Abstract
OBJECTIVES: Older adults transitioning to nursing homes face challenges in adapting to a new environment and imposed lifestyle changes. This study aimed to identify factors associated with poor nursing home adjustment and to assess their impact on 1-year mortality. DESIGN AND SETTINGS: This study is a secondary analysis of the KArukera Study of Ageing in 'Établissement d'Hébergement pour Personnes Agées Dépendantes' (EHPAD) (KASEHPAD) cohort, a prospective observational study conducted over 1 year in six nursing homes in the French Caribbean. PARTICIPANTS: 159 older adults (aged 60 years or older) living in nursing homes who were able to complete the self-administered adaptation scale. MAIN OUTCOME MEASURES: Nursing home adjustment was assessed at baseline using the adaptation scale for older adults to their residence (EAPAR). Bivariate analysis was used to assess associations between adjustment status and sociodemographic or clinical characteristics at baseline. Poisson regressions were used to assess the relationship between 1-year mortality and adjustment status. RESULTS: A total of 159 older adults (mean age: 79.6 years; male/female ratio: 84/75) were included. The mean length of stay was 4.1 years. Among older adults, 78 (49.1%) were classified as poorly adapted. Age, gender, education level, dependency, cognition and comorbidities were not significantly associated with poor adjustment. In contrast, depressive symptoms, lower social support, lower health-related quality of life, lower subjective quality of life, malnutrition and sleep disturbances were associated with poor adjustment. After 12 months, 14 deaths (17.9%) occurred in the poor adjustment group, compared with 4 (4.9%) in the no major adjustment difficulties group (adjusted relative risk for age, gender and baseline activities of daily living score=4.64 (95% CI 1.53 to 17.5; p=0011). CONCLUSIONS: In a sample of older adults with moderate cognitive impairment, poor adjustment to nursing home was associated with depressive symptomatology and increased 1-year mortality. The issue of adjustment in nursing homes represents an emerging research area that warrants further investigation through dedicated interventional studies. TRIAL REGISTRATION NUMBER: NCT04587466.