Full Project – KNOWLEDGE, ATTITUDE AND PRACTICE OF CARE OF THE ELDERLY PATIENTS AMONG HEALTH WORKERS

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 ABSTRACT

The increasing global ageing population has resulted in a corresponding rise in age-related health conditions, creating a growing demand for specialized healthcare services for elderly patients. In developing countries, including Nigeria, the challenges associated with elderly care are intensified by limited geriatric healthcare services, inadequate specialized training, and increasing pressure on healthcare systems. This study assessed the knowledge, attitude and practice of care of elderly patients among health workers in University of Calabar Teaching Hospital, Calabar, Cross River State. The specific objectives of the study were to: determine the level of knowledge of health workers regarding the physical, emotional, and social care needs of elderly patients; assess the attitude of health workers towards elderly patient care; determine the practices of health workers in providing care for elderly patients; and identify factors influencing health workers’ attitudes and practices towards elderly patient care. The study adopted a cross-sectional descriptive survey design. The population of the study consisted of 1,023 health workers, comprising 402 doctors, 600 nurses, 10 dentists, and 11 physiotherapists who provided direct clinical care to elderly patients in University of Calabar Teaching Hospital, Calabar. A sample size of 461 health workers was selected for the study. Data were collected using a structured questionnaire divided into five sections covering socio-demographic characteristics, knowledge, attitude, practice, and factors influencing elderly patient care. The validity of the instrument was established by experts in Nursing Science and Measurement and Evaluation, while reliability was determined using the test-retest method, yielding a reliability coefficient of 0.91. Data collected were analysed using frequency, percentage, mean, standard deviation, and Chi-square statistics. A criterion mean of 2.50 was used for decision-making, while the hypothesis was tested at the 0.05 level of significance. The findings revealed that health workers possessed a high level of knowledge regarding the physical, emotional, and social care needs of elderly patients, with a grand mean score of 3.36. The study also showed that health workers demonstrated positive attitudes towards elderly patient care, with a grand mean score of 3.39. Furthermore, the findings indicated that health workers exhibited good practices in providing care for elderly patients, with a grand mean score of 3.23. Factors such as adequate geriatric training, availability of hospital resources, and years of professional experience were identified as major influences on healthcare workers’ attitudes and practices towards elderly patient care, with a grand mean score of 3.42. The hypothesis test revealed a statistically significant association between years of professional experience and health workers’ attitudes towards elderly patient care (p < 0.05). The study concluded that health workers in University of Calabar Teaching Hospital possess adequate knowledge, positive attitudes, and appropriate practices in caring for elderly patients. However, continuous professional development, improved geriatric education, and better availability of healthcare resources are necessary to sustain and improve the quality of elderly healthcare services. The study recommended regular geriatric training programmes for healthcare workers, establishment of elderly-friendly healthcare policies, provision of adequate healthcare resources, and integration of gerontology education into medical and nursing training programmes.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Ageing is a natural biological process characterized by progressive changes in physical, psychological, and social functioning that occur throughout the lifespan. It represents a stage of human development associated with gradual decline in physiological capacity, increased vulnerability to diseases, and changing social roles. Although ageing is often associated with functional limitations and chronic health conditions, it is not a disease condition but a normal phase of life requiring appropriate support and healthcare interventions to promote healthy ageing and quality of life (World Health Organization [WHO], 2022). The increasing number of older adults globally has created significant challenges for healthcare systems, particularly in developing countries where healthcare resources and specialized geriatric services remain limited.

The global population is experiencing a remarkable demographic transition, with the proportion of older persons increasing rapidly. According to the United Nations (2023), the number of people aged 60 years and above is projected to increase from about 1 billion in 2020 to approximately 2.1 billion by 2050. This demographic shift is driven by improved healthcare services, declining fertility rates, and increased life expectancy. However, the rapid growth of the elderly population has resulted in increased demand for healthcare services, as older adults are more likely to experience multiple chronic illnesses, disabilities, and age-related health complications requiring continuous and specialized care (Beard et al., 2016).

In developing countries, including Nigeria, population ageing is becoming an emerging public health concern. Historically, ageing was perceived as a challenge mainly affecting developed countries; however, current demographic trends indicate that low- and middle-income countries are experiencing the fastest growth in elderly populations. Nigeria, as the most populous country in Africa, has witnessed a steady increase in the number of older persons. The National Population Commission (NPC) and other demographic reports indicate that Nigerians aged 60 years and above constitute a growing proportion of the population, creating the need for adequate healthcare planning and policies targeted toward elderly care (National Bureau of Statistics [NBS], 2020). Despite this demographic reality, geriatric healthcare services in Nigeria remain insufficient due to limited awareness, inadequate training of healthcare providers, and weak institutional structures for elderly care.

Care of elderly patients involves a comprehensive approach aimed at addressing the physical, psychological, emotional, social, and spiritual needs of older adults. Elderly care extends beyond the management of diseases to include assistance with activities of daily living, prevention of disability, promotion of independence, and enhancement of overall well-being. Effective elderly care requires healthcare workers to possess adequate knowledge, positive attitudes, and appropriate clinical practices that recognize the unique needs of older patients (WHO, 2019). Healthcare workers play a central role in ensuring that elderly patients receive compassionate, respectful, and evidence-based care.

Knowledge among healthcare workers is a critical factor influencing the quality of care provided to elderly patients. Adequate knowledge enables healthcare professionals to understand age-related physiological changes, recognize common geriatric conditions, and implement appropriate interventions. However, studies have shown that many healthcare workers, particularly in developing countries, have inadequate exposure to geriatric education and training during their professional preparation (Musa et al., 2021). Limited knowledge of ageing processes and elderly healthcare needs may contribute to misconceptions, poor assessment practices, and inadequate management of elderly patients.

The attitude of healthcare workers toward elderly patients significantly affects the quality of interaction and care provided. Positive attitudes encourage respectful communication, empathy, patience, and individualized care, while negative attitudes may result in neglect, discrimination, and age-related stereotypes. Ageism, which refers to prejudice, stereotyping, or discrimination against individuals based on age, remains a challenge within healthcare settings worldwide. Older adults may experience reduced attention, inadequate communication, or assumptions that their health problems are simply consequences of ageing rather than treatable conditions (Officer et al., 2020). Therefore, developing positive attitudes among healthcare workers is essential for improving elderly patients’ healthcare experiences.

Healthcare workers’ practices in caring for elderly patients reflect the application of their knowledge and attitudes in clinical settings. Appropriate elderly care practices include comprehensive assessment, effective communication, pain management, prevention of complications, nutritional support, medication management, and promotion of functional independence. However, evidence suggests that elderly care practices in many Nigerian healthcare institutions face challenges such as inadequate staffing, limited geriatric facilities, insufficient training, and high workload among healthcare providers (Abdullahi et al., 2022). These challenges may affect the ability of healthcare workers to provide holistic and patient-centred care for older adults.

The Nigerian healthcare system faces increasing pressure to respond effectively to the healthcare needs of its ageing population. Unlike some developed countries where geriatric medicine is well established as a specialized field, Nigeria has limited geriatric units and few healthcare professionals with specialized training in elderly care. Most elderly patients receive care within general medical settings where healthcare workers may have varying levels of knowledge and experience in gerontology and geriatrics (Ogunniyi & Faluyi, 2019). Consequently, assessing the knowledge, attitudes, and practices of healthcare workers is important for identifying existing gaps and developing strategies for improving elderly healthcare delivery.

Healthcare workers’ demographic characteristics and professional experiences may also influence their approach to elderly care. Factors such as age, years of professional experience, educational background, previous exposure to elderly patients, and availability of institutional support may affect healthcare workers’ perceptions and practices. Experienced healthcare workers may develop better understanding and confidence in managing elderly patients, while those with limited exposure may require additional training and professional development opportunities (Kydd et al., 2018).

The University of Calabar Teaching Hospital (UCTH), Calabar, Cross River State, serves as a major tertiary healthcare institution providing specialized medical services to patients, including elderly persons. As the elderly population continues to increase, healthcare workers within the institution are expected to provide appropriate and compassionate care to older adults. Understanding the level of knowledge, attitude, and practice of healthcare workers regarding elderly care is therefore essential for identifying strengths, weaknesses, and areas requiring improvement.

This study is therefore designed to assess the knowledge, attitude, and practice of care of elderly patients among health workers in University of Calabar Teaching Hospital, Calabar, Cross River State. The findings of the study will provide valuable information for improving healthcare workers’ capacity, strengthening elderly healthcare services, and promoting better health outcomes among the ageing population.

1.2 Statement of the Problem

The increasing number of elderly persons globally and in Nigeria has created a growing demand for healthcare services that are responsive to the unique physical, psychological, social, and emotional needs of older adults. Although ageing is a normal stage of life, elderly individuals experience increased risks of chronic diseases, reduced functional ability, multiple health conditions, and dependence on healthcare services. Consequently, healthcare workers are expected to possess adequate knowledge, demonstrate positive attitudes, and practice appropriate approaches to elderly care to ensure improved health outcomes and quality of life among older patients (World Health Organization [WHO], 2022).

Despite the importance of quality elderly care, evidence suggests that healthcare systems in many developing countries, including Nigeria, are not adequately prepared to address the increasing healthcare needs of the ageing population. The Nigerian healthcare system continues to experience challenges such as inadequate geriatric care structures, limited availability of specialized elderly care services, insufficient training in gerontology, and shortage of healthcare workers with expertise in managing age-related conditions (Ogunniyi & Faluyi, 2019). These challenges may negatively influence the quality of care provided to elderly patients and contribute to poor health outcomes among this vulnerable population.

Healthcare workers’ knowledge of elderly care is a major determinant of effective healthcare delivery. Inadequate knowledge regarding ageing processes, common geriatric syndromes, psychological needs, and appropriate management approaches may result in inappropriate clinical decisions, poor communication, and ineffective interventions. Although healthcare workers encounter elderly patients frequently in hospitals and clinics, many may not have received sufficient education or specialized training in geriatric healthcare during their professional preparation (Kydd et al., 2018). This knowledge gap may affect their confidence and competence in providing comprehensive care to older adults.

Furthermore, attitudes held by healthcare workers toward elderly patients can influence the nature and quality of healthcare interactions. Negative perceptions, stereotypes, and age-related discrimination may result in reduced attention to elderly patients’ needs, poor communication, and inadequate involvement of older adults in decisions concerning their health. Although many healthcare workers demonstrate compassion and willingness to support elderly patients, factors such as workload, limited resources, and misconceptions about ageing may affect their attitudes and commitment to elderly care (Officer et al., 2020).

In addition, healthcare workers’ actual practices in caring for elderly patients remain an area of concern. Effective elderly care requires regular assessment of physical functioning, emotional well-being, nutritional status, medication use, mobility, and social support systems. However, inadequate staffing, limited institutional support, lack of geriatric protocols, and insufficient training opportunities may prevent healthcare workers from implementing comprehensive elderly care practices. This situation may result in elderly patients receiving care that focuses mainly on disease treatment rather than holistic management of their overall well-being.

At the University of Calabar Teaching Hospital (UCTH), Calabar, elderly patients constitute part of the population requiring healthcare services from doctors, nurses, dentists, physiotherapists, and other healthcare professionals. However, there is limited empirical information regarding the level of knowledge, attitudes, and practices of healthcare workers concerning elderly patient care within the institution. Without adequate evidence, it becomes difficult for healthcare administrators and policymakers to design appropriate training programmes, improve service delivery, and strengthen elderly healthcare practices.

Previous studies conducted in different settings have examined healthcare workers’ knowledge, attitudes, and practices regarding elderly care; however, many have focused on specific professional groups such as nurses or have been conducted outside the Nigerian tertiary healthcare context. There remains a need for institution-specific evidence that captures the experiences and practices of different categories of healthcare workers who provide direct clinical care to elderly patients. Understanding these factors in UCTH will provide a clearer picture of existing strengths and gaps in elderly care delivery.

Therefore, this study seeks to assess the knowledge, attitude, and practice of care of elderly patients among health workers in University of Calabar Teaching Hospital, Calabar, Cross River State. The study will provide evidence that can guide healthcare training, policy development, and interventions aimed at improving the quality of elderly healthcare services.

1.3 Aim of the Study

The aim of this study is to assess the knowledge, attitude, and practice of care of elderly patients among health workers in University of Calabar Teaching Hospital, Calabar, Cross River State.

1.4 Specific Objectives of the Study

The specific objectives of the study are to:

1. Determine the level of knowledge of health workers regarding the physical, emotional, and social care needs of elderly patients in University of Calabar Teaching Hospital, Calabar.
2. Assess the attitude of health workers towards the care of elderly patients in University of Calabar Teaching Hospital, Calabar.
3. Determine the practices of health workers in providing care for elderly patients in University of Calabar Teaching Hospital, Calabar.
4. Identify factors influencing health workers’ attitudes and practices towards the care of elderly patients in University of Calabar Teaching Hospital, Calabar.

1.5 Research Questions

The study will answer the following research questions:

1. What is the level of knowledge of health workers regarding the physical, emotional, and social care needs of elderly patients in University of Calabar Teaching Hospital, Calabar?
2. What is the attitude of health workers towards the care of elderly patients in University of Calabar Teaching Hospital, Calabar?
3. What are the practices of health workers in providing care for elderly patients in University of Calabar Teaching Hospital, Calabar?
4. What factors influence health workers’ attitudes and practices towards elderly patient care in University of Calabar Teaching Hospital, Calabar?

1.6 Research Hypothesis

The following null hypothesis will be tested at 0.05 level of significance:

H₀: There is no significant association between years of professional experience of health workers and their attitude towards care of elderly patients in University of Calabar Teaching Hospital, Calabar.

1.7 Significance of the Study

The study on knowledge, attitude, and practice of care of elderly patients among health workers in University of Calabar Teaching Hospital, Calabar is significant because it will provide empirical evidence on the preparedness and capacity of healthcare workers in addressing the healthcare needs of the ageing population. As the number of elderly persons continues to increase, understanding healthcare workers’ knowledge, perceptions, and practices becomes essential for improving the quality and effectiveness of elderly healthcare services.

The findings of this study will be beneficial to healthcare workers by identifying existing gaps in their knowledge, attitudes, and practices regarding elderly patient care. The results may encourage healthcare professionals to improve their understanding of geriatric healthcare principles, adopt patient-centred approaches, and enhance their commitment to providing compassionate and comprehensive care for older adults. The study may also highlight areas where continuous professional development and specialized training are required.

The study will be useful to healthcare administrators and management of University of Calabar Teaching Hospital by providing information that can support decision-making regarding elderly healthcare services. The findings may assist hospital administrators in developing appropriate training programmes, establishing geriatric care protocols, improving healthcare infrastructure, and creating supportive working environments that enable healthcare workers to provide effective care for elderly patients.

Furthermore, the study will be valuable to health policymakers and government agencies involved in healthcare planning and elderly welfare. Evidence generated from the study may contribute to the formulation and implementation of policies aimed at strengthening geriatric healthcare services in Nigeria. It may also emphasize the need for integrating elderly care education into healthcare professional training programmes and improving national preparedness for population ageing.

The study will benefit elderly patients and their families by contributing to improved healthcare practices and better understanding of their unique healthcare needs. When healthcare workers possess adequate knowledge and positive attitudes toward elderly care, older adults are more likely to receive respectful, dignified, and holistic healthcare services that promote independence and quality of life.

The findings will also be useful to educational institutions and healthcare training programmes such as schools of nursing, medicine, physiotherapy, and other health-related disciplines. The study may provide evidence supporting the inclusion or strengthening of gerontology and geriatric care courses within healthcare education curricula. This will help prepare future healthcare professionals to effectively respond to the growing healthcare demands of older adults.

Additionally, the study will contribute to the existing body of knowledge in the field of gerontology and healthcare delivery, particularly within the Nigerian context. Researchers, students, and scholars interested in elderly healthcare, healthcare workers’ behaviour, and geriatric nursing may find the study useful as a reference material for further studies.

1.8 Scope of the Study

This study focuses on assessing the knowledge, attitude, and practice of care of elderly patients among health workers in University of Calabar Teaching Hospital (UCTH), Calabar, Cross River State.

The study will specifically examine healthcare workers’ knowledge regarding the physical, emotional, and social care needs of elderly patients. It will also assess their attitudes toward elderly patients, including their perceptions, beliefs, willingness to provide care, and level of empathy when attending to older adults. Furthermore, the study will evaluate healthcare workers’ practices in providing care for elderly patients, including assessment, communication, treatment support, and other aspects of elderly healthcare delivery.

The study population will consist of health workers who provide direct clinical care to elderly patients in University of Calabar Teaching Hospital. These will include doctors, nurses, dentists, and physiotherapists. The study will involve a population of 1,023 healthcare workers comprising 402 doctors, 600 nurses, 10 dentists, and 11 physiotherapists, from which a sample size of 461 respondents will be selected using the Taro-Yamane formula.

The study will also examine factors that influence healthcare workers’ attitudes and practices toward elderly care, including years of professional experience, age, training exposure, and workplace-related factors. The study will be conducted within University of Calabar Teaching Hospital, Calabar, Cross River State.

1.9 Operational Definition of Terms

Ageing: Ageing refers to the natural biological, psychological, and social process of growing older, which is associated with gradual changes in body functions, increased vulnerability to diseases, and changing healthcare needs.

Elderly Patients: Elderly patients refer to individuals who are generally aged 60 years and above and require healthcare services due to age-related conditions, chronic illnesses, or functional limitations.

Care of Elderly Patients: Care of elderly patients refers to the comprehensive healthcare services provided to older adults to address their physical, emotional, psychological, social, and spiritual needs while promoting dignity, independence, and quality of life.

Health Workers: Health workers refer to healthcare professionals involved in providing direct clinical care to patients, including doctors, nurses, dentists, and physiotherapists in University of Calabar Teaching Hospital, Calabar.

Knowledge: Knowledge refers to the level of understanding and awareness possessed by health workers regarding ageing processes, elderly healthcare needs, and appropriate approaches to providing care for elderly patients.

Attitude: Attitude refers to the beliefs, perceptions, feelings, and behavioural tendencies of health workers toward elderly patients and their care.

Practice: Practice refers to the actions, behaviours, and professional activities performed by health workers in the provision of healthcare services to elderly patients.

Geriatric Care: Geriatric care refers to specialized healthcare services focused on promoting health, preventing diseases, managing age-related conditions, and improving the quality of life of older adults.

Health Workers’ Experience: Health workers’ experience refers to the length of time healthcare professionals have spent working in their respective healthcare professions and providing patient care.

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