How medical professional students view older people with dementia: Implications for education and practice


Autoři: Theresa L. Scott aff001;  Melissa Kugelman aff001;  Kristen Tulloch aff001
Působiště autorů: School of Psychology, The University of Queensland, St Lucia, Queensland, Australia aff001
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225329

Souhrn

Background

Healthcare professionals’ attitudes to older people, and especially those living with dementia, may contribute to unsatisfactory healthcare. Despite repeated calls to address increasing need, training an adequate geriatric workforce remains an international concern. Of particular concern are the attitudes and knowledge healthcare workers may hold about people living with dementia. Students’ knowledge of dementia has been found to be low at the beginning of their university education and has shown limited improvement throughout their coursework; greater understanding of students’ attitudes to ageing and dementia, upon entry and throughout their degrees, may help inform targeted educational interventions to improve the healthcare delivered to older people.

Methods

This study measured knowledge of and attitudes toward dementia and ageing in an Australian university student sample (n = 183), comparing students from medical professional versus non-medical professional related fields at both undergraduate and postgraduate levels. We examined diagnostic and prognostic biases through age manipulation of a vignette describing a hypothetical patient (aged 42 or 72 years), who was experiencing symptoms that were consistent with DSM-5 criteria for both dementia and depression. Based on information provided in the vignette, student participants were asked to select a primary disorder that they would assign to the patient.

Results

Showed that while medical professional students held significantly more positive attitudes toward ageing than 'other' students, average attitudinal scores indicated neutrality. Medical professional students indicated a diagnostic bias toward the older vignette patient, who was more likely to be diagnosed with dementia than depression. A history of geriatric-specific training did not predict dementia knowledge; however, having prior contact with people with dementia predicted both dementia knowledge and more positive prognoses.

Conclusions

Overall, findings indicated medical professional students held neutral attitudes towards older people and showed deficits in knowledge of dementia. Educational interventions that introduce students to people living with dementia may improve knowledge, skills, and attitudes. All university students would benefit from education about dementia and inclusivity to reduce stereotyping and stigma.

Klíčová slova:

Aging – Alzheimer's disease – Dementia – Depression – Diagnostic medicine – Elderly – Geriatrics – Undergraduates


Zdroje

1. Saxon RL, Gray MA, Oprescu FI. Reducing geriatric outpatient waiting times: Impact of an advanced health practitioner. Australasian Journal on Ageing. 2018;37(1):48–53. doi: 10.1111/ajag.12459 29044886

2. Quinn JF. Dementia. Oxford: John Wiley & Sons Ltd.; 2013.

3. World Health Organisation. The top ten causes of death 2018 [Available from: http://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death.

4. GBD 2016 Dementia Collaborators. Global, regional, and national burden of Alzheimer's disease and other dementias, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology. 2019;18(1):88–106. doi: 10.1016/S1474-4422(18)30403-4 30497964

5. Jorm AF, Dear K, B. G., Burgess NM. Projections of future numbers of dementia cases in Australia with and without prevention. Australian and New Zealand Journal of Psychiatry. 2005;39:959–63. doi: 10.1080/j.1440-1614.2005.01713.x 16343295

6. Brown L, Hansnata E, La HA. Economic cost of dementia in Australia 2016–2056. Canberra: National Centre for Social and Economic Modelling (NATSEM) 2017.

7. Prendecki M, Florczak-Wyspianska J, Kowalska M, Lianeri M, Kozubski W, Dorszewska J. Normal aging and dementia. 2016. In: Update on Dementia [Internet]. IntechOpen; [251–72].

8. Cahill S, Pierce M, Werner P, Darley A, Bobersky A. A systematic review of the public's knowledge and understanding of Alzheimer's disease and dementia. Alzheimer Disease & Associated Disorders. 2015;29:255–75.

9. Corner L, Bond J. Being at risk of dementia: Fears and anxieties of older adults. Journal of Ageing Studies. 2004;18:143–55.

10. Low L-F, Anstey KJ, Lackersteen SM, Camit M, Harrsion F, Draper B, Brodaty H. Recognition, attitudes and causal beliefs regarding dementia in Italian, Greek and Chinese Australians. Dement Geriatr Cogn Disord. 2011;30:499–508. doi: 10.1159/000321667 21252544

11. Chenoweth B, Spencer B. Dementia: The experience of family caregivers. The Gerontologist. 1986;26(3):267–72. doi: 10.1093/geront/26.3.267 3721234

12. Jones C, Moyle W, Stockwell-Smith G. Caring for older people with dementia: An exploratory study of staff knowledge and perception of training in three Australian dementia care facilities. Australasian Journal on Ageing. 2013;32(1):52–5. doi: 10.1111/j.1741-6612.2012.00640.x 23521737

13. Cations M, Radisic G, Crotty M, Laver KE. What does the general public understand about prevention and treatment of dementia? A systematic review of population-based surveys. PLoS ONE. 2018;13(4).

14. Phillipson L, Magee C, Jones S, Skladzien E. Exploring Dementia and Stigma Beliefs: A Pilot Study of Australian Adults Aged 40 to 65 Years. Sydney: Alzheimer’s Australia, 2012:15.

15. Isaac M. G. E. K. N., Isaac M. M., Farina N., Tabet N. Knowledge and attitudes towardsdementia in adolescent students. Journal of Mental Health. 2016;419–425. doi: 10.1080/09638237.2016.1207234 27809625

16. Baste NV, Ghate MR. Prevalence of myths about dementia amongst doctors: A comparison between psychiatrists and non-psychiatrists. Journal of Evidence Based Medicine and Healthcare. 2015;2(9):1263–70.

17. Gintner GG. Differential diagnosis in older adults: dementia, depression, and delirium. Journal of Counseling and Development. 1995;73(3):346–51.

18. Maier W. Distinction of dementia and depression in various stages of the disease process. European Psychiatry. 2016;33.

19. Ahmad Basri M.A.F., Subramaniam P., Ghazali S.E., Singh D.K.A. A review of knowledge and attitudes towards dementia among college and university students. Journal of Clinical and Diagnostic Research. 2017;LE01–LE07.

20. Chapman E. N., Kaatz A., Carnes M. Physicians and implicit bias: How doctors may unwittingly perpetuate health care disparities. Journal of General Internal Medicine. 2013;1504–1510. doi: 10.1007/s11606-013-2441-1 23576243

21. Helmes E, Gee S. Attitudes of Australian therapists toward older clients: Educational and training imperatives. Educational Gerontology. 2003;29(8):657–70.

22. Tomko J. K., Munley P. H. Predicting counselling psychologists attitudes and clinical judgments with respect to older adults. Aging & Mental Health. 2013;233–241. doi: 10.1080/13607863.2012.715141 22913506

23. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). Arlington, VA: American Psychiatric Association; 2013.

24. Woudstra FH, van de Poel‐Mustafayeva AT, van der Ploeg MV, deVries JJ, van der Lek RFR, Izaks GJ. Symptoms mimicking dementia in a 60‐year‐old woman with bipolar disorder: a case report. BMC ResNotes. 2014;7(1):381.

25. Chi S, Wang C, Jiang T, Zhu X-C, Yu J-T, Tan L. The Prevalence of Depression in Alzheimer’s Disease: A Systematic Review and Meta-Analysis. Current Alzheimer Research. 2015;12(2):189–98. doi: 10.2174/1567205012666150204124310 25654505

26. Evans LK, Strumpf NE, Allen-Taylor SL, Capezuti E, Maislin G, Jacobsen B. A clinical trial to reduce restraints in nursing homes. Journal of the American Geriatrics Society. 1997;45(6):675–81. doi: 10.1111/j.1532-5415.1997.tb01469.x 9180659

27. Fitzgerald JT, Wray LA, Halter JB, Williams BC, Supiano MA. Relating medical students’ knowledge, attitudes, and experience to an interest in geriatric medicine. The Gerontologist. 2003;43(6):849–55. doi: 10.1093/geront/43.6.849 14704384

28. Lu WH, Hoffman KG, Hosokawa MC, Gray MP, Zweig SC. First year medical students' knowledge, attitudes, and interest in geriatric medicine. Educational Gerontology. 2010;36(8):687–701.

29. Bardach SH, Rowles GD. Geriatric education in the health professions: Are we making progress? The Gerontologist. 2012;52(5):607–18. doi: 10.1093/geront/gns006 22394495

30. Gellis ZD, Sherman S, Lawrance F. First year graduate social work students’ knowledge of and attitude toward older adults. Educational Gerontology. 2003;29(1):1–16.

31. Gonçalves DC, Guedes J, Fonesca AM, Pinto FC, Martín I, Byrne GJ, et al. Attitudes, knowledge, and interest: preparing university students to work in an aging world. International Psychogeriatrics. 2011;23(2):315–21. doi: 10.1017/S1041610210001638 20843393

32. Williams B, Anderson MC, Day R. Undergraduate nursing students’ knowledge of and attitudes toward aging: Comparison of context-based learning and a traditional program. Journal of Nursing Education. 2007;46(3):115–20. 17396550

33. Carpenter BD, Balsis S, Otilingam PG, Hanson PK, Gatz M. The Alzheimer’s Disease Knowledge Scale: Development and psychometric properties. The Gerontologist. 2009;49(2):236–47. doi: 10.1093/geront/gnp023 19363018

34. Liu Y, While AE, Norman IJ, Ye W. Health professionals’ attitudes toward older people and older patients: A systematic review. Journal of Interprofessional Care. 2012;26(5):397–409. doi: 10.3109/13561820.2012.702146 22780579

35. Scerri A, Scerri C. Nursing students’ knowledge and attitudes towards dementia–A questionnaire survey. Nurse Education Today. 2013;33:962–8. doi: 10.1016/j.nedt.2012.11.001 23182308

36. Tinker A. The social implications of an ageing population. Mechanisms of Ageing and Development. 2002;123:729–35. doi: 10.1016/s0047-6374(01)00418-3 11869730

37. Skinner TR, Scott IA, Martin JH. Diagnostic errors in older patients: a systematic review of incidence and potential causes in seven prevalent diseases. International Journal of General Medicine. 2016;9:137–46. doi: 10.2147/IJGM.S96741 27284262

38. Nelson PT, Jicha GA, Kryscio RJ, Abner EL, Schmitt FA, Cooper G, et al. Low sensitivity in clinical diagnoses of dementia with Lewy bodies. 2010;257(3):359–66.

39. Intrieri RC, von Eye A, Kelly JA. The Ageing Semantic Differential: A confirmatory factor analysis. The Gerontologist. 1995;35(5):616–21. doi: 10.1093/geront/35.5.616 8543218

40. Intrieri RC, Kelly JA, Brown MM, Castilla C. Improving medical students’ attitudes toward and skills with the elderly. The Gerontologist. 1993;33(3):373–8. doi: 10.1093/geront/33.3.373 8325525

41. Stewart T, Roberts E, Eleazer P, Boland R. Reliability and validity issues for two common measures of medical students’ attitudes toward older adults. Educational Gerontology. 2007;32:409–21.

42. Eshbaugh EM. Gaps in Alzheimer’s knowledge among college students. Educational Gerontology. 2014;655–665. doi: 10.1080/03601277.2013.863573

43. James JW, Haley WE. Age and health bias in practicing clinical psychologists. Psychology and Aging. 1995;10(4):610–6. doi: 10.1037//0882-7974.10.4.610 8749588

44. IBM Corp. IBM SPSS Statistics for Windows. 22.0 ed. Armonk, NY: IBM Corp.; 2013.

45. Yates F. Contingency tables involving small numbers and the χ2 test Supplement to the Journal of the Royal Statistical Society. 1934;1(2):217–35.

46. Gekoski WL, Knox VJ. Ageism or healthism? Perceptions based on age and health status. Journal of Ageing and Health. 1990;2(1):15–27.

47. Stallman H. Embedding resilience within the tertiary curriculum: a feasibility study. Higher Education Research & Development. 2011;30(2):121–33.

48. Garcia CA, Reding MJ, Blass JP. Overdiagnosis of dementia. Journal of the American Geriatrics Society. 1981;29(9):407–10. doi: 10.1111/j.1532-5415.1981.tb02379.x 7264133

49. Perlick D, Atkins A. Variations in the reported age of a patient: A source of bias in the diagnosis of depression and dementia. Journal of Consulting and Clinical Psychology. 1984;52(5):812–20. doi: 10.1037//0022-006x.52.5.812 6501666

50. Cheston R, Hancock J, White P. Does personal experience of dementia change attitudes? The Bristol and South Gloucestershire survey of dementia attitudes. Dementia. 2018:1–13.

51. Australian Institute of Health and Welfare. Life expectancy and disability in Australia: Expected years living with and without disability. 2017.

52. Boswell SS. Predicting trainee ageism using knowledge, anxiety, compassion, and contact with older adults. Educational Gerontology. 2012;38(11):733–41.

53. Gonzales E, Morrow-Howell N, Gilbert P. Changing medical students’ attitudes toward older adults. Gerontology & Geriatrics Education. 2010;31(3):220–34.


Článek vyšel v časopise

PLOS One


2019 Číslo 11