Attitude, perception and interest of physiotherapy students to participate in geriatrics master’s degree program: a pilot study

INTRODUCTION

Population ageing is one of the most discussed phenomena in the present century. Growing old is irreversible and a continuous process and as age increases, changes take place in the body. Clinical gerontology has stated that these changes occur across human lifespan and influences the risk of age related conditions.¹

The term ‘degenerative changes’ are the changes that happen as age increases which are commonly associated with older adults or 60 years and above. Degenerative changes occur in many joints and it is combined with the loss of muscle mass which inhibits elderly patients' locomotion.² It is essential to take care of the health before these changes have an impact, as they take lesser time to occur and a much longer time to reverse.

In 2010, India had more than 91.6 million elderly and the number of elderlies was projected to reach 158.7 million in 2025.³ According to a survey conducted in 2012, the population over the age of 60 years has tripled in last 50 years in India. With such a rise in the population, there is an impact on health. As per 2011 census, most common disabilities among the aged were locomotor and visual. Almost half of the elderly disabled population was reported to be suffering from these two types of disabilities.⁴ Other conditions identified commonly in elderly are hypertension, osteoarthritis, COPD, ischemic heart disease, diabetes mellitus, lower GI dysmotility (dyspepsia and constipation), and depression. These account for nearly 85% of all diagnosis among elderly.⁵

Musculoskeletal disorders especially arthritis is a major cause of disability and discomfort among elderly. This has led many elderly to depend on others for their day-to-day activities.³

In India, it is estimated that one out of two elderly suffers from at least one chronic disease.⁴ Thus there is a need to increase the number of health professionals supporting such large population to replenish the deficit of medical manpower and gaps in delivering healthcare to the elderly. Despite this geriatric care is relatively new to many medical service providers- nursing agencies, physiotherapists and medical suppliers in many developing countries like India.⁵ It is envisaged that there will be an increased demand on the physiotherapy services for older people in multiple workplace settings.⁶ It is thus essential to impart the students with importance of geriatric care and the benefits for future.

Treatment of geriatric not only includes disease specific treatment, but a broad understanding of strategies is required to treat them. The elderly tends to be cared for in a variety of settings: home, geriatric out-patient department, in-patient units or intensive care unit depending on the nature and the clinical problem. The needs and problems of the elderly vary significantly according to their age, health, socioeconomic status, general health status and other such background characteristics.

Thus, this study explored attitude, perception and interest of physiotherapy students for pursuing; further education in geriatric master’s degree program.

METHODS

This cross-sectional survey was conducted on 70 physiotherapy interns. This was to ensure that the students had already gained experience of working with older people during their clinical placements. Participants were informed verbally and in writing about the purpose of the study and the survey that would be implemented. The study was conducted in physiotherapy OPD, M. G. M. College of physiotherapy and hospital, Kamothe, Navi Mumbai.

Instruments and procedure

All the students filled out forms of demographic information obtained from them, including personal data as for e.g., gender, age.

A pre-validated self-administered personal history questionnaire (PHQ) was used to assess their interest in pursuing further education in geriatric masters’ degree program. Students were asked to choose and rank their choice of career preferences as first, second and third rank. They were asked background questions about their relationships with older adults (both family and nonfamily members), experience caring for older adults, the age group they anticipate they will prefer to work with as physiotherapists, and their overall interest in geriatric physiotherapy as a career.

Attitude and interest towards geriatric population was investigated. Attitude towards geriatric was evaluated using geriatric attitudinal scale (GAS). This scale was selected as a most suitable measure of attitudes because the scale contained a clinical component and was easy to administer and score. It was a 14-item instrument consisting of 5 positively worded items and 9 negatively worded items (Ruben 1998). Students were required to indicate their response to items on a 5-point scale ranging from strongly disagree (1) to strongly disagree (5) and score of three denotes a neutral response.

RESULTS

A total of 80 physiotherapy interns were invited to participate in the study. Ten surveys were discarded due to missing item responses. As a result, data obtained from 70 students were used for the analyses.

Results were analysed using MS excel (version 2001). The mean age of all the participants was 21.88 years. Ninety five percent of all the participants were females.

Attitude towards geriatric population was measured using GAS. Student’s attitude was significantly positive with a mean score of 3.71. On analysing few components from GAS, three separate questions were related to the respondent’s experience of working with older people. 37% of participants answered as being with elderly is a pleasant feeling while 21% were neutral in their response. 61% of them felt that taking history is not an ordeal and treating them is essential which 57% of the participant was.

The detailed responses of these questions have been shown in Figures 1, 2 and 3.

Career preferences (personal history questionnaire)

Participants typically described positive response towards caring and treating older patients. Although most students indicated an interest in working with adult patients, 20% (n=14) preferred patients aged 60 and older. Among them majority of the students indicated slight (42%) or moderate (50%) interest in geriatric physiotherapy as a career. The details of students’ response for career preferences have been shown in Figure 4.

DISCUSSION

In this research the student’s attitude towards older people of students of health and social care and their perceptions of working with elderly were examined. This research has a number of implications for the physiotherapy profession in relation to the ageing population. The findings are encouraging that there is a positive attitude of the students towards geriatric population. 20% students should interest to pursue geriatric specialty as a masters’ degree program. But still there exists a lack of interest in 80% students to pursue this program. The lack of cooperation in geriatric population was the principal cause for students to not pursue. Most old people tend to have multiple complaints related to their health. Due to age, their confused state of mind makes it difficult to prioritize their health conditions.

When the students are exposed to any particular population, it may influence their attitude towards that population. 12% of students have shown their interest in geriatric which they had developed through outreach camps and awareness programs. Personal family/friends influenced the interest by only 10%. These results were similar to a study by Sahin and colleagues that determined that having an elderly relative (a close friendship with an elderly person) is not a predictor of positive attitudes toward the elderly, although 15% of students’ interest in geriatrics began during their physiotherapy education.⁷ Didactic teaching and exposure of students in clinical practice has an influence in understanding geriatric care and so there is a need to take special care in their rehabilitation program.⁸

There is a need to educate physiotherapy students to deal with the challenges and care for elderly population during undergraduate program. This can be done in the form of appropriate training to understand the changes that happen during old-age and the correct treatment programs to be applied during geriatric rehabilitation.^9,10 During academic lectures and clinical placement, educators need to emphasize that there is increase demand for health care for older people and to promote the evidence that physiotherapy for older people has a valuable and successful career role in health promotion and health care. This should not be underestimated.¹¹ Apart from their undergraduate education, there should be number of visits by students to elderly care centres and nursing homes to create awareness amongst students. Visiting to care centres will improve their attitudes and behaviour towards elderly.

The contribution of physiotherapy clinical educators to facilitate students’ knowledge of older people will improve the enhancement of professional competencies and educational skills.¹² Standardizing the screening tools for frailty used by physiotherapists could be an impactful step towards gathering data of elderly prone towards early degenerative changes. This will help in planning appropriate treatment protocol which could be personalized depending on the condition. This will eventually help in improving healthcare facility to elderly.¹³ Efficient health care to the elderly is, therefore, possible only by comprehensive and multidisciplinary approach.

11% students believe that older people do not contribute much to the society. A study done by Bakirhan et al believed that undergraduate students need to be informed about elderly rights and the attitude and behavior of healthcare professionals towards elderly patients.⁸ This should be more extensively explained in the curriculum of the professional ethics course, and educational programs to change their perceptions towards older people. In general students depicted a positive perception of working with older people. The majority of respondents (55.7%) agreed and strongly agreed that ‘they would rather treat younger patients than elder one’ as it does not require much skill as it is challenging to treat patients with multiple complains. However, many (37.1%) were undecided i.e. neither agreed nor disagreed. These results were similar to Ortolon et al where he found treating a high number of elderly patients with chronic illnesses was reported to be less attractive than curing younger patients with acute illnesses.⁹ It is possible that such perception could impact negatively on speciality selection.

In addition to increasing the number of geriatric physiotherapist, we have to ensure that all future physiotherapists have the skills to manage the problems of elderly patients, as they will be spending more and more time caring for these patients. Hence, medical curricula as well as residency training programs should pay more attention to the principles of geriatrics.¹⁴ Students should be encouraged to do research and different studies related to elderly population during their undergraduate program. This will improve their perceptions and attitude towards elderly and reinforce their relationships with older people.

Students provided both positive and negative feelings about working with older people. Positive aspects were learning from the older people, being appreciated, and feeling more competent. The most frequently cited negative aspect was that older people died and these students did not feel adequately prepared to deal with this loss. The study raised implications for student’s preparation to work in older people settings.

CONCLUSION

In conclusion, this study demonstrated that these students have positive attitude towards older people but there is a lack of interest in pursuing further education in this field. However, the low level of attitude suggests that educational and workplace sectors need confrontation for workforce preparation in relation to care for older people. Attitudes to ageing and lack of interest in working with older people not only diminishes the numbers of people working with this population but it also may affect the quality-of-care older people receive.

Hence physiotherapy shortages for older people will increase unless practitioners recognise the opportunities that exist.

ACKNOWLEDGEMENTS

Authors would like to thank all the participants who volunteered for the study for their co-operation.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

1. 1. Division of geriatrics and clinical gerontology. Clinical Gerontology Branch. 2016. Available from: https://www.nia.nih.gov/research/dgcg/clinical-gerontology-branch. Accessed on 4 January 2020.
2. 2. Boss GR, Seegmiller JE. Age-related physiological changes and their clinical significance. West J Med. 1981;135(6):434.
3. 3. Mane AB. Ageing in India: some social challenges to elderly care. J Gerontol Geriatr Res. 2016;5(2):e136.
4. 4. Khan S, Itrat M. Current issues in geriatric health care in India-A review. J Community Med Health Care. 2016;1(1):1003.
5. 5. Mathur A. Contemporary Issues in the Health of the Elderly. Available from: https://apiindia.org/wp-content/uploads/pdf/medicine_update_2007/7.pdf. Accessed on 4 January 2020.
6. 6. Elderly in India-Profile and Programmes 2016. New Delhi: Ministry of Statistics and Programme Implementation. Government of India. 2016. Available from: http://phdcci.in/live_backup/image/data/Research%20Bureau-2014/Economic%20Developments/Economic-2016/April/Elderly%20in%20India.pdf. Accessed on 4 January 2020.
7. 7. Sahin S, Mandiracioglu A, Tekin N, Senuzun F, Akcicek F. Attitudes toward the elderly among the health care providers: Reliability and validity of Turkish version of the UCLA Geriatrics Attitudes (UCLA-GA) scale. Arch Gerontol Geriatr. 2012;55(1):205-9.
8. 8. Bakirhan S, Özkeskin M, Aktar Reyhanioğlu D, Gülpinar D. Analysis of the attitudes and approaches of the physiotherapy and rehabilitation students towards the elderly. Turkish J Geriatr. 2017;20(2).
9. 9. Ortolon K. Spread too thin. Tex Med. 2008;104(1):29-33.
10. 10. Evans JM, Kiran PR, Bhattacharyya OK. Activating the knowledge-to-action cycle for geriatric care in India. Health Res Pol Syst. 2011;9(1):1-0.
11. 11. Reuben DB, Lee M, Davis Jr JW, Eslami MS, Osterweil DG, Melchiore S, et al. Development and validation of a geriatrics attitudes scale for primary care residents. J Am Geriatr Soc. 1998;46(11):1425-30
12. 12. Verma R, Khanna P. National program of healthcare for the elderly in India: a hope for healthy ageing. Int J Prevent Med. 2013;4(10):1103.
13. 13. Taylor LF, Tovin MM. Student physical therapists' attitudes toward working with elderly patients. Phys Occupat Therap Geriatr. 2000;18(2):21-37.
14. 14. Meiboom AA, de Vries H, Hertogh CM, Scheele F. Why medical students do not choose a career in geriatrics: a systematic review. BMC Med Educ. 2015;15(1):1-9.