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Professional & personal attitude of physiotherapy students towards Geriatric population.

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Introduction & literature review
Aseela Kanwal
Professional and personal attitude of physiotherapy students towards geriatric population
Attitudes are a union of past practices, opinions and approaches regarding a person or object that effect behavior. (Mario, Esses, Arnold, & Olson, 2004). Attitudes toward people and specific 3behaviors are, therefore, intensely influenced by an individual’s philosophies and learned practices. The Theory of Reasoned Action (Ajzen;Fishbein, 1980) suggests that an individuals’ intentions towards behavior are influenced by attitudes. People with constructive approaches concerning a specific person or object are more likely to have acceptable beliefs, behaviors and feelings toward those specific items. Negative attitudes are predecessors to negative feelings, behaviors, beliefs. In summary, attitudes affected by knowledge and beliefs, or deficiency, thereof, can encourage behaviors in definite directions.aOlder people make up the biggest set of service users, as they are referred to physiotherapy throughout a wide range of hospital and community based health and social care (Hogg, 2002). As physiotherapists frequently signify the interests of older people, it is important that they do not have ageist affinities so that treatments and communications with older people are optimally effective (French, 1990). Revell, Simpson and Dyer (1993) cautioned that discriminatory conduct along with deprived arrangements for working with older people will possibly lead to elder patients receiving a poorer standard of physiotherapy than is presented to younger people. It is important, therefore, that the beliefs and attitudes of physiotherapy students toward older people are investigated with a view to helping physiotherapy educators and hopefully students themselves understand them in order to ensure that care/rehabilitation of elders is not compromised.

Baron and Byrne (1991), characterized attitudes as persistent mental representations of innumerable characteristics of the physical or social world. Unluckily, in American society, stereotypical and often bad attitudes persist toward elderly people. It is a reasonable step to assume that these attitudes are also a part of the characteristics of health care providers. As a matter of fact, French (1995) reports that attitudes of health professionals are incredibly similar to those of the general society. If it is presumed that there are explicit relations between behaviors, behavioral objectives, and attitudes, then concentration must be focused toward the quality of care offered to the elderly people (Golden, 1989).

Ageism exists and our society inclines to hold negative attitudes about aging and the aged and this is verified by the evidences within the literature. Proves also exists to validate the opinion that ageism is not only common amongst the residents at large but also exists among many of those who care for elder people in a professional scope. Physiotherapists are amongst the individuals of health care professionals who have formerly been reported as having ageist attitudes. Elder people make up the major group of service users and are represented to physiotherapy department across a extensive range of hospital society and communal care settings. As physiotherapists often represent the interests of older people, it is vital that they do not have ageist tendencies so that communications and treatments with older people are optimally effective. Simpson, Revell, and Dyer (1993) warned that discriminatory behavior as well as poor preparation for working with older people might lead to older patients receiving a lower standard of physiotherapy than is offered to younger people. It is important, therefore, that the beliefs and attitudes of physiotherapy students toward older people are investigated with a view to helping physiotherapy educators and hopefully students themselves understand them in order to ensure that care/rehabilitation of elders is not compromised.
In Australia, the staff unavailability in the domain of human services, predominantly for elder people, have been long-lasting. (Access Economics 2001). The enhancement in the lifespan of the elder people will influence health and aged care expenses. There will be a larger number of elder Australians, as well as Native Australians, who will need health facilities such as physiotherapy. A longer timeframe for health care provision to individuals is forecasted as Australian life endurance proliferate. In addition, natural ageing will expand the intensity necessary for health care provision (workforce’s hours) because elder people are normally more time-consuming in execution of the same life chores than younger people (Pickles et al 1995). Health professionals take a longer time to analyze and facilitate health care requirements of elder people as they have more complicated health status (Creasey 1999). As a consequence, it is envisioned that there will be a greater requirement on the physiotherapy personnel for capacity, concentration and duration of services for elder people in numerous workplace sites. This enlarged requirement will have consequences that may disturb many shareholders such as clients, careers, academics, national/international groups, workplace contributors and learners. The modification in population report denotes that an increasing number of physiotherapists will be required to reinforce the health care necessities of this increasing sector of the population. Moreover, it is accepted that the degree of disability surges with age (Andrews 2001). Hence, the alterations in the inhabitants’ profile propose that the aggregate of elder Australians, predominantly the very old aged 85 years and above, pursuing physiotherapy amenities will rise. Furthermore, this population will need extended sessions and greater expertise in physiotherapists, due to co indisposition and socioeconomic concerns such accommodation, finances, career sustenance and conveyance. Henceforth physiotherapy scarcities for elder persons will enlarge unless practitioners recognize the opportunities that subsist. In the past era, the number of physiotherapy degrees has increased in within Australia. (Crosbie et al 2002). In part, this was an effort to discourse workplace requirement for physiotherapists and students’ attentiveness in this profession. Beginning practitioners are apparently hesitant to work with older people. It is reassuring to see the profession propagate and interests in other zones of the profession increase (Finn 1986, Morris ;Minichiello 1992). The intention of this survey was to observe the variations that ensued in physiotherapy students’ approaches and information concerning elder people, if any, throughout their undergraduate course. It was foreseen that, in addition to other variables such as evolution and wide-ranging life experiences, educational elements of learning and clinical posts, both of which comprised of exposure to elder clients, would upgrade students’ attitudes towards and knowledge of elder individuals. Earlier studies of physiotherapy students’ attitudes towards elder people exposed contradictory conclusions about attitudes interrelated to conduct. Fake elderly clinical placements and actual clinical placements have confirmed that physiotherapy students’ attitudes regarding elder people could be amended (Brown et al 1992, Taylor and Tovin 2000). Service-learning has also been presented to advance students’ approaches regarding elder people (Beling 2003). Other examination, not restricted to physiotherapy students, argues that revelation to healthy and fit elder people (Rowland and Shoemake 1995, van Zuilen et al 2001), course work (Davis-Berman and Robinson 1989, Gorelik et al 2000), and clinical practice (Francesco et al 1997, Richardson et al 1997, Rowland and Shoemake 1995, Royle et al 1998, van Zuilen et al 2001) positively affect students’ attitudes to working with elder people. Physiotherapy students’ ignorance of and generalities about elder people have also been exposed to effect destructively their decision to work with older people (Coren et al 1987, Dunkle and Hyde 1995, Noose and Wilson 1994). Students’ observations of their families’ expectancies about them working with elder people were also persuasive prognosticators for working in elderly care (Dunkle and Hyde 1995).

Some have stated that there is no confirmation that professional assistants are any less inclined in their private lives than others in the community. Others have taken the contradictory position, stating that physiotherapists have encouraging attitudes concerning elder persons A chief reason for this supposition is that people who have negative approaches concerning the disabled will be doubtful to select an occupation that would bring them into interaction with the elderly population.

Bad attitudes towards elder people and mythologies concerning aged are universal. Elder adults are occasionally regarded as a health care worker’s burden and a hindrance to the more significant work of caring for younger adults. The attitude towards the aged is predominantly important for students and practitioners in healthcare professions, such as physicians, nurses, physiotherapists, geriatric specialists, and, specifically, for social gerontologists. Although many studies have been published aiming on relatively different characteristics of the attitudes of health care professionals and of students of health sciences towards the aged, deductions are many times inadequate and unreliable.

Aspects such as the students’ age (Dunkle and Hyde 1995), former connections (both social and working) with elder people (Dunkle and Hyde 1995, Wong 1991), attending at gerontology progressions (Dunkle and Hyde 1995, Taylor and Tovin 2000), and passionate instructors (Dunkle and Hyde 1995) did not considerably altered students’ conduct. The purpose of this study was to study Australian physiotherapy students’ attitudes towards and knowledge of elder people. Students’ attitudes and knowledge were calculated at three points in time during their undergraduate program to observe variations over time and to define their attitudes and knowledge as beginning physicians.16
Medicinal literature indicates that in a world with greater needs for aged care,1–3 health care professionals and in particular physicians tend to reveal negative attitudes regarding the elderly. The University of Salamanca is dedicated to instructing its students in focusing to and caring for the elder people. As part of this commitment, the university co organized a session in 1998,4 intending to target the requirement for broadening geriatric and gerontology guidance at various stages of educational training on the public memo. This significance of instructing human sources has presently attained the highest ranks of political conclusions making 5 bodies. In 2004, the Ministry of Labor and Social Issues in Spain directed the MIPPA professional gathering,6 with Training of Professionals as the main subject matter and intended to monitor the goals set by the United Nations World Assembly on Ageing 2002. Amendments to exercising plans or academic approved courses should be created on the best prove accessible. Thus, we accomplished a study of a small cross section of students from different health care linked specialties, who, in the near future, would be engaged in the supervision of elder persons. We highlighted two characteristics that we counted relevant: attitudes, because of their adjustable character, and the literary year of the students’ studies, as students in their final year are actually a short time away from being certified personnel in our society. Surveys were conducted from students of seven different specialties. In our study, in view of the explicit impact on practical actions, attitudes are seen as a negotiating association between clinical capability and performance.

This research done in a novel way, focused on the mindsets of the physical therapy students regarding the elderly. Students’ attitudes regarding aged people were evaluated along with their concerns towards working with elderly patients. We expect that the more inclusive scheme of this study will submit explanation of some of the contrary conclusions of preceding attitudinal researches.

Literature Review:
Regardless of the level of their specialized participation with elder people, the opinions and attitudes of physiotherapy students/physiotherapists regarding elderly are badly signified in the sources. Current study, some of which is now relatively outdated, was observed to be connected chiefly with physiotherapists’ work aims along with the consequence of instructive interferences and life practices rather than the specifies of their opinions and attitudes regarding elder people. Mowbray and Donaghy (1994) discovered that only 7% of 57 physical therapy students in Scotland would select chiefly to work with elders. Morris and Minichiello (1992) discovered that most of 233 physiotherapists in Australia favored employment in regions other than geriatrics. Coren, Andreassi, Blood, and Kent (1987) discovered that only 24% of the 314 physical therapy students in Ireland envisioned to work with elders, and Finn (1986) discovered that 59% of the 178 American physiotherapists were longing to work with elders only in the short term. In a small study of 37 first-year and 20 fourth-year physical therapy students, Mowbray and Donaghy (1994) found more positive approaches concerning elder people possessed by superior physical therapy students, contrasted to junior ones on the identical curriculum. In another small study (n = 47), Gardner, Perritt, Kelly, Brown (1992) presumed that physical therapy students’ attitudes concerning elderly can be inclined positively by unusual instructional schemes. Beling (2003) observed that 20 physiotherapists students who primarily had adverse attitudes concerning elder adults considerably progressed their approaches only subsequent to a service acquiring experience. Then again, Taylor and Tovin (2000) narrated that taking a class “addressing content pertaining to geriatric physical therapy” did not cause further constructive approaches concerning elders amongst 190 student physiotherapists. An American report (Taylor ;Tovin, 2000) inspected the attitudes of physical therapy students concerning elder people and the students’ interpretations about working with elder patients. The writers discovered that usually deprived attitudes were in subsistence but that those students with a more positive approach regarding elder people were more prone to work with them more positively. In conflict, Krauss, Horowitz, Savino, (1999) acquired exercising occupational therapists were not ageist and did not treat chronologic age as a factor of feasible therapy consequences.

Former investigators (Todd, Rider, & Pate-Robin,1986) discovered that undergraduate physiotherapy students held comparatively positive approaches regarding elder adults, assuming that practiced socialization might add to this. To track changes in attitudes during training, they suggested longitudinal designs.

A study was conducted incorporating 46 junior physical therapists working in three its maximum restoration potential. The conclusions also specify that adjoining Health Districts in the South of England. An implicit minorizing the use of stereotypes could encourage such an attitude methodology was used to investigate the therapists’ opinions, attitudes and treatment purposes concerning elder people. The physical therapists were independently revealed to two videos one presenting the gait training of a younger, and the other of an elder patient. Consequently, they were asked to evaluate each patient on an attitude scale and review the proposed treatment methodology in a partially organized interview. It was discovered that most physical therapists held more negative attitudes towards the characteristics of elder clients, specifically in the zones of motivation and rehabilitation consequences. In agreement with this conclusion, treatment intentions were predicted to be less concentrated and less precise than for younger patients. Therapists who remained most severely to typecasts in their treatment methodology also favored to work with younger patients. Furthermore, the subjects’ beliefs on physical therapy in general appeared associated to approaches to treating elder clients. The outcomes of this study indicate that approaches towards working with elder patients ought to be modified, to permit this, patient assemble to acquire its maximum rehabilitation capacity. The outcomes also signify that minorizing the usage of stereotypes may provoke such an attitude alteration. (1)
Hobbs, Dean, Higgs, and Adamson (2006) found that the albeit positive attitudes of 145 physiotherapy students toward older people did not change significantly before going out on their first clinical placement just prior to graduation, despite a significant gain in relevant knowledge. Hobbs et al. (2006) however recognized that, despite their gain in knowledge, participants were still not well informed about aging when they graduated, posing a risk to the quality of physiotherapy provided to older people by new graduates.
Stewart et al. (2005) indicated that 71 first-year Occupational Therapy, Nursing, and Physiotherapy students who had more than monthly contact with older people had less negative attitudes and beliefs toward older people than 142 students on the same courses who did not have that contact. A review of the literature provides only limited insight into physiotherapy students’ beliefs and attitudes toward older people. The effects of educational interventions and other student characteristics including contact with older people on beliefs and attitudes toward older people could not be established. (12)
In a study assessing nursing and physical therapy students’ intentions to work with elderly persons (n = 201), Dunkel and Hyde (1995) found that the strongest positive predictors were attitudes, subjective norm, and beliefs such as a desire to get to know the patient and their families and the belief that it would be pleasant to work with elderly patients. Other studies have shown that exposure to active, healthy older people improves attitudes of student nurses and physical therapists (Brown, Gardner, Perrit, & Kelly, 1992; Haight et al., 1994). No longitudinal data are available to assess if this attitude shift translates into permanent change, or if this attitude change applies to chronically ill elderly clients.

In studies of medical students by Weiler, Ogren and Olafson (1989), and Warren, Painter, and Rudsill (1989), positive faculty role models were found to be instrumental in fostering the development of an interest in geriatric specialization. Wong (1991) found that 60% of physical therapy students who had experienced nursing home work were less interested in working with elderly patients but those students who had enjoyed the long-term care clinical experience were much more likely to pursue employment in chronic care settings than students without nursing home experience.

Coren, Andreassi, Blood and Kent (1987) developed a questionnaire to assess the attitudes of physical therapy students toward elderly patients and their intent to work with this population. The questionnaire consisted of 21 questions in four content areas: four biographical, seven experiential, three perceived socioeconomic, seven attitudinal, and one about intent. In this study (n = 326), students reporting neutral or negative attitudes toward the elderly did not intend to work with this population. Nosse and Wilson (1994) conducted a follow-up study of students’ and geriatric physical therapists’ attitudes using a modified version of the same questionnaire, and reported similar conclusions. Nosse (1995) resurveyed the student sample 28 months later and found that 60% of the students who had reported not intending to work with elderly were working primarily with this population. Nosse explains this somewhat surprising result considering the changing health care environment, noting the degree of freedom physical therapists previously experienced in choosing their ideal job and client population may no longer exist. Physical therapists may be working in the field of geriatrics, but not necessarily because of the personal preference (1995). This finding supports Roth and Upmeyer’s (1989) assumption that attitude is a latent variable that may ormay not be expressed in a behavior. Whether these practicing physical therapists have changed their attitudes toward working with elderly patients, or whether those negative attitudes remain latent is uncertain. Nosse (1995) discussed the need for future attitudinal studies to utilize multivariate design to help determine the relative influence of various factors in working with the elderly. (15)
While most of the studies report a mostly positive attitude towards the elderly, an investigation by Kearney et al., (2000) among a specific group of medical staff (oncology healthcare professionals) found that regardless of gender, profession, clinical experience, and specialist education, persistently negative attitudes were displayed towards elderly people. Previous relations and contact with the elderly may have a significant impact on someone’s attitude towards them. For example, Khan (2011) states that students who had cared for an older adult reported a more positive attitude toward older adults than other students who had not had such an experience. Preferences to work with older people and knowledge of ageing appeared to be associated with positive attitudes towards older people.20
Intercultural studies of the attitude towards the elderly revealed some differences between eastern and western countries. For example, a survey among four countries (Japan, China, Taiwan, and Vietnam) in Eastern cultures and in two countries (USA and UK) in the West showed that the level of knowledge about aging in Western countries is significantly higher than that in Eastern countries, and attitudes toward aging are more positive in the western countries compared to the eastern countries (Huang, 2013). This suggests that the tradition of respecting older adults in Eastern cultures may have weakened gradually, and it appears industrialization devalues aging populations in Eastern countries but not in Western countries.20
A recent New Zealand study (Giles, Paterson, Butler, & Stewart, 2002) comparing knowledge and attitudinal differences towards older people held by final year physiotherapy and occupational therapy students and their clinical educators showed that attitudes of both groups of students towards older people were consistently more negative than their clinical educators of both professions. Despite this, there were no differences in knowledge across the four groups, although students showed more negative bias in their incorrect answers to factual question


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