Identification of nursing students’ attitudes toward older people

Abstract

Objectives: The present study aims to identify nursing students’ attitudes toward older people.
Methods: This descriptive study was conducted with 166 nursing department students enrolled in a four-year undergraduate programme in a university located in Eastern Turkey. The participants were chosen using convenience sampling method, and data were collected through the Descriptive Characteristics Form and Turkish version of Kogan’s Attitudes toward Older People Scale (KAOPS).
Results: It was found that the students participating in the study had positive attitudes toward older people, and the mean scores of those who wanted to work with older people after graduation were significantly high (p < 0.05). Scale mean scores according to receiving gerontology nursing course showed that there were no significant differences between the groups who received gerontology nursing course and who did not.
Conclusions: This study found that nursing students’ attitudes toward older people were positive. Cultural features of the region where the study was conducted are considered to have effects on this result.
Impact statement: As nursing students will provide care to older people in the future, it is important to know and assess their attitudes towards the older.

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Contemporary Nurse
ISSN: 1037-6178 (Print) 1839-3535 (Online) Journal homepage: http://www.tandfonline.com/loi/rcnj20
Identification of nursing students’ attitudes
toward older people
Ayse Berivan Bakan, Senay Karadag Arli & Ela Varol
To cite this article: Ayse Berivan Bakan, Senay Karadag Arli & Ela Varol (2018):
Identification of nursing students’ attitudes toward older people, Contemporary Nurse, DOI:
10.1080/10376178.2018.1501276
To link to this article: https://doi.org/10.1080/10376178.2018.1501276
Published online: 21 Jul 2018.
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Identification of nursing students’attitudes toward older people
Ayse Berivan Bakan , Senay Karadag Arli*and Ela Varol
Department of Nursing, Agri Ibrahim Cecen University School of Health, Agri, Turkey
(Received 20 May 2016; accepted 29 June 2018)
Objectives: The present study aims to identify nursing students’attitudes toward older people.
Methods: This descriptive study was conducted with 166 nursing department students enrolled
in a four-year undergraduate programme in a university located in Eastern Turkey. The
participants were chosen using convenience sampling method, and data were collected
through the Descriptive Characteristics Form and Turkish version of Kogan’s Attitudes
toward Older People Scale (KAOPS).
Results: It was found that the students participating in the study had positive attitudes toward
older people, and the mean scores of those who wanted to work with older people after
graduation were significantly high (p< 0.05). Scale mean scores according to receiving
gerontology nursing course showed that there were no significant differences between the
groups who received gerontology nursing course and who did not.
Conclusions: This study found that nursing students’attitudes toward older people were
positive. Cultural features of the region where the study was conducted are considered to
have effects on this result.
Impact statement: As nursing students will provide care to older people in the future, it is
important to know and assess their attitudes towards the older.
Keywords: older people; attitudes; gerontology; nursing students
Introduction
The proportion of people aged 65 and older has been increasing in the world population as a result
of many changes and developments in the world. Ageing worldwide has become inevitable due to
such factors as mainly improvements in health conditions and prolonged life expectancy with the
technological developments, and decreased infant mortality and birth rates (Aksoydan, 2009;
Erdemir, Kav, Citak, & Karahan, 2011; Turan et al., 2016; World Report on Ageing and
Health –World Health Organization, 2015). In 2050, nearly half of the world’s population will
live in countries where at least 20 per cent of the population are aged 60 or over, and one in
four people will live in countries where older people account for more than 30 per cent of the
population (World Population Ageing, 2015: Highlights, 2015). According to Turkish Statistical
Institute, while the elderly population (65 years and over) was 5 million 682 thousand 3 persons in
2012, it increased by 17.1% in the last five years and became 6 million 651 thousand 503 persons
in 2016. While the proportion of the elderly population in the total population was 7.5% in 2012,
it increased to 8.3% in 2016. 43.9% of elderly population was males and 56.1% was females.
(Turkish Statistical Institute, 2016).
© 2018 Informa UK Limited, trading as Taylor & Francis Group
*Corresponding author. Email: senay1981@yahoo.com
Contemporary Nurse, 2018
https://doi.org/10.1080/10376178.2018.1501276

Ageing, which is a physiological process, is a period when social, psychological, and
physical changes happen. This period brings along various social problems such as a
decrease in productivity, impairment in social relationships, and changes in roles and
status. Besides, with the decrease in the individual’s functional capacity and increase in
health problems caused by chronic diseases, ageing is perceived as a situation to be
avoided. People may thus develop negative attitudes and prejudices toward older people
and ageing. Negative attitudes and prejudices about older people and ageing cause discrimi-
nation against the older (Kose et al., 2015; Ozdemir & Bilgili, 2014). Discrimination against
the older is defined in the related literature as a concept that includes a different attitude,
prejudice, behaviour, and action shown toward someone just because of his age (Vefikuluçay
Yılmaz & Terzioğlu, 2011).
In order to eliminate negative attitudes toward older people, it is important for young people to
see ageing as a natural process and have positive attitudes and accurate information about older
people. To achieve this, it is very important to identify attitudes and views of nursing students
toward older people, as they will provide service in the health field (Kose et al., 2015;Vefikuluçay
Yılmaz & Terzioğlu, 2011).
Health professionals, who provide care and treatment to older people, have important roles in
the identification of the quality of care (Yen et al., 2009). Studies show that health services are one
of the fields where discrimination against the older is experienced, and reportedly it is generally
done by young people (Kite, Stockdale, Whitley, & Johnson, 2005; Kose et al., 2015; McGuire,
Klein, & Chen, 2008; Ozdemir & Bilgili, 2014; Zhou, 2007). Studies on the discrimination
against the older found attitudes toward older people to be positive, negative, or mixed
(Akdemir, Çınar, & Görgülü, 2007;Vefikuluçay Yılmaz & Terzioğlu, 2011). An ageing popu-
lation requires nurses to be fully equipped in order to provide care for their special needs (Aben-
droth & Graven, 2013). Nurses should have qualities that will help them recognize the
physiological, psychological, emotional, and cognitive changes occurring in older people and
provide the care they need (Ozdemir & Bilgili, 2016).
There is an increase in older people population, which brings along the problem of older
care. As the most competent health professionals who will provide care are nurses, we aimed
to explore nursing students’attitudes about this issue. Older care gains more importance
with the ageing of the world’s population. Therefore, as nursing students will provide care to
older people in the future, it is important to know and assess their attitudes towards the
older. Besides, strategies should be developed to increase positive attitudes towards the
older. Therefore, the present study was conducted with a view to identifying nursing students’
attitudes toward older people.
Research question: Do nursing students’demographic features and receiving gerontology
course affect their attitudes towards older people?
Method
This study, which is descriptive in nature, aims to identify nursing students’attitudes toward older
people. The study was conducted in the Nursing Department of Ağrıİbrahim Çeçen University
School of Health. Target population of the study was 175 students who were enrolled in the
Nursing Department of Ağrıİbrahim Çeçen University School of Health. No sampling was
used, 166 nursing students currently enrolled in a four-year undergraduate programme were
involved in the study. The students were given information about the study, and their written
and verbal consent were obtained. Ethical committee approval was obtained from the Ağrı
İbrahim Çeçen University where the study was conducted.
2A.B. Bakan et al.

Measurements
The data were collected using Descriptive Characteristics Form and Kogan’s Attitudes toward
Older People Scale. The data were collected by the researchers, via face-to-face interviews
with the students.
Socio-demographic characteristics form
The form included 10 questions evaluating students’personal and family characteristics (grade
level, age, gender, family type, having an older family member, living with an older person, inter-
est in working with older people, etc.) (Kucukguclu, Mert, & Akpinar, 2011; Neville, 2015;
Turan, Yanardag, & Metintas, 2015; Turgay et al., 2015; Usta, Demir, Yönder, & Yildiz, 2012).
The Turkish version of Kogan’s attitudes toward older people scale (KAOP)
Kogan’s Attitudes toward Old People Scale “KAOPS”, developed by Nathan Kogan in 1961. It
was declared to be used in the evaluations of the attitudes towards the older people in Turkey by
Erdemir et al. (2011), Kucukguclu et al. (2011) and Uğurlu et al. (2011). This scale has been
applied not only to health professionals but also to people from society, for the purpose of iden-
tifying attitudes toward older people. It has a social context and a 6-point Likert scale that does not
include medical terms. The 34-item scale has 17 positive and 17 negative statements. Odd num-
bered items contain negative statements, and even numbered items contain positive statements.
Due to the nature of the scale, negative statements are scored as 654321,from right to left,
and positive statements are scored as 1 2 3 4 5 6, from left to right. Scores obtained from all
items are added together in order to attain the total score. Total scores to be obtained from the
scale range between 34 and 204; and higher scores indicate positive attitudes while lower
scores indicate negative attitudes (Kogan, 1961). Kogan divided the scale into two, as positive
and negative scale, and tested the validity and the reliability of the scale on two different popu-
lations. The first group was composed of students from Psychology Department. Cronbach’s
alpha values of the scale were found 0.77 and 0.76 for the positive and negative scales respect-
ively. The second group was formed with workers in an older care centre. Cronbach’s alpha values
of the scale were found 0.73 and 0.83 for positive and negative scales respectively (Kogan, 1961).
Hilt evaluated the scale as a whole and found its Cronbach’s alpha as 0.81 (Hilt & Lipschultz,
1999). Increase in the total scores indicates positive attitudes toward older people (Hilt &
Lipschultz, 1999; Kogan, 1961). Kogan, in other studies conducted for the validity and the
reliability of Kogan’s Attitudes toward Older People Scale, concluded that the scale could be
used for identifying attitudes of society toward older people (Erdemir et al., 2011; Kiliç &
Adibelli, 2011; Kucukguclu et al., 2011; Söderhamn, Lindencrona, & Gustavsson, 2001;
Uğurlu et al., 2011; Yen et al., 2009).
The KAOP was translated into Turkish and a reliability test was conducted to ensure the internal
consistency. With Cronbach’s alpha of 0.84, r= 0.73 and CVI = 0.94, CV = N 0.30 values, the test
was found valid and reliable for assessing attitudes towards older people (Erdemir et al., 2011). The
present study found Cronbach’salphacoefficient 0.75 for the total scale.
Data collection/procedure
Data collection for this study took place at a university in Turkey. The data were collected in
January 2016. Nursing students chosen using convenience sampling method were asked to
sign a consent form. The participants filled in the Turkish version of the questionnaire. The
Contemporary Nurse 3

data were collected by the researchers in classroom by administering the forms to students and
taking them back when they filled them in.
Data analysis
Data obtained in the study were evaluated using the SPSS 20.0 software program (IBM, Armonk,
NY, USA). Normality analysis using the Shapiro–Wilk test was applied before the evaluation to
determine whether the attitude scores of the students showed normal distribution. The SPSS Stat-
istics Packet Program was used in the data analysis for the descriptive statistics such as indepen-
dent samples t-test. The significance level was set at p< 0.05 for all statistical tests.
Results
Average age of the students who participated in the study was 21.44 ± 2.2. Of all the participants,
56.6% of them were female, 69.3% had a nuclear family, and 57.8% were fourth year students.
The ratio of those who lived with an older person in any period of their lives was 48.2%, and
66.9% of the participants were found to be willing to work with older people after graduation
(Table 1).
Of all the participants, 57.8% were fourth year students, 85.5% thought nursing education
should include a course for older care and 69.2% of these students thought it should be given
as a separate course. 57.2% of the students received gerontology nursing course, and 57.9% of
the students who received the course found it moderately adequate (Table 2).
The analysis of students’mean scores according to their age, gender, family type, experience
of living with older people, experience of providing care to older people, and receiving gerontol-
ogy nursing course indicated that there were no statistically significant differences between the
groups. Mean scores of those who wanted to work with older people after graduation were
found to be statistically higher (p< 0.05). Generally, the participants were found to have positive
attitudes toward older people (Table 3).
Table 1. Students’descriptive characteristics (N= 166).
N%
Gender Female 94 56.6
Male 72 43.4
Type of family Nuclear family 115 69.3
Extended family 51 30.7
Grade level 1 38 22.9
231 18.7
316
496 57.8
Experience of living with an old person Yes 113 68.1
No 53 31.9
Experience of providing care to an old person Yes 80 48.2
No 86 51.8
Wanting to work with an elderly group after graduation Yes 111 66.9
No 55 33.1
X+SD
Age 21.44 ± 2.2
(min.17,max.28)
4A.B. Bakan et al.

Discussion
Life expectancy all over the world has increased with the effect of such factors as a decrease in the
fertility rate, increase in healthy diet, easier access to health care services, and technological
developments (World Population Ageing, 2015: Highlights, 2015). Similar to countries all
over the world, the recent increase in the older population has frequently made the older
people care a current issue in Turkey (Turan et al., 2015; Turgay et al., 2015).
The related literature on the identification of the attitudes toward older people indicates that
various instruments have been used and attitudes of students in health-related departments, par-
ticularly nursing and medicine, have been analysed (Kose et al., 2015; Ozdemir & Bilgili, 2016;
Vefikuluçay Yılmaz & Terzioğlu, 2011). While some studies report positive attitudes of health
professionals and students toward older people (Altay & Aydın, 2015; Güven, Ucakan Muz, &
Efe Ertürk, 2012; Ucun, Mersin, & Öksüz, 2015;Vefikuluçay Yılmaz & Terzioğlu, 2011;
Yılmaz, Altıok, Polat, Darıcı, & Sungur, 2012;Yıldırım-Usta et al., 2012). Kose et al., 2015
reported that negative attitudes of students in the health field toward older people.
Table 2. Students’suggestions concerning gerontology nursing course (N= 166).
N%
Should nursing education include courses for
elderly care?
Yes 142 85.5
No 24 14.5
What is your suggestion about a course for
elderly care in nursing education?
Undergraduate education should include
Gerontology course.
99 69.2
The content of geriatric education should be
increased in other courses.
44 30.8
Having received gerontology nursing course
before
Yes 95 57.2
No 71 42.8
What is the adequacy level of the gerontology
nursing course you received?
Adequate 29 30.5
Moderately Adequate 55 57.9
Inadequate 77.4
I am not sure 44.2
Table 3. Distribution of students’Kogan’s attitudes toward old people scale scores according to their
personal characteristics (N= 166).
nX+SD t p
Age ≤22 113 131.88 ± 14.5 −.926 .356
≥23 53 134.11 ± 14.6
Gender Female 94 134.03 ± 13.8 1.469 .144
Male 72 130.71 ± 15.3
Family Type Nuclear Family 115 132.78 ± 14.4 .256 .798
Extended family 51 132.16 ± 14.8
Wanting to work with an elderly group after
graduation
Yes 111 135.00 ± 13.4 3.122 .002
No 55 127.73 ± 15.6
Experience of living with an old person in any
period of your life
Yes 113 132.46 ± 14.7 −.168 .866
No 53 132.87 ± 14.1
Experience of providing care to an old person
before
Yes 80 134.49 ± 14.4 1.634 .104
No 86 130.83 ± 14.5
Having received gerontology nursing course
before
Yes 95 133.16 ± 14.1 .582 .561
No 71 131.83 ± 15.1
Contemporary Nurse 5

Studies that investigated discrimination against the older indicated the variables affecting atti-
tudes toward older people as age, gender, education level, culture, and experience of living with
an older person before (Bleijenberg, Jansen, & Schuurmans, 2012; Kose et al., 2015; Liu,
Norman, & While, 2013; Turgay et al., 2015). Based on the data obtained in the present study,
the students were aged 22 on the average, and no significant differences were found between stu-
dents’age and their attitudes toward older people. In a similar vein, in their study conducted with
nursing students, Yılmaz and Özkan (2010) reported that the students’average age was 20, and
there were no relationships between students’age and their attitudes towards older people
(Yılmaz & Özkan, 2010). Unlike the present study, Soyuer, Ünalan, Güleser, and Elmalı
(2010) found that students aged below 20 had more negative attitudes, and Söderhamn et al.
(2001) reported more negative attitudes of students aged below 25 (Soyuer et al., 2010; Söder-
hamn et al., 2001).
An evaluation of the students in the present study according to their gender revealed that
gender did not affect attitudes. The related literature on the issue includes studies showing that
gender affects attitudes (Kose et al., 2015; Turgay et al., 2015; Usta et al., 2012) and those
showing that it does not (Soyuer et al., 2010; Yazici, Kalayci, Kaya, & Tekin, 2015;Yılmaz Vefi-
kuluçay and Terzioğlu, 2011).
Various studies report that even if students’attitudes toward older people are positive, they do
not want to work in Geriatrics (Chua Melvin, Tan, Merchant, & Soiza, 2008; Çilingiroğlu &
Demirel, 2004). According to a study that investigated attitudes of students in the health field
toward older people, students reported that they did not want to work Geriatrics and they
wanted to work with young patients because they thought providing care to a population of all
ages would be more beneficial for their professional development; working with older people
would affect their psychology negatively; and providing care to older people would be demanding
and difficult (Kose et al., 2016). The present study found that majority of the students participat-
ing in the study had positive attitudes toward older people and they wanted to work with older
people after graduation. The positive attitudes of students with regard to aging were reflected
most strongly in terms of respect for the older adults, listening to the older adults, and having
older relatives. The latter, in particular, has an important place in traditional Turkish culture.
Our findings are similar to other studies in terms of nursing students’holding generally positive
attitudes toward older individuals (Chen & Walsh, 2009; Henderson, Xiao, Siegloff, Kelton, &
Paterson, 2008;Lambrinou, Sourtzi, Kalokerinou, & Lemonidou, 2009; Ozdemir & Bilgili,
2016; Ryan, Melby, & Mitchell, 2007). A study conducted with 192 nursing department students
reported that age, class, place of living and hometown variables did not have effects on attitudes
towards older persons; however, it was found that students who did not have older persons in
family had significantly more positive attitudes towards older persons in comparison to students
who had older persons in their family (Ozkaptan, Altay, & Cabar, 2012).
Education is also reported to have an important role in developing positive attitudes toward
older people and increasing knowledge about ageing. The relationship between the increase in
education level and knowledge in the field of Geriatrics/Gerontology and attitudes toward
older people has been emphasized in several studies (Bleijenberg et al., 2012; Hweidi & Al-
Obeisat, 2006; Söderhamn et al., 2001). In a study that investigated the effect of education on
attitudes, nursing department students’positive attitudes scores were found to increase in the
third year of their education (Bleijenberg et al., 2012). Bleijenberg et al. report that fourth year
nursing students with more knowledge about older people also think more positively about
them. This study compared the effect of a course given in one term. The present study has also
investigated the students’mean scores according to their receiving gerontology nursing course;
and both groups were found to have positive attitudes toward older people. This finding is con-
sidered to be resulted from the fact that majority of the participants had the experience of living
6A.B. Bakan et al.

with an older person before. In addition to this, by the nature of cultural features in the eastern part
of our country, older people are respected and honoured, which indicates effects on this outcome.
Considering the cultural differences between the eastern and western parts of Turkey, it is rec-
ommended that these kinds of studies should be conducted in a comparative way, with the par-
ticipation of nursing students from all parts of Turkey. This way, factors affecting people’s
attitudes toward older people can be explored in a more detailed way.
Conducting the study in only one university located in the eastern part of Turkey and having
limited number of participants are the limitations of this study. Besides, data were collected using
a questionnaire; qualitative data collection tools such as interviews would probably shed more
light on the issue. Therefore, study results could be generalized only to the population involved
in the study.
Impact statement
This study found that nursing students’attitudes toward older people were positive. Cultural fea-
tures of the region where the study was conducted are considered to contribute to this result. Posi-
tive attitudes toward older people can be sustained by including topics related with older age and
elderly care in a more detailed way, perceiving Geriatrics education as a separate profession, pro-
viding nurses who work in this field with certificate about Geriatrics, and organizing post graduate
and doctoral programmes on the issue. These regulations would meet the needs of the ageing
Turkish population, raise specialist nurses in the field of elderly health, and increase the
quality of elderly care.
Conclusions
The students’general attitudes towards older persons were found to be positive, and the attitudes
of those who wanted to work with older persons were better. In addition, higher mean scores of
those who received gerontology course were not statistically significant; this result makes us think
that further training is required. Therefore, future studies could investigate the effects of gerontol-
ogy education.
ORCID
Ayse Berivan Bakan http://orcid.org/0000-0002-0052-9890
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