There is a total of 226 healthcare undergraduates and 359 SS students who participated in the program from 2015 to 2018. Response rate was 80.1% and 62.4% amongst the healthcare undergraduates and SS students respectively. Table 2 describes the profile of the participants.
Kogan’s Attitude towards Old People Scale
Healthcare undergraduates
There was a statistically significant increase in KOP score pre- and post-intervention for healthcare undergraduates with a mean increase of 12.8 (95% CI: 9.46 - 16.2, p < 0.001). (Table 3) This increase was found in all groups of undergraduates. All subgroups analysed had a statistically significant increase in KOP score pre- and post-intervention. There was a statistically significant difference in pre-intervention KOP score between those who stay with their grandparents and those who do not (p = 0.03). A Tukey post hoc test revealed that undergraduates who stay with their grandparents have higher pre-intervention KOP scores (i.e. have less ageist attitudes) (mean score 138.3, 95% CI: 132.5 - 144.2) as compared to those who do not (mean score 132.1, 95% CI: 128.9 - 135.3). There was no statistically significant difference for pre-intervention KOP found for different genders (male versus female), seniority (preclinical versus clinical), previous or current volunteer work involving the older persons.
Pre-intervention KOP scores is weakly positively associated with post-intervention KOP scores (r=0.177, p=0.020) and moderately negatively associated with the difference in KOP scores (r=-0.724, p<0.001).
Secondary School Students
There was a statistically significant increase in KOP score pre- and post-intervention for SS students with a mean increase of 8.3 (95% CI: 6.2 - 10.3, p < 0.001). (Table 4) All subgroups analysed had a statistically significant increase in KOP score pre- and post-intervention. There was no statistically significant difference for pre-intervention KOP found between the different genders (male versus female), secondary schools, seniority (lower secondary versus upper secondary), whether they are living with their grandparents or having previous volunteering experience in an old person facility.
Number of hours spent on home visits is weakly positively associated with difference in KOP scores (r = 0.234, p < 0.001). Pre-intervention KOP scores is weakly positively associated with post-intervention KOP scores (r = 0.333, p < 0.001) and moderately negatively associated with the difference in KOP scores (r = -0.598, p < 0.001).
The baseline KOP score of the healthcare undergraduates is significantly higher than that of the secondary school students (mean = 6.8, 95% CI: 3.7 to 9.9, p < 0.001), and the increase in KOP score for healthcare undergraduates was also significantly more than that of the secondary school students (mean = 4.6, 95% CI: 0.7 to 8.4, p = 0.022).
Palmore’s Facts of Aging Quiz
Healthcare undergraduates
The average pre- and post-intervention PFAQ score is 15.8 and 16.0 respectively, but there was no significant difference in PFAQ score (p=0.112). (Table 5)
There is a weak positive correlation between: i) baseline KOP and baseline PFAQ scores (ρ=0.183, p=0.008); ii) post-intervention KOP and post-intervention PFAQ scores (ρ=0.373, p<0.001); and iii) change in KOP and change in PFAQ scores (ρ=0.266, p<0.001).
Secondary School Students
There was a statistically significant increase in PFAQ score pre- and post-intervention for SS students with a mean increase of 0.8 (95% CI: 0.3 – 1.4, p = 0.005). (Table 6) Female students, older students, those who do not live with their grandparents, those who had never volunteered in an old person facility and those who have siblings were associated with a statistically significant increase in PFAQ score. There was no statistically significant difference in pre-intervention PFAQ score between the different genders (male versus female), secondary schools, seniority (lower secondary versus upper secondary), whether they are living with their grandparents or having previous volunteering experience in an old person facility.
There is no correlation between time spent visiting the elderly and change in PFAQ scores (ρ=0.136, p=0.084). There is a moderate positive correlation between: i) baseline KOP and baseline PFAQ scores (ρ=0.437, p<0.001); and ii) post-intervention KOP and post-intervention PFAQ scores (ρ=0.472, p<0.001). There is a weak positive correlation between the change in KOP scores and the change in PFAQ scores (ρ=0.349, p<0.001).
Healthcare undergraduates had a significantly higher baseline (2.5, 95% CI: 1.8 to 3.1, p < 0.001) and post-intervention (1.8, 95% CI: 1.1 to 2.5, p<0.001) PFAQ score than SS students. However, the healthcare undergraduates did not have a significant difference in change in PFAQ score compared to the SS students (-0.3, 95% CI: -1.1 to 0.5, p = 0.412).
Fund for improving postsecondary education survey
Healthcare undergraduates
Most healthcare undergraduates felt that TriGen was beneficial across all nine FIPSE domains (Table 7). 90 – 100% of students reported learning in all 9 domains except for ability to make clinical diagnosis (81.6%) and apply what they have learnt in the training sessions to the home visits (80.1%).
When adjusted for clinical experience, female students were more likely to report gains in the area of participation in community affairs and taking action. When adjusted for gender, students in the clinical phase of their training were more likely to report gains in their clinical diagnostic skills and application of knowledge and skills learned during the training session and the ability to comprehend the moral and ethical issues in healthcare.
Secondary School Students
Most SS students felt that TriGen was beneficial across all nine FIPSE domains (Table 8). When adjusted for age, females were more likely to report gains in respect different opinion, compromise. When adjusted for gender, older students were more likely to report gains in appreciate teamwork and cooperation among peers, appreciate and identify gaps or deficiency in the healthcare system and enhance understanding of use of public health measures in resource poor setting.
Program feedback
Healthcare undergraduates
Majority of the healthcare undergraduates felt more prepared for their practice as healthcare professionals in the future. 92.4% are now more aware of the problems faced by the older persons. 91.9% would recommend the program to their friends. (Table 9)
Secondary School Students
83.1% of SS students are more aware of problems faced by the older persons and 91.3% would recommend the program to their friends. (Table 9)
Patients’ reported satisfaction and clinical outcomes
Table 10 describes the demographic of our patients There were 116 patients who participated in the program. The mean age is 73.5 years-old. The mean age-adjusted Charlson co-morbidity index is 9.1.
A Wilcoxon signed-rank test showed a statistically significant decrease in hospital admission rates during the 6 months period before the program and the 6 months period after from a median of 1 visit (range of 0 to 5) to 0 visit (range of 0 to 10). (Z= 2.72, p = 0.006). A Wilcoxon signed-rank test showed a statistically significant decrease in emergency department visits during the 6 months period before the program and 6 months period after from a median of 1 visit (range of 0 to 10) to 1 visit (range of 0 to 10). (Z = 2.91, p = 0.004)
A total of 51 patients answered the patient feedback survey. The majority (> 80%) felt less lonely and happier because of the home visits. Most (>50%) felt that they have changed their lifestyle for the better and feel more confident taking care of their own health as a result of the home visit. (Table 11)