The Involvement of Nursing Home Residents as Peers

to Support Relocated Elders

Retno Indarwati

, Rachmat Hargono

, Setho Hadisuyatmana

and Makhfudli

Faculty of Nursing Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia

Faculty of Public Health Universitas Airlangga, Kampus C JL Mulyorejo, Surabaya

Keywords: Peer Support, Wellness, Stress Relocation, Elderly

Abstract: Peer-support is a substitutional support by trained peers led by nurses to relief stress among the elderly after

being relocated to nursing homes. This study aimed to evaluate the results of the development of peer-group

support in nursing homes and assess the stress levels of elderly people who were relocated to institutions.

This study used a quasi-experimental design and involved a total of 30 relocated elders, randomly selected

from UPTD (Unit Pelaksana Teknis Daerah) Griya Werdha Surabaya and UPT PSLU (Unit Pelaksana

Teknis Panti Sosial Lanjut Usia) Pasuruan under the inclusion criteria. They were randomly allocated to

both control and treatment groups in equal numbers. Pre-designed and trained peer groups developed and

acted as independent variables, and wellness was evaluated as the dependent variable in this study. The data

were collected by questionnaire and analyzed by using an independent t-test (selected level of α <0,05). The

results showed that pre-designed peer-group support significantly influenced the elderly people’s wellness

(by p = 0,000). However, this discovery requires further analysis as a feasible solution in reducing

relocation stress among the elderly in similar settings.

1 BACKGROUND

Relocation stress syndrome is a physiological and

psychological disorder that arises from resettlement

from one environment to another (Maas et al., 2011).

This problem is often experienced by the elderly,

who are either forcedly or are willingly moved from

their homes to new environments such as nursing

homes, retirement villages, hospitals, and houses

(Wold, 2012). This is because the process involves

changes in life situations that stimulate physical

movement and psychological adjustments to new

atmospheres. The stress could be even worse for

those who had just lost their previous environment

or loved ones, causing a lack of adequate preparation

and depleting physical conditions and supportive

systems.

The common problems that elderly people

suffering from this syndrome are feelings of

loneliness, anger, anxiety, fear, insecurity,

depression, and increased physical complaints and

withdrawals (Herdman, 2015). Elderly people who

decided to move to a residential institution are prone

to suffering from the syndrome due to new

environments and socio-cultural differences that

require adaptation in daily living activities. One of

the most significant factors that affects the success

of relief from the syndrome is linked to a personal

desire to accept living in the facility (Ariyani, 2014).

On the other hand, the compulsion of staying in

the facility, unresolved anxiety, lack of privacy, and

moving to a dependent environment exacerbates the

chance of elderly people suffering from stress

(Piekarski, 2008). The resettlement causes them to

feel separated and outcast from their home, family,

the community, their beloved ones, and hobbies and

can cause depression, anxiety, and loneliness.

Data obtained from a piloted study determined

that 12 out of 40 new residents (no longer than three

months from admission) of UPTD (Unit Pelaksana

Teknis Daerah) Griya Werdha and UPT PSLU (Unit

Pelaksana Teknis Panti Sosial Lanjut Usia)

Pasuruan were experiencing relocation-stress

syndrome. They felt uncomfortable because they

were unable to carry out their previous work or

make friends with other residents. Additionally,

residential staff and nurses were not aware that new

residents can suffer with the syndrome.

Empowering peers as an substitutional support

system in the residential is a feasible option to help

new residents recover from stress. This is because

Indarwati, R., Hargono, R., Hadisuyatmana, S. and Makhfudli, .

The Involvement of Nursing Home Residents as Peers to Support Relocated Elders.

DOI: 10.5220/0008320900840088

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 84-88

ISBN: 978-989-758-336-0

most elderly people who resided in the facility did

not have their families as immediate support

systems. Peer-group support is emotional and mental

support that can be provided by others with a similar

background, or who are expecting behavioral or

social change. Acceptance and empathy that are

built through mutual relationships are fundamental

in peer-group support. The sense of having a better

future becomes one of the offered benefits from

building a good peer-group support system. This

study aimed to gain further understanding on how a

peer-group as could relieve relocation-stress

syndrome among new elderly residents in nursing

homes.

2 METHODS

2.1 Study Design

The approach used in this study was a quasi-

experimental method conducted pre- and post-test to

evaluate the designed treatment. The control group

received standard care from the participating nursing

home. The experimental group received peer

support.

2.2 Study Population, Sampling, and

Procedure

Seven cognitively competent volunteers registered

themselves as peers and were then trained by the

team of researchers to support the subject of this

study: the wellness of relocated elderly people. New

elderly residents, who had lived for no longer than

three months in nursing homes, in Surabaya and

Pasuruan, were purposively screened using a

translated geriatric depression scale. Thirty elderly

people who suffered from and were diagnosed with

relocation stress voluntarily participated in this

study. The participants were then purposively

allocated into each treatment and control group.

The data collection occurred over a two-month

period through January and February 2017. The

peers attended 60 hours of training, which consisted

of tutorial and coaching activities. These peers were

then assigned to support the treatment group for two

weeks, while the control group were pre-provided

with group activities and recreational therapies,

which are standard for all residents in nursing homes

and institutions. The pre- and post-treatment data

were gathered using a wellness questionnaire that

was independently developed following the

functional consequence theory by the researcher (RI)

and was tested for validity and reliability issues.

2.3 Data Analysis

The gathered data were then analyzed using a paired

t-test with a selected significant level of p = 0.000.

2.4 Ethical Clearance

This study was certified for ethical clearance by the

Faculty of Public Health, Universitas Airlangga with

the number 424/KEPK, July 1, 2016.

3 RESULTS

This section describes the data gathered in the study,

including the demographic data of participants in

relation to stress characteristics and wellness

distribution before and after the intervention. Seven

elders who were recruited as peers were mostly

admitted to the nursing home through their own

personal will; they had graduated from 6th grade

(primary school) as their highest level of education;

and they had lived in the institution as residents for

longer than one year (Table 1).

These peers were then trained to support other

residents who were involved as participants of this

study. A total of 30 involved participants were

Table 1: Characteristics distribution of elders who were

recruited as peers.

Characteristics

Age

1. 60–74 years

2. 75–90 years

Gender

1. Male

2. Female

Education level

1. 6

grade

2. 9

grade

3. 12

grade

4. Bachelor

14.5

Personal reason of residing

1. Personal will

2. Had no option

Length of stay

1. <1 year

2. 1–5 years

3.> 5 years

Total

100

The Involvement of Nursing Home Residents as Peers to Support Relocated Elders

assigned into treatment with the control group at an

exact equal number (15 people in each) (Table 2).

The results determined that most participants

were female and graduated from primary schools as

their highest level of education. Most of the

participants were forced by external factors to live in

nursing homes. Almost all were new residents and

had stayed in the institution for less than two

months.

The result of this study shows that trained elders

can support their peers and improve the wellness of

newly relocated residents (as shown in Table 3

treatment group) significantly when compared with

the counterpart group. This indicates the significance

of peer-group support in improving the wellness of

residents who experience relocation stress.

4 DISCUSSION

Elderly people who have good cognitive skills have

the potential to be peers for other residents in

nursing homes. An earlier study reveals that elderly

people who have good cognitive skills are most

likely to have better social interaction compared

with others that have lower cognitive skills (Rosita,

2012). These people have positive emotional

attachment with their friends. Moreover, those who

are physically active would be good peers for others.

This is because physically-active elders are more

likely to have better cognitive function compared

with the opposite functionality (Muzamil & Martini,

2014). As it is known that physically active people

are less likely to suffer from cognitive deprivation,

such as dementia, due to sustained brain

vascularization, maintained dopamine level, and

preserved molecular changes, all of which increase

neuroprotective functioning.

The major criteria to become a peer were that the

elderly people should have a sense of care and

empathy and sensitivity to assist other residents and

also build positive social relationships. Facilitators

in this study supported them in their roles as peers.

This group acted as an substitutional support system

for new residents to help them solve problems,

strengthen their potential, fulfill their daily life

needs, and improve their access to health and social

services. This support is fundamental, especially to

relieve new residents from relocation-related stress,

which can display symptoms of withdrawal and self-

isolation.

A state of personal wellness can be identified

through assessing one’s independence in meeting

his/her daily needs (activities of daily living) and

maintaining safety. This is closely correlated with

one’s quality of life (QOL) and includes, but is not

limited to, independency in feeding, moving,

dressing, bathing, toileting, and minimizing their

own risks of falling. Decreased physical ability

increases the risk of falling in inappropriate features

within environments (such as a slippery floor

surface, ramp, conventional toilet), and prolonged

use of medication (Probosuseno, 2009). Not only

does falling impair physical mobility, but also

lessens self-esteem and psychological trauma, all of

which lead to walking disorders and decreasing

QOL (Darmojo, 2009).

Most participants of this study were aged

between 60 and 74 years old. Those who were 70

years of age and older have a higher risk of falling

Table 2: Characteristic distribution of elderly people

who participated in the study of relocation stress in

East Java, 2017.

Characteristic

Treatment

Control

Age

60–74 years

75–90 years

46.7

53.3

Total

100

Gender

Male

Female

33.3

66.7

Total

100

Education

Primary

School

Grade

86.7

13.3

Total

100

Personal

reason of

residing

Desire alone

Forced

26.7

73.3

33.3

66.7

Total

100

Length of

stay

< 1 month

1–2 months

46.7

53.3

Total

100

Table 3: T-Test results in the study of peer support to

improve wellness among the elderly experiencing

relocation stress as residents in nursing homes in East

Java, 2017

Indicator

Treatment

group

Control

group

p-Sig.

(2 tailed)

Pre

Post

Pre

Post

Wellness

30.53

±2.99

36.53

±4.47

30.20

±4.02

31.00

±5.61

0.00

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

and lose their independency in maintaining QOL

(Maryam, 2008). Elderly people could become less

self-caring and more dependent on others who are

younger and more reliable to remind them of things

they should do. The participants of this study

incidentally stated that it was not necessary to

change clothes or to bathe frequently, since there

were not many daily activities to do. Participants

perceived themselves as strong and did not need to

hold on to hand-rails when using the toilet. This

indicates that they were insufficiently aware of the

increasing risks of falling. This was shown in their

lack of initiative in preserving the cleanliness of the

toilet and making personal decisions regarding

maintaining a supportive environment (Sommer in

Ebersole & Hess, 1990). Presumably, this is due to

the cleaning service staff hired to ensure the

environment is safe for the residents of the nursing

home. Prior to the development of the peer group as

the predictor variable, elderly people who suffered

from relocation-stress exhibited withdrawn behavior,

self-isolation, and avoided social interaction with

other residents. These findings lend support to work

by Melrose (2004), who explains the characteristics

of elderly people with relocation stress as more

dependent, confused, anxious, depressed, and

socially isolated. They risk their own personal safety

due to never asking for help in maintaining their

daily living activities. The peers were trained by the

study team for at least 60 hours to provide support

for new residents exhibiting symptoms of relocation

stress. The support consisted of four steps including

introducing new residents to a physical and social

environment, provision of essential information,

instrumental and emotional support, and rewards.

The implementation of these steps was closely

monitored and assisted for four weeks. This is due to

the risk of high tension during the adjustment period,

until integration is achieved. Only two participants

reject the support; their wellness did not improve.

They were older than 75 years of age, and forcibly

relocated to the nursing home. They were angry and

irritable, which is caused difficulties regarding peer

support. Anger is a characteristic that indicates one’s

rejection of the new environment and the perception

that life is a depressive experience. This indicates

that the success of peer support is also influenced by

one's pre-existing characteristics, social roles, and

habits.

The assistance given to the peer group aimed to

facilitate supportive interactions between the group

and the participants: elderly people suffering from

relocation stress. This included the capacity for

problem solving, strengthening support, optimizing

the potential of available resources, and improving

access to social and health services. The four-week

assistance was necessary due to the heterogeneity of

the peer elders and novice experience as peers. They

required assistance as this was their first time

working with stressed peers, who tended to be

socially self-isolated and less likely to have social

interaction with others.

Knowledge forms one's actions obtained from

active interactions, influenced by internal factors

(age, intelligence, and physical condition) and

external factors (such as information, infrastructure,

family support, and the learning process). The

information given by elderly peers to stressed

residents built fundamental awareness from risks of

falling and actions of self-reliance. This learning

experience intends to facilitate exchanges of

information, decision making, and emotional support

to accelerate the positive adaptation process.

The results of this study indicate that peer group

capacity development is effective to improve the

wellness of relocated elderly people. This finding

lends support to previous research by Rash (2007),

who states that social support can improve elderly

people’s self-reliance. The social interaction

between peers and stressed elders is a mutual

relationship that facilitates a supportive atmosphere

and achieves good emotional control. It builds a

sense of having friends to rely on, to share stories,

attention, and collaborative activities. This leads to

acceptance to changes, psychological adaptation,

and physical stress disengagement.

5 CONCLUSIONS

The results of this study suggest that peer support is

effective in promoting psychological wellness

among relocated elderly people. Not only does peer

support promote social interaction, but also

improves positive adaptation and emotional control.

However, these findings suggest further

investigation to evaluate other components of

relocation-related stress among elderly residents in

nursing homes.

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INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research