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Gerontology & Geriatrics Studies

Nursing Students’ Perception towards Ageism in Nigeria

Ifeoluwapo Oluwafunke KOLAWOLE*, Aonat Bukola SALMAN, Lucia Yetunde OJEWALE and Titilayo Dorothy ODETOLA

Department of Nursing, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Nigeria

*Corresponding author: Ifeoluwapo Oluwafunke KOLAWOLE. Department of Nursing, University of Ibadan, Nigeria

Submission: March 01, 2021;Published: March 18, 2021

DOI: 10.31031/GGS.2021.06.000647

ISSN 2578-0093
Volume6 Issue4

Abstract

Introduction: The discrimination against individuals on the basis of their age has harmful effects on their health, especially when this occurs among future health professionals.

Objective: the primary aim of this study was to assess the perception of student nurses towards ageism.

Methods: This was a descriptive cross-sectional design. Questionnaires were used in collecting data from 188 nursing students in three purposively selected nursing schools in Nigeria, using a random sampling technique. Data were analyzed using SPSS version 20.0. Chi-square was used to test the relationship between variables at α0.05.

Results: The mean age of participants was 21+2.9 years. Half (50%) demonstrated a low level of knowledge, about the same number (51.6%) had a good perception while the majority (66.5%) had a negative attitude towards ageism. Students’ knowledge of ageism has a strong influence on their perception of it (p = 0.015).

Conclusion: Stakeholders need to institute strategies that will improve students’ attitudes towards ageism, and such should be well spelled out in the training curricula. Further studies need to be performed on interdisciplinary approaches to elderly care.

Keywords: Perception; Ageism; Knowledge; Attitude

Overview of Ageism

The rising population of older adults is one of the issues currently facing international health care systems [1]. Globally, the number of aging people (60 years and over) is expected to increase from 600 million to 2 billion between 2000 and 2050 [2]. In 2015, there were 46 million people aged 60 years or over in sub-Saharan Africa, an increase from 23 million in 1990. In 2050, a projected 161 million older persons will reside in the region. Notably, the growth rate of the older population of sub-Saharan Africa that is projected for the 2040s is faster than that experienced by any other region since 1950 [3]. While in the recent report, the elderly population is estimated to be 31.9 million and projected to be about 101.4 million in 2050 [4].
In Nigeria, those aged 65 years and above (the elderly) made up 3.1%, that is, 5.9 million of the total population of 191 million in, which in crude numbers represents an increase of 600,000 during the 5-year period 2012-2017 [5]. Recent statistics also reveals that the general population is growing rapidly and is approaching 205 million which is about 2.64% of the total world population [6]. Like other countries in sub-Saharan Africa, Nigeria’s elderly population is also increasing rapidly. By 2050, the number of people aged above 60 years in the Nigeria is expected to increase to 15.9 million from the current 5.5 million [4]. Among several studies conducted on elderly care, one emphasized the need for Nigeria to make serious efforts to take care of the wants and needs of this group and highlighted the fact that older people need special policy intervention for care and protection [7].
Ageism is the stereotyping, prejudice, and discrimination against people on the basis of their age [2]. Ageism is widespread and an insidious practice which has harmful effects on the health of older adults. However, unlike other forms of discrimination, including sexism and racism, it is socially accepted and usually not challenged, because of its unquestionable nature [8]. Ageism can seriously influence policies and services which in turn have negative impact on older people [9].
Studies have shown that negative attitude towards older people, is associated with negative effects on both physical and mental health of ageing population. When older adults have feelings of being a burden or not being accepted by people around them, they are at a risk of developing depression, social isolation and they do not recover from illnesses like younger adults [10]. Discrimination in health care settings can make elderly people feel rejected, lose confidence in health care practitioners and prevent them from getting quality health care services [11].
Negative perception leads members of a society to view old age as an unfavorable status, which then leads to age discrimination or ageism [12]. Nurses are in contact with elderly at different levels of care. However, relational gaps have been observed to exist, resulting in negative elderly patients’ outcomes [13]. Also, the healthcare provided for older adults have been severely threatened by stereotypic attitudes and misconceptions by nurses [14]. A study conducted among nurses towards older people and their care have identified negative attitudes towards geriatric nursing [13]. As nursing students will be frequently interacting with elderly people in health care facilities, misconceptions about aging and negative attitudes may impair behavior towards older adults and also affect the quality and effectiveness of services provided [14].
Diverse opinions have been documented in the literature about student nurses’ knowledge on care of the elderly. It was found in a study conducted in Saudi Arabia among 320 nursing students in their fourth year to investigate knowledge about elderly care in relation to ageism, that majority of the students had unsatisfactory level of knowledge about elderly care and a negative attitude towards ageism [1]. This is similar to the findings of a study in Poland [15]. However, a group of researchers reported a positive perception among 280 nursing students in Ile-Ife, Nigeria toward old age and care of older adults [16]. A study conducted in Turkey among nurses and physicians made a similar report [17].
Moreover, concerning student nurses’ attitude towards elderly care, negative attitude was found among them in a study conducted in Poland [15]. Similar finding was documented in a study conducted in Badamlidere district of Ankara among youths especially among the married youths [12] and that of Turkey where negative discrimination was reported which was attributed to elderly poor working conditions [18].
Miller’s Functional Consequences Theory for Promoting Wellness in Older Adults is the model guiding this study. The model states that nurses have the power and duty to skillfully use valid and reliable assessment tools and health education interventions to promote optimal health, functioning, and quality of life [19]. In applying the model to the perception towards ageism, the knowledge of nursing students on age-related changes will help reduce the misconceptions about the aging process, age-related changes increase the vulnerability of older adults to the detrimental effects of risk factors. This model offers students an opportunity to have a positive perspective on the care of elderly patients. Understanding aspects of age-related changes, risk factors, and subsequent quality of life in the older adult, as provided in this framework, may be a successful strategy in enlightening students about the impact of ageism and stereotyping attitudes. Nursing students who do not have an understanding of this framework are not likely to have a positive attitude towards elderly patients.
In addition to the above, there is currently a dearth of information and lack of studies about nursing students’ knowledge and skills of effectively caring for the needs of the elderly in Nigeria as a nation, therefore, to better understand the issues involved in the care of elderly in Ibadan, Oyo State, this study seeks to assess student nurses’ perception towards ageism. The findings of this study are expected to provide information on how to improve the perception of nursing students towards ageism and also the quality of care provided to older adults.

Purpose

The purpose of this study was to assess student nurses’ perception towards ageing. The research questions to be answered include:
1. What is the level of knowledge of nursing students on elderly care?
2. How do nursing students perceive ageism?
3. What is the attitude of nursing students towards ageism?

Methods

Design

The is descriptive cross-sectional study assessed the student nurses’ perception towards ageing. The population include all consenting penultimate and final year nursing students currently enrolled in three purposively selected nursing schools (including both University and hospital-based respectively) in the southwest region of Nigeria.

Sample

The study recruited 188 out of 289 available students being the minimum sample size calculated using Taro Yamane’s formula. Simple random sampling technique was used to select the students through balloting because these students are believed to have more clinical experience regarding the care of the elderly. The schools were enumerated because they are the only nursing schools located within a southwestern city of Nigeria.

Data collection/Analysis

This study made use of two instruments, a modified Kogan’s Attitude towards Old People scale (KAOP) and a self-developed questionnaire for the assessment of student nurses’ perception towards ageism. The KAOP scale consists of 24 sentences on a five-point Likert scale divided into 12 positive and 12 negative statements concerning the elderly.
The research questions were answered by each section of the questionnaire, the level of knowledge of nursing students on elderly care was answered by the section containing 10 items with the total accruable score being 24, a score of 12 and above was classified as good knowledge and scores below 12 were classified as poor knowledge level. The attitude of nursing students towards ageism was answered by the section containing 24 items with a total score of 72, a score of 36 and above was classified as positive attitude and scores below 36 were classified as negative attitude and the perception of nursing students towards ageism was answered by the section containing 10 items on a five-point Likert scale with a total score of 50, a score of 25 and above was classified as good perception and scores below 25 were classified as poor perception.
The validity of the instruments was ensured by checking its consistency with existing literature, ability to answer research questions and expert’s review. The reliability of the KAOP scale has been confirmed by a number of researchers including Strugala et al. [15]. It has been pre-tested and standardized over several years with Cronbach’s alpha reliability coefficient of 0.81. The modified and self-developed instruments for data collection was subjected to test-retest among nursing students to determine its reliability coefficient which is 0.767.
The questionnaires were administered by the researchers to participants in their schools in September 2019. They were approached daily between Monday and Friday and within the hours of 8am to 2pm. The respondents were expected to fill the questionnaires within 20-25 minutes and then return them. A summary of study protocol was submitted to UI/UCH Ethics Committee in order to seek permission to carry out this study, same was granted with IRB number: UI/EC/19/0311. Privacy, confidentiality and anonymity was ensured. Consent was taken from participants prior to data collection. No harm was caused to the participants and the specific objectivity of this study was maintained with honesty and impartiality.
The collected data were analyzed using the Statistical Package for Social Sciences (SPSS version 20.0). Descriptive statistics were presented in tables and figures, chi-square was used to determine the significant relationship between variables.

Results

The socio-demographic characteristics of participants were assessed (Table 1), and results of the variable assesses are shown as follow:

Table 1:Socio-demographic characteristics of respondents (n=188).


Nursing students’ level of knowledge about ageism

From this study almost all the participants 172 (91.5%) agreed that old age is a period of irreversible psychological, chronological and social changes. An appreciable number of them 137 (72.9%) supported that elderly care should be given by health care personnel only and at special elderly care facilities. More than half 103 (54.8%) of them were of the opinion that the use of technology such as phones, tablets, laptops in the care of older people cannot improve their lives. Almost half of the respondents 88 (46.8%) disagreed that elderly care cannot be given at home because it involves medical training, skills and equipment. In all, half 94 (50.0%) had a poor knowledge of elderly care, 86 (45.7%) had good knowledge and the rest 8 (4.3%) had excellent knowledge of the care (Figures 1 & 2).

Figure 1:Bar graph showing respondents’ knowledge level.


Figure 2:Summary of respondents’ attitude towards ageism


Perception towards ageism

Findings revealed that 74(39.4%) agreed that they get depressed when they think about how aging might affect the things that they do. 80(42.6%) agreed that as they get older, they can only take part in fewer activities. 80 (42.6%) agreed that slowing down with age is not something one can control. Less than half of the participants 81(43.1%) agreed that they worry about the effects that getting older may have on their relationships with others. 77(41.0%) agreed that they have no control over the effects which getting older may have on their relationships with others. 75(39.9%) perceived coping with problems might not be difficult with aging. Majority 109 (58.0%) tend to appreciate things more as they grow older. In summary, more than half 97 (51.6%) of the respondents had a positive perception towards ageism, while 91 (48.4%) had negative perception.

Hypothesis testing

H01: There is no significant association between age of nursing students and perception towards ageism among nursing students.
Table 2 below shows that x2= 0.406 with p-value= 0.816, meaning that that there is no significant association between age of nursing students and perception towards ageism among nursing students. Therefore, the null hypothesis is not rejected.

Table 2:Chi-square test showing association between age of nursing students and perception towards ageism.


H02: There is no significant association between level of knowledge and perception towards ageism among nursing students.

Table 3 below shows that X2= 8.386 with p-value= 0.015 and that there is a significant association between level of knowledge and perception towards ageism among nursing students. Therefore, the null hypothesis is hereby rejected.

Table 3:Chi-square test showing association between level of knowledge and perception towards ageism among nursing students.


Discussion

This study examined the perception of student nurses towards ageism in Ibadan, Oyo State, Nigeria. The result of the findings revealed that there was a poor level of knowledge of nursing students on elderly care. Half of the students had poor knowledge on elderly care and the other half had good knowledge about the care of older adults. This implies that not more than half of the students have a good knowledge about elderly care. This is consistent with the finding of a study which assessed the knowledge about elderly care in relation to ageism attitude among nursing students and found that the students had unsatisfactory level of knowledge about elderly care [1]. The findings of this study were contrary to the finding of a study that assessed the perception, knowledge and attitude of nursing students towards old age and care of older adults in Ile-Ife, Nigeria and found that there was good knowledge of essential clinical practice in the care of older adults [16].
The attitude of student nurses towards ageism was also examined and the result revealed that more than half of the selected nursing students had a negative attitude. This implies that majority of the students have negative attitudes towards older people. This finding is consistent with the finding of a study where the attitude of nursing students towards older people was assessed and found that majority of the students had a negative attitude towards older people [15]. The finding of this study was contrary to the finding which was conducted to determine the attitude of community dwelling young people towards ageism. They reported that young people had positive attitude towards aging and ageism [12].
The perception of nursing students towards ageism was examined and the result revealed that more than half of the students had a positive perception towards ageism. This implies that majority of the students had a positive perception towards ageism. The finding of this study was consistent with the finding of previous studies which assessed the perception of nurses and physicians towards older people. They found that the nursing students, registered nurses and physicians generally had a positive perception and attitude towards older people [16,17].
From the hypothesis tested, no significant association between age and perception towards ageism was seen. It can be deduced that their age does not have a significant influence on their perception towards ageism in Ibadan. The result of this finding is consistent with that of a study which revealed that age and perception are not statistically significant [15]. Also, the result revealed that there was a significant association between level of knowledge and perception towards ageism. This is not too surprising because myths and misconceptions can affect the way people view others. The result of this study is consistent with that of a group of researchers who found that level of knowledge and perception are statistically significant [15].
The aim of this study was to assess the perception of nursing students towards ageing. Study limitations included a self-selected sample of nursing students who might have been more positive in sharing their personal perspectives related to elderly care. The sample lacked inter-professional diversity, which may have limited a broader perspective. Future research recommendations include interdisciplinary approaches to the care of elderly. A study of community-based approach to elderly care might also be valuable.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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© 2021 Ifeoluwapo O. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and build upon your work non-commercially.



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