Received date: May 08, 2015 Accepted date: July 28, 2015 Published date: July 30, 2015
Citation: Yasemin Kavlak Y, Yildiz S, Akin Tug O (2015) Nurses’ Attitudes towards Older People: Report from a Single Institution Study. Int J Phys Med Rehabil 3:296. doi:10.4172/2329-9096.1000296
Copyright: © 2015 Kavlak Y, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Background: Discrimination against the elderly is generally a definition used for the whole of the bias, negative attitudes, acts and corporate arrangements developed against elderly individuals and growing old. The aim of this study was to determine the attitudes of nurses concerning discrimination against the elderly and the factors that influence these attitudes.
Methods: This was a descriptive study. Two hundred forty-four nurses between the ages of 18 and 54, who provide one-on-one services to elderly individuals at a medical faculty teaching hospital, and who agreed to take part voluntarily, were included in the study. The tools used to collect data were a questionnaire prepared in line with the literature that contained personal and occupational questions and an Ageism Attitude Scale.
Results: Two hundred forty-four nurses with an average age of 31.79 ± 8.0 participated in the study. There was a significant difference in the average Ageism Attitude Scale total and sub-dimension scores of the participants according to their educational status, age, marital status and manner of working (p<0.05). It was also found that the average Ageism Attitude Scale total and sub-dimension scores of those who had received (or wished to receive) training on old age during their employment and those who did not see the elderly as just a group in the hospital were significantly higher (p<0.05).
Conclusion: It is possible for attitudes of discrimination against the elderly to be affected positively by improving the working conditions of nurses working with elderly individuals and by organizing training programs that will increase information, skills and awareness about old age.
Ageism; Attitudes the elderly; Nursing; Healthy living
Old age is a period when irreversible physiological, chronological, spiritual and social changes and losses of roles are experienced and the adaptation of the system to the environment decreases [1-3]. Elderly individuals often experience more than one health problem and visit health centers usually . The length of the period of old age brings with it an increased need for long-term care, and this in turn means new arrangements for families. Additionally, with regard to the policies of governments, periods of adaptation and more investment are needed [5,6].
The socio-cultural structures and customs of communities play a role in the formation of the attitudes and behavior towards the elderly [7,8]. Especially the changes of economic and social life, having an impact on the communication between young individuals and the elderly and their attitudes towards old age [9-11]. Discrimination against the elderly describes the different attitudes, prejudices, manners and behavior towards someone just because of their age and covers both positive and negative attitudes [9,12]. The term “discrimination against the elderly” was first used in 1969 by the Gerontologist Robert Butler, who was the Chairman of the American National Old Age Institute, as a term that defined racial and gender discrimination directed at elderly persons. On the other hand, Palmore has used this term to define the prejudice, attitudes and behavior directed at individuals of an old age [7,10-14]
Studies examining the attitudes of health care workers towards elderly individuals have been included in the literature recently. It is considered that the prejudices held by health care workers towards the elderly, their own values, perceptions and beliefs are among the fundamental reasons for discrimination against the elderly . Further, it is shown that age, gender, level of education, living/spending time with an old person, areas of application and professional socializing could have an influence on attitudes towards discrimination against the elderly [16-22].
Nurses provide one-on-one services for elderly individuals in many areas, from protective health services to palliative care. In addition, they offer full-time service working with the shift system [17,18]. Long and tiring hours, insufficient number of staff to work with causes that require special attention and detailed inspection and maintenance to develop negative attitudes towards older groups [10,11,13]. Therefore, studies on discrimination against the elderly concentrate on nursing students and those working in the area [9,10]. The aim of this study was to determine the attitudes and behaviours of nurses who provide clinical services at the Medical Faculty hospital; and examine the relationship of attitudes with factors that are thought to have an impact.
The study was planned with the purpose of evaluating the attitudes towards the elderly of nurses who have been employed for at least one year at the Medical Faculty hospital, and connected to the university, between June and August 2014. A questionnaire prepared by examining previous studies [2,5,7,10,23] and personal experiences of authors and an ageism attitude scale (AAS). One of the writers who worked as an emergency service for many years has worked personally in the management of elderly patients. Other authors have followed patients for nearly twenty years working as a nurse in charge of the service is currently evaluating nursing services and also serves as the deputy director of patient and their relatives complained about the service offered. The last author, long time, nursing homes and clinics orthopedics, conducted assessments and treatments to improve the quality of life of the elderly. One of the authors has prepared questions and questions are checked by a more experienced writer who has made the necessary arrangements. The third author was carried out in the interview. Permission was obtained from the Chief Physician’s Office of the Medical Faculty and the Clinical Research Ethical Committee of the Eskisehir Osmangazi University Faculty of Medicine prior to starting work on the study. The individuals who were included in the study were informed of the objective of the study, their verbal and written consent was received, and the questionnaires were completed during face-to-face interviews. Additionally, permission was obtained from the author of the original study to use the Ageism Attitude Scale to collect data .
The study was planned to include all 652 nurses employed at the Medical Faculty hospital rather than selecting a sample. The study was completed with 244 nurses because of participation was voluntary, also the nurses employed in the basic medical departments because of they are not face to face encounter with the patient and paediatrics clinics were excluded from the study.
The Ageism Attitude Scale (AAS) is composed of three dimensions and 23 items-limiting the life of the elderly individual (9 items), positive discrimination towards the elderly individual (8 items) and negative discrimination towards the elderly individual (6 items). The scale, which is scored in accordance with the 5-point Likert scale, was developed by Vefikuluçay in 2008 [8,11]. The maximum score that can be obtained from the questionnaire is 115, and the minimum score is 23. As the score obtained from the scale increases and the positive attitude also increases [2,11,13,23].
The IBM SPSS statistics program was used to analyze the data. The conformity of the data to a normal distribution was first assessed using the Shapiro-Wilk test. The descriptive statistics given are the means ± standard deviation and medians (minimum-maximum). As the variables did not conform to the normal distribution, the Mann Whitney U test and Kruskal-Wallis analysis were used in the comparison of the groups. As it does not show a normal distribution, the Spearman correlation analysis was useful in the comparison of the variables. Chi-Square was used to test whether the difference between two or more groups. A level of P<0.05 was deemed to be statistically significant .
Two hundred twenty-five women (92.2%) and nineteen men (7.8%) with an average age of 31.79 ± 8.05 took part in the study. This difference between the number of men and women is due to the nursing profession until recently only by women in Turkey. It was determined that 50.4% of the participants were married, 90.2% were part of a nuclear family, 60.8% worked in shifts, and 54.5% possessed undergraduate degrees.
The total and sub-dimension means of the AAS, minimum-maximum values results and related to age, duration of employment, and living or having lived with persons aged 65 or over are shown in Table 1. The mean total score of the individuals who took part in the study was determined 82.66 ± 8.26.
|Living in the same house with>65 y people in the past||97||1||48||10.91||10.43|
|Working time (years)||244||1||34||10.7||8.32|
|Restricting life of elderly||244||19||45||34.52||3.82|
|Total Ageism Attitudes||244||52.00||103.00||82.66||8.26|
|Living in the same house with>65 y people in the present||46||0.25||44||13.43||12.25|
|S: Standart deviation|
Table 1: Individuals descriptive data.
When the relationship between the AAS and the independent variables concerning the socio-demographic characteristics of the individuals was examined, it was found that the total positive discrimination score of males was higher than that of females but that this difference was not statistically significant. When the relationship between marital status and the scale was examined, it was determined that the negative discrimination sub-dimension score of married individuals had a higher score (p=0.02) (Table 2).
|Restricting life of elderly||Positive ageism||Negative ageism||Total Ageism Attitudes|
|n||Median (Q25-Q75)||p||Median (Q25-Q75)||p||Median (Q25-Q75)||p||Median (Q25-Q75)||p|
|Female||225||35 (32-37)||0.864||30 (26-32)||0.093||19 (17-21)||0.601||82 (77-88)||0.302|
|Male||19||34 (33-37)||32 (28.5-35.5)||19 (18-21)||84 (78-92)|
|Married||123||35 (33-37.5)||0.365||29 (26-32)||0.560||19 (17-22)||0.033||83 (77-89)||0.507|
|Single Educationa||121||35 (32-37)||30 (27-33)||18 (17-20)||82 (78-86)|
|Medical college||48||34 (31.5-36.5)||0.485||30 (25-32)||0.774||18 (16-20)||0.023||80 (74-85)||0.077|
|Under graduate||42||35 (33-37)||29 (26-32)||20 (17-22)||83.5 (80.75-88.25)|
|Graduate||134||35 (32-37)||30 (26-33)||18.5 (17-21)||82 (77-88)|
|Post graduate||20||35.5 (32.5-37)||30 (26.5-33.5)||21 (18-24)||84.5 (80.25-90)|
|Modern (nuclear)||220||35 (32-37)||0.612||30 (26-33)||0.629||19 (17-21)||0.417||82 (78-88)||0.607|
|Extended||23||35 (31.5-36.5)||29 (25.5-32)||18 (16-21.5)||82 (73-91)|
|Type of study|
|Shift||166||35 (32-37)||0.314||30 (26-32)||0.574||18 (16-21)||0.003||82 (77-87)||0.053|
|Day||78||35 (33-38)||30 (27-33)||20 (18-22)||83.5 (79-89.25)|
|The longest living place|
|City||201||35 (32-37)||0.233||30 (26-33)||0,763||19 (17-22)||0.688||83 (77.5-88)||0.163|
|village/district||43||34 (31.5-36)||30 (25.5-32)||19 (17.5-20)||81 (77-85)|
|living in the same house with>65 y people in the present|
|Evet||46||36 (33-37)||0.355||30 (28-33)||0.449||20 (17-22)||0.422||84 (79-88.25)||0.210|
|Hay?r||198||35 (32-37)||30 (26-32)||19 (17-21)||82 (77-88)|
|living in the same house with>65 y people in the past|
|Yes||96||35 (32-37)||0.817||29 (26-33)||0.289||19 (17-21)||0.961||82 (78-88)||0.519|
|No||147||35 (32-37)||30 (27-32)||19 (17-21)||83 (77-88)|
|Pairwise comparisons: Mann-Whitney U testi , aKruskal-Wallis test|
Table 2: Relations between ageism attitudes scales and personal characteristics.
When the means of the total and sub-dimension scores of the AAS were examined in connection with the educational status of the individuals, it was determined that holders of postgraduate degrees obtained higher scores from the dimension of negative discrimination (p=0.02).
No statistically significant difference was found between the AAS total and sub-dimension scores in regard to the family type of the individuals, the place where they have resided the longest, and whether they live with or have lived with an elderly individual in the same home (p>0.05). Further, it was found that the negative sub-dimension scores of those who worked during the day were higher (p=0.003).
Eighteen percent of the participants stated that they had taken geriatrics courses, and 38.9% stated that they wanted to take part in a course. The differences between the groups were found to be significant in the chi-square analysis (difference between who has not received any geriatrics training and then do not want to take courses with geriatrics and want to get) (p=0.01). Further, the positive discrimination scores of those wishing to take a geriatrics course were found to be higher (Table 3).
|Chi-Square||Geriatrics course request|
|Have a geriatrics course||Yes||10||33||43||0.012|
Table 3: Ageism attitudes of those who received and want to take courses in geriatrics.
When the relationship was examined between the AAS total and sub-dimension scales and age, a relationship was found between age and negative discrimination towards the elderly (r=0.346; p=0.00) and the total scale score (r=0.220; p=0.001). Further, a correlations were also detected between duration of employment and limiting the life of the elderly individual (r=0.130; p=0.04), negative discrimination (r=0.317; p=0.00) and the total scale score (r=0.187; p=0.00) (Table 4).
(n=244) r (p)
|living in the same house with>65 years people in the past (n=96) r (p)||living in the same house with>65 years people in the present (n=46) r (p)||Working time
(n=244) r (p)
|Restricting life of elderly||0.123 (0.055)||-0.100 (0.334)||-0.012 (0.939)||0.130 (0.043)|
|Positive ageism||0.040 (0.538)||0.144 (0.162)||0.010 (0.900)||-0.004 (0.954)|
|Negative ageism||0.346 (0.000)||-0.100 (0.330)||0.088 (0.566)||0.317 (0.000)|
|Total Ageism Attitudes||0.220 (0.001)||0.022 (0.831)||0.102 (0.505)||0.187 (0.003)|
|r=Spearman correlation coefficient|
Table 4: The relationship between some of the internal variables and ageism total and sub-scores.
The fact that the old age population is rising quickly throughout the world brings with it the requirement to consider the increase in the numbers of the aged population in the social and health services plans to be prepared. The facts that they have multiple health problems, and that these problems frequently form a vicious cycle increase the need for health services for aged .
To plan successfully, it is necessary to determine how the individuals who are to serve this group perceive the elderly . The evaluation of the attitudes, values and beliefs of health care workers towards the elderly will facilitate the effective performance of health care services and organizational services directed at protecting and improving the health of the elderly [25-27].
The belief that it is elderly individuals who benefit most from health care services, as the position of being ill and a dependent individual is higher than that of the general population, is shown among the reasons for the development of negative attitudes against old age by those providing health care services . In one of the striking studies on this subject, Marshall has published the conclusion that a reduction in age discrimination may also reduce the frequency and severity of many negative health-related incidents, such as myocardial infarction, and increase human life by an average of 7.5 years .
Nurses provide one-on-one services as practitioners, moderators or instructors in every department that aged individuals use for treatment and care. Therefore, studies on age discrimination concentrate on nursing students and those working in the field. The studies have published conclusions as to whether nurses consider the problems suffered by elderly individuals as a natural occurrence and do not place importance on it or delay it as well as whether they perceive the elderly as being dependent, inactive and isolated [29-31]. This type of negative bias, values, beliefs and attitudes of nurses towards elderly individuals reflects on the quality of the care they provide to the elderly individuals . Courtney has stated that there is insufficient information regarding care for the elderly and that this influences the quality of the care provided to the elderly . On the other hand, Cilingiroglu states that the negative attitudes about the elderly who are in receipt of care reduce not only the quality of the care but also the self-respect of the elderly individuals [1,34]. In their studies, Kemper and Rue have found that caregivers in nursing homes do not place sufficient importance on elderly individuals and that they are insensitive to the cultural needs, preferences and decisions of the elderly [4,12,35,36].
When the literature is examined, it can be seen that different conclusions have been stated in studies that examine the attitude of discrimination towards the elderly with independent variables such as age, gender, marital status, their class levels and their length of time spent living with an elderly person [13,37-39]. The old age discrimination attitude scale was found to be high and linked with certain external and internal causes such as age, manner of or duration of work, desire to take a course in the area of geriatrics and not seeing the aged as a cause for the increase of the crowding in hospitals in our study. Despite the fact that the number of individuals in our study is low, the AAS total score and the other sub-dimension scores were found to be higher among nurses who have received post-graduate training and this was a statistically significant difference in the negative discrimination against the elderly sub-dimension.
Guven and Usta have stated that female students possess a more positive attitude towards elderly individuals [13,37] and that this may have been influenced by the caregiver role of the woman in the traditional family structure of Turkish society. On the other hand, there are also studies that show that female workers and students exhibit a negative attitude towards the elderly [2,7,23]. Our study is consistent with the study conclusions of Unalan et al.  in that the positive discrimination sub-dimension score and old age discrimination attitude scale total score of male nurses was found to be higher. This situation has been explained by Yilmaz et al. as the individuals being viewed as wise and prestigious. According to Koc and et al. this result may suggest that there have occurred changes in the roles of the girl students in the traditional family structure of Turkish society, and Turkish women have been stripped of their care giving role . Also, women attach more importance to their physical appearances. In addition, it may be that the aging of the woman body increases the level of anxiety, leading to their acquisition negative attitudes towards aging process  Another view, Unal et al. in meeting self-care needs of the elderly such as bathing, women are physically forced to have said could lead to frustration and exclusion .
Liu et al. stated that wishing to work with elderly individuals and those knowledgeable on old age and the development of a positive attitude towards elderly individuals . While there were no questions concerning the desire to work with elderly individuals in our study, the positive discrimination scores of those who answered ‘yes’ to the question, ‘would you like to take a geriatrics course?’ and those who thought that the elderly did not increase crowding in hospitals were found to be higher.
As a part of the lifecycle of individuals who live with old-aged individuals, it can be said that they know the period of old age and lived with an elderly person within the family may have gained a positive attitude and point of view towards the elderly [7,10,13]. In this study, both the AAS total scores and all of the sub-dimension scores of individuals who have lived in the same home as an elderly individual were found to be higher, but this difference was not statistically significant. This conclusion may be due to a majority of those taking part in the study being married and part of a nuclear family and to only one in four living in the same home as an elderly individual.
When the relationship between the marital status of the individuals who took part in our study and their attitude to discrimination towards the aged is examined, it is observed that the positive discrimination sub-dimension of single individuals. Unalan et al. published as a similar conclusion and that the difference is significant. Despite the fact that our country is transforming to one of a nuclear family, the traditional culture is still dominant. Therefore, the increase in the number of parents that comes with marriage, the responsibility for looking after them, and the expectations within the community that older people should be looked after may be a cause for the development of a more negative attitude.
The very nature of the nursing occupation makes continuity a must. Therefore, the shift system of work is generally in operation in departments that provide nursing services. However, the changeability of working hours, the obligation to work at night, and the requirement to adapt the time spent at home and with the family according to work are the biggest negatives for the staff of this occupation. While we have not come across any studies within the literature that support our own study, it has been found that shift workers possess a more negative attitude. Daytime working generally becomes more prevalent as the time spent in the occupation and seniority increases. This improves working conditions and makes private life more comfortable, thus reducing the pressure on individuals and increasing their job satisfaction. The increase in positive attitudes, together with a higher age and a longer duration on the job, can be explained in this way. Other causes of the development of this positive attitude may be the fact that it is easier to empathize with the elderly as one also grows older or that communication becomes easier with more experience, or that the command of the treatment becomes easier.
Another striking conclusion from the study of Yilmaz et al. is their emphasizing that students who were born in smaller localities, such as villages and small towns, develop a more positive attitude . This probably results from living in the same home as elderly people during a particular period of life or closer and more frequent social and emotional contact with the elderly in rural settlement areas where social relationships are more intense. In our study, only forty-three people stated that they had spent a significant part of their life in a village or district. However, no difference could be found between the attitude scores of these individuals and of those who lived in cities.
It is stated that in working life, individuals who possess prior knowledge concerning gerontology are able to communicate with elderly individuals more comfortably and more easily and that they are more thoughtful and respectful of them. Additionally, the change in negative attitudes towards the aging of a person will also contribute to that person’s living a healthier and longer life [41-45].
It may be possible to present certain criteria that may influence the positive attitudes of nurses concerning old age. These can be said to include choosing the profession voluntarily and desiring to work at a center that provides care to old-age individuals following graduation, 10 living with, or having lived with an elderly individual in the past [9,13,39] being knowledgeable about old age and the aging process [39,45], wanting to live with parents after having established their own families [37,39] and clinical experience .
But, such as the intensive working environment of the clinic where the individual is employed; long working hours that require concentration; the requirement to work in shifts, which has also been shown among the conclusions of our study; and a heavy workload due to an insufficient number of personel may be effect to negative attitudes [39,46]. Also, difficulties experienced in establishing communication with an individual who suffers from sensory and cognitive incompetence may be relation with this by nurses towards the elderly .
It is extremely important that nurses are equipped with the knowledge and skills in order to respond to the health and support needs of the future population structure.16 The provision of information and awareness about old age and the aging process through on-the-job training and participation in courses, seminars and certificate programs, either during the hiring process and/or in later periods, is a priority. The provision of training and guidance services by nurses who are experienced in the field and knowledgeable on the aging process will ensure a significant contribution . Further, the clear determination of the roles and responsibilities of nurses who provide care to elderly individuals and encouragement to specialize in the field of the health of the elderly need to be ensured [4,12]
In conclusion, it can be said that the marital status of the individual and his/her manner of working, age and duration of work within the profession do contribute to the development of a positive attitude. The other important conclusions of our study are that nurses who have a desire to increase their level of knowledge about old age and those who do not view the aged as just a factor that increases the crowding at hospitals display a more positive attitude. As a result, our country recently winning experience in elderly care, in order to develop more effective service delivery, making similar studies can be useful.