ORIGINAL

Attitudes, knowledge, and interest of future professionals towards geriatrics: a cross-sectional study

Marina Mariano Roquetti Borges1, Maria Giovana Borges Saidel1, Daniella Pires Nunes1, Maria Helena Melo Lima1, Ana Railka de Souza Oliveira-Kumakura1

1 Federal University of Campinas, Campinas, SP, Brasil

ABSTRACT

Objective: this study aimed to examine health students' attitudes, knowledge, and interest towards geriatrics and gerontology and evaluate associations. Method: a total of 225 students in the final year of Nursing, Medicine, Speech therapy, Pharmacy, and Physical education participated. The questionnaires included a characterization form, the Aging Semantic Differential Scale, and the Palmore Fact on Aging Quiz. Multiple regression models were used. Results: the attitude towards older people was negative (50.67%) and associated with less interest. The level of knowledge was better among Nursing, Medicine, and older students. Increased knowledge was related to attitude and, in total, 71.43% were interested in geriatrics. Interest was strongly associated with female gender. Conclusion: students showed a high level of knowledge, interest in geriatrics, and a negative attitude towards geriatric care. Actions focused on geriatric training should be implemented.

Descriptors: Attitude; Aging; Students, Health Occupations.

INTRODUCTION

With an increase in life expectancy, reduced fertility rates, and technological advances, the population of older adults has grown worldwide bringing with it social, economic, and health challenges(1).

Although we have seen changes in healthcare, the increasing number of older people leads to an increased demand for specialized services(2). These issues are not restricted to developing countries and current health systems cannot meet the aging-related demands(3). Moreover, senescence leads to functional, mental, and cognitive losses, increasing vulnerability, morbidity, and disability(3).

There are no doubts regarding the peculiarities of aged individuals. They require a comprehensive assessment with functional capacity being the main requirement for their care. Therefore, trained health professionals must meet the characteristics of this population in an integrated manner(3). The literature reports the insufficiency of multidisciplinary teams with the necessary knowledge to act at different care levels for older adults(1). In addition, several factors have been associated with providing care for this group, including the lack of interest(3). Thus, academic training investments are essential, with disciplines aimed at comprehensive teaching on the topic(4,5).

Therefore, the following questions emerged: What is the current level of knowledge, interest, and attitude of future health professionals towards geriatrics and gerontology? Given the growing demand for care towards older people in health services, how are these three domains related?

In university, the involvement and engagement of students with geriatrics and gerontology can enable the acquisition of knowledge, a cognitive component that, along with beliefs, can be shared. Knowledge influences the perceptions about the world; when shared with a social group, these perceptions can strengthen connections with culture and increase the degree of involvement and active participation of group members.

Attitude is defined as a "mental or neural state of readiness, organized through experience, exerting a directive or dynamic influence upon the individual's response to all objects and situations with which it is related". In other words, it is the predisposed way how a person feels, perceives, and behaves(6). Some studies show that attitude can influence older people's care(7).

There are still many issues related to geriatrics training. Low interest in this career may be due to a lack of exposure, the nature of this kind of work, the perceived low status of the profession, and financial rewards(8).

There is a relationship between interest and personal values. Consequently, students' choices in their professional practice are related to their interests. The literature shows that developing the empathy of undergraduate students can improve positive attitudes in older people's care(9).

An association between knowledge, attitude, and interest has been found(10). While knowledge and attitude are influenced by external, employment, and individual factors(11), interest is influenced by previous experience, recognition of the profession, work conditions, attitudes, and knowledge(10).

It is a challenge for health students to promote the approach of gerontological content in their curricula, thus acquiring a positive attitude towards older people's care(12). This study aimed to examine health students' attitudes, knowledge, and interest towards geriatrics and gerontology and evaluate associations.

METHOD

Study design

A cross-sectional quantitative study was conducted according to the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Participants

Study participants were health students, with a gerontological content in their curricula, in their final year of a Bachelor of Science (Nursing, Medicine, Speech therapy, Pharmacy, and Physical education), from a public university in São Paulo, Brazil.

All eligible students had clinical hours of supervision and practical activities involving older adult care in community or hospital settings (N=540). However, Speech therapy and Pharmacy programs do not have a specific discipline on the topic. There are 30-hour and 60-hour theoretical courses related to the topic in Nursing and Physical education programs, respectively. Medicine students in their fourth year must complete 35-hours of practical training in a geriatric setting, and fifth year students must complete 60-hours in a geriatric outpatient clinic.

Sample size was estimated considering a binomial distribution, a level of significance of 5%, a sampling error of 3%, and a proportion of .50 (maximum variance), resulting in a sample of 225 students from a total of 540, distributed as follows: 137/330 Medicine students, 42/100 Physical education, 17/40 Pharmacy, 17/40 Nursing, and 12/30 Speech therapy. The selection was non-probabilistic and by convenience.

The inclusion criteria used for Nursing, Speech therapy, Pharmacy, and Physical education students was that students needed to be in their last year. Medicine students in the fourth, fifth, and sixth years were included. Students who did not fill out the questionnaires correctly were excluded.

Procedures

Data collection was carried out from September to December 2019. The students were invited to participate via e-mail. All potential participants were contacted by a nursing student in the last year of the program. All students who chose to participate filled a consent form. As described below, the self-administered questionnaires were distributed to volunteer students, who took about 20 to 40 minutes to complete them.

Ethical considerations

The study was approved by the Human Research Ethics Committee at the University of Campinas and followed the tenets of the Declaration of Helsinki. All participants signed the informed consent form.

Instruments

The research team developed a questionnaire for the study addressing demographic characteristics (age and gender), contact with older people in the family (who, when and how) and at the university, questions related with the interest in geriatrics and gerontology, and questions about providing care to older people.

Aging Semantic Differential Scale (ASDS)

The ASDS was developed in Brazil to assess attitudes towards older people and achieved a good internal consistency (Cronbach's alpha = .89 – .94)(13). This scale comprises 30 paired adjectives, such as "wise–foolish" and "accepted–rejected" and involves the following domains: cognition with 10 items (social adaptation reflected in information processing and problem-solving); agency, 6 items (autonomy and instrumentalization to perform actions); interpersonal relationships, 7 items (social interaction, assessed by affective-motivational aspects); and persona, 7 items (social labels to designate or differentiate older people). Scores below 3 were considered positive, 3 neutral, and 3 or above negative(13).

Palmore Fact on Aging Quiz (PFAQ)

The PFAQ has 25 multiple-choice questions with 4 options and a "do-not-know" answer addressing general knowledge on older people and the aging process. The PFAQ is used worldwide(14,15) and has been adapted and validated for the Brazilian culture with a good internal consistency (Cronbach's alpha = .75)(13). Its questions cover the cognitive, psychological, and social domains. For example, in the Physical domain, there is a question on lung capacity; in the Social domain, there is a question about the proportion of Brazilians over 65 living in nursing homes. The following classification was adopted according to a previous study(12): 11 or less correct answers = low level of knowledge, and more than 11 correct answers = high level of knowledge.

Data analysis

SAS version 9.4 was used for data processing, with a level of significance of 5%. First, a descriptive analysis was performed. Then, the Shapiro-Wilk test was used for testing normality. For comparisons between quantitative and qualitative variables in two categories, the Mann-Whitney test was used. For comparisons with a qualitative variable in more than two categories, the Kruskal-Wallis test followed by Dunn's post-test were used. The Chi-squared test and the Fisher's exact test were used to test associations between qualitative variables.

The Spearman's coefficient was used to analyze associations among quantitative variables based on the following guidelines(16): 0.1 to 0.29: weak correlation, 0.30 to 0.49: moderate correlation, and 0.50 and above: strong correlation.

Multiple linear regression models were developed, and the total scores obtained for attitude and knowledge were considered dependent variables. Estimates of regression coefficients, confidence intervals, and p-values were calculated. For the variable "interest in geriatrics and gerontology", the Poisson model was used, and we estimated the prevalence ratios, confidence intervals, and p-values. Variables with a p-value ≤ .20 were selected for further analysis.

RESULTS

Participants' characteristics

In total, 244 students participated in the study, from which 19 did not fill out all scales and were excluded. Among 225 participants, the mean age was 23.95 (SD = 3.32) years, 57.33% were female, and 60.89% were medical students. Overall, 93.33% had contact with older people in the family, and 83.04% had living grandparents, 80.27% of whom had contact with them. Contact with older people was weekly (31.84%) or monthly (25.56%) and mainly on commemorative dates. Regarding this association, 80.44% were affectionate and 72% respectful (Table 1).

At university, 85.33% reported having experiences with older people, which occurred in hospital internships, primary care or gyms in the case of physical education students (Table 1). Regarding geriatrics/gerontology, of the 196 students exposed to this specific content, 57.14% had studied it previously.

Characterization of the leading research variables

The overall attitude was negative (50.67%, mean ASDS = 11.87), and more evident in the Cognition and Social relationships domains. The Agency and the Persona domains of the ASDS had a more positive attitude. The students' mean level of knowledge about old age was high (60.55%, mean PFAQ = 11.87), mainly in the Cognition and Physical domains; and lowest in the Social and Psychological domains (Table 1). In terms of interest in geriatrics/gerontology, 71.43% of students expressed an interest, but interest in exclusively developing care for older people was 18.75% (Table 1).

Table 1 - Descriptive characteristics of health students (n = 225). São Paulo, SP, Brazil, 2019

Source: Elaborated by the authors, 2019.

(a) SD: Standard deviation; (b) Total: 196 (Nursing, Physical education, and Medicine students); (c) ASDS: Aging Semantic Differential Scale; (d) PFAQ: Palmore Fact on Aging Quiz.

Associations of the leading research variables

After Dunn's post-test (p < .05), we observed that nursing students had a higher PFAQ in the Physical domain than physical education (4.82 vs. 3.83, difference = .99) and medicine students (4.82 vs. 4.05, difference = .77). Medicine students showed a higher PFAQ mean than physical education students in the Psychological (2.93 vs. 2.26, difference = .67) and Psychological/Social/Physical domains (.94 vs. .60, difference = .34), and also in the PFAQ total (12.20 vs. 10.69, difference = 1.51) (Table 2).

Table 2 - Comparison of age, attitude, and knowledge scores among the students (n = 225). São Paulo, SP, Brazil, 2019

Source: Elaborated by the authors, 2019.

(a) ns: not statistically significant; (b) Kruskal-Wallis test; (c) Mann-Whitney test. (d) Dunn's post-test.

Regarding age, older students had a higher PFAQ (Table 2). After Spearman's correlation tests, we observed a positive and weak correlation between age and knowledge in the Social domain (r = .1378) and in the total PFAQ (r = .1391) (Table 3).

A positive and weak correlation between the Psychological domain of knowledge and the Cognition domain of attitude (r = .2150), and between the Social domain of the PFAQ and the total ASDS (r = .1495) was observed (the increase in knowledge in these domains was related to a negative attitude). There was also a negative and weak correlation between Psychological knowledge and Social relationship (r = -.1467) indicating that high knowledge was related to a positive attitude (Table 3).

 Table 3 - Spearman's correlation coefficient (n = 225). São Paulo, SP, Brazil, 2019

Source: Elaborated by the authors, 2019.

(a) p<.05.

Students who did not take classes on geriatrics/gerontology showed a negative attitude in the Agency domain (3.06 vs. 2.87, p=.0244), and those with no interest in caring exclusively for older people showed a negative attitude in the Cognition domain (3.09 vs. 2.92, p = .0091) (Table 2).

We also found that contact with older people in the family (p = .0120) and not being interested in caring exclusively for older people (p = .0125) were associated with a negative attitude in the Cognition domain. Previous experience at university was associated with a negative attitude in the Social relationship domain (p = .0398), and students with no contact with grandparents showed a positive attitude in the Agency domain (p = .0293) (Table 4).

Table 4 - Test of association between interest and classification of knowledge and attitude (n = 225). São Paulo, SP, Brazil, 2019

Source: Elaborated by the authors, 2019.

(a) Chi-square test; (b) ns: not statistically significant.

Regarding age, older students had a neutral attitude in the Persona domain (Table 2). We observed a positive and weak correlation between age and attitude in the Persona domain (r = .1825) and in the total ASDS (r = .1449). An interest in geriatrics/gerontology was associated with female gender and with interest in exclusively providing care for older people (Table 3).

Regression models of the leading research variables

No significant association was observed between independent variables and attitude. We observed a significant association between knowledge and program. There was a negative association between speech therapy and physical education with nursing (reference course for the model), decreasing the total PFAQ score to 2.32 and 2.27. In terms of interest in geriatrics/gerontology, male students showed a 22% lower probability, and those interested in exclusively caring for older people were 1.25 times more likely to be interested (Table 5).

Table 5 - Multiple regression models (n = 225). São Paulo, SP, Brazil, 2019

Source: Elaborated by the authors, 2019.

(a) CI: confidence interval; (b) LL: lower limit; (c) UL: upper limit; (d) Multiple linear regression model; (e) Poisson regression model; in this case, the probability of "Yes" was estimated.

DISCUSSION

This study assessed the knowledge and interest in geriatrics and gerontology of future health professionals and their attitudes towards old people. Although students had an adequate level of knowledge, this was not enough to generate a positive attitude or greater interest in this field, as reported in other studies(17-18).

The findings show that the attitudes of health students were negative. Previous study reported mixed and contradictory findings towards older people: stereotyped, inconsistent, negative, positive in most situations(6-7,17) or even neutral(18).

Most students had contact with older people in the family or university. Studies show that the burden of providing care, communication difficulties, and a tedious job could lead to negative attitudes(17). We observed a negative attitude in the Cognition and Social domains among students who had contact with older people. Although the curriculum of health courses have not been examined, interventions are needed. The suggestions found include curriculum changes with intergenerational contacts(19), gerontological experiences at the beginning of courses(18), innovative educational strategies(7), studying with peers, and continuous programs on the topic(17).

We found a weak correlation between attitude and knowledge and a correlation between attitude and age (older students showed a negative attitude). The increased knowledge is not related to a more positive attitude towards older people(14), and both students at a senior undergraduate level and healthcare professionals can have negative attitudes(10). McCloskey et al.(18) pointed out that attitude is being translated into the practice fields.

Students' knowledge toward older people and the aging process showed significantly high levels, similar to other studies(18), despite the fluctuations(17). Therefore, education on geriatrics needs to be promoted, since not all programs cover this subject. For the programs with no geriatrics and gerontology classes, the level of knowledge was higher in the Physical domain and lower in the Social and Psychological ones.

Although knowledge alone cannot provide integrated care to older people, these findings indicate a need to keep discussing the scope of the gerontological teaching(18). In addition to the inclusion of geriatrics and gerontology content in healthcare programs, we need to swift the focus from diseases to multidimensional and holistic care. Nursing students showed a higher level of interest due to their course involving holistic care, explaining the differences found.

Findings regarding the interest in older people's care highlighted that a negative attitude is related to a lack of interest, as observed in previous studies(17). Moreover, knowledge was not related to increased interest. Despite the lack of preference for a gerontological career among students(18), interest in caring for older people was associated with interest in geriatrics/gerontology.

Gender was also correlated with an interest in geriatrics and gerontology (female students showed more interest). This association is possibly linked to social issues; women are involved in professions similar to those performed in their daily lives, such as caring for parents/grandparents. This finding was also reported in other study that shows that male students tend to value intervention and technique more than females(5).

The study limitations include the single-centre study design (the sample might not represent Brazil as a whole), the convenience sampling, and the fact that cross-sectional studies do not imply causality. Besides, knowledge, attitude towards older people, and interest are complex constructs that may not have been captured by the instruments used. Finally, the curriculum content of each course was not examined.

CONCLUSION

Health students showed a high level of knowledge and interest in geriatrics and gerontology, and a negative attitude towards older people's care. Knowledge on the topic was negatively associated with attitude and interest. Nursing and medical students showed more knowledge on the topic, as well as older students. Being female and interested in caring for older people increased the ratio for choosing to work in geriatrics and gerontology.

CONFLICT OF INTEREST

The authors have declared that there is no conflict of interest.

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Submission: 10/28/2021

Approved: 06/08/2022