Last year, for the first time ever, the developed countries of the world had more people aged 60 and over than youths aged 14 and under. For the world as a whole, the same will be true by the year 2043. The percentage proportion of older people in Western Europe is predicted to increase by 14. 8%, 8. 8 in Japan and 2. 7% in the U. S. (U. S Census bureau). Two major forces drive the shift in age distribution. First, birth rates are declining in most parts of the world, but especially in the industrialized nations. and second, life expectancy is increasing almost everywhere.
The U. K is a prime example of this phenomenon. In 1999 16 % of the population was 65 and over (DOH 1999). With the advent of new medicine and treatment for more and more illnesses and diseases the trend will increase. The implications of a human population that is both growing and aging are numerous and worrying. Advances in medical science, nutrition and fitness, and even bioengineering point to the day when many human beings will have the option of living well past the age of 100 (CSIS global initiative 99).
The elderly have been for a long time the greatest users of healthcare (Lefebre et al. 79). It can be inferred that this demand will continue to rise as the elderly population does. Nearly half of the NHS expenditure in 1999 was spent on the care of the over 65 this equates to 5. 21 billion pounds(DOH 1999). From hospital beds to prescriptions the elderly were responsible for the greater share of the cost. In the front line of healthcare are nurses, who play a primary role in providing support and provision The perception and attitudes of these primary caregivers will greatly affect the response to the growing problem.
It has previously been suggested that these caring services will be stretched to breaking point in future (Martin et al. 1988; Redfern, 1991). Past research on attitudes of nurses towards the elderly has looked at the many different facets of primary nursing care of the elderly. At one end of the spectrum Robb (1967) highlighted examples of cruelty and abuse within the care of the elderly. Similarly in the USA Stannard (1973) showed that institutionalised cruelty existed on both sides of the Atlantic. Both papers are not con but one only needs to look in the recent press to see examples of systematic abuse and negative attitudes.
Harold Shipman was convicted of murdering 15 elderly patients in his care, similarly a nurse was convicted of the murder of 3 elderly patients. Examples such as these, taken with evidence of an increasing elderly population, show that the need to understand the polarity of care workers attitudes is pressing The question of which are the right attitudes towards the elderly has been a discussion point in the past. This idea and the study of current attitudes of care workers and how they have been formed has been the starting point of the majority of work within this field.
Looking first at the idea of the right attitude Irvine (1970) suggested that the right attitude towards the elderly should be constructed from acceptance, respect, sympathy, and the ability to encourage. But the fundamental construct of the right attitude has been brought into question by many. Ingham and Fielding question whether there is a single right attitude suggesting that this is dependant on institutions aims and the perception of older people as individuals. Institutions are more concerned with smooth running than the needs of individual patients.
However this philosophical approach is of little help when addressing the problem and in studies which show stereotyping and malcontent in working with the elderly, discussion on the rightness of right attitudes has proved of little use. Care of the elderly has for some time been an unpopular field within healthcare (Ray et al. , 1987; Solomon & Vickers, 1979; Mutschler, 1971). Past research highlighted the reluctance to work with older patients in hospitals and nursing homes (Campbell, 1971; Gillis, 1973; Gunter,1971) Why should this be the case even when the elderly are recognised as the group most in need, in society (Hardie, 1975)?
Psychologists have looked towards stereotyping and ageism for possible answers. Ageism, a term first coined by Butler (1969), is a process of systematic stereotyping of, and discrimination against people because they are old (Butler & Lewis 1975 p117). Ageism and stereotyping has been developed as a possible reason for the negative perception and behaviour to the elderly. Not all research has found comparable results. Schoenfeild (1982) and Treharne (1990) suggested that in fact there is no evidence to suggest negative attitudes towards the elderly exists.
However the majority of research has shown negative stereotyping of the elderly (Levin, 1988; Ray et al. , 1987). It has been argued that attitudes held by professional workers such as nurses can directly determine the quality of care given to old people (Wells, 1980; Fielding,1986; Armstrong-Esther et al. , 1989). The bulk of research on nurses attitudes towards the elderly has focused on the level of training and experiences of respondents and how these impacted on their attitudes.
A short period of training or intervention has resulted in increases in positive attitudes towards the elderly (Gunter, 1971; Robb, 1979; Tobiason et al. , 1979), the majority of this work focusing on nurses. Snape (1986) however found contrary evidence. Student nurses who had been training for 2-3 years held more negative attitudes than recently enrolled nurses. Snape suggested that this was due to the absence from education, of extra directly specific material to do with the elderly. Other variables such as characteristics of the nurses and patients have been studied including age race, sex, and degree of care needed.
On the subject of degree of care studies have shown that the greater the dependency of a patient the greater the negative attitudes shown by the nurse (Fielding, 1979). The improvements mentioned above (Gunter, 1971; Robb, 1979; Tobiason et al. , 1979) have mostly come from a positive starting level. Some research has shown negative attitudes but the majority has shown neutral to positive attitudes (Slevin, 1991). One must first look at the methodological rigour when approached with this contradiction.
One answer to this problem is that throughout the different studies there have been wide ranges of methodologies, which can suggest difficult in drawing direct comparison. The majority of the previous studies have looked at attitudes of nurses and inferred the level of care associated. (Wells, 1980; Fielding, 1986; Armstrong-Esther et al. , 1989) Other studies have tried to translate those attitudes into an intention to behave. Study of actual behaviour is problematic in certain contexts, and few have attempted this convincingly.
Put together, the past research offers a confused mosaic not quite covering every facet of a complex question. Previous research has not attempted to separate out and explain intention to behave from attitudes and seems to miss out completely other influencing factors. Past research shows that attitudes although fundamental, are not the only predictive factor in explaining behaviour (Wicker, 1969; Kraus, 1995). In the present study an investigation into nurses attitudes towards the elderly will focus on the theory of reasoned action as a framework to predict an intention to behaviour and hence the reason for that behaviour.
