Nursing Home Adjustment Of Older Adults: A Path Model

Objectives:1.To develop a path model of stress on nursing home adjustment in older adults.2.To test the path model of stress on nursing home adjustment in older adults using a multi-center survey.Methods:Part Ⅰ:This part was to develop and test psychometrical properties of the Chinese version of Nursing Home Adjustment Scale(NHAS)for nursing home residents.According to the guidelines of cross-culture adaptation process,the Chinese version of NHAS was formed through forward translation,back translation,expert committee,and a pilot study.Exploratory Structural Equation Modeling(ESEM)was applied to evaluate the NHAS scale.Internal consistency,test-retest reliability,and construct validity were examined.Part Ⅱ:Associated factors of nursing home adjustment in older adults was synthesized through a systematic review.Nine databases were systematically searched.Study selection,data extraction,and quality assessment were conducted.Then,a path model of the effect of stress on nursing home adjustment in older adults was developed based on self-control model,stress-coping model,and the systematical review.Part Ⅲ:A cross-sectional study was conducted to test the path model of stress on nursing home adjustment in older adults.A sample of 386 nursing homes residents were recruited from 11 nursing homes in Fujian,China.A structured questionnaire,including the resident characteristics,Nursing Home Adjustment Scale(NHAS),Chinese Perceived Stress Scale(CPSS),Resourceful Scale(RS),General Self-Efficacy Scale(GSES),Social Support Rate Scale(SSRS)were conducted.The path model of nursing home adjustment was examined by mediation and moderation analysis.Results:Part Ⅰ:The final structure of the Chinese version NHAS with 23 items was categorized into five dimensions,including emotional distress,depressed mood,relationship development,acceptance of new residence and feeling at home.The Cronbach’sαof the scale is 0.87,with 0.72 for the test-retest reliability.Exploratory structural equation modeling(ESEM)supported the five-factor model(χ~2=531.450,df=148,CFI=0.974,TLI=0.956,RMSEA=0.078).Convergent validity and discriminant validity were assessed by the associations between the NHAS total/subscale scores and other measure outcomes.Part Ⅱ:20 out of 6,358 articles were finally included.43 factors were identified,dividing into six categories:demographic characteristics(n=11),physiological factors(n=3),and psychological factors,social factors(n=9),social factors(n=9),relocation factors(n=6),facility factors(n=5).Activities of daily living,transition decision control,length of stay,social support,and self-efficacy were considered as important factors.Part Ⅲ:The mechanisms of stress,resourcefulness,self-efficacy,social support,and nursing home adjustment were explored.The results showed that stress can negatively predict nursing home adjustment,and can also predict psychological adjustment through three paths:the mediating role of resourcefulness,the mediating role of self-efficacy,and the chained mediating role of resourcefulness and self-efficacy.And social support operated as a moderator the pathway of stress on resourcefulness.Conclusions:1.The Chinese version of NHAS is a reliable and valid instrument for accessing nursing home adjustment among older adults in China.2.The moderated mediation model elucidates the mechanisms of how stress affects nursing home adjustment.It provides theoretical basis to develop targeted interventions for nursing homes.3.This study implies the importance of resourcefulness,self-efficacy,and social support for nursing home residents in future interventions,which facilitate the healthy aging.