The attitudes and effect of gerontology education on students of Medicine and of Maritime Studies in Split have been examined using Kogan’s scale and Palmer’s questionnaire. In addition to the impact of knowledge, the questionnaire also examined the effect of some socio-demographic factors on the formation of attitudes concerning ageing and elderly persons among students (3).
School of Medicine students were selected due to the possibility of their earlier education in the area of gerontology, and due to awareness of social groups with increased needs. Students of the Faculty of Maritime Studies were selected as a comparative group, representative of the bulk of the population with no gerontology education during the course of their studies.
Two hypotheses were defined. According to the first hypothesis, attitudes of the School of Medicine students concerning ageing are more positive than those of students of the Faculty of Maritime Studies of the University of Split, partly due to gerontology education in the course of studies, and this hypothesis has been confirmed. The second hypothesis was that negative attitudes of the School of Medicine students concerning ageing and the elderly is linked with the preferred specialization upon the completion of studies, and that students do not wish to become specialized in gerontology due to their negative attitude. This hypothesis has been rejected.
Attitudes concerning ageing and elderly persons are formed under the influence of various factors (14). Since the number of elderly persons is on the rise, there is a growing need to change negative attitudes among the public towards ageing and persons of age (15). Academic findings and research see the average age of the population of a given community as the first indicator and benchmark of the quality of life. Extension of life expectancy is a major achievement. Each individual, regardless of age, wants to live as many years as possible, but without the negative connotations of old age, and with the highest achievable quality of life (16).
When considering the elderly, it is often forgotten that most people in this population group are in the period of early old age, when changes caused by ageing are not pronounced to such a degree that they would substantially limit their daily activities, except in cases of complications caused by chronic illness (11).
In this study, students expressed their own attitudes concerning ageing and elderly persons using the Kogan scale, by selecting the number closest to their perception of a given claim. They agreed the most with the claim that most elderly persons have their own habits that cannot be changed. On the other hand, students agreed the least with the claim that most elderly persons allow their homes to become shabby and unpleasant.
The impact of knowledge on the formation and change of attitudes has already been proven (17). Palmer’s questionnaire comprised claims that respondents assessed as true or false. There were 34 claims where more than 50% of the respondents knew the correct answer, and four claims where the majority of the respondents did not know the correct answer. Students' responses included stereotypes and fallacies most frequently connected with social life of the elderly, and correct answers were typically those pertaining to the physical condition of organism and changes arising due to ageing.
In case of our respondents, there is a positive and statistically significant link between the results of Kogan and Palmer scales, i.e. persons with a higher degree of knowledge concerning persons of age have more positive attitudes towards ageing and the elderly, and the opposite is true as well. Fallacies in connection with ageing include lack of knowledge on the plasticity of the central nervous system and decay of brain activity excluding neurological disorders (18). Elderly persons can learn, but their motivation and learning methods differ, which requires the adaptation of teaching methods to their age and needs. While the manner in which they memorize new data and written material can be taken into account through proper teacher training, various games help maintain mental fitness, just as in other organic systems (19). It is important to point out that elderly persons do not memorize new data as well as young persons; however, their learning capacity as well as long-term memory are preserved. It is therefore extraordinarily important to initially assess the psychological independence of a person, and to exclude depression and neurological disorders that are frequent in old age (11).
Among our respondents, a more positive attitude towards ageing and the elderly was recorded in students Medicine than in students of Maritime Studies.
Age, sex and domicile have also shown to have an impact on the formation of attitudes concerning ageing and the elderly (20). Male students scored lower median values in both Kogan scale and Palmer questionnaire, when compared to female students. Furthermore, female students exhibit a more positive attitude towards ageing and the elderly compared to their male counterparts (1.898 times higher probability for Kogan scores higher than 133; B = 1.898; p = 0.038). In most cultures, the role of women in family is to care for the children, the ill, the old and disabled persons; as a result of upbringing, female children have a pronounced sensibility for the needs of other family members (21).
Each subsequent year of study increases the probability that a person will achieve a Kogan scale score higher than 133 by 1.234 times (B = 1.234; p = 0.017), which points to a conclusion that a more positive attitude among students is developed in the course of years of study.
Respondents from urban settlements have shown a more positive attitude towards ageing and the elderly compared to respondents residing in rural settlements, but difference in knowledge (Palmer’s test) has not been determined. This result is contrary to our expectations. In fact, rural areas are frequently perceived through the prism of a traditional form of life and nurturing of family values, where care for the needs of each family member is pronounced and, in line with that, we expected respondents living in rural areas to have more positive attitudes concerning ageing and the elderly.
Students were divided into three age groups. One age group comprised students from 18 to 22 years of age; one group from 23 to 27 years of age; and one group comprised persons older than 33. The youngest age group (18 to 22 years of age) has shown a lower level of Palmer scale results (knowledge) compared to older age groups. The highest results under Kogan’s scale were achieved by the 23–27 age group, which means that attitudes towards ageing and the elderly turn more positive as life experience increases. However, if students have no gerontology training foreseen in their study programme, the chance for formation of positive attitudes will remain unused (22).
Experience of life with the elderly did not result in differences in Kogan scale and Palmer questionnaire results, between persons who have such an experience and those who do not.
Desired specialization among students of the School of Medicine does not impact the attitude concerning ageing and the elderly. The reason why relatively few students choose Gerontology as future specialization in the course of professional life is probably grounded in insufficient information concerning the opportunities and education methods within this branch of medicine, and probably also due to insufficient attractiveness of the specialization (23).
We have compared the results obtained through our survey with two existing pieces of research. An earlier research from Slovenia compared attitudes towards ageing and the elderly between Croatian and Slovenian nursing students (13). The total number of respondents in the Slovenian study amounted to 825 nursing students, 408 of whom were from Croatia and 417 from Slovenia. The same questionnaires were applied as in our research. As regards important characteristics of the two groups, it is important to point out that 22.55% of the Croatian student group had no education concerning care for the elderly, compared with only 8.39% of the total number of Slovenian students covered by the study who had no such education. In accordance with that, 81.86% of Croatian students believe that additional educational programs are needed concerning ageing and the elderly, with 70.74% of Slovenian students believing the same.
Differences in students’ attitudes towards ageing and the elderly have been identified as depending on training in gerontology, i.e. on differences in educational programmes between Croatia and Slovenia. Slovenian respondents have substantially better indicators as regards perception and attitudes of students compared to Croatian respondents/students, while respondents with prior education in care for the elderly also exhibit substantially better attitudes and perception compared to those who had no prior education (13).
Whenever results differ depending on sex, domicile, type of study and employment, such results obtained in the Slovenian study are similar to the ones identified in our research. Answers from the Slovenian survey show that female respondents perceive ageing and elderly persons substantially better than men. However, in the Slovenian study, respondents residing in rural areas have shown better results (more positive attitudes and a higher level of knowledge) compared to those living in urban areas, which is opposite to our findings.
Links between professional preferences following the completion of one’s studies on the one hand, and attitudes towards ageing and the elderly on the other, have not been found in the discussed Slovenian survey either.
Attitudes of medicine students towards ageing and elderly persons were also examined in a study performed in Turkey, involving students of the School of Medicine. The research encompassed 324 students of the fourth, fifth and sixth year of medical school, and attitudes were examined using the Kogan scale (24). The Turkish respondents’ median value according to Kogan’s scale was lower than that of our respondents’ from the School of Medicine, which points to a more benevolent attitude towards ageing and the elderly at the University of Split. In addition, the Kogan scale result was higher for female students compared with male students, which is identical to our results. No differences were found concerning other socio-demographic factors. The use of the same instrument for the examination of attitudes in three culturally different environments is interesting in terms of the diverse character of obtained results. Differences in Kogan scores for the examined attitudes, revealed when comparing the obtained data, point to the need to educate young people and to adapt educational programmes. Through this research, we have shown that knowledge is the only effective measure in combating prejudice and negative stereotypes. Correct information is the only cure against ill-informed beliefs. That is why young people need to be made aware of societal problems and of the increasingly older community, as early as possible. Moreover, Medicine, Dental Medicine and Pharmacy students need to be better acquainted with the possibilities of resolving health issues of elderly persons through study programmes (23).
The comparative analysis of surveys is all the more interesting when taking into account that respondents were chosen among students of Nursing (Slovenia and Croatia) and Schools of Medicine (in Croatia and Turkey). Our research provides an additional dimension, by providing a comparison with students of the Faculty of Maritime Studies, whose education is not founded on healthcare programmes, and whose attitudes are not impacted by their professional knowledge, but rather by general health literacy. A positive impact on the formation of attitudes and knowledge shown in the survey has been found among first-year School of Medicine students who obtained education in the optional course of Gerontology.
Our research has found that there is a difference in attitudes between students who were exposed to educational content from gerontology and those who were not. The group that was not exposed to gerontology training had a negative attitude compared to the group had had gerontology lessons. This paper confirms that the provision of truthful and timely information is the best method of preventing negative attitudes and stigmatization of groups that have increased needs in society.
Potential Limitations and Gaps
This is a cross-sectional study involving the students of two faculties of the University of Split at one point in time. Although the ratio of males and females among respondents is approximately the same (160/53.16% females; 141/46.84%; p = 0.273 males) it is possible that the students of Medicine have more positive attitudes towards and more knowledge of ageing and the elderly due to the fact that at that faculty there is a greater share of female than of male students. The female group of students is also made up of a part of female students of Maritime Studies since the overall number of Medical School students was 148, and the total number of female respondents 160. According to a research conducted in Croatia, males make up the majority of enrolled students (73.1%) only in regular and full-time university specialist courses in the field of technical sciences. The highest ratio of females at the Faculty of Maritime Studies is in the Maritime Management study program. In areas such as biomedicine and health, males make up less than a third of all students enrolled: 28.06% (25), and the situation at the University of Split is in line with the trends at country level.