KNOWLEDGE, E

UNIVERSITY OF CALABAR TEACHING HOSPITAL

FACULTY OF HEALTH SCIENCES AND TECHNOLOGY

Ebere Omeje

EFIONG, MERCY. B. PG/M.Sc/08/47747

KNOWLEDGE, ATTITUDE AND PRACTICE OF CARE OF THE ELDERLY PATIENTS AMONG HEALTH WORKERS IN

UNIVERSITY OF CALABAR TEACHING HOSPITAL CROSS RIVER STATE, NIGERIA.

FACULTY OF HEALTH SCIENCES AND TECHNOLOGY

DEPARTMENT OF NURSING SCIENCES

Ebere Omeje Digitally Signed by: Content manager’s

DN : CN = Webmaster’s name

O= University of Nigeria, Nsukka

OU = Innovation Centre

1

AND PRACTICE OF CARE OF THE LDERLY PATIENTS AMONG HEALTH WORKERS IN

UNIVERSITY OF CALABAR TEACHING HOSPITAL CALABAR,

FACULTY OF HEALTH SCIENCES AND TECHNOLOGY

DEPARTMENT OF NURSING SCIENCES

: Content manager’s Name

Webmaster’s name

a, Nsukka

2

KNOWLEDGE, ATTITUDE AND PRACTICE OF CARE OF THE

ELDERLY PATIENTS AMONG HEALTH WORKERS IN UNIVERSITY OF CALABAR TEACHING HOSPITAL

CALABAR, CROSS RIVER STATE, NIGERIA.

BY

EFIONG, MERCY. B. PG/M.Sc/08/47747

DEPARTMENT OF NURSING SCIENCES

FACULTY OF HEALTH SCIENCES AND TECHNOLOGY UNIVERSITY OF NIGERIA

ENUGU CAMPUS

JULY, 2015.

3

TITLE PAGE KNOWLEDGE, ATTITUDE AND PRACTICE OF CARE OF THE

ELDERLY PATIENTS AMONG HEALTH WORKERS IN UNIVERSITY OF CALABAR TEACHING HOSPITAL

CALABAR, CROSS RIVER STATE, NIGERIA.

BY

EFIONG, MERCY B. PG/M.Sc/08/47747

M.SC DISSERTATION

PRESENTED TO THE DEPARTMENT OF NURSING SCIENCES FACULTY OF HEALTH SCIENCES AND TECHNOLOGY

UNIVERSITY OF NIGERIA, ENUGU CAMPUS

IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE AWARD OF MASTERS OF SCIENCE DEGREE IN NURSING

SUPERVISOR: DR (MRS) I. O. EHIEMERE

JULY, 2015.

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APPROVAL

This dissertation has been approved for the award of Master of Science Degree in Nursing in the

Department of Nursing Sciences, Faculty of Health Sciences and Technology, University of

Nigeria, Enugu Campus.

By

………………………………………….. …………………………… Dr.(Mrs.) I. O. Ehiemere Date Supervisor ………………………………………. …………………………… Dr. A. C. Nwaneri Date Head, Department of Nursing Science ………………………………………… …………………………… External Examiner Date …………………………………………. …………………………… Prof. Obinna Onwujekwe Date Dean, FHST UNEC

5

CERTIFICATION

I Efiong, Mercy Bassey, Reg. No. PG/MSC/08/47747 hereby certifies that this dissertation is my

original work and that either the whole or part of it has been submitted to this University or any

other Institution for the award of Masters of Science degree.

……………………………………….. …………………………… EFIONG, MERCY BASSEY DATE ………………………………………… …………………………….. DR. (MRS) I.O.EHIEMERE DATE

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DEDICATION

This work is dedicated to the ALMIGHTY GOD for the grace of longevity on my family

lineage.

My father passed on at the age of ninety five while his other siblings died between 85 to 93 years

of age. To God Be The Glory.

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ACKNOWLEDGEMENTS

My greatest appreciation goes to the Almighty God, the most merciful, compassionate and

gracious for enabling me to conduct this research study.

My sincere appreciation to my diligent Supervisor Dr. (Mrs.) I. O. Ehiemere for her support,

constructive criticisms and assistance throughout this endeavor, she helped me establish realistic

goals for completing each phase of this thesis and proved to be a valuable proponent of this

research study. I am eternally grateful for her guidance, support and encouragement, throughout

this exercise. It was an honour to work with an expert like her. I remain grateful to the Head of

Nursing Science Department Dr. A. C. Nwaneri and the entire lecturers in Nursing Science

Department for their own contributions and intelligent corrections.

Special appreciation goes to my husband, children and family members for their support, Co-

operation and encouragement.

Special thanks to Mrs. Lilian Eyam, Diana John and Agbor Oben for helping make this a

scientifically sound, clear and readable research. A special expression goes to my friends

MaEfiom, Gupo, Helen, Salama, Afi Ekpenyong and Afi Eduwem for their suggestions that

contributed so much to this research

Finally, I am grateful to the research participants, Nurses, Doctors, Physiotherapists and Dentists

in University of Calabar Teaching Hospital, Calabar. If they had not shared their views, this

research would not have been complete.

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TABLE OF CONTENTS

Title page i

Approval page ii

Certification Page iii

Dedication iv

Acknowledgement v

Table of Contents vi

List of Tables viii

List of Appendices ix

Abstract x

CHAPTER ONE: INTRODUCTION

Background to the Study 1

Statement of the Problem 3

Purpose of Study 4

Specific Objectives of the Study 4

Research Questions 4

Significance of the Study 5

Scope of the Study 5

Operational Definition of Terms used in this Study 6

CHAPTER TWO

: LITERATURE REVIEW

Conceptual Review 7

Theoretical Framework 25

Empirical Review 28

Summary of the Literature Review 33

CHAPTER THREE: RESEARCH METHOD

Research Design 34

Area of Study 34

Population of the Study 35

The Sample size for the Study 35

Sampling Procedure 35

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Method of Data Collection 36

Validity of the Instrument 37

Reliability of the Instrument 37

Ethical Consideration 37

Procedure for Data Collection 38

Method of Data Analysis 38

CHAPTER FOUR: PRESENTATION OF RESULTS

CHAPTER FIVE: DISCUSSION, CONCLUSION AND RECOMMENDA TION

Discussion of the Findings 48

Implication of Findings to Nursing 51

Limitation of the Study 51

Summary 52

Conclusion 53

Recommendations 53

Suggestion for further studies 54

References

Appendices

Questionnaire

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LIST OF TABLES

Table 1: Socio-Demographic Characteristics of the Respondents …………………… 39

Table 2a: Level of Knowledge of Health Workers towards the care of the Elderly …… 40

Table 2b: Categorization of knowledge Score …………………………………………. 41

Table 2c: Proportion of health workers and their level of knowledge on the care of the elderly patients ----------------------------------------------------------- 41

Table 3: Attitude of Health Workers towards the Care of the Elderly ………………… 42

Table 4a: Health Workers Practice of Care of the Elderly …………………..………….. 43

Table 4b: Categorization of Practice Score …………………………………………. 44

Table 4c: Proportion of health workers and their practice of care of the elderly patients 44

Table 5: Factors Influencing the Attitude of Health workers towards Care of the Elderly …45

Table 6a: Mean years of Experience of Health Workers and Attitude of care towards the Elderly ……………………………………………………… … 46

Table 6b: Years of Experience and Attitude of Health Workers 47

Table 6b Proportion of health workers with positive and negative altitude towards the care of the elderly patients. 47

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LIST OF APPENDIXES

Appendix i: Sample Questionnaire

Appendix ii: Calculation of Sample size

Appendix iii: Informed Consent form

Appendix iv: Clearance before Seminar Presentation

Appendix va: Ministry of Health Ethical Approval

Appendix vb University of Calabar Teaching Hospital Ethical Approval

Appendix vi Clearance before Seminar Post Field

Appendix vii Calculation of Sample Size

Appendix viii Letter of Identification

Appendix ix Application for Permission to Collect Data

Appendix x: Letter of Introduction

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ABSTRACT

With the global trend towards an increasing aging population, there is a corresponding increase in the health problems associated with elderly population especially in developing Countries including Nigeria. With this increase in the growth of the aging population, the number of people that will need health care will undoubtedly increase, which motivated this study. The study was aimed to assess the level of knowledge, attitude and practice of care of the elderly patients among health workers in University of Calabar Teaching Hospital, Calabar, Cross River State. The specific objective were to (i) determine the level of knowledge of the physical, emotional and social care of the elderly in the University of Calabar Teaching Hospital, Calabar (ii) determine the attitude of health workers in the care of the elderly, (iii) determine the health workers practices in the provision of care of the elderly, (iv) identify factors that influence the health workers attitude towards the elderly in University of Calabar Teaching Hospital, Calabar. The hypothesis for the study tested the association between years of experience of health workers and their attitude towards care of the elderly in UCTH. Calabar. The study adopted a cross sectional descriptive design. The population of the study was 1023 health workers, which was made up of 402 Doctors, 600 Nurses, 10 Dentists and 11 Physiotherapists that provided direct clinical care of elderly patients. The sample was calculated using Taro-Yamane (1967) simplified formula for finite population giving a sample of 461 health workers. The instrument for data collection was questionnaires, the reliability of the instrument was done using test retest method and a reliability co-efficient of 0.91 was obtained. The questionnaires had five sections, section A covered socio demographic data, section B, C, D consisted of items which explored level of knowledge. Attitude, practice and section E elicited information on factors influencing the care of the elderly. The completed questionnaire was coded and analyzed using E.P.I info-7. Descriptive statistics of percentage, mean, standard deviation were used for data analysis. The criterion mean of 2.5 was also used and results of the study revealed that 95% of the health workers had good knowledge of care of the elderly. Majority of the health workers had positive attitude above rating scale of 2.5. The health workers moderately practiced care of the elderly. The factors that positively influenced health workers attitude to the care of the elderly were years of experience, age and mental state of the elderly. There was significant association (P<0.05) between attitude of Health Workers and mean years of experience. Workers with less years of experience had negative attitude, while those with more years of experience had positive attitude, towards the care of the elderly. In conclusion, health care professionals need to have the right skills to manage a more demanding role in the future. In order to offer effective services for the elderly, a skilled workforce of health professionals is therefore very necessary. The study recommended that Geriatric Nursing content in the curriculum be strengthened and also geriatric wards be established in all general hospitals.

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CHAPTER ONE

INTRODUCTION

Background to the Study

Ageing is the accumulation of changes in a person over time (Bowen and Atwood 2004).

It involves a multidimensional process of physical, psychological and social change. Some

dimensions of aging grow and expand over time, while others decline. Research shows that even

in late life, potentials exist for physical, mental and social growth and development (Papalia,

Sterns, Feldman, and Camp, 2002). It is not a disease; but phase of life where there is retrograde

biological process in growth and development which leads to decreased powers for survival and

adjustment. Aging is an important part of all human societies reflecting the biological changes

that occur and also reflecting cultural and societal convention.

An estimated 100,000 people worldwide die each day of age related causes (Aubrey de

Grey, 2007). According to National Population Commission (NPC, 2006), persons who are old

enough to receive pension who are between ages of 60-65 years are regarded as the elderly. The

elderly are classified by age into young old for those aged 60-74years, middle old for those aged

75-84years, old for those aged 85-94 years and oldest old for those 95years and above. (Barman,

Snyder, Kozier & Erb , 2008).

Care of the elderly is the fulfillment of the special needs and requirements that are unique to

senior citizens. It covers such services as assisted living, adult day care, long term care, nursing

homes, hospice care and home care. Elderly care emphasizes the social and personal

requirements of senior citizens who need some assistance with daily activities and health care,

but who desire to age with dignity. The care of the elderly is multidimensional and these include

physical, emotional, spiritual and social care (Ayres, 2008).

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However, improvement in primary health care with focus on prevention of childhood diseases

through immunization did not highlight the care of the elderly which should be one of the

components of primary health care programme in most developing countries (Olise, 2011). A

cursory look at the implementation of Millennium Development Goals (MDGs) by the federal

government shows that there is little or no consideration of this very important segment of the

population – the elderly. Also most curricula for training Health Manpower in Nigeria do not

highlight the care of the elderly (Donatelle, 2011). Yet the population of this segment of the

society is increasing in developing countries with their special care needs. Traditionally, in

Nigeria elderly care has been the responsibility of family members and was provided within the

extended family system (Ting and Woo, 2009).But with modernization, elderly care is now being

provided by state or charitable institutions. This is attributable to decreasing family size, the

greater life expectancy of elderly people, the geographical dispersion of families, and the

tendency for women to be educated and work outside the home (Lee, 2009).

In most developing countries including Nigeria the population of the elderly is increasing

rapidly but the government does not seem to be making any major commitments to elderly

healthcare (Adio-Moses, 2001). The government is still assuming that families should take care

of their elderly without recognizing that the extended family system is at the verge of collapse.

Currently most families find it difficult to manage their own homes and face their challenges.

This is gradually leading to neglect and abuse of the elderly (Gubrium, 2002). Care of the elderly

requires adequate knowledge of the ageing process, nutrition and daily needs of the elderly. In

Nigeria, marginalization of the elderly especially in their care is a common episode

(Abdulraheem & Parakoyi, 2005). Those involved in the provision of health care have important

roles to play in programmes relating to elderly care especially in screening and detecting abuse.

15

Unfortunately doctors do not diagnose abuse because it is not part of their formal or professional

training hence does not feature in their list of differential diagnosis (Donatelle, 2011). The health

worker, according to Abdulrahem & Parakoyi (2005) plays major roles in determining and

implementing desirable standards of health care, acting as a professional in developing core of

professional knowledge and should have ability to impart same to others. They are often the

providers of services designed to maintain health and prevent illness. Research has also shown

that the quality of health care service provided to older population is strongly influenced by care

givers attitude towards older people (Gallaghar, Bennet & Halford, 2006). This underscores the

need to assess the knowledge, attitude and practice of care of the elderly among health workers

in University of Calabar, Calabar Cross River State.

Statement of the Problem

The population of the elderly in the world is increasing rapidly (United Nations, 2004)

and the rate of increase is higher in developing countries including Nigeria. Currently, Nigeria

has the highest number of the elderly people in Africa estimated to be about 5.6% of the Nigeria

population (NPC, 2008). With this increase in the growth of the aging population, the number of

people that will need health care will undoubtedly increase. Donatelle (2011) posited that in most

curricula for health professionals, little or nothing is indicated about the care of the elderly

showing absolute neglect in this area Mclafferly and Morrison (2004) stated also that most health

workers have very poor knowledge of mental health conditions which are common with the

elderly and as such health workers come to service with deep seated, negative, diluted and

superstitious belief about caring for the elderly. This lack of adequate knowledge and negative

attitude towards the care of the elderly may result in serious problems in our society in the near

future. In a recent study of the elderly in Ibadan by Oyetunde, Ojo & Ojewale (2013) show that

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attitudinal relational gaps exist, resulting in negative patient outcome. From my clinical practice

in different hospitals in Calabar, frequent misunderstanding between elderly patients and health

care providers especially the young ones, was observed. Based on these, the researcher seeks to

find out the knowledge, attitude and practice of care of the elderly among health workers in the

only tertiary health facility in Calabar, University of Calabar Teaching hospital.

Purpose of the study

The purpose of the study is to determine the level of knowledge, attitude and practice of

care of the elderly among health workers in University of Calabar Teaching Hospital, Calabar,

Cross River State.

Objectives of the study

Specifically the objectives of the study include to:

1. determine the health workers level of knowledge of the physical, emotional and social

care of the elderly in University of Calabar Teaching Hospital ,Calabar, Cross River State

2. determine the attitude of the health workers towards the care of the elderly.

3. determine the health workers practices in the provision of care for the elderly.

4. identify the factors that influence health workers attitude of care towards the elderly in

University of Calabar Teaching Hospital, Calabar.

Research Questions

1. What is the level of knowledge of the care of the elderly among health workers in a tertiary

health facility in Calabar, Cross River State?

2. What is the attitude of health workers towards care of the elderly in a tertiary health facility

in Calabar?

17

3. What are the health workers practices in the provision of care of the elderly in a tertiary

health facility in Calabar, Cross River State?

4. What are the factors that influence health workers attitude of care towards the elderly?

Hypothesis.

1. There is no association between years of experience of health workers and their attitude

towards care of the elderly in UCTH, Calabar.

Significance of Study

The result will help to provide basic information for designing structures and

programmes for the care of the elderly in the community. It will also provide evidence based

information for health education on graceful ageing. It will serve as a reference material to other

researchers in the field of community health practice.

Findings of the study will help in showing the level of knowledge and attitude of the health

workers towards the care of the elderly and will help improve the decision making. The result

will also help in building up knowledge base on the care of the elderly patients. Improving data

base on elderly health nutrition and standard of living which will help for further research,

advocacy, policy dialogue and programming.

Scope of Study

The study focused on the level of knowledge, attitude and practice of the care of the

elderly among health workers in University of Calabar Teaching Hospital, Calabar. The study

was delimited to only health workers providing direct clinical care (hand on care to the elderly)

consisting of nurses, doctors, dentists and physiotherapists in University of Calabar Teaching

Hospital.

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Operational Definition of Terms

Knowledge of physical care are expressing understanding of bed bath, skin care, oral hygiene,

feeding, elimination and ambulation.

Knowledge of Emotional care; refers to expressing attention, acceptance and love.

Knowledge of social care; means financial support and visitation by family members and friends

(co-workers, church member’s, social club, and neighbors).

Practice of physical care expressing competence in providing skin care, oral hygiene, feeding,

ambulation and elimination.

Attitude means health workers’ expression of cheerfulness, listening to patient’s complaints and

prompt attention, positive attitude while negative attitude means expression of harsh words, lack

of respect and “stone face”.

Health Workers refers only to Nurses, Doctors, Physiotherapists and dentists that are directly

involved in the clinical care of the elderly.

Elderly refers to people aged 60 years and above.

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CHAPTER TWO

LITERATURE REVIEW

This chapter presents the review of literature related to the work, from books, Journals,

Abstracts, and internet materials, under the following subheadings:

Conceptual Review,(Concept of ageing, Biopsychosocial challenges of the care of the elderly,

Knowledge of care of the elderly amongst health workers, Attitude / practice of health workers

on the care of the elderly, Problems associated with the care of the elderly, Factors influencing

health workers practice of care towards the elderly), Theoretical Review, Empirical Review and

Summary of review.

Conceptual Review

Concept of Ageing

Aging is a universal phenomenon that is obvious as well as inevitable. Old age is a

significant stage in life and normally related to life expectancy of given area, hence the

conditions and the needs of the aged becomes imperative. Preparation for old age cannot be over

emphasized. Aging can be observed as a consistent pattern of change that every human being

undergoes, starting at a very slow rate at around age 30, and progressing at a more rapid rate

beyond age 65 (Olowookere, 2003). Aging is a sensitive and seriously regarded issue and it is a

process of becoming older. The aged in Nigeria are highly revered, respected and often held in

high esteem. The aged constitute a repository of wisdom and experiences.

The aged are often seen as the custodians of knowledge due to their experience in life.

The population of old people throughout the world is increasing at a very rapid rate (Population

Reference Bureau, 2011). The most rapid increase is taking place in the developing world with

Africa alone projected to have between 204 and 210 million old people by the year 2050. This

20

unprecedented rise in the number old people presents fundamental socio-economic difficulties

(Olaleye, 2011). Nigeria with a population of 140.8 million people (NPC 2006) is the most

populated nation in Africa and the ninth in the world (UN, 2005). Life expectancy at birth stands

at 57.6 years (NPC, 2008). The population growth rate (2000 – 2005) is 2.5% with 5.6% of the

total population aged 60 and above. As the most populous country in Africa, Nigeria currently

has the highest number of aged or elderly people in Africa Population Reference Bureau(PRB,

2011) with the largest population in Africa and the ninth in the world, it is estimated that by year

2025, the population of Nigeria aged 60 and above will constitute 6 percent of the entire

population as projected by (UN population Division, 2005)

Old age is not a disease; it is the phase of retrograde biological process in growth and

development which leads to decreased powers of survival and adjustment. The World Health

Organization has always designated as “Elderly” people aged 65 years and above. In 1980, the

United Nations defined 60 years as the age of transition of people. (U N 2004). Older people

make up an increasing proportion of the population in developed world and this demographic

transition also affects some developing countries. Generally older people are at increased risk of

disease, disability, social and financial deprivation compared to the younger generation in the

same population (National Council on Ageing and older people (NCAOP) , 2005). An increase

in the number of older people will lead to increased demands on health and support services

including aged care residential services and acute health service (Mccormacks, 2004).

Mcmurdo (2000) also stated that the elderly have reduced ability to generate resources;

they lack the basic needs that affect their health status. Where one finds well developed Maternal

and Child Health Services, a vacuum exists in the elderly health policy. Population growth

combined with ageing will mean that greater number of older people will need health and

21

community care services, more older people in the hospital mean more people with dementia

needing appropriate care. Varice (2010) indicated that society where the elderly population is

expanding and cultural values are changing, the needs of the elderly become increasing by

entwined with appropriate health care needs. Death of older people both in institutional settings

and the community have often been attributed to natural, accidental or undetermined causes

when in fact they were consequences of abusive or neglectful behavior. As long as older people

are devalued and marginalized by society they will suffer from loss of self identity and remain

highly susceptible to discrimination and all forms of abuse (Szucs, 2001)

The concept of aging is multifaceted. This is because its in-depth description or

explanation covers diverse areas of human development. There are chronological, biological,

psychological and social, functional dimensions of aging (Papalia, Feldman and Camp, 2002;

Hoyer and Roodin, 2003). The chronological dimension describes the number of years that have

slipped away since one’s birth while the biological explains the status of vital organs of the body

as an individual advances in age. The psychological dimension focuses on individuals’ ability to

adapt to environmental demands/challenges while social dimension sheds light on how an

individual conforms to written and unwritten norms, roles expected of him/her by the society in

which he/she operates. The functional dimension measures how effective an individual is in

physical and social environment when compared with other people within his/ her age bracket

(Hoyer and Rodin, 2003). The concept of aging to some scholars is not a single or one-way

process, Berger, Dev, Mutrie & Hannah (2005) posits that there are three distinct but interrelated

processes of ageing. These are primary, secondary and tertiary aging. The primary ageing

represents the inevitable age – related changes, which all human beings are expected to pass

through. The period is characterized by inability of human organism to replace damaged parts of

22

the body. The secondary aging involves all the age related changes, which are consequences of

individual and societal failure to eradicate unhealthy conditions. It is at this period that certain

diseases such as Cancer, diabetes, arthritis, visit the elderly. The tertiary ageing on the other

hand, deals with numerous losses or unpleasant experiences associated with old age. Most

developed world countries have accepted the chronological age of 65years as a definition of

‘elderly’ or older person, but like many westernized concepts, this does not become accustomed

to the situation in Africa, while this definition is somewhat arbitrary, it is associated with the age

at which one can begin to receive pension benefits. At the moment, there is no United Nations

standard numerical criterion, but the UN agreed cut –off is 60+ years to refer to the older

population (UN, 2004)

Bio-psychosocial challenges of the elderly in Nigeria

Physical changes

According to Berger Dev, Mutrie and Hannah (2005) the first sign of ageing begins with

the skin which becomes drier, thinner and has elastic wrinkles, visible blood vessels and pocket

of fat under the skin appear as irrefutable evidence of the passage of time. Merrill and verbrugge

(2001) also revealed that with time pockets of fat settle on various parts of the body most

noticeable around the abdomen, but also on the upper arms, the buttocks, eyelids and double

chin, bones become fragile and more easily broken and difficult to heal. The Muscles loose

power and become atrophy while joints stiffen or wear out, circulation slows down, blood

pressure rises and because the lungs hold less oxygen the aged has less energy, reaction to

stimuli is slower and there is less resistance to illness. There are difficulties to fall asleep and

remaining asleep and vision, hearing and sense of smell became less acute (Nur et al, 2009).

Disability significantly affects quality of life in old age though it is considered to be

23

consequences of the normal ageing process; they are often caused by chronic diseases which the

elderly are at risk (Szucs, 2001). There seems to be a problem with providing the appropriate

care for these disabilities for this segment of the population yet the population is growing rapidly

in both developed and developing countries (Vitalianie, Zhang and Scsarian, 2003).

Accessibility to Care

The lack of health care for senior citizens is a crucial problem with the assumption that

Provision of healthcare services has always been adequate. This assumption is wrong as recent

research has shown that Medical care is not easily accessible. This is because the geographical

distance to get to these services makes it difficult, if not impossible for many older people to

access, particularly in the rural areas (Nussbaum, 2003). Hence, their health needs still has to be

met by visiting traditional medical men and herbalists. At the family level care services provided

do not adequately meet the needs of the old persons. Diminishing economic power has hindered

the willing family members. However these changes demand that governments, the private

sector, nongovernmental organizations and the civil society in general be prepared to deal with

them, bearing in mind the special needs of the people.

Affordability

Nevertheless, most elderly persons cannot afford quality medical care. A survey of more

than 3,200 senior citizens found that many people would be prepared to pay for high quality

elderly care, while wanting a safety net for those who cannot afford to pay(O’ Neil, 2010).

Essy (2002)opines that old people are particularly disadvantaged due to lack of social security

especially in this part of the world, for their everyday social and economic needs. The care and

support by the family and community that were taken for granted in the past have stopped,

because of changes in the society associated with urbanization and development in general (Ting

24

and Woo, 2009). In some communities in Africa instead of relaxing and enjoying old age, the

senior citizens are obliged, once again, to take up the responsibility of caring for children and

young adults suffering from HIV/AIDs related problems or migrate. Apart from the children, old

people are the social group most vulnerable to the numerous ills facing Africa, poverty, food

insecurity, civil strife, armed conflict, violence and inadequate social welfare services.

Culture

According to Mullick (2005) the traditional African culture has ways of taking care of the

elderly. For example, their extended family and children are expected to provide for them and

young people in the immediate environment are supposed to help them run errands whether the

elder are their relative or not. These types of caring are fast becoming a thing of the past.

However, African family structure is changing, although the family is an institution which is not

disappearing, rather, families are responding and adapting to new conditions, while older persons

are adopting new roles within the families (Mullick, 2005). Harrision (2005) also observes that

family structures are changing and traditional patterns of care are no longer guaranteed.

Depression and Anxiety

According to Philips (2003) the elderly often have uniformed feelings that are ubiquitous,

such feeling include, mourning that results from loss of dear ones, guilt that emanates from

resurgence of past conflicts and regrets, depression and anxiety brought about by loneliness and

fear of death. Other major problems faced by the elderly are often from the mass media that are

supposed to be the custodian and promoters of successful and better aging. But they rather

portray them as being stereotypical, cantankerous, deteriorating, unproductive, slow, senile,

stubborn, and useless or irrelevant to the society. These negative portrayals do contribute to the

lower psychological performance of elderly in Africa where the family remains the most

25

important source of support for the old people (Moemeka 2001). Gubrium (2002) suggest that

sensory loss will make any elderly person to forget something that is immediate, but may

sometimes remember things in the far past. Most elderly are afraid to being hospitalized, for they

had already assumed hospital to be dying places (Lecovich, 2008). Humphries, Brugha and

Mcgee (2008) also observed that living patterns are changing as urbanization has resulted in

many elderly people living alone in rural areas. This occurs, when their children might have

migrated to the urban centre, in search for greener pasture. Economic pressure and changing

social values mean that many families are either unable or unwilling to care for the aged. The

contributions that elderly people make to the family are seldom acknowledged and programmes

designed to support families fail to take into account the valuable role that old people do play

(Abdulraheem and Parakoyi, 2005).

Poor Policy Implementation

National Centre for Protection of Older People (NCPOP), (2009) recommends that,

member states, ought to design, develop and implement practical, realistic and appropriate social

welfare strategies which will include the concerns of the people. Also they should develop

review and implement strategies, which emphasize traditional community support and care

mechanism for their elders. According to Essy (2002), member states as a matter of importance

should discourage the institutionalization of elderly people and retain the cultural respect from

them; encourage the emphasis of community based support such as kinship, extended family and

neighborhood support. Elderly people are abused by family and community members and are

accused of everything from witchcraft to preventing or causing too much rain for which they are

tortured and assaulted. Economically, they suffer, as their assets are stolen and financial

institutions refuse them credit and other services. Age based discrimination is pervasive and

26

prevents old people from accessing basic rights such as adequate health care and legal protection

(Olaleye, 2011)

Social and economic problems

Sociologically, the elderly are seen as the organizers of the society, and as people through

whom intergenerational beliefs and customs are transferred to the younger generations (Olaleye,

2011). Currently, social and economic Implications state that the lack of state provision of elder

care in Nigeria requires the family to provide the needs for the survival of the older people

(Lecovich, 2008). Family members provide food, shelter, clothing, drugs and other basic

necessities. Children now play the most important role of providing economic security in old

age. Older parents live in their adult children homes and receive care. On the other hand, they

support their children in taking care of their grandchildren, when they live in their own homes,

grandchildren or other relatives often live with them to give support such as washing clothes,

running errands, cooking meals and taking general care of the older people’s environment

(Lecovich, 2008). At the family level, care services provided do not adequately meet the needs of

the elderly person in Nigeria. Diminishing economic power has hindered the willing family

member’s capability to give. Priorities are given to the needs of the members of the nuclear

family – spouse and children at the expense of older family members, parents or grandparents.

Care provided by the family attempts to satisfy the needs of elderly persons. With the changing

social and economic configurations, elderly persons are most of the time left in the care of

strangers i.e. people who are not properly trained to be care givers given that many of them are

uneducated, young and frustrated. Adio-Moses (2001) suggests that inadequate preparation for

retirement or sudden retirement from previous lucrative job may lead to financial worries and

property loss. Especially, to those who have enjoyed political or official position in the past, as

27

they reminisced on their past lives (Vansina, 2003). They are most likely left with nothing but

grievous frustrations about themselves.

Lack of Adequate Facilities

W.H.O.(2004) in the survey on health status and health seeking behaviors of the elderly

persons in Nairobi revealed that most of the health facilities accessible to the elderly persons do

not have service for their degenerative condition which is very common in these age groups, no

special health services for geriatrics and negative attitude of health workers towards care of the

elderly was due to lack of knowledge to identify those conditions that can be treated effectively

and inadequate resources to treat the degenerative conditions.

Health Worker’s Knowledge of Care towards the Elderly

It is important for health workers to have adequate knowledge on the basic needs of the

elderly than the rest of the population (Okoye and Asa, 2011). This is necessary because these

needs must be met every day for the elderly to be able to live independently for as long as

possible and Caretakers would be able to help the aged meet these needs without compromising

their health and safety. These needs include personal Hygiene, mobility, nutrition, doctors’ visit

and prescription and physical activity (exercise). (Okoye and Asa, 2011)

Personal Hygiene: The aged needs to have proper hygiene. Teeth need to be brushed and

dentures need to be soaked. Whether elderly people under your care want to shower or bath daily

or every few days, safety need to be a top concern. Railings and nonslip mats can help them

maintain balance and prevent falls. Some safety seats fit directly into bathtubs, and another kind

actually lifts the person into the tub from the outside. If incontinence is a concern, adult diapers

will need to be worn and changed regularly. (Brog, Hallberg and Blomgrist, 2006).

28

Mobility: Mobility is a concern for the elderly if the person under care has muscle weakness,

vision loss or other health conditions that can occur with aging. If the elderly person needs a

wheelchair; a ramp will be needed and other wheelchair accessible features. Similarly, walkers

and canes are required to help the aged get around safely. (Sarrimaki and Stenbock – Hult,

2000) .

Nutrition: According to Less, Hoerr, Weatherspoon & Schiffma (2008), it is important to

ensure that an elderly person continues to eat proper meals, especially if he is living alone and

may have difficulty cooking. Check labels and fridge items frequently and throw out all expired

items. A caretaker can prepare food in advance and freeze the meals to be reheated and eaten.

Volunteer and paid services also can bring healthy meals regularly. However, the care of the

older people in acute care settings has been increasingly criticized for lack of attention on patient

dignity and the fundamental aspects of care such as nutrition and hygiene (Bridges, 2012).

Health: According to Lee, Wong & Loh (2006) health issues that require attention is a greater

concern with age. If the elderly person has any condition requiring medications prescribed by a

doctor, it is vital that he takes the medications at the right time and in the proper dosage. If he

uses over the counter products as well, the labels should be read and a doctor or pharmacist

consulted to ensure that the products do not have possible interactions with prescribed

medications. Watch for possible side effects from medication and health. Ensure that the elderly

maintain regular doctor visits by providing transportation and making the appointment if

necessary.

Exercise and Activity: Exercise is important to maintain muscle function and to keep elderly

people as healthy as possible, Socializing with other people and engaging in mind stimulating

29

activities will need to be planned according to mobility and health issue. (Iwasaki and Jones,

2008).

Pain Management in the elderly Patients without Drugs.

Pain is not a normal part of aging, and may be a sign that something is wrong. Pain is a common

complaint that is often poorly treated in elderly adults. Sometimes there is no clear or exact cause

of pain. Pain management is an important part of elderly care.

- According to Truven Health Analytics information (2015) on how to manage pains

without medicine caregivers should try to treat the cause of the pain. This may include

treating infections or cancer the following may be needed to control pain:

- Heat: Heat helps decrease pain and muscle spasms. Heat should be applied on the area 20

to 30 minutes every two hours or as directed.

- Ice: Ice helps to decrease swelling and pain: ice helps to prevent tissue damage. Ice pack

should be used or ice crushed and put in plastic bag. Cover with towel and place on the

area for 15 to 20 minutes every hour or as directed.

- Rehabilitation: A physical therapist can teach the patient exercises to help improve

movement and strength and to decrease pain. An occupational therapist can teach the

patient skills to help in her daily activities.

- Assistive devices: A care, walker, or crutches can help the patient to move around and

decrease her risk of falling. Caregivers should teach the patients how to use these devices

correctly.

- Electrical stimulation: A device sends mild and safe electrical signals. The signals

decreases pain when used over a painful body part.

30

- Surgery and other procedures: Caregiver may use ultrasound, radiowaves, thermal

(heat) or laser therapy to relieve an elderly patients pain.

Health Workers Attitude and Practice towards the Care of the Elderly

Negative Attitudes (Ageism)

According to O’ Neil (2010) ageism is the systematic, stereotyping of discrimination

against people because they are old. This is perpetuated by the portrayal of older people as frail,

ill, suffering mental deterioration, poor and dependent, and the alternative portrayal of living

affluent life styles and scrounging off the welfare state (Vincent, Patterson & Wale, 2001).

Health workers are at risk of developing ageist attitudes because they are exposed to a

disproportionate percentage of ill or dependent older people (Mandy, Elizabeth and O’Neil,

2011). Lee (2009) asserted that negative attitudes towards older people and instances of ageism

in American society can become an obstacle to training qualified elder care providers. Also

Doherty Mitchel and Elisbeth (2011) opined that attribution of ill health to ageing, low economic

status and negative attitude of health workers towards the care of the elderly are some of the

factors associated with delay in seeking health care. Unfavorable attitudes and stereotypes of

older people among staff are also believed to act as a barrier to the successful delivery of health

information and education and overall health management (Lee, Wong, & Loh, 2006). In

contrast, nurses that express negative attitude towards old people indicated that they prefer to

work with younger patients. When caring for older patients, these nurses were more likely to use

physical restrictions, to disrespect the patient’s autonomy and dignity and discriminate against

them (Weiss 2005).

According to Redmond, Guerin & Devitt, (2008) ageism has been found to negatively

affect the health care services that older persons receives, both implicitly through unfair resource

31

allocation by stakeholders and explicitly by providing offensive and poor quality treatment.

Maltreatment of older people has been identified in facilities for continuing care such as nursing

home, residential care, hospitals and day care facilities. The spectrum of these within institution

may be related to any of the following, the provision of care for example resistance to changes in

geriatric medicine, erosion of individuality of care, inadequate nutrition and deficient nursing

care problem with staffing, poor interaction/communication and poor environment, and

organization policies – bureaucratic or unsympathetic attitudes toward residents. (Alliance for

Aging Research, 2003).

Positive Attitudes

Positive attitudes among healthcare students and staff are essential in the education and training

and in the delivery of good healthcare for older people (Nelson, 2004). In a study that examined

nurse’s attitude towards older acute care patients in United States, it was revealed that nurses

have positive attitude towards older patients in Geriatrics and surgical departments of various

hospitals (Mclafferty, and Morisson 2004). However similar attitudes of nurses has been noticed

in studies done in Australia and Jordan by several researches (Mitchell and McCance, 2010)

(Brown, Nolan, Davis and Keady, 2008).

On attitude of health workers towards older people, Mandy, Elizabeth and O. Neil (2011)

in a survey using the Kogan scale to assess the attitude of health care workers toward older

people in a rural population revealed positive attitude of health care workers toward older

people. Abyad (2006) stipulated that in the care of the elderly, the severely impaired and

dependent aged will need range of professional care as well as with their families so in the

process of creating adequate services home care and institutional service are complementary and

multi directional and care of such patients need shared responsibility of both families and

32

professional service provider. This may be alternately provided at home, community or the

institution with the role of providing communities and concerned professionals with the

knowledge and the skills to solve their problems. Bowling (2005) suggests that quality aged care

requires positive attitude towards empowering elderly patients to take active part in maintaining

their health and ability to deal with and prioritize the numerous problems that the aged may

present with (including associated diagnostic and management dilemmas).

Problems associated with the care of the Elderly

The Health workers experience different health problems when taking care of the elderly.

These problems results from the responsibilities and task involved in caring for the elderly. The

daily tasks involved include bathing, dressing, feeding, lifting, turning him or her in bed,

cooking, shopping, paying of bills, running errands, giving medicine, keeping him or her

company, providing emotional support (Okoye and Asa, 2011). All these help can be time

consuming and emotionally, physically and psychologically draining and may expose the health

worker to stress, risk of diseases, neglect of one self, poor health and depression. (Donatelle,

2011).

Stress: According to Donatelle (2011) Health workers get easily irritated when taking care of the

aged than when taking care of other age groups because of the daily task involved. The stress

impact negatively on the health of the health workers or cause the health workers to be

physically or verbally aggressive towards the care receiver. Studies have shown that one reason

for elderly abuse and neglect is caregivers stress (Lecovich, 2008). It is also very common for

health workers to get angry, feel frustrated, guilt, isolated, unhappy in marriage, anxiety,

depressed, diminished socially, loss of self-esteem from time to time and dissatisfaction with life.

According to Okoye and Asa (2011) feeling guilty about all the things that are not going on right

33

is the cardinal feature of a health workers experience. Stress of caregivers has been shown to be

influenced by many factors which include the attitude of the health worker or care giver (Okoye

and Asa, 2011).

Self-Neglect: Losada et al (2009) in a study of leisure and distress in care givers for elderly

patients revealed that health worker taking care of the elderly are more likely to neglect their

own needs because care of the elderly is time consuming and tasking. They may not recognize or

may ignore the signs of illness, exhaustion or depression that they are experiencing. Frustration

is also one of the feelings that may occur as a result of taking care of the elderly. This arises out

of trying to change an uncontrollable condition in taking care of the elderly especially

Alzheimer’s disease or other kinds of dementia (Alzheimer’s, Society, 2009).

Risk of Diseases: Health workers taking care of the elderly are at risk of contracting diseases

because of the closeness and commitment needed in the care of the aged. (Lecovich, 2008).

Accordingly, Merril and Verbuge, (2011) common diseases that affect the elderly that can be

transmitted to the caregivers are Tuberculosis, HIV/AIDS etc.

Factors influencing Health worker’s Attitude of care towards the elderly

Research demonstrates that many factors have influence on attitude and practice of elderly care

and these include age (Soderhamm et al.2001) gender (Lookinland 2002) education, exposure to

well older people (Gallagher, Bennet and Halford 2006), area of practice (Mclafferty and

Morrison 2004) and professional socialization (Mandy et al 2011). However numerous previous

studies has also argued that several other factors including those mentioned above can also affect

attitudes toward the care of the elderly these include culture, ethnicity, spirituality, education,

personal traits, clinical-experiences and past experience with older people (Brown, Nolan, Davis

and Keady 2008, Lookinland 2002).

34

Age

According to Okoye and Asa (2011) health workers age has an effect towards the attitude of care

giver to the aged. The younger the health worker the greater the stress experienced during the

care. This is because the care given to the aged is time consuming and emotionally, physically

and psychologically draining. In a study on knowledge and attitude carried out in Greece it was

noticed that age influenced attitude and knowledge of health workers positively in the care of the

aged (Lambrinou, Sourtzip, Kalokerinou and Lemonidou, 2009).

Gender

Gender has also being seen to influence attitude of health workers positively or negatively

(Cummings, Kroff and Deweaver, 2000). Studies have shown that gender influences the attitude

of care of the aged positively although female caregivers are easily stressed up and have

frustrating feeling and a feeling of guilt when their care receivers are not satisfied (Herdman,

2002).

Education

According to Lee (2009) education seems to influence the attitude and knowledge of

nurses towards the care of the aged. Although the study concluded that the curriculum of the

nursing education should be revised and improved on for there to be a holistic understanding of

care of the aged. In a study that was done in Greece it was revealed that the higher the level of

education the more positive the attitude towards the care of the elderly amongst Health workers

.Kaemffer, Wellman and Himburg (2002) suggested that gerontology education should be

provided to nurses in all settings regardless of their ethnicity, especially those with less education

and those working in acute patient care settings. Findings has also shown that registered nurses

35

with masters degree hold positive attitude towards the care of the elderly while retired nurses and

less educated nurses display the most negative attitude ( Loh , 2006).

Area of Specialization

Health care professionals and nurses in particular tend to be gate keepers for health

information, and play a key role in health promotion and education for older people (Lee 2006).

A large body of research has focused on the association between health student’s attitudes

towards older people and ageing and their interest or willingness to work in geriatric care.

Redmond, Guerin and Devitt (2008) for example, proposed that the attitude of social work

students before they enter practice could have a significant impact on their occupational choices

as professionals. Discriminatory practices by staff may not necessarily be based on intent but

rather provoked by a lack of skills and confidence in working with older people (Nussbaum

2003). Serious shortcomings in training for healthcare professionals and a need for further

education in the care of older people have been identified (Alliance for Aging Research 2003,

Brown et al. 2008). As populations continue to age there is increasing concern globally about the

quality of health care currently available to older people, and the availability of suitably qualified

health and social care staff with an interest in working with older people (Happel 2002; Brown et

al. 2008). However, the identification of unfavorable views towards geriatrics as a career choice

amongst students in health and social care appears to be a long standing and current theme in the

literature. (Happel 2002; Alliance for Ageing Research 2003; Brown et al. 2008). Studies across

many countries (e.g. Australia, Brazil, England, Germany, Hungry, Isreal, and the United State)

have found working with older people to be amongst the lowest preference career choice

(Fitzgerald et al (2003) Weiss (2005) Lee et al. (2008), Redmond et al. (2008). Happel (2002),

for example found out that just under 2% of nursing students cited care of the elderly as their

36

most desired area for future employment, while over two third of nursing students ranked this

area within their last three preferences. Caring for the elderly is often considered basic,

unchallenging and unrewarding based on the commonly held perception that older patients do

not get better and therefore work in this area is of limited value (Brown et al. 2008). A recent

study in Ireland revealed that health and social service staff felt that there was little opportunity

for career development within the care of the elderly, particularly for home helps and care

assistants (NCAOP, 2005b). Working with children or in areas perceived as more technical such

as acute care tend to be preferred as they are considered more worthwhile, more exciting and

dynamic and result in observable and useful outcomes (Happel, 2002).

Conversely, a smaller number of studies (Tan, Zhang and Fan, 2004, Lee et al, 2006)

have uncovered neutral or positive feeling among university students about working with the

elderly in their future careers. As the population is growing older, it is imperative that healthcare

services have highly skilled and trained staff; however care of the elderly is among the least

favored areas of healthcare as it is considered unrewarding and to have few opportunities

(NCPOP, 2009).

Culture and ethnicity

It is evident that cultural competence and ethnicity can play a major role in the attitudes

of health workers towards the care of the elderly. Many studies have shown that the general level

of cultural competence may be a predictor of positive attitude amongst nurses. According to

Beard (2004) who examined the attitude of nurses toward the elderly in a study that explored the

relationship of cultural competence to attitudes and also assessed demographic and work

characteristics. It was concluded that cultural competence had a very strong positive attitude

towards elderly care.

37

Theoretical Review

Theory of Planned Behavior and Theory of Reasoned Action

The theory of planned behavior, a derivative of the theory of reasoned action, postulates

that people are motivated to change based on their perception of norms, attitudes, and control

over behaviors. Each of these factors can either increase or decrease a person’s intent to change

his or her behavior. The theory shows several important constructs that are involved in these

value expectancy theories: attitude, subjective norm, perceived behavioral control, intention, and

behavior (Montano & Kasprzyk, 2008). The theory of planned behavior explains how behavioral

intention determines behavior, and how attitude toward behavior, subjective norms, and

perceived behavioral control influence behavioral intention. According to the theory, attitudes

toward behavior are shaped by beliefs about what is entailed in performing the behavior and

outcomes of the behavior. Beliefs about social standards and motivation to comply with those

norms affect subjective norms. The presence or lack of things that will make it easier or harder to

perform the behaviors affects perceived behavioral control. Thus a chain of beliefs, attitudes and

intentions drive behavior. The strength of the relationship between the first three constructs i.e.

attitude, intention and behavior varies, depending on the population and the specific topic being

studied (Hardeman, (2002).

Application of the theory

This theory is applicable, in this study in that the health workers intention and their

beliefs are what influence their behavior and attitudes. The demographic factors and the

resources available have a role to play in the outcome which is the result of the health workers

care towards the elderly. Health workers perception of norms and beliefs that is knowledge of the

health worker on the care of the elderly build-up his intention and this is what influences the

38

( P e r f o r m e d

b e h a v i o u r )

A t t i t u d e

a n d

p r a c t i c e o f

c a r e

Knowledge ,

Social experience and

resources available

• D e m o g r a p h i c f a c t o r s• P e r c e p t i o n o f

n o r m s a n d

b e l i e f s

• C u l t u r a l v a l u e s• S u b j e c t i v e n o r m s

I n t e n t io n

A n d b e h a v io u r

H e a l t h w o r k e r s

A p p l i c a t i o n o f t h e T h e o r y o f

r e a s o n e d a c t i o n a n d p l a n n e d

b e h a v i o u r b y M o n t a n o a n d

K a s p r z k y , 2 0 0 8 t o t h e s t u d y .

health workers attitude and practice of care towards the elderly. Thus, the theory of planned

behavior views attitude, subjective norms and perceived behavioral control as contributing to the

formation of behavioral intention, based on the assumptions that human behavior is often

reasoned than illogical.

This theory is also used in this study because it highlights potential meanings of attitudes,

beliefs, subjective norms and perceived behavioral control as determinants of intention to

perform behavior. Moreover, in this theory demographic factor, values and variables are

considered as background factors. These factors are presumed to influence intention and

behavior, normative and control beliefs. This study will assume that the intentions of health

workers towards the elderly are influenced by cultural values, religion, social experiences,

education etc.

39

Social Network and Social Support Theory

It is widely recognized that social networks and the social relationships that are derived

from them have powerful effects on important aspect of both physical and mental health. Social

network refers to the existence of social ties. Research into how aspect of social networks

influence health (positively and negatively) offers insights into the pathways through which

social ties influence health provision of social support (2) social influence (3) social engagement

(4) person- to- person contact; and (5) access to resources and material goods (Ayres, 2008

Twoy, Connolly, and Novak, (2007).

Most obviously, the structure of network ties influence health via the provision of social

support. Social support has been defined as the physical and emotional comfort given to us by

our family, friends, co-workers, and others (Uchino, 2004). Social support is typically divided

into five subtypes (constructs): emotional, instrumental, appraisal, sharing points of view, and

informational support. Equally important are the ways in which social relationships provide a

basis for intimacy and attachment. Intimacy and attachment have meaning not only in

relationships that are traditionally thought of as intimate (for example, between couples or

between parents and children) but also in more extended ties to the community. For instance,

scholars have recently focused on the role of social capital in overall health (Stephens, 2008).

Social capital refers to the degree to which a community or society collaborates and cooperates

(through such mechanisms as networks, shared trust, norms, and values) in order to achieve

mutual benefits (Baum and Ziersch, 2003). When relationships are solid at the community level,

individuals feel strong bonds and attachment into places (for example, a neighborhood) and

organizations (for example, voluntary or any or religious organizations) bonds that may lead to

improvements in psychological and physical health.

40

Application of these theories to the study

The social network theory applies to the study of knowledge, attitude and practice of the

care of the elderly in that health workers form a social network and caring for the elderly does

not just involve a group of health workers but involves several groups and several health workers

that forms a network. This implies that many health workers may have to work together in

providing the care for the elderly in order to achieve the desired goal. The social support theory

works in collaboration with the social network and it is also applicable in this study in that for

the effective care of the elderly to occur, the health workers should be able to establish a

relationship with the elderly that will allow the health worker to love and be ready to care for the

elderly. This may affect the attitude of the health worker resulting to the health worker either

having negative or positive attitude. This has to do with passion for the job or willingness to

specialize in this area. Liaising with other support groups to support in the care of the elderly

may also be very necessary. For example inviting the priest or Church members to visit and pray

for the elderly.

Empirical Review

Knowledge

In a study conducted by Kaur, Kumar, Kaur, Rani, Ghai, & Singla (2014) in India to

assess the knowledge and attitude regarding care of the elderly among nursing students. A cross

sectional study was undertaken on 267 undergraduate nursing students. A pre-validated, self-

administered questionnaire was used for the assessment. The knowledge questionnaire consisted

of 28 multiple choice questions with one right answer. The total score was further categorized as

poor, average and good as per the score obtained by the subject. The attitude was assessed on a

Likert five point scale and it consisted of 16 items. The total score was further categorized as

41

unfavorable, neutral and favorable attitude as per the scores obtained. Majority (95.5%) of the

subjects were females. Mean age (yrs) +- SD was 22.61 + - 3.31 with the range of 19-48yrs mean

knowledge score + - SD was 22.10 + - 2.91, with the range of 9-27. Around two third (76.4)

were in good category of knowledge score. Mean attitude score + - SD was 60.38 + - 8.95 with

the range of 22 -78. 64.6% were in the positive category of attitude. Knowledge and attitude

were positively correlated. According to Kaur et al (2014) nurses need to be well equipped with

knowledge and should also have positive attitude regarding elderly care.

In a study conducted in Australia by Mellor, Chew & Greenhill (2006) it was explored

that the attitudes of nurses working in a multi-purpose health service (MPHS) towards elderly

people and their understanding of gerontic care. A descriptive, non-experimental quantitative

research design using a self report questionnaire was used for the study. A sample group of thirty

–one (31) staff members from a single MPHs were the participants for the study. Multi outcome

measures were used. Nurse’s attitudes were assessed using Kogan’s old people scale (KOPs).

Nurse’s knowledge was measured using Palmore’s facts of aging Quiz (PFAQ) and a second

instrument, the nurse’s knowledge of elderly patients Quiz (NKEPQ), which was developed by

the authors of the study. The key findings indicated that even though nurses in this MPHs have

strong positive attitude towards the elderly people, they had knowledge deficits in key clinical

areas both gerontic nursing and socio-economic understanding of the ageing population in

Australia. In conclusion the result of the study assisted in the identification of knowledge gaps

and also highlighted areas for improved education which are essential in the delivery of high

quality, effective care.

According to Olayiwola, Olusanya and Ketiku (2013) in a study on the knowledge of

population of ageing nutrition among undergraduates in a Nigerian University. The result

42

showed that 50% have the knowledge that biological age of the elderly begins at 60 years and

50% also have the knowledge that life expectancy in Nigeria has increased while 70% strongly

agreed on health policy of the elderly. The above study concluded that the knowledge of the

subjects on the nutrition of the elderly was very high amongst the subjects especially those with

background in food science and nutrition while those with very low scores did not have such

background. It was also reported that there was a very strong correlation between knowledge of

the elderly and knowledge of nutrition. Large gaps still exist in the knowledge on health status

and health seeking behaviors of the elderly person (Fitzgerald, Wray and Halter 2003). In survey

on staff perception of patients with dementia survey on evaluation of education and training of

staff in Dementia indicated that most acute care staff does not find caring for people with

dementia unrewarding or difficult but that caring for patients with dementia gave no job

satisfaction. (Nur Asyura et al, 2009)

Attitude

In a study conducted by Oyetunde, Ojo & Ojewale (2013) in Ibadan, Nigeria measuring

the attitude of nurses towards the care of the elderly in two (2) selected hospitals in Ibadan, with

130 self-administered questionnaires were administered to nurses. Results showed that 73% of

the respondents agreed that elderly are difficult to care for and over 80% agreed that effective

care for the elderly requires special training and more than 90% believed that effective care of

the elderly will require the hospital to provide a special geriatric ward for the elderly and their

complications. The respondents in above study also showed positive attitude towards the care of

the elderly and good knowledge of ageing process. According to Oyetunde, Ojo & Ojewale

(2013) effective care of the elderly requires special training, provision of geriatric ward,

adequate staffing to reduce stress and improved quality care.

43

In a study done by Mandy, Mitchel & O’ Niel (2011) in Ireland on 109 health workers to

identify and evaluate attitude and knowledge of health workers towards the elderly, reported that

higher level of education increases the health workers knowledge of care of the elderly. The

study was undertaken in a rural country, on various caders of health workers e.g. ward managers,

registered staff nurses, health care assistants, public health nurses and student nurses. The aim of

the study was to explore the attitudes held by these health care workers towards older people in

rural population. The variation of intensity of attitude was illustrated by dividing the potential

range of scores into six equal categories and this showed that healthcare workers held positive

attitudes towards older people, indeed 97.3% of the scores fell into the Slightly positive to very

positive score range. An independent T-test was conducted to compare KOP scores for those

who had attained a university degree, higher diploma or M. Sc and those who had not attained

qualification at university. There was a significant difference in score for university graduates

M= 149.34, S. D 15-4) compared to those who had not attained university qualifications (M =

144.88 = 12.45) t (161) = 202, P = 044). In conclusion the study revealed that vast majority of

the participants had positive attitude. In addition it was revealed that study to a higher level of

education appears to mitigate towards holding more positive attitude and this is an important

finding in light of the shift towards nursing as an all-graduate profession. Research has shown

that the quality of health care services provided to older population is strongly influenced by care

givers attitude towards older people (Gallagher, Bennet & Halford, 2006). The affirmative

attitudes of nurses have a positive influence on the health of older patients (Courtney, Tong &

Walsh, 2000). Nurses with constructive attitude towards older people have been noted to listen

attentively, bond deeply, assist respectfully and engage in friendly relationships with their clients

(Courtney et al, 2000).

44

However, according to Engstrom and Fagerbreg (2011) in a study ‘on the attitude

towards older people among Swedish health care students and health professionals working in

eldercare’ The study included 928 health care students and three groups of professional health

care givers with university degrees and certified nursing assistants selected by convenient

sampling method in a variety of health settings in Sweden. The result that was analyzed using the

Kogan scale revealed that the statement made score of 17 to 85 respectively. A significant

difference in positive and negative scores was observed among the three professional care givers.

Registered nurses had the highest positive score as well as the lowest negative score. Health care

students in the first semester had the most unfavourable attitude towards older people while

students in semester two had the most favorable attitude towards older people. Registered Nurses

had a high positive score as well as low negative score compared to nurses without academic

degree. Progression in ones educational level was also seen to contribute in the reduction of

unfavorable attitude towards the elderly.

Practice

According to Okoye and Asa (2011) providing care especially to the elderly, takes a huge

toll, both physically and emotionally on the caregiver. With the population of the elderly

growing in Nigeria, one of the emerging issues is the care and support of elderly persons in years

to come. Few people are prepared for the responsibilities and tasks of caring for the aged because

of the stress involved. In a study conducted in Nsukka Enugu State by Okoye and Asa (2011) to

investigate the experiences of caregivers of elderly relatives. Questionnaires were distributed to

330 respondents result shows that there exists a significant relationship between caregiver’s age

and level of stress (P = 0.001). the sex of the receiver, the level of education of caregivers, level

of education of care receiver are all significantly related to the level of stress.

45

Summary of Literature Review

A review of literature on the concept of the ageing, the biopsychosocial challenges of the

elderly receiving care and the knowledge, attitude and practice of care of the elderly among

health workers was done. According to Papalia, Feldman & Camp, (2002) the concept of aging

is multifaceted, this is because it’s in depth description covers diverse areas of human

development which includes the chronological, biological, psychological, social and functional

dimensions of age. The biopsychosocial challenges of the elderly in receiving care include

physical changes, insensibility problems, affordability, anxiety and depression and poor policy

implementation. Data based literature review and empirical studies, revealed the elderly needing

care due to the natural ageing process, and marginalization of the elderly is very common. There

is poor knowledge of elderly care by the health professional and negative attitude towards the

elderly, in terms of practice, there are no special health services provided for them while most of

the facilities do not have services for their degenerative problems, leaving a wide vacuum to be

filled and addressed by the current study on knowledge, attitude and practice of care of the

elderly among health workers in a tertiary health facility UCTH in Calabar, Cross River State

46

CHAPTER THREE

RESEARCH METHOD

This chapter presents research design, area of study, population of study,

sample, sampling procedure, research instrument, validation of the instrument, reliability testing,

ethical consideration, procedure for data collection and method of data analysis.

Research Design

A Cross sectional descriptive study design was used to determine the level of knowledge,

attitude and practice of care of elderly among health workers in University of Calabar Teaching

Hospital Calabar Cross River State. According to Isangedihi, Joshua, Asim & Ekuri (2004), the

descriptive study survey allows orderly collection of data. The cross sectional approach involves

the collection of data at a point in time and considered suitable for the phenomenon being studied

(Polit & Beck, 2006).

Area of the Study

The area of study was University of Calabar Teaching hospital (UCTH). It is a tertiary

institution located in Calabar, Cross River State. UCTH Calabar is a research, training and

service centre for health professionals and health care needs of all age groups are met. It has the

permanent site in Calabar and an annex at Okoyong in Odukpani local government area. It

consists of so many units namely casualty, Outpatient Department, Medical, Surgical, Theatre,

orthopedic, Pediatric, Maternity, community Health, E.N.T and Administration to mention but

few. It has 600 beds for inpatients and is headed by a Chief Medical Director and other

subordinates in sub units.

47

Population of Study

The population of study consisted of (402) doctors, (600) nurses,(10) dentists and

(11)physiotherapists that provide direct clinical health care to elderly patients making up a total

of one thousand and twenty three (1023) health workers .

Sample and Sampling Procedure

The sample was calculated using the Taro - Yamane (1967) simplified formula for finite

population proportions. The sample was 461 respondents made up of 200 Doctors, 240 Nurses,

11 Physiotherapists and 10 Dentists

n = N 1+N(e)2

n = sample size

N = population size

e = acceptable sample error (See Appendix II)

95% confidence level and P = 0.05 are assumed

Sampling Procedure

A multistage sampling technique was used to select respondents for the study. The health

workers were stratified according to profession (Nurses, Doctors, Dentists and physiotherapies)

For the nurses, six wards were selected using random sampling method and the duty roaster of

each ward was used as the sampling frame. The number of the nurses in the duty roaster was

copied out and written on pieces of paper. This was placed in a basket and shuffled and for each

ward 40 nurses were selected making a sum of 240 nurses. For doctors, ten (10) departments

were selected using simple random sampling and 20 doctors were selected from each selected

department by random sampling technique using the duty roaster as the sampling frame making a

sum of 200. Where the health workers or professional in a selected cadre were not up to 20 all

the health workers were used for the study (Pls see Appendix vii)

48

Inclusion criteria

• Should be Nurses, Doctors, Dentists or Physiotherapists

• Should have direct contact with the patient

• Willingness to participate in the study

Instrument for Data Collection

The instrument used for data collection was questionnaire. It had five sections A, B, C, D and E.

- Section A had seven items which elicited information on socio demographic profile of

the respondents

- Section B had eighteen items on the level of knowledge of care of the elderly. Yes and

No responses were used and 1 point was allocated to correct responses.

- Section C with twelve items elicited information on attitude of health workers towards

care of the elderly.

- Section D consisted of nine items on practice of the Care of the Elderly. The variables

were weighted as follows. Always 2 points, Sometimes 1 point, Never No point.

- Section E was made up of nine items on factors influencing the attitude of health workers

on care of the elderly.

A rating scale 1- 4 was used.

The negative statements were coded in the reverse.

1 =strongly disagree (strongly unfavorable to the concept)

2 = Disagree (somewhat unfavorable to the concept)

3 = Agree (somewhat favorable to the concept)

4 = strongly agree (strongly favorable to the concept)

(See Appendix I)

49

Validity of the Instrument:

Face and content validity of the instrument was done by the Researchers Supervisor, a

Community Health Specialist and two others who are experts in measurement and evaluation.

Their observations were used to make necessary modifications before final approval and

administration.

Reliability of the Instrument :

Test retest method was adopted. Ten percent of the sample which is Forty six (46) copies

of the questionnaire was administered on health workers in University of Uyo Teaching Hospital

entirely outside the area of study setting with similar population characteristics. 20 copies of the

questionnaires were administered to doctors, 24 were administered to nurses and 1 each was

administered to a dentist and a physiotherapist. The questionnaires were administered on 46

health workers and after two weeks interval the same questionnaires were administered to the

same health workers in the same hospital and the data obtained from the two administrations

were used to calculate the reliability coefficient. Using Pearson product measurement correlation

coefficient statistics giving a reliability coefficient of 0.91.

Ethical Consideration

Application for ethical approval and introduction letter endorsed by the Head of

Department of Nursing Sciences, University of Nigeria, Enugu Campus and abridged copy of the

research proposal were submitted to the Research and Ethical committee of the Cross River

State, Ministry of Health Calabar and UCTH ethical committee and approval was given, after

due consideration by the ethical committees. The ethical clearance was granted for the study.

(See Appendix Va and Vb)

50

Finally, individual informed consent was obtained from each study participant who met

the inclusion criteria. Confidentiality and anonymity were assured to the respondents with

respect to the information they have shared. These enabled them to give the necessary assistance

on the collection of data. (See Appendix III)

Procedure of Data collection

The researcher recruited six research assistants and trained them on the purpose of the

study to ease data collection With the letter from the Department of Nursing Science, permission

to carry out the study was obtained from the hospital administration. The data were collected by

the researcher and six trained research assistants. The researcher and her assistants administered

the questionnaires to the selected health workers at their work place between 2pm and 4pm when

work in the ward is minimal. The questionnaires were collected on the spot. This was to ensure a

high return rate and avoid the problems usually associated with the posting of instrument and to

offer explanation where and when necessary. Data collection lasted for 6 weeks.

Method of Data Analysis

Data collected was collated, tallied and analyzed using E.P.I info-7. Descriptive statistics

of percentages, mean, standard deviation and mean decision rule of any score greater than 2.5 is

positive. Inferential statistics (Chi-square) was used to test the association of the variables at 0.05

significance level.

51

CHAPTER FOUR

PRESENTATION OF RESULTS

The results are presented in Tables and figures according to the research

questions. Out of 461 questionnaires that were administered 460 questionnaires were returned

giving a returned rate of 99.9%.

Table 1 Socio-Demographic characteristics n = 460

Demographic Characteristic Frequency Percentage (%) Age Category

20-29 168 37 30-39 186 40 40-49 86 19 >50 20 4 Gender Male 172 38 Female 288 62 Professional Status Doctors 200 44 Nurses 240 52 Dentists 10 2 Physiotherapist 10 2 Years of Experience 1-8 250 54 9-16 123 27 17-24 51 12 25-32 25 5.0 33 and above 11 2.0 Marital Status Single 300 64.7 Married 150 32.6 Widow 7 1.5 Divorced 3 0.6 Educational Status Primary 0 0 Secondary 0 0 Tertiary 460 100 Categories of patients you will like to care for by gender

Male 300 64.7 Female 160 35.3

52

From Table 1data analysis of the socio demographic characteristics of the respondents revealed

that age ranged from 20 >50 years with a mean age of 34 years and standard deviation of 4.8.

More than half of the respondents 62% percent were females, For educational status all the

health workers were educated 460 (100%) up to tertiary level.

RESEARCH QUESTION 1. What is the level of knowledge of care of the elderly among the

health workers in UCTH, Calabar

Table 2a: Level of Knowledge of Care of the Elderly among Health Workers

Table 2a: shows the responses given by the subject regarding their level of knowledge of care of

the elderly. For majority of the items more than 90% of the subjects gave the correct answers.

Items Yes No Mean correct Answer

The elderly people need regular exercise 440 (96%) 20(4%) 96 Proper mouth care is a basic need for the elderly 448(97%) 12(3%) 97 Aging process leads to anatomical and physiological changes 452(98%) 8 (2%) 98 Lung capacity tends to decrease in old age 418(91%) 42(9%) 91 Railings and nonslip can help maintain balance and prevent falls in old age

434 (94%) 26(6%) 94

Elderly people need to eat regularly and properly 432(94%) 28(6%) 94 The fear and anxiety related to inability to perform usual roles by the elderly can be reduced by maintaining calm, unhurried, confident manner when interacting with the patient

446 (97%) 14(3%) 97

Sound sleep in the elderly can be encourage by restricting visitors during rest periods and providing care in groups

460(100%) 0 100

Bedsores in the elderly is prevented by keeping the skin clean and dry and bed linens wrinkle free and dry

448(97%) 12(3%) 97

Memorizing capabilities in the elderly person is affected due to structural changes in the brain

450(98%) 10(2%) 98

Care can be rendered to the elderly with altered sensory perception by reducing environmental noise and speaking louder and slowly with nonverbal cues when appropriate

437(95%) 23(5%) 95

Sleep patterns among the elderly steadily increase compared to persons under 60 years

10(2%) 450(98%) 98

Most of the elderly in Nigeria live above the poverty level 13(3%) 447(97%) 97 Elderly workers have the highest rate of absentism than younger workers

430(93%) 30(7%) 93

Majority of the elderly are able to adapt to change more easily compared to young people

40(9%) 420(91%) 91

As a healthy person reaches old age, his/her voluntary participation in organization usually

418(91%) 42(9%) 91

In Nigeria, majority of the elders whose children have left home suffer from empty nest syndrome

413(90%) 47(10%) 90

The elderly have more fear of crime compared to younger persons 454(99%) 6(1%) 99

53

TABLE 2b

Categorization of knowledge score n%

Poor – 01-8 Mean +

16.2± 1.4

Range 01-18

3(0.7%)

Average 9-14 20(4.3%)

Good 15-18 437(95%)

Table 2b: shows categorization of knowledge score regarding the care of the elderly (maximum

attainable score 18) most of the subjects (95%) had good knowledge regarding care of the

elderly, 4.3% had average knowledge while 0.7% of the subjects had poor knowledge regarding

care of the elderly. Mean knowledge score was 16.2 SD ± 1.4 with the range of 01-18.

TABLE 2c

Proportion of health workers and their level of knowledge on the care of the elderly patients Health workers Poor Average Good Total

Doctors 0(0%) 8(4) 192(96) 200(100)

Nurses 1(0.1) 8(3) 23(96) 240(100)

Dentists 1(10) 2(20) 7(70) 10(100)

Physiotherapist 1(10) 2(20) 7(70) 10(100)

Total 3(0.7) 20(4.3) 437(95) 460(100)

54

Research Question 2: What is the attitude of health workers towards the care of the elderly?

Table 3: Attitude of health workers towards the care of the elderly

Items Strongly Agree n (%)

Agree n (%) Disagree n (%)

Strongly Disagree n (%)

Mean SD Decision

I feel good taking care of the elderly

122(27%) 276(60%) 48(10%) 14(3%) 3.0 0.75 •

I see care of the elderly as

being time consuming 136(29.6%) 182(39.6%) 120(26%) 14(3%) 2.7 0.68 •

I prefer giving attention to younger patients than the elderly ones

74(16%) 150(33%) 180(39%) 56(12%) 2.3 0.57 #

The older the elderly the more demanding he/she becomes

220(48%) 176(38%) 54(12%) 10(2%) 3.2 0.8 •

The elderly are difficult to care for

124(27.1%) 214(46.7%) 104(22.7%) 14(3.5%) 2.8 0.7 •

Time should not be wasted for elderly with terminal illness

18(3.9%) 68(14.8%) 218(47.4%) 156(33.9%) 1.8 0.45 #

The elderly do not deserve the care health workers give them

12(2.6%) 58(12.6%) 162(35.2%) 228(49.6%) 1.8 0.45 #

Some elderly look untidy and dirty. And as such I do not like caring for them

32(7.8%) 96(20.9%) 198(43%) 130(28.3%) 2.0 0.5 #

The elderly can often provoke the care giver

93 (21.3%) 238(51.7%) 80(21.3%) 44(9.6%) 2.7 0. 67 •

The majority of the elderly are senile

42(9.6%) 228(50%) 154(34%) 34(7.4%) 2.3 0.57 #

I get stressed up when taking care of the elderly

92(20%) 220(48%) 128(28%) 18(4%) 2.6 0.65 •

Calling the patient by name when treating or caring for the elderly is very important

238(51.7%) 168(36.5) 42(9.1%) 12(2.6%) 3.3 0.82 •

Level of Decision = 2.5 Positive = • Negative = #

Table 3 above indicates the attitude of health workers on the care of the elderly. On those that

feel good taking care of the elderly 60% agreed while 27 % strongly agreed and 3% and 10%

strongly disagreed and agreed respectively with a mean of 3.0. On the item that sees care of the

elderly as time consuming 29.6 % strongly agreed while 39.6% agreed that caring for the elderly

55

consumes time. On the item that examines the fact that the elderly do not deserve the care given

to them, 49.6% strongly disagreed while 35.2% disagreed with a mean of 1.8. The item of

Elderly is untidy and dirty, 43% disagreed and 28.3% strongly disagreed while 7.8% strongly

agreed and 20.9% agreed mean of 2.0. The item on the mental state of elderly shows the 50% of

the health workers agreed that elderly are senile while 34% disagreed. About 48% of health

workers agreed that they get stressed up when taking care of the elderly while 28% disagreed,

20% strongly agreed that they get stress-up and 4 % strongly disagreed with a mean of 2.6.

About 51.7% and 36.5% of the health workers strongly agreed and agreed respectively on calling

patient by name while 2.6% strongly disagreed with a mean of 3.3.

RESEARCH QUESTION 3: WHAT ARE THE HEALTH WORKERS PRACTICES OF CARE OF THE ELDERLY?

TABLE 4A: HEALTH WORKERS PRACTICE OF CARE OF THE ELDERLY .

Table4a. Above shows health workers practices of care of the elderly, 246 (54%) and 208 (45%)

respectively accepted that they always and sometimes give prompt attention to the elderly even

Items Always Sometimes Never

I like taking care of older people 122(27%) 276(60%) 63 (13%)

I attach titles to the names of elderly while taking care of them to create relationship

168(36.5%) 238(51.7%) 54(11.7%)

Nutritional assessment of the elderly is promoted and l also encourage the elderly to eat adequately and at times assists in feeding them

288(63%) 156(34%) 16(4%)

Prompt attention is given to elderly patients even in emergency

246(54%) 208(45%) 4(1%)

Assessment and evaluation are needed for effective care of the elderly

236(51%) 206(45%) 16 (4%)

Decreased mental ability of elderly patient often by aging process and illness affect response to care

200(43%) 238(52%) 20(4.4%)

I get so stressed up when taking care of the elderly

92(20%) 220(48%) 148 (32%)

Taking care of the elderly is time consuming

136(29.6%) 182(39.6%) 142(30.8%)

I neglect myself and concentrate only on the elderly when taking care of them

40(8.7%) 106(23%) 314(68.3%)

56

in emergency. 236(51%) and 206 (45%) respondents accepted respectively that they always and

sometimes carry out assessment and evaluation for effective care while 14 (3%) opined never to

do it. On the importance of nutritional assessment 288 (63%) accepted carrying it out always 156

(34%) sometimes while 16 (4%) never did it.

Table 4b

Categorization of practice score n%

Low (never) 01-8 Mean ± SD

12.02 ± 4.27

Range 01.18

87(19%)

Moderate (sometimes) 09-14 203(44%)

High (always) 15-18 170(36%)

Table 4b: shows categorization of responses given by respondents on their practice of care of

the elderly. 170 (36.9%) highly practiced (always) care of the elderly, 203 (44.1%) moderately

(sometimes) practiced care of the elderly while 87 (19%) never practiced care of the elderly.

Mean practice score was 12.02 SD ± 4.27 with the range of 01-18.

Table 4c

Proportion of health workers and their practice of care of the elderly patients Health workers Low Moderate High Total

Doctors 40(20%) 100(50) 60(30) 200(100)

Nurses 40(16) 100(42) 100(42) 240(100)

Dentists 3(30) 2(20) 5(50) 10(100)

Physiotherapist 4(40) 1(10) 5(50) 10(100)

Total 87(19) 203(44) 170(37) 460(100)

57

Research Question 4: What are the factors that influence health workers attitude towards the

elderly?

Table 5: Factors influencing the attitude of health worker towards care of the elderly.

N = 460 Items Strongly

Agree n (%) Agree n (%) Disagree

n(%) Strongly Disagree n(%)

Mean SD Decision

I choose this department because I like taking care of the elderly

76(16.7%) 182(40%) 158(34.8) 38(8.4%) 2.4 0.06 #

Taking care of the elderly is very demanding

144(31.4%) 250(54.6%) 58(12.7%) 6(1.3%) 3.0 0.075 •

Effective care of the elderly requires special training

230(50%) 176(38%) 52(12%) 0 3.3 0.083 •

Hospital should have special ward i.e. geriatric wards for effective care of the elderly

278(61%) 166(36%) 14(3%) 2(0.4%) 3.2 0.08 •

The health care policy of Nigeria has made the care of the elderly difficult

22(4.7%) 220(46%) 92(20%) 136(30%) 2.4 0.06 #

Mental status of the elderly patients affects their care and decision making

176(38%) 268(59%) 16(3.5%) 0 3.3 0.083 •

Elderly patient exhibit different behaviors which affect their care

138(30.1%) 290(63.3%) 26(5.7%) 4(0.9%) 3.2 0.08 •

It is difficult to persuade and convince reluctant about their care in the hospital

132(28.8%) 282(61.6%) 44(9.6%) 0 3.1 0.078 •

Some elderly are abandoned due to lack of social support

190(41.7%) 230(50.4%) 26(5.7%) 10(2.2%) 3.3 0.083 •

Level of Decision = 2.5 Positive = • Negative = #

Table 5: above shows factors that influence the health workers care of the elderly, 220 (46%)

Agreed that Nigeria health policy influence the care of the elderly while 136 (30%) strongly

disagreed with a mean of 2.4.On mental status 268 (59%) agreed that mental status of the elderly

58

influence the practice of care while 16 (3.5%) disagreed with a mean of 3.3.On training 230

(50%) strongly agreed that special training is required for health workers taking care of the

elderly while about 52(12%) disagreed with a mean of 3.3.On wards for admission, 278 (61%)

strongly agreed that there should be special wards while 14(3%) disagreed with mean of 3.2.

Hypothesis 1 There is no association between years of experience and the health workers

attitude towards the care of the elderly

Table 6a: Mean years of experience of health workers and attitude of care towards the

elderly.

Items Strongly Agreed

Agreed Disagreed Strongly disagreed

Mean F-S P. value

Care of the elderly is more demanding

220(48) 176 (38) 54(12) 10(2) 7.6 2.7 0.0085

I neglect my self

214(46.5) 180(39) 27(12) 10(2.2) 7.3 24. 0.022

It is time consuming

136(29.6) 182(39.6) 120(26) 14(3) 6.7 2.2 0.037

Time should not be wasted in care of elderly

18(3.9) 68(14.8) 218(47.4) 156(33.9) 6.4 2.6 0.017

Elderly people are difficult to care for

124(27.1) 214(46.7) 104(22.7) 14(3.5) 6.0 3.9 0.004

I feel good caring for the elderly

122(27) 276(60) 48(10) 14(3) 8.3 1.7 0.12

Calling the patient by name

238(51.7) 168(36.5) 42(9.1) 12(2.6) 10.5 4.8 0.001

I like taking care of the elderly

74(16) 316(68) 58(13) 12(2.5) 8.0 2.4 0.03

Elderly people are normal people

198(43) 242(52.6) 16(3.5) 2(0.4) 7.1 2.0 0.08

Table 6shows the mean years of working experience of health workers and their attitude towards

the care of the elderly. On the item of the caring for the elderly is more demanding 38% agreed

while 48% strongly agreed with a mean years of experience of 7.6 years and a P- value of 0.0085

which was statistically significant. The item of elderly care is time consuming was statistically

59

significant with a mean years of experience of 6.7 years and a P-value of 0.037. The elderly are

difficult to care for was statistically significant with a mean years of experience of 6 years and a

P- value of 0.004. On the item I feel good caring for the elderly was not statistically significant

with a P-value of 0.12 and mean years of experience of 8.3 while like taking care of elderly

people was statistically significant with mean years experience of 8.0 and P-value 0.03

Table 6b: Years of Experience and Attitude of Health Workers

Years of Experience Positive attitude Negative attitude Total

1-8 144(57%) 106 (43%) 250

9 - 16 77 (63%) 46 (37%) 123

17 – 24

25 -32

39 (76%)

21 (84%)

12 (24%)

4(16%)

51

25

33 and above 9 (81%) 2 (19%) 11

290 170 460

Table 6b above shows that there is a relative increase in positive attitude of health workers

towards the care of the elderly as the years of experience increases.

Table 6c Proportion of health workers with positive and negative altitude towards the care of the elderly patients. Health workers +ve -ve Total

Doctors 116(63) 84(37) 200(100)

Nurses 175(75) 75(25) 240(100)

Dentists 4(40) 6(60) 10(100)

Physiotherapist 5(50) 5(50) 10(100)

Total 290(67) 170(33) 460(100)

CHAPTER FIVE

DISCUSSION OF FINDINGS

60

This chapter presents discussion of major findings; conclusion, implication of findings to

nursing, recommendations, suggestions for further studies and summary as well as limitation of

the study.

Research Question 1

What is the level of knowledge of care of the elderly among health workers in UCTH,

Calabar. The findings in this study indicate that majority(95%) of the health workers had

adequate knowledge on the basic needs and care of the elderly. The findings also revealed that

health workers who had sufficient knowledge on the nutrition and personal hygiene of the elderly

were also in the majority. The explanation for this may be because all the health workers have

tertiary education and are already in specialized areas. This agrees with the finding of Okoye and

Asa (2011) that knowledge on the basic needs of the elderly will help care givers to assist the

elderly to meet their needs without compromising their health and safety. It is also in agreement

with Mandy, Mitehell and Oneil , (2011) that higher level of education increases health workers

knowledge of care of the elderly. However, this findings disagrees with Donatelle (2001)

and Mcfarely and Morrison(2004) that posits that most curricula of health professionals have

little or nothing to do about the elderly and as such most health workers have very poor

knowledge on the care of the elderly.

Research Question 2

What is the attitude of health workers towards the care of the elderly in UCTH Calabar

The study reveals that the positive attitude of the health workers was higher than the negative

attitude that they like taking care of the elderly; they called the patient by name and created a

relationship with the elderly. This agrees with Mandy, Mitchel and Oniel (2011) that reported

health workers have positive attitude towards the care of the elderly. It is also in line with the

61

Oyetunde, Ojo and Ojewale (2013) opinion that there is positive attitude of health workers

towards the care of the elderly. The positive attitude of health workers towards the care of the

elderly in the study is probably due to high level of education and well trained health workers.

This is in accordance with Nelson (2004) who concluded that trained health workers are more

likely to develop positive attitude to the care of the elderly. And also agrees with Kaempfer,

Wellam & Himburg, (2002) that opines that the higher the level of education the more positive

the attitude towards the care of elderly among health workers.

However the findings also revealed that a large proportion of health workers also (68%)

agreed that caring for the elderly is difficult and stressful so they prefer to take care of younger

patients, than elderly people. Also the fact that taking care of the elderly is time consuming, and

that the mental state of the elderly affects their response to care. This agrees with Lee, (2007)

and Weiss (2005), that reported negative attitude of health workers towards the care of the

elderly could be due to the inability of the health workers to identify those conditions that can be

treated effectively as well as inadequate resource to treat. It also agrees with Okoye & Asa,

(2011) that concluded that health workers experience stress when caring for the elderly greatly

because it is time consuming and emotionally, physically and psychologically draining.

Findings from the study also revealed that majority of the health workers prefer taking

care of younger people. This could be because taking care of the elderly is time consuming and

stressful. This agrees with Weiss (2005) and Lee (2007) that reported that health workers show

negative attitude towards the elderly by using physical restrictions to disrespect the patient

autonomy and dignity and discriminate against them.

Research Question 3

What are the health workers practices in the provision of care towards the elderly.

62

The findings revealed that majority of health workers (81%) provided adequate care for

the elderly. The practices included nutritional assessment, thorough assessment during

emergency, evaluation and effective care, calling patient by name and creating a relationship.

These findings are due to the high level of education and specialization of the health workers.

This is in accordance with Lecovich (2008) that concluded that calling patient by their name is

one of the good behavioral practices of care of the elderly. It is also in line with Oyetunde, Ojo

and Ojewale (2013) that also concluded that nutritional assessment is an integral part of clinical

assessment for the elderly. However this finding disagrees with Sulaimen et al (2010) who still

emphasizes on the preservation of the family and value of taking care of their parents at home.

Research Question 4

What are the factors that influence health workers attitude towards the care of the elderly?

These findings revealed that most of the respondents (97%) agreed that taking care of the

elderly requires special training and those special wards should be created for the elderly

(geriatric wards). This finding is probably because the elderly have some peculiarities that would

require special care and also a cordoned area. The study also reveals that most of the health

workers would not prefer this area of specialization except when they are being forced to. This

agrees with Happel (2002), alliance for ageing research, (2003) and Bowen et al, (2008), whose

findings showed that identification of geriatrics as a career choice amongst health workers and

social care workers appear to be a long standing theme in literature.

HYPOTHESIS 1. There is no association between the years of experience of the health workers

and their attitude towards the care of the elderly.

63

The findings reveal that negative attitudes of health workers with mean years of

experience are statistically significant. With the item that health worker neglects themselves

when taking care of the elderly. Health workers with less years of experience strongly agreed

that they will neglect themselves while those with many years of experience disagreed.

This shows that there is association of attitude with many years of experience therefore rejects

the null hypothesis. There is association of mean years of experience with attitude of health

workers towards the care of the elderly. This may be due to the fact that the health workers with

lesser years of experience have not had enough experience of caring for the elderly. With

increased years of experience there may be improved attitude towards the care of the elderly.

Implication of Findings to Nursing

• Geriatric Nursing content in the curriculum to be strengthened.

• Consistent and frequent education programmes need to be implemented to address

knowledge gaps in contemporary Geriatric Nursing.

Limitation of the study

The study was conducted in University of Calabar Teaching Hospital, Calabar. This

means that there may not be much room for generalization because health workers in other

institutions may have different knowledge, attitude and practice of the care of the elderly. Also

only selected health workers in special professions were considered therefore the knowledge of

health workers in other disciplines of health were left out. Information was based on the

respondent’s perception which could have been influenced by other factors such as the time,

schedule, etc. Practice of health workers care was assessed by their knowledge on practice of

care, not by the process-outcome approach.

Summary

64

The study focused on the knowledge, Attitude and practice of care of the elderly patients among

health workers in University of Calabar Teaching Hospital, Calabar. The specific objectives were

to (i) determine the level of knowledge, the physical, emotional and social care of the elderly

patients in the University of Calabar Teaching Hospital, Calabar (ii) determine the attitude of

health workers in the care of the elderly patients, (iii) determine the level of health workers

practices in the provision of care of the elderly patients, (iv) identify factors that influence the

health workers attitude towards the elderly patients in University of Calabar Teaching Hospital,

Calabar. The hypothesis for the study tested the association between years of experience of

health workers and their attitude towards care of the elderly patients in UCTH. Calabar. The

study adopted a cross sectional descriptive design. The population of the study was 1023 health

workers, made up of 402 Doctors, 600 Nurses, 10 Dentists and 11 Physiotherapists that provided

direct clinical care to elderly patients. The sample was calculated using Taro-Yamane simplified

formula for finite population giving a sample of 461 health workers. The instrument for data

collection was questionnaire, the reliability of the instrument was done using test retest method

and a reliability co-efficient of 0.91 was obtained. The questionnaire had five sections, section A

covered socio demographic data, section B, C, D consisted of items which explored level of

knowledge. Attitude, practice and section E elicited information on factors influencing the care

of the elderly patients. The completed questionnaire was coded and analyzed using E.P.I info-7.

Descriptive statistics of percentage, mean, standard deviation were used for data analysis. The

criterion mean of 2.5 was also used and results the study revealed that 95% of the health workers

had good knowledge of care of the elderly patients. Majority of the health workers had positive

attitude above rating scale of 2.5. The health workers moderately practiced care of the elderly

patients. The factors that positively influenced health workers attitude to the care of the elderly

65

were years of experience, age and mental state of the elderly. There was significant association

(P<0.05) between attitude of Health Workers and mean years of experience. Workers with less

years of experience had negative attitude, while those with more years of experience had positive

attitude, towards the care of the elderly patients.

Conclusion

In conclusion, health care professionals need to have the right skills to manage a more

demanding role in the future. In order to offer effective services for the elderly patients, a skilled

workforce of health professionals is therefore very necessary.

Recommendations

Although the findings of the study show that health workers have good knowledge on the care of

the elderly, the attitude of the health workers was statistically significant with mean years of

experience i.e. the years of experience is associated with attitude of health workers. There is need

to provide more resources and also training of personnel in area of elderly care.

• Special wards / department should be created for the elderly in the hospitals with well

trained staff in the area of specialization.

The researcher also suggested that the government should develop a health policy for the elderly

that will capture the care of the elderly.

• Develop a system of periodical health workers evaluation to determine strategies of

upgrading their knowledge and enhancing practice.

• Development of follow up courses and in service training programs should be conducted

to maintain efficient performance of individuals previously trained in the care of the

elderly

66

• Encouraging health workers to attend national and international congresses, seminars

symposiums and workshops on care of the elderly.

Suggestion for further studies

The researcher suggests that similar study on the knowledge of care of the elderly should

be done in other health facilities in other States. Other studies that include the problems

associated with health workers attitude towards the care of the elderly.

67

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APPENDIX 1

DEPARTMENT OF NURSING SCIENCE,

UNIVERSITY OF NIGERIA,

ENUGU CAMPUS.

75

SAMPLE QUESTIONNAIRE

Dear Respondents,

I am a Postgraduate Student in the Department of Nursing Sciences conducting a survey on

knowledge, attitude and practice of care of the elderly among health workers in the University of

Calabar Teaching Hospital, Calabar.

This survey seeks your views on knowledge, attitude and practice of care of the elderly.

The information will be treated with utmost confidentiality. The research will appreciate

genuine, direct, specific and clear answer.

Yours faithfully,

Mercy B. Efiong

SECTION A

INSTRUCTIONS

Please answer the following questions

Socio Demographic Data

1. What is your Age Range?

A. 20 - 29

B. 30 - 39

C. 40 - 49

D. 50 and above

2. Gender

A. Male [ ]

B. Female [ ]

3. Marital Status

A. Single [ ]

B. Married [ ]

4. Educational level

76

A. Primary [ ]

B. Secondary [ ]

C. Tertiary [ ]

D. None [ ]

5. What is your year(s) of experience-------

6. Professional status

A Doctor [ ]

B. Nurse [ ]

C. Dentists [ ]

D. Physiotherapist [ ]

7. Categories of elderly patient that you would like to care for by gender

a. Male [ ]

b. Female [ ]

SECTION B

Knowledge of Health Workers in the Care of the Elderly

Yes No

8 The elderly people need regular exercise. 9 Proper mouth care is a basic need for the elderly 10 Aging process will lead to anatomical and

77

physiological changes. 11 Railing and nonslip can Help maintain balance and

prevent falls in old age.

12 Elderly people need to eat regularly and properly. 13 Lung capacity tends to decline in old age. 14 The fear and anxiety related to inability to perform

usual roles by the elderly can be reduced by maintain calm, unhurried confident manner when interacting with the patient

15 Sound sleep in the elderly can be encouraged by restricting visitors during rest periods and providing care in groups

16 Bedsores in the elderly is prevented by keeping the skin clean and dry and bed lines wrinkle free and dry

17 Memorizing capability in the elderly person is affected due to structural changes in the brain

18 Care can be rendered to the elderly with altered sensory perception by reducing louder and slowly with nonverbal cues when appropriate

19 Sleep patterns among the elderly steadily increase compared to person under 60 years

20 Most of the elderly in Nigeria live above the poverty level

21 Elderly workers have the highest rates of absentism than younger workers

22 Majority of the elderly are able to adapt to change more easily compared to young people

23 As a healthy person reaches old age, his/her voluntary participation in organization usually declines

24 In Nigeria, majority of the elders whose children have left home suffer from empty nest syndrome

25 The elderly have more fear of crime compared to younger persons

SECTION C

Attitude of Nurses towards the care of the Elderly

Strongly

Agreed

Agreed Disagreed Strongly

Disagreed

78

SECTION D

Practice of Care of the Elderly by Health Workers

Always Sometimes Never

26 I feel good taking care of the elderly.

27 I see the care of the elderly patients

as being time consuming.

28 I prefer giving attention to younger

patients than the elderly ones.

29 The older the elderly the more

demanding he/she becomes.

30 Time should not be wasted for

elderly persons with terminal

illnesses.

31 The elderly do not deserve the care

health workers give them.

32 Some elderly look untidy and dirty.

And as such I do not like caring for

them.

33 The elderly can often provoke the

care giver.

34 The majority of the elderly are senile.

35 I get stressed up when taking care of

the elderly

36 Calling the patient by name when

treating or caring for the elderly is

very important

79

2 1 0

37 I like taking care of older people.

38 I attach titles to the names of the elderly

while taking care of them to create

relationship

39 I encourage the elderly to eat adequately

and at times assists in feeding them

40 Prompt attention is given to elderly

patients even in emergency

41 Assessment and evaluation are needed for

effective care.

Decreased mental ability of elderly

patients often by aging process and illness

affect response to care.

42 I get so stressed up when taking care of the

aged.

43 Taking care of the aged is time consuming.

44 I neglect myself and concentrate only on

the aged when taking care of them.

45 Categories of Elderly People you will like to care for by age

a. Young old (60 - 74)[ ]

b. Middle old (75 -84)[ ]

c. Old old (85 -94)[ ]

d. Oldest old (≥ - 95) [ ]

SECTION E

Factors influencing the Health Workers attitude towards the Care of the Elderly

80

Strongly

Agreed

Agreed Disagreed Strongly

Disagreed

46 I choose this department because I

like taking care of the aged.

47 Taking care of the aged is very

demanding.

48 Effective care of the elderly requires

special training

49 Hospitals should have special wards

i.e. geriatric wards for effective care

of the elderly

50 The health care policy of Nigeria has

made the care of the elderly difficult.

51 mental status of the elderly patients

affects their care and decision

making

52 Elderly patients exhibit different

behaviors which affect their care

53 It is difficult to persuade and

convince reluctant patient about their

care in the hospital

54 Some elderly are abandoned due to

lack of social support

APPENDIX II

Calculation for sample size

81

n = N 1+N(e)

For Doctors

n = 402 1+402(0.05)2 n = 402 2.005 n = 200 For Nurses n = N 1+N(e)2

n = 600 1+600(0.05)2 = 600 2.5 n = 240 For Dentist n = N 1+N(e)2

n = 10 1+10(0.05)2 n = 10 1.025 n = 9.7561 n = 10 For Physiotherapist n = N 1+N(e)2

82

n = 11 1+11(0.005)2 = 11 1.0275 = 10.7056

n = 11

Doctors = 200

Nurses = 240

Dentists = 10

Physiotherapist = 11 461

APPENDIX III

83

INFORMED CONSENT FORM

I agree to be participant in this study being conducted by Mrs. Mercy B. Efiong of the

Department of Nursing Sciences, university of Nigeria, Enugu Campus.

I have made this decision based on the information l have read in the information letter.

As a respondent in this study, I have realized that I will be asked to complete several

questionnaires. I may decline answering any question, if I so choose.

All information which I provide will be he in confidence and I will not be identified in

any way in the final report. I understand that I may withdraw this consent at any time by ceasing

to fill out the questionnaires

……………………………… ………………………… Signature and Date Signature and Date (Respondent) (Witness)

…………………………………………….. Signature and date

(Principal Investigator)

84

Appendix vii

Composition of Sample of Nurses used for the study

Composition of Doctors per Departments used for the study

Wards Surgical

ward (MS

Wsoopd)

Medical

ward

(FMMW)

MMW

MOP

Orthopedic

Ward and

Dental

ward

Eye ward

and Clinic

ENT ward

ENT Clinic

Family

Medical and

Casualty

Population 44 44 45 53 50 41

Sample of

Nurses

selected for

the study

40 40 40 40 40 40

Department Population Sample selected

Surgical ward/ Cardio Thoracic

ward/ intensive care unit

50 20

Internal Medicine/ Medical ward 46 20

Orthopedic ward 42 20

Eye ward and clinic 37 20

ENT ward and clinic 37 20

Family medicine 42 20

Casualty/ Accident and Emergency 41 20

Community Medicine 30 20

Obstetric and Gynecology 47 20

Dental clinic 30 20

Total 402 200