Efficacy and challenges of a culturally relevant intervention to improve attitudes to aging

Interventions to improve attitudes toward older people in undergraduate health and social sciences students. A systematic review and meta-analysis

OBJECTIVE

To determine which interventions are the most effective in improving attitudes toward older persons in undergraduate health and social sciences students.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

A literature search was made in PubMed, EBSCO and SCOPUS and additional records were identified by manual searching. The selection criteria were studies that evaluated an intervention designed to improve positive attitudes; studies in undergraduate health and social sciences students; and studies using direct instruments to measure attitudes.

REVIEW METHODS

Two independent reviewers extracted study-level data from records using a common data collection spreadsheet. Two reviewers also assessed study quality by using the Cochrane Risk of Bias Tool. The primary outcome was the effect of an intervention upon attitudes toward older people, while the secondary outcome was the effect upon knowledge about aging and older people in those studies that had previously assessed subject attitude. The meta-analysis was carried out based on mixed statistical models.

RESULTS

The search identified 53 eligible studies published during 1982-2020, comprising 35 pre-post studies and 18 randomized clinical trials, of which 14 were included in the meta-analysis. A strongly significant effect upon attitudes was observed for empathy-based interventions (differences of standardized mean differences (d_SMD) = 1.26; 95%CI: 0.04-2.48; p = 0.04), knowledge + empathy-based interventions (d_SMD = 0.22; 95%CI: 0.05-0.39; p = 0.01), and knowledge + clinical skills-based interventions (d_SMD = 0.22; 95%CI: 0.01-0.43; p = 0.04). The overall effect was d_SMD = 0.50; 95%CI: 0.01-0.43; p = 0.004. In addition, a positive effect in terms of increased knowledge about the older was observed after knowledge + empathy-based and knowledge + clinical skills-based interventions (d_SMD = 0.24; 95%CI: 0.07-0.40; p = 0.005).

CONCLUSIONS

Interventions to improve attitudes in health and social sciences students are effective, with those based on empathy having the greatest impact. Improving attitudes among future professionals could improve the management and quality of care of older people. More rigorous and better designed studies are recommended to determine the effect of the interventions. Registered on PROSPERO ID: CRD42021220677.

TWITTABLE ABSTRACT

Ageism is present in healthcare settings. Empathy-based interventions are the most effective strategies in health and social sciences students.

Factors Affecting Attitudes towards Older People in Undergraduate Nursing Students

Background: The population of older people is increasing worldwide. The social and healthcare systems need many nurses to care for the elderly. Positive attitudes increase the preference to work with older people and improve the quality of care. This study describes attitudes towards the elderly in a sample of nursing students, and analyzes the potential factors influencing these attitudes. Methods: A cross-sectional study was carried out in nursing students during the academic course 2017–2018. Kogan’s Attitude Toward Old People Scale was used to assess student attitudes towards older people. Results: The study included 377 undergraduate nursing students, of which 75.9% were women. The mean age was 22.23 (5.69) years. Attitude proved positive, with a mean Kogan’s score of 131.04 (12.66). Women had higher scores than men, with a mean difference of 7.76 (95% CI: 4.87–10.66; p < 0.001). The male sex, age ≥ 25 years, and previous experience with institutionalized older adults worsened attitudes, while studying the subject of geriatrics, each higher course within the degree, work placements in hospitals and nursing homes, and previous experience with community older adults or with older relatives favored a more positive attitude. Participants with no interest in working with older adults yielded lower scores. Conclusions: Attitudes towards the elderly among nursing students are positive. Women have a more positive attitude. Analyzing the factors that improve attitudes in nursing students is suggested, as it may contribute to improve nursing care.

Improving Expectations Regarding Aging in Younger Adults: A Classroom Study

Younger adults generally hold negative attitudes and stereotypes about aging, which can affect the success with which they age as well as how they interact with older generations in everyday settings. The current study sought to improve expectations about aging in a largely first-year undergraduate student population through a small, discussion-based course on successful aging. Students in the successful aging course and a control course completed the 12-item expectations regarding aging (ERA) scale at the beginning and the end of the 10-week academic quarter. Students in the aging class also provided adjectives that came to mind when thinking about older adults. Students in the successful aging course had higher ERA scores at the end of the quarter than at the beginning of the quarter, but scores in the control class did not change. Further analyses indicated students' expectations about cognitive functioning and physical health improved, but not expectations about mental health. In addition, self-generated adjectives were more positive at the end than the beginning of the quarter, but some negative adjectives persisted. Thus, a smaller, discussion-based class about aging led to a more positive view of aging, suggesting that negative attitudes about aging may be modifiable by a short intervention in early adulthood. These results can have implications for how younger adults interact with older adults and how they may prepare for, hold future expectations about, and ultimately experience older age.