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Table 4 Synthesized findings

From: The adaptation of older adults’ transition to residential care facilities and cultural factors: a meta-synthesis

Synthesized finding




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 [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].