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International Journal of Nursing Practice 2015; 21: 184–191
RESEARCH PAPER
Factors influencing the adaptation to skilled nursing facilities among older Korean adults Jin Yi Choi RN PhD Assistant Professor, Department of Nursing, Kon Kuk University, Chungju-si, Chungcheongbuk-do, South Korea
Sohyune R Sok RN PhD Associate Professor, College of Nursing Science, Kyung Hee University, Seoul, South Korea
Accepted for publication June 2013 Choi JY, Sok SR. International Journal of Nursing Practice 2015; 21: 184–191 Factors influencing the adaptation to skilled nursing facilities among older Korean adults This study was conducted to identify the factors that influence the level of adaptation of older Korean adults to skilled nursing facilities. The subjects were 500 adults aged 65 or older who were living in six different skilled nursing facilities in Seoul and Gyeong-gi-do, South Korea. The measures were a demographic form, Health Self-Rating Scale, Activities of Daily Living Scale, Self-Efficacy Instrument, Korean Simple Depression Scale, Quality of the Facility Scale and Facility Adaptation Scale. The analyses showed that the prediction model was significant (F = 128.624, P < 0.001). The value of the adjusted R2 was 0.435, which corresponds to the explanatory power of 43.5%. The factor that was found to have the greatest influence on the adaptation of older Korean adults to skilled nursing facilities was activities of daily living (β = −0.564), followed by self-efficacy (β = 0.321), quality of the facility (β = 0.164), depression (β = 0.133), decision to enter a skilled nursing facility (β = 0.122), perceived health status (β = 0.064) and age (β = −0.010). This cross-sectional study provides preliminary evidence that the level of adaptation of older Korean adults to skilled nursing facilities is related to their activities of daily living, self-efficacy, depression, decision to enter a skilled nursing facility, perceived health status and age, and to the quality of the facility. Key words: adaptation, aged, nursing facility.
INTRODUCTION Based on the February 2010 statistical data in South Korea, older adults aged 65 or older accounted for 10.7% of the population. In addition, it was estimated that this figure will increase to 14%, making the South Korean society a super-aged society by 2018.1 This sharp increase in the older population has made South Korea’s population the fastest growing in the world in terms of its becoming an aged society.
Correspondence: Sohyune R. Sok, College of Nursing Science, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul 130701, South Korea. Email: [email protected] © 2014 Wiley Publishing Asia Pty Ltd
Recognizing the serious need to provide support to older adults due to the rapid-ageing phenomenon currently being experienced by the country, the South Korean government enacted a law in July 2008 involving the implementation of a long-term insurance support system.2 Moreover, the number of skilled nursing facilities has increased from 583 in 2005 to 898 in 2006 and 1186 in 2007.3 Considering the rapid increase in the older-adult population, however, more facilities are needed, and accordingly, the role of the nursing staff (helping those residing in these facilities) is expected to become increasingly important. Research in Western and Asian countries has revealed a high prevalence of depression among older people living doi:10.1111/ijn.12235
Older, adaptation, facility
in both communities and nursing homes.4,5 Especially, among older people living in nursing homes, depression is one of the prevalent mental health problems.6,7 Such mental health problems are characterized by a depressed mood, a lack of interest in life, self-criticism and selfblame, poor concentration, and appetite and sleep disturbances.8 The physical health state of the older adults in nursing homes was consistently shown to be associated with the mental health problems.9,10 These mental health problems might have been due to the maladaptation related to relocation to a nursing home.11,12 The transfer to a nursing home among elderly people over 65 is problematic.13,14 It is well known that the relocation of older adults negatively affects their social and psychological well-being as well as their survival. It is highly probable that the relocation greatly reduces and potentially destroys family ties, severing social relationships and emotional attachments.2 Thus, for older adults, moving into a skilled nursing facility requires a considerable amount of effort in terms of adaptation. Therefore, this relocation is often said to cause ‘relocation shock’ or ‘relocation stress syndrome’.2 In the case of involuntary relocation, adaptation to a skilled nursing facility becomes very difficult, and the rate of death tends to increase.14 In addition, longitudinal studies also revealed that the support received from family members was associated with a lower level of depression in the follow-up study.5,15 Some studies reported that older adults transferred to nursing homes received less family support, resulting in a higher level of depression and/or maladaptation to the nursing home.16,17 Older adults who fail to adapt often suffer from anxiety, confusion, insomnia, sadness, depression, loneliness, lethargy and/or loss of appetite,18 and in severe cases, they attempt to commit suicide.12 Therefore, it is important to help older adults adapt to a skilled nursing facility so as to address such problems. Some studies have discovered that the higher the level of activities of daily living of older adults is, the higher the level of their life satisfaction;6,19 others, that the perceived health status differs based on the personal lifestyles of older adults;20,21 some others, that there is a correlation between the perceived health status and the spiritual wellbeing of older adults;10,20,22 and still others, that the services provided in skilled nursing facilities positively affect the level of adaptation of older adults to such facilities.23 Figure 1 shows the conceptual model employed in this study. The factors influencing the level of adaptation to skilled nursing facilities that were used in this study were
185
selected based on the findings from previous studies. These factors affected the level of adaptation of older Korean adults to skilled nursing facilities as dependent factors. As the number of older adults in skilled nursing facilities throughout the country is increasing along with the increase in the older-adult population, determining the factors related to the level of adaptation of older Korean adults to skilled nursing facilities will help offer concrete and practical information to those providing geriatric nursing care, in addition to improving nursing intervention programmes for older Korean adults. The aims of the study were (i) to identify the demographic characteristics of older Korean adults in skilled nursing facilities; (ii) to determine their level of adaptation to the skilled nursing facility and related factors; (iii) to determine the correlations between their level of adaptation to the skilled nursing facility and related factors; and (iv) to determine the factors that influence their level of adaptation to the skilled nursing facility.
METHODS Study participants The study participants were 520 older Korean adults. They were recruited through convenient sampling from six nursing homes in Seoul and Gyeong-gi-do, South Korea. These nursing homes were skilled nursing facilities providing general care by time schedule and also individual-suit nursing interventions by skilled nurses. The eligibility criteria included participants aged 65 years or older and who understood the purpose of this study, consented to participate in it, had no cognitive impairment(s), had full capability to verbally communicate in Korean and had lived in a skilled nursing facility for 6 months or longer.24 Among them, 20 participants were excluded for various reasons; thus, 500 subjects were ultimately enrolled in the study. Considering that the ideal sample size in a correlation survey study is 5–10 times the number of questions included in the questionnaire,25 the minimum required sample size in this study was 490. Therefore, the sample size was adequate.
Materials and procedure The response data were collected by the author and an assistant researcher from March 2008 to July 2009. The researchers visited six skilled nursing facilities located in Seoul and Gyeong-gi-do, South Korea. The researcher contacted the prospective participants and explained to © 2014 Wiley Publishing Asia Pty Ltd
186
JY Choi and SR Sok
Related factors/Influencing factors
Dependent factor
Perceived health state
Activities daily living
Self-efficacy
Depression
Adaptation to skilled nursing facilities
Quality of facility
Age
Decision to enter
Figure 1 Conceptual framework.
them the purpose of this study as well as the participation details and the instruments that were to be used. The survey consisted of a self-reporting questionnaire to be administered by the researcher and the assistant. Each of the participants took ≈25–30 min to complete the questionnaire. The Health Self-Rating Scale developed by Northern Illinois University,26 which was used by Sung,22 was revised and was used in this study to measure the perceived health status of the participants. This was designed for self-reporting using a five-point scale and consisted of a total of three questions. The possible score range was 3–15, and the higher the score was, the better the respondent’s perception of his or her health status. The reliability of this instrument was Cronbach’s α = 0.82. © 2014 Wiley Publishing Asia Pty Ltd
The Activities of Daily Living Scale translated by Choi27 based on the Barthel Index28 was used to measure the activities of daily living among older Korean adults in skilled nursing facilities. It consisted of a total of 10 questions using a five-point scale. The possible score range was 10–50, and the higher the score was, the higher the level of activities of daily living. The reliability of this instrument was Cronbach’s α = 0.91. The Self-Efficacy Instrument developed by Sherer et al.29 and translated by Oh30 was used in this study to measure the self-efficacy of the participants. It consisted of a total of 17 questions using a five-point scale. The possible score range was 17–85, and the higher the score of the respondent was, the higher his or her self-efficacy. The reliability of this instrument was Cronbach’s α = 0.86.
Older, adaptation, facility
The Korean Simple Depression Scale for the Elderly developed by Ki31 was revised and was used to measure the level of depression of the participants. It consisted of a total of 15 questions using a four-point scale. The possible score range was 15–60, and the higher the score of the respondent was, the higher the level of his or her depression. The reliability of this instrument was Cronbach’s α = 0.83. The Observation Indicators of Nursing Home Care Quality Instrument developed by Rantz et al.32 was changed into the Quality of the Facility Scale by Lee.33 The Quality of the Facility Scale was used in this study to measure the quality of the skilled nursing facilities. It consisted of a total of 30 questions using a five-point scale. The possible score range was 30–150, and the higher the score was, the higher the quality of the skilled nursing facility. The reliability of this instrument was Cronbach’s α = 0.93. The reliability of the subscales of this instrument was Cronbach’s α = 0.82–0.94. The Facility Adaptation Scale developed by Lee34 was used in this study to measure the level of adaptation of older Korean adults to a skilled nursing facility. It consisted of a total of 23 questions using a five-point scale. The possible score range was 23–115, and the higher the score of the respondent was, the higher the level of his or her adaptation to a skilled nursing facility. The reliability of this instrument was Cronbach’s α = 0.81.
Data analysis The collected data were analysed using the SAS version 6.12 statistical software program SAS Institute, Cary, NC, USA. The general characteristics of the older-adult participants in skilled nursing facilities were analysed using descriptive statistics. The correlations between their level of adaptation to a skilled nursing facility and related factors were analysed using Pearson’s correlation coefficient. To examine the factors influencing their level of adaptation to a skilled nursing facility, multiple-regression analysis was used.
Ethical considerations This study was approved by the Institutional Review Board of a university in Seoul, South Korea. The participants were informed of the aim and method of the study and were told that their participation was voluntary and that they had the right to withdraw from the study at any point. The participants were also informed of the anonymity and confidentiality of the data to be obtained from
187
them in the study. The researchers received accomplished written consent forms from those who agreed to participate in the study.
RESULTS The demographic characteristics of the participants are shown in Table 1. There were more female subjects (74.4%) than male subjects (25.6%). The largest age group was those aged 75–79 years old (30.6%). More than half of the participants were Buddhists (51.2%). As for the level of education, most of the participants had no formal education, some had elementary school education and some were elementary school graduates (33%). Most of the participants had no spouse (88.4%). Also, most of the participants received support from their family (41.8%). Most of the participants also reported a perceived health status of moderate (73.2%). The decision to enter a skilled nursing facility was mostly made by the participants or their spouse (59.4%). The main motivation for entering a skilled nursing facility was to live a comfortable life during older age (59.4%). The levels of perceived health status, activities of daily living, self-efficacy, depression, quality of the facility and adaptation of the participants to a skilled nursing facility are shown in Table 2. The mean score of the participants in terms of their perceived health status was 6.83, which indicates a moderate level of perceived health status, and their mean score in terms of activities of daily living was 39.27, which indicates a high level of daily life activities. The mean score of the participants in terms of self-efficacy was 54.45, which indicates a moderate level of selfefficacy. The mean score of the participants in terms of depression was 6.34, which indicates a moderate level of depression. The mean score obtained in terms of the quality of the facility was 95.62, which indicates that the quality of the facilities was moderate, and the mean score of the participants in terms of their adaptation to a skilled nursing facility was 77.02, which indicates a slightly high level of adaptation. The correlations between the participants’ adaptation to a skilled nursing facility and related factors are shown in Table 3. The analyses of the participants’ perceived health status (r = 0.518, P = 0.001), activities of daily living (r = 0.423, P = 0.001), self-efficacy (r = 0.724, P = 0.001), and decision to enter a skilled nursing facility (r = 0.228, P = 0.001), and of the quality of the facility (r = 0.218, P = 0.001), showed positive correlations, whereas the analysis of the participants’ depression © 2014 Wiley Publishing Asia Pty Ltd
188
JY Choi and SR Sok
Table 1 Demographic characteristics (n = 500) Characteristics category Gender Male Female Age (year) 65∼69 70∼74 75∼79 80∼84 85∼89 >90 Education Elementary school Middle school High school Above college Religion Protestant Buddhist Catholic None Spouse Yes No Help from Family Relation Neighbourhood Friend Health state Good Moderate Poor Decision to enter Myself (spouse) Child Daughter-in-law Relation Motivation to enter Comfort old age No caregiver Conflict with child
n
%
128 372
25.6 74.4
63 88 153 138 49 9
12.6 17.6 30.6 27.6 9.8 1.8
165 128 129 78
33.0 25.6 25.8 15.6
124 256 63 57
24.8 51.2 12.6 11.4
58 442
11.6 88.4
214 57 137 92
42.8 11.4 27.4 18.4
19 366 115
3.8 73.2 23.0
212 113 113 31
59.4 31.7 31.7 9.0
212 113 113
59.4 31.7 31.7
(r = −0.586, P = 0.001) and age (r = −0.212, P = 0.001) showed a negative correlation. The factors that were found to influence the study participants’ adaptation to a skilled nursing facility are © 2014 Wiley Publishing Asia Pty Ltd
shown in Table 4. Multiple-regression analyses of the participants’ perceived health status, activities of daily living, self-efficacy and depression; of the general characteristics of the participants’ age and decision to enter a skilled nursing facility; and of the quality of the facility were performed to identify the major factors influencing the level of adaptation of older Korean adults to skilled nursing facilities. The analyses showed that the prediction model for the level of adaptation of older Korean adults to skilled nursing facilities was significant (F = 128.624, P < .001). The value of the adjusted R2 was 0.435, which corresponds to the explanatory power of 43.5%. The factor that was found to have the greatest influence on the adaptation of older Korean adults to skilled nursing facilities was the activities of daily living (β = −.564), followed by self-efficacy (β = .321), quality of the facility (β = .164), depression (β = .133), decision to enter a skilled nursing facility (β = .122), perceived health status (β = .064) and age (β = −.010) (see Table 4).
DISCUSSION In the results of this study, the average level of adaptation of older Korean adults to a skilled nursing facility was 95.62, which was higher than the median score of 90. This showed that the level of adaptation of older Korean adults to skilled nursing facilities was good. This result was identical to that of the study by Lee et al.2 It is believed that this result could be attributed to the fact that the study participants had relocated to a skilled nursing facility 6 months before the study was conducted and thus had already adapted to it. Therefore, it is necessary to conduct another study to measure the level of adaptation to a skilled nursing facility of older Korean adults who had relocated to a skilled nursing facility
International Journal of Nursing Practice 2015; 21: 184–191
RESEARCH PAPER
Factors influencing the adaptation to skilled nursing facilities among older Korean adults Jin Yi Choi RN PhD Assistant Professor, Department of Nursing, Kon Kuk University, Chungju-si, Chungcheongbuk-do, South Korea
Sohyune R Sok RN PhD Associate Professor, College of Nursing Science, Kyung Hee University, Seoul, South Korea
Accepted for publication June 2013 Choi JY, Sok SR. International Journal of Nursing Practice 2015; 21: 184–191 Factors influencing the adaptation to skilled nursing facilities among older Korean adults This study was conducted to identify the factors that influence the level of adaptation of older Korean adults to skilled nursing facilities. The subjects were 500 adults aged 65 or older who were living in six different skilled nursing facilities in Seoul and Gyeong-gi-do, South Korea. The measures were a demographic form, Health Self-Rating Scale, Activities of Daily Living Scale, Self-Efficacy Instrument, Korean Simple Depression Scale, Quality of the Facility Scale and Facility Adaptation Scale. The analyses showed that the prediction model was significant (F = 128.624, P < 0.001). The value of the adjusted R2 was 0.435, which corresponds to the explanatory power of 43.5%. The factor that was found to have the greatest influence on the adaptation of older Korean adults to skilled nursing facilities was activities of daily living (β = −0.564), followed by self-efficacy (β = 0.321), quality of the facility (β = 0.164), depression (β = 0.133), decision to enter a skilled nursing facility (β = 0.122), perceived health status (β = 0.064) and age (β = −0.010). This cross-sectional study provides preliminary evidence that the level of adaptation of older Korean adults to skilled nursing facilities is related to their activities of daily living, self-efficacy, depression, decision to enter a skilled nursing facility, perceived health status and age, and to the quality of the facility. Key words: adaptation, aged, nursing facility.
INTRODUCTION Based on the February 2010 statistical data in South Korea, older adults aged 65 or older accounted for 10.7% of the population. In addition, it was estimated that this figure will increase to 14%, making the South Korean society a super-aged society by 2018.1 This sharp increase in the older population has made South Korea’s population the fastest growing in the world in terms of its becoming an aged society.
Correspondence: Sohyune R. Sok, College of Nursing Science, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul 130701, South Korea. Email: [email protected] © 2014 Wiley Publishing Asia Pty Ltd
Recognizing the serious need to provide support to older adults due to the rapid-ageing phenomenon currently being experienced by the country, the South Korean government enacted a law in July 2008 involving the implementation of a long-term insurance support system.2 Moreover, the number of skilled nursing facilities has increased from 583 in 2005 to 898 in 2006 and 1186 in 2007.3 Considering the rapid increase in the older-adult population, however, more facilities are needed, and accordingly, the role of the nursing staff (helping those residing in these facilities) is expected to become increasingly important. Research in Western and Asian countries has revealed a high prevalence of depression among older people living doi:10.1111/ijn.12235
Older, adaptation, facility
in both communities and nursing homes.4,5 Especially, among older people living in nursing homes, depression is one of the prevalent mental health problems.6,7 Such mental health problems are characterized by a depressed mood, a lack of interest in life, self-criticism and selfblame, poor concentration, and appetite and sleep disturbances.8 The physical health state of the older adults in nursing homes was consistently shown to be associated with the mental health problems.9,10 These mental health problems might have been due to the maladaptation related to relocation to a nursing home.11,12 The transfer to a nursing home among elderly people over 65 is problematic.13,14 It is well known that the relocation of older adults negatively affects their social and psychological well-being as well as their survival. It is highly probable that the relocation greatly reduces and potentially destroys family ties, severing social relationships and emotional attachments.2 Thus, for older adults, moving into a skilled nursing facility requires a considerable amount of effort in terms of adaptation. Therefore, this relocation is often said to cause ‘relocation shock’ or ‘relocation stress syndrome’.2 In the case of involuntary relocation, adaptation to a skilled nursing facility becomes very difficult, and the rate of death tends to increase.14 In addition, longitudinal studies also revealed that the support received from family members was associated with a lower level of depression in the follow-up study.5,15 Some studies reported that older adults transferred to nursing homes received less family support, resulting in a higher level of depression and/or maladaptation to the nursing home.16,17 Older adults who fail to adapt often suffer from anxiety, confusion, insomnia, sadness, depression, loneliness, lethargy and/or loss of appetite,18 and in severe cases, they attempt to commit suicide.12 Therefore, it is important to help older adults adapt to a skilled nursing facility so as to address such problems. Some studies have discovered that the higher the level of activities of daily living of older adults is, the higher the level of their life satisfaction;6,19 others, that the perceived health status differs based on the personal lifestyles of older adults;20,21 some others, that there is a correlation between the perceived health status and the spiritual wellbeing of older adults;10,20,22 and still others, that the services provided in skilled nursing facilities positively affect the level of adaptation of older adults to such facilities.23 Figure 1 shows the conceptual model employed in this study. The factors influencing the level of adaptation to skilled nursing facilities that were used in this study were
185
selected based on the findings from previous studies. These factors affected the level of adaptation of older Korean adults to skilled nursing facilities as dependent factors. As the number of older adults in skilled nursing facilities throughout the country is increasing along with the increase in the older-adult population, determining the factors related to the level of adaptation of older Korean adults to skilled nursing facilities will help offer concrete and practical information to those providing geriatric nursing care, in addition to improving nursing intervention programmes for older Korean adults. The aims of the study were (i) to identify the demographic characteristics of older Korean adults in skilled nursing facilities; (ii) to determine their level of adaptation to the skilled nursing facility and related factors; (iii) to determine the correlations between their level of adaptation to the skilled nursing facility and related factors; and (iv) to determine the factors that influence their level of adaptation to the skilled nursing facility.
METHODS Study participants The study participants were 520 older Korean adults. They were recruited through convenient sampling from six nursing homes in Seoul and Gyeong-gi-do, South Korea. These nursing homes were skilled nursing facilities providing general care by time schedule and also individual-suit nursing interventions by skilled nurses. The eligibility criteria included participants aged 65 years or older and who understood the purpose of this study, consented to participate in it, had no cognitive impairment(s), had full capability to verbally communicate in Korean and had lived in a skilled nursing facility for 6 months or longer.24 Among them, 20 participants were excluded for various reasons; thus, 500 subjects were ultimately enrolled in the study. Considering that the ideal sample size in a correlation survey study is 5–10 times the number of questions included in the questionnaire,25 the minimum required sample size in this study was 490. Therefore, the sample size was adequate.
Materials and procedure The response data were collected by the author and an assistant researcher from March 2008 to July 2009. The researchers visited six skilled nursing facilities located in Seoul and Gyeong-gi-do, South Korea. The researcher contacted the prospective participants and explained to © 2014 Wiley Publishing Asia Pty Ltd
186
JY Choi and SR Sok
Related factors/Influencing factors
Dependent factor
Perceived health state
Activities daily living
Self-efficacy
Depression
Adaptation to skilled nursing facilities
Quality of facility
Age
Decision to enter
Figure 1 Conceptual framework.
them the purpose of this study as well as the participation details and the instruments that were to be used. The survey consisted of a self-reporting questionnaire to be administered by the researcher and the assistant. Each of the participants took ≈25–30 min to complete the questionnaire. The Health Self-Rating Scale developed by Northern Illinois University,26 which was used by Sung,22 was revised and was used in this study to measure the perceived health status of the participants. This was designed for self-reporting using a five-point scale and consisted of a total of three questions. The possible score range was 3–15, and the higher the score was, the better the respondent’s perception of his or her health status. The reliability of this instrument was Cronbach’s α = 0.82. © 2014 Wiley Publishing Asia Pty Ltd
The Activities of Daily Living Scale translated by Choi27 based on the Barthel Index28 was used to measure the activities of daily living among older Korean adults in skilled nursing facilities. It consisted of a total of 10 questions using a five-point scale. The possible score range was 10–50, and the higher the score was, the higher the level of activities of daily living. The reliability of this instrument was Cronbach’s α = 0.91. The Self-Efficacy Instrument developed by Sherer et al.29 and translated by Oh30 was used in this study to measure the self-efficacy of the participants. It consisted of a total of 17 questions using a five-point scale. The possible score range was 17–85, and the higher the score of the respondent was, the higher his or her self-efficacy. The reliability of this instrument was Cronbach’s α = 0.86.
Older, adaptation, facility
The Korean Simple Depression Scale for the Elderly developed by Ki31 was revised and was used to measure the level of depression of the participants. It consisted of a total of 15 questions using a four-point scale. The possible score range was 15–60, and the higher the score of the respondent was, the higher the level of his or her depression. The reliability of this instrument was Cronbach’s α = 0.83. The Observation Indicators of Nursing Home Care Quality Instrument developed by Rantz et al.32 was changed into the Quality of the Facility Scale by Lee.33 The Quality of the Facility Scale was used in this study to measure the quality of the skilled nursing facilities. It consisted of a total of 30 questions using a five-point scale. The possible score range was 30–150, and the higher the score was, the higher the quality of the skilled nursing facility. The reliability of this instrument was Cronbach’s α = 0.93. The reliability of the subscales of this instrument was Cronbach’s α = 0.82–0.94. The Facility Adaptation Scale developed by Lee34 was used in this study to measure the level of adaptation of older Korean adults to a skilled nursing facility. It consisted of a total of 23 questions using a five-point scale. The possible score range was 23–115, and the higher the score of the respondent was, the higher the level of his or her adaptation to a skilled nursing facility. The reliability of this instrument was Cronbach’s α = 0.81.
Data analysis The collected data were analysed using the SAS version 6.12 statistical software program SAS Institute, Cary, NC, USA. The general characteristics of the older-adult participants in skilled nursing facilities were analysed using descriptive statistics. The correlations between their level of adaptation to a skilled nursing facility and related factors were analysed using Pearson’s correlation coefficient. To examine the factors influencing their level of adaptation to a skilled nursing facility, multiple-regression analysis was used.
Ethical considerations This study was approved by the Institutional Review Board of a university in Seoul, South Korea. The participants were informed of the aim and method of the study and were told that their participation was voluntary and that they had the right to withdraw from the study at any point. The participants were also informed of the anonymity and confidentiality of the data to be obtained from
187
them in the study. The researchers received accomplished written consent forms from those who agreed to participate in the study.
RESULTS The demographic characteristics of the participants are shown in Table 1. There were more female subjects (74.4%) than male subjects (25.6%). The largest age group was those aged 75–79 years old (30.6%). More than half of the participants were Buddhists (51.2%). As for the level of education, most of the participants had no formal education, some had elementary school education and some were elementary school graduates (33%). Most of the participants had no spouse (88.4%). Also, most of the participants received support from their family (41.8%). Most of the participants also reported a perceived health status of moderate (73.2%). The decision to enter a skilled nursing facility was mostly made by the participants or their spouse (59.4%). The main motivation for entering a skilled nursing facility was to live a comfortable life during older age (59.4%). The levels of perceived health status, activities of daily living, self-efficacy, depression, quality of the facility and adaptation of the participants to a skilled nursing facility are shown in Table 2. The mean score of the participants in terms of their perceived health status was 6.83, which indicates a moderate level of perceived health status, and their mean score in terms of activities of daily living was 39.27, which indicates a high level of daily life activities. The mean score of the participants in terms of self-efficacy was 54.45, which indicates a moderate level of selfefficacy. The mean score of the participants in terms of depression was 6.34, which indicates a moderate level of depression. The mean score obtained in terms of the quality of the facility was 95.62, which indicates that the quality of the facilities was moderate, and the mean score of the participants in terms of their adaptation to a skilled nursing facility was 77.02, which indicates a slightly high level of adaptation. The correlations between the participants’ adaptation to a skilled nursing facility and related factors are shown in Table 3. The analyses of the participants’ perceived health status (r = 0.518, P = 0.001), activities of daily living (r = 0.423, P = 0.001), self-efficacy (r = 0.724, P = 0.001), and decision to enter a skilled nursing facility (r = 0.228, P = 0.001), and of the quality of the facility (r = 0.218, P = 0.001), showed positive correlations, whereas the analysis of the participants’ depression © 2014 Wiley Publishing Asia Pty Ltd
188
JY Choi and SR Sok
Table 1 Demographic characteristics (n = 500) Characteristics category Gender Male Female Age (year) 65∼69 70∼74 75∼79 80∼84 85∼89 >90 Education Elementary school Middle school High school Above college Religion Protestant Buddhist Catholic None Spouse Yes No Help from Family Relation Neighbourhood Friend Health state Good Moderate Poor Decision to enter Myself (spouse) Child Daughter-in-law Relation Motivation to enter Comfort old age No caregiver Conflict with child
n
%
128 372
25.6 74.4
63 88 153 138 49 9
12.6 17.6 30.6 27.6 9.8 1.8
165 128 129 78
33.0 25.6 25.8 15.6
124 256 63 57
24.8 51.2 12.6 11.4
58 442
11.6 88.4
214 57 137 92
42.8 11.4 27.4 18.4
19 366 115
3.8 73.2 23.0
212 113 113 31
59.4 31.7 31.7 9.0
212 113 113
59.4 31.7 31.7
(r = −0.586, P = 0.001) and age (r = −0.212, P = 0.001) showed a negative correlation. The factors that were found to influence the study participants’ adaptation to a skilled nursing facility are © 2014 Wiley Publishing Asia Pty Ltd
shown in Table 4. Multiple-regression analyses of the participants’ perceived health status, activities of daily living, self-efficacy and depression; of the general characteristics of the participants’ age and decision to enter a skilled nursing facility; and of the quality of the facility were performed to identify the major factors influencing the level of adaptation of older Korean adults to skilled nursing facilities. The analyses showed that the prediction model for the level of adaptation of older Korean adults to skilled nursing facilities was significant (F = 128.624, P < .001). The value of the adjusted R2 was 0.435, which corresponds to the explanatory power of 43.5%. The factor that was found to have the greatest influence on the adaptation of older Korean adults to skilled nursing facilities was the activities of daily living (β = −.564), followed by self-efficacy (β = .321), quality of the facility (β = .164), depression (β = .133), decision to enter a skilled nursing facility (β = .122), perceived health status (β = .064) and age (β = −.010) (see Table 4).
DISCUSSION In the results of this study, the average level of adaptation of older Korean adults to a skilled nursing facility was 95.62, which was higher than the median score of 90. This showed that the level of adaptation of older Korean adults to skilled nursing facilities was good. This result was identical to that of the study by Lee et al.2 It is believed that this result could be attributed to the fact that the study participants had relocated to a skilled nursing facility 6 months before the study was conducted and thus had already adapted to it. Therefore, it is necessary to conduct another study to measure the level of adaptation to a skilled nursing facility of older Korean adults who had relocated to a skilled nursing facility
