pressure on social security and public services and continuously affect the social vitality, innovation dynamics, and potential economic growth rate, which is a significant risk and challenge to population development in the new era.
The demand for long-term care is increasing. Many older adults begin to lose the ability to take care of themselves owning to chronic disease, disability, and weakness [
3]. Family care for older adults is reducing, with the development of the economy and the change of family structures [
4]. Nursing homes are designed to provide a safe environment and continuous care. Relocation is considered to be one of the most stressful events that a person can experience, usually accompanied by depression, anxiety, loneliness, insomnia, and suicide attempts [
5]. Transitions are complicated emotional regulation and are characterized by profound changes affecting one’s perception and understanding of the world and self [
6]. Maladjustment to a new environment damages the quality of life and health of older people. The decision to move is a necessity rather than a choice [
7]. People must accept the loss of familiar surroundings and adapt to the new environment. If nursing staff understand the variables affecting nursing home adjustment, they are more likely to help older adults achieve better adaptation, and interventions are more effective.
Nursing home adjustment is a process that changes over time [
8]. Adapting to a new living environment requires an older adult to learn to follow new routines, participate in value activities, to establish and maintain new social relationships, and to manage personal property [
9]. Xiao defined the operational concept of nursing home adjustment which included five dimensions: emotional distress, relationship development, acceptance of new residence, depressed mood, and feeling at home [
10]. Nursing home adjustment varies depending on the length of stay, interventions should be taken during the most effective period because appropriate interventions are carried out promptly to improve effectively older adults’ quality of life in nursing homes [
11]. Promoting factors of nursing home adjustment included satisfaction with the facility and the care that they received. The greater the satisfaction the older people living in a nursing home had, the better their adaptation [
12]. Unplanned admissions to nursing homes usually caused severe health outcomes for older people, such as anxiety, emotional distress, and increased confusion [
13]. It was reported that older adults with planned nursing home admissions progressed faster in the adjustment phase than older adults with unplanned admissions [
8]. The physical health of older people in nursing homes was related to mental health problems, causing maladaptation [
14]. This adaptation has been reported to be associated with a decline in physical and cognitive function [
15]. In the case of involuntary relocation, the adjustment to long-term care facilities became very hard and there was a trend towards increased mortality [
14,
16]. Over the past few decades, a few studies have been conducted to determine the factors that influence the adaptation of older adults. In South Korea, factors influencing adaptation included self-efficacy, the quality of the facility, depression, the decision to move, perceived health status, age, self-reported health, preconceptions about nursing homes, emotional support from staff and other residents, and general satisfaction with the facility [
14,
17]. In a synthesis study, the facilitators and inhibitors of adjustment covered four themes: resilience of the older person, interpersonal connections and relationships, a feeling that “this is my new home”, and a view of the care facility as an organization [
18]. However, Fitzpatrick pointed out that the heterogeneity of research limited the generalizability of the findings, such as the use of multiplicities of terms and concepts, quality of different methods, timelines for different investigation of the transitions [
18]. Transition to long-term care facilities causes variations in their responses to relocation since older adults have different socioeconomic statuses, educational levels, careers, and cultural backgrounds [
19]. Sociocultural values and ethnic background were also predictors of adjustment [
20]. In the context of filial piety, older Chinese adults expected their children to take care of them at home, however, relocation caused the ambivalence of social expectations among Chinese families; this traditional virtue had a profound impact on nursing home adjustment [
21]. Moreover, although the factors identified in previous studies affecting adaptation were similar, there were differences in the most influential factors due to different regions and ethnicities [
14].
Research from Taiwan, China, showed the most important factors affecting overall adaptation were sufficient funding for admission, voluntary admission, and the number of roommates. However, the local culture, welfare systems, and policies in Taiwan are different from those in mainland China. So far, there has been few studies on nursing home adjustment in mainland China. The purpose of this study was to identify the predictors of older adults’ adjustment so that nursing staff could promote a healthy transition. The findings may also be used to inform Chinese geriatric care policy to help older Chinese people and their families adapt more easily to the new home environment.