ANALYSIS OF FACTORS AFFECTING SELF-ACCEPTANCE IN OLDER ADULT LIVING IN NURSING HOMES

identified and screened (n=64) Full copies retrieved and assessed for eligibility (n=13) Study included in synthesis (n=13) Excluded (n=652) Problem/Population : Does not focus on topic (n=152) Intervention : Irrelevant with topic (n=34) Outcome : Does not discuss the older adult acceptance who lived in nursing home (n=366) Study design : Systematic review (n=24), Literature review (n=16), and Book chapters (n= 60) Excluded (n=51) Participants: Does not focus on analysis factor (n=9) Intervention: Irrelevant topic’s location (n=11) Outcome :Does not discuss acceptance of older people (n=31) INDONESIAN JOURNAL OF COMMUNITY HEALTH NURSING http://e-journal.unair.ac.id/IJCHN| 67 informants (80%) said that giving a statement that the Covid-19 vaccination can prevent the virus, 3 informants (75%) said that herd immunity can form protection, almost all of the informants (85%) said that if you refuse the Covid-19 vaccination, impact on the body is easily exposed to Covid-19 virus. Community Perceived Barriers to Covid-19 Vaccination Based on results of interviews with community, 3 informants (80%) stated side effects of Covid-19 vaccination were fever, feeling tired and hungry, 3 informants (80%) stated considered dose of Covid-19 vaccination to be high, but a small number of informants also stated informants did not know how many doses of Covid-19 vaccination, 3 informants (75%) stated prevented informants from carrying out Covid-19 vaccination by saying they were afraid, all of informants (100%) gave a statement did not believe in the hoax news about Covid-19 vaccination.


INTRODUCTION
Older adults who have recently lived in nursing homes are experiencing various changes that are difficult to deal with (Patricia, 2015). It was also conveyed by Chang (2013) that older adult people living in social services will experience many problems such as physical, psychic, social stress and cannot accept a new environment. So it can cause depression, stress, loneliness, and low quality of life. This can lead to obstacles in self-acceptance and adaptation processes in older adults. Self-acceptance is one of the important components that must be owned and exists in the individual. Because with a sense of self-acceptance, the individual can accept himself with all his shortcomings and advantages. The process of acceptance of a person does not just happen; some factors can influence one's selfacceptance process, including the understanding of self, realistic expectations, no obstacles in the environment, social support from the environment, no emotional stress, self-perspective, and stable selfconcept (Hurlock, 1999in Aphrodita, 2018. From these problems, it is necessary to have a literature review to explain what factors affect self-acceptance in older adult people living in nursing homes. Based on data from WHO, in the next four decades, the population of the older adult population is estimated to increase by 10% to 22% (Ministry of Health, 2017). Data from the Indonesian Ministry of Health in 2017 estimates that in 2017 there were 23.66 million older adult people in Indonesia (Yuniartika and Muhammad, 2020). In 2020-2050 it is estimated that seniors aged 60 and over will continue to experience significant improvements. By 2050 it is predicted that the number of older adult people will reach 25.07% of the total population. While in Indonesia itself, in 2050, the percentage of older adults will reach 28.68% of the total population (Kemenkes, 2013). Along with the increasing older adult population, the number of older adult people entering the nursing home will also continue to increase to meet social welfare for the older adult.
The difficulty of adapting to the new environment is a definite impact on the older adult who has just entered the nursing home. According to Dina (2016), another factor is the absence of relatives or family in the new older adult environment. The older adult who lives at the nursing home will undoubtedly experience various problems. According to Chang's statement (2013), the transfer of residence from residence to nursing home can cause stress in the older adult, both physically, psychologically, and socially. This will lead to a refusal in the older adult to accept the changes that occur to him. Rejection can cause various psychological impacts such as feeling lonely, restless, sad, angry and causing depression.
Several factors can achieve self-acceptance. Among them are personal factors consisting of socioeconomic, religiosity, and older adult spirituality, and community factors in the form of social support obtained from health workers, peers, and older adult families (Alligood, 2010). In addition, another factor that can also affect self-acceptance in older adults is positive thinking. Thinking positively and focusing on positive aspects is an adaptation step the older adult takes to accept their new environment in the nursing home and its entirety (Rinnan, 2018). The purpose of this literature review is to find out what are the factors that contribute to self-acceptance in older adult people living in nursing homes.

METHOD
The research design used in this study is a literature review. This literature review uses the PICOS framework written in (Table 1). As for article searches starting from May to July 2020 using Scopus, Science Direct, Google Scholar, and Pubmed databases with the last ten years. Article search uses keyword and boolean operators to expand or specific searches, making it easier to determine articles and has been adapted to Medical Subject Heading (Table  2).

Inclusion and Exclusion Criteria
The inclusion criteria used in this literature review are as follows: 1) Older adult people living in nursing homes. 2) Research design used (Pre experimental study, experimental study, qualitative study, mix methods study, correlation analysis, and comparative analysis.). 3) Outcome in the form of self-acceptance. 4) Articles published in the 2010-2020 range using both Indonesian and English. 5) Discuss the factors that affect self-acceptance in the older adult who lives in the nursing home.
The exclusion criteria used in this literature review are as follows: 1) Older adult people living at home. 2) Research design used (Literature review, Systematic review, and Book chapter). 3) articles published before 2010 and using languages other than Indonesian and English.

Study Search and Selection Results
Based on literature search results through publications in four databases and using keywords that have been adapted to MeSH, researchers obtained 1466 articles that matched those keywords. The search results that have been obtained are then checked for duplication and found there are 521 articles in the same article, so it must be issued and the remaining 718 articles. The researchers then conducted a screen based on the title (n=718), abstract (n= 64) and full text (n=13) that was tailored to the topic of the literature review. The assessment was conducted based on the feasibility of inclusion and exclusion criteria obtained from 13 articles used in the literature review.
The quality assessment of the article was carried out using The Joanna Briggs Institute (JBI) Critical Appraisal. The criteria assessment is rated 'yes', 'no', 'unclear' or 'invalid', and each 'yes' score is given one point, and the other value is zero. Each score is then calculated and summed. Researchers do a critical appraisal for assessing qualified articles. If the article score of 50% meets the Critical appraisal criteria with the cut-off point agreed upon by the researcher, then the article is included in the inclusion criteria.

Community Perceived Suchephibility of Covid-19
Based on the results of interviews with community that most of the informants were vulnerable to themselves, 4 informants (70%) stated that they were easily infected with Covid-19, 3 informants (67%) stated that they believed that they were not easily exposed to Covid-19 virus because they had no previous illness history, all informants (100%) stated that many people around them were sick, 3 informants (55%) stated that their efforts were to maintain immunity, 4 informants (85%) stated that vaccination could make body vulnerable to covid-19 virus, all informants (100%) stated that they strongly agree with covid-19 vaccination program.

Community Perceived Severity of Covid-19
Based on the results of interviews with community, 3 informants (67%) expressed their opinion that Covid-19 can be deadly because there is a history of illness, 2 informants (40%) each stated that Covid-19 virus spreads quickly and stated that Covid-19 was dangerous because look at news, 3 informants (67%) said that Covid-19 vaccination was not dangerous, 3 informants (67%) stated that vaccine had been tested in labboratory, 4 informants (85%) said the body is easily exposed to the Covid-19 virus .

Community perceived benefits of Covid-19 vaccination
Based on the results of interviews with the community, it was found that almost all informants stated that their community became strong (40%), their bodies became vulnerable (40%), and some said that they could reduce transmission (17%), 3 The population in the articles and articles that will be reviewed are the older adult who lives in nursing homes.

Interest
(Interest in certain events, activities, actions or processes) Interest in the article is psychological factors, social support, religiosity, and spirituality. The article was studied, observed, and analyzed whether these factors influenced selfacceptance in older adult people living in nursing homes. Comparation (Other management used as a comparison) Nothing

Outcome
(Results or results obtained in the study) The outcome in the article to be reviewed is the relationship between self-acceptance factors such as psychological, physical, social support, religiosity, and spirituality to selfacceptance in older adult people living in nursing homes.

Study design (Design research on the article)
The research design used in the article is pre-experimental study, experimental study, qualitative study, mix methods study, correlation analysis, and comparative analysis.  informants (80%) said that giving a statement that the Covid-19 vaccination can prevent the virus, 3 informants (75%) said that herd immunity can form protection, almost all of the informants (85%) said that if you refuse the Covid-19 vaccination, impact on the body is easily exposed to Covid-19 virus.

Community Perceived Barriers to Covid-19 Vaccination
Based on results of interviews with community, 3 informants (80%) stated side effects of Covid-19 vaccination were fever, feeling tired and hungry, 3 informants (80%) stated considered dose of Covid-19 vaccination to be high, but a small number of informants also stated informants did not know how many doses of Covid-19 vaccination, 3 informants (75%) stated prevented informants from carrying out Covid-19 vaccination by saying they were afraid, all of informants (100%) gave a statement did not believe in the hoax news about Covid-19 vaccination.

DISCUSSION Factors Affecting Self-Acceptance in Older adult Living in Nursing Homes
Good self-acceptance is an important component that the older adult must have after relocation to the nursing home. Poor self-acceptance in the older adult will make obstacles for the older adult adaptation process, so it will cause various problems when the older adult can not accept themselves completely. After searching the four databases, some factors affect self-acceptance in the older adult in the nursing home, namely:

Social Support
After analyzing the thirteen articles of findings used in this study, 53% of articles described social support as an important factor influencing the level of selfacceptance in older adults living in nursing homes. Social support allows social to function fully and can improve adaptation in social health (Friedman, et al., 2010). According to Sarafino (2006), the sources of social support can come from a variety of sources such as spouses, family, girlfriends, friends, coworkers, and community organizations. The support obtained can be in the form of interaction between the residents of the nursing home, recognition from the residents of the nursing home, emotional and nonemotional support from the staff, and the comfort of the nursing home environment. The emotional support that the older adult gets from the residents of the nursing home and staff can improve the adjustment of the older adult (Lee, 2015). This is in line with Eunhee's research et al. (2017) that social support or interaction with other nursing home residents can positively affect adjustments after relocation. Therefore, social support obtained from the nursing home residents, staff, families, and relatives are very important to increase selfacceptance in the older adult living in the nursing home. Support can be in the form of emotional support (such as recognition, appreciation, motivation, and hearing), physical support in meeting the needs of care, and setting a supportive environment. In addition, to increase socialization among fellow older adult residents of the nursing home, it is necessary to hold various activities that can increase socialization, empathy actively, and care among older adults, such as regularly holding a sports agenda and holding group races and other.

Spirituality
In addition to social support, spirituality also affects self-acceptance in older adults (Herlina, 2018). In his research, Pidemont (2001) mentioned spirituality as a motivational trait, the presence of nonspecific affective forces that encourage, direct, and choose behavior. Spirituality is an awareness of oneself and an individual's awareness of origin, purpose, and fate (Hasan, 2006). Spirituality significantly helps the older adult adapt to any changes that occur in her to grow good self-acceptance (Dewi, 2014). Whether it decreases physical, cognitive, or psychosocial conditions, the emergence of various health problems is a natural process that occurs and inevitably occurs in everyone. This has become God's statute as old age comes. Older adults who can understand that every change that occurs is a provision of God that must occur tend to have a good level of spirituality so that the older adult can accept the changes that occur to him. Therefore, the increase in older adult spirituality is directly proportional to the self-acceptance experienced by older adults living in nursing homes. Things that can be sought to improve spirituality in the older adult living in the nursing home are such as spiritual guidance and seminars on old age in which discusses the changes that are natural to occur in the older adult so that the older adult can accept any changes that occurred as a normal process.

Religiosity
Religiosity has the basis of theological beliefs (godhead) in accordance with a particular religion, has guidelines on the ways, methods, and practices of worship, and serves to help individuals understand their life experiences (Amir & Rini, 2016). In the research article (Ramadhiati, 2020), the higher the religiosity of the older adult, the higher the acceptance of him. Older adults with a good level of religion (religiosity) will experience better physical and psychological well-being, good social function, and a feeling of peace (Efrina, 2018). Therefore, the older adult's level of religiosity, whether it is close to God or his gratitude for his life, is an internal factor that can improve poor self-acceptance in the older adult living in the nursing home. Examples of religiosity factors that can be pursued in the field are scheduling worship regularly and holding other religious activities that can increase the worship of the older adult in their old age.

Positive Thinking
Positive thinking also has a part in self-acceptance that occurs in older adults. Positive thinking is a cognitive process that creates a positive image, confidence, problem-solving, positive decision making, and can see ugliness from a positive point of view (Safari & Akbar, 2018). Positive thinking is a form of perspective that sees everything from the positive side to bring up positive values in the older adult. By thinking positively, the older adult can see all the changes that occur and accept himself entirely.

CONCLUSION
Based on 13 articles of findings used in the literature review, several factors can influence self-acceptance in older adults living in nursing homes. The factors obtained are divided into four parts, while the factors that can influence self-acceptance in the older adult living in the nursing home are spirituality, social support, religiosity, and positive thinking. The majority of articles discuss social support as an important factor in the emergence of good selfacceptance for older adults. Social support is obtained from the nursing home residents, both staff and fellow seniors in the nursing home, family support, and emotional support.