Journal of Gerontological Nursing

OLD AGE STEREOTYPING: A Comparison of Nursing Staff Attitudes Toward the Elderly

Barbara A Devine

Abstract

This descriptive study compares the opinions of nursing staff from two geriatric settings in an effort to explore the degree of stereotyping of the elderly.

Many progressive geriatric institutions have attempted to manipulate the total milieu of the residents in an effort to lessen the pernicious effects of institutionalization. It is hoped that new rehabilitative programs will develop networks of formative relationships for the resident. Moreover, in many circumstances "milieu therapy" should instill in the residents feelings of worth and independence that will result in an increase in functional abilities. Nursing staff attitudes must be positive and constructive in an effort to form a therapeutic environment.

The two settings differed in that one institution, a geriatric hospital had initiated milieu therapy, whereas the other, a private nursing home, had not yet set into motion the program, although they were in the planning stages.

Data was collected by using a questionnaire developed by Ontario Welfare Council that measured opinions toward the elderly. A sample size of 97 nursing staff, (registered nurses, certified nursing assistants, and nursing orderlies) were used, most specifically to measure the degree of stereotyping of the elderly.

The results from a three-factor analysis of variance with age as a covariate did not indicate any statistically significant differences in attitudes toward the elderly between the nursing staff in both institutions.

Abstract

This descriptive study compares the opinions of nursing staff from two geriatric settings in an effort to explore the degree of stereotyping of the elderly.

Many progressive geriatric institutions have attempted to manipulate the total milieu of the residents in an effort to lessen the pernicious effects of institutionalization. It is hoped that new rehabilitative programs will develop networks of formative relationships for the resident. Moreover, in many circumstances "milieu therapy" should instill in the residents feelings of worth and independence that will result in an increase in functional abilities. Nursing staff attitudes must be positive and constructive in an effort to form a therapeutic environment.

The two settings differed in that one institution, a geriatric hospital had initiated milieu therapy, whereas the other, a private nursing home, had not yet set into motion the program, although they were in the planning stages.

Data was collected by using a questionnaire developed by Ontario Welfare Council that measured opinions toward the elderly. A sample size of 97 nursing staff, (registered nurses, certified nursing assistants, and nursing orderlies) were used, most specifically to measure the degree of stereotyping of the elderly.

The results from a three-factor analysis of variance with age as a covariate did not indicate any statistically significant differences in attitudes toward the elderly between the nursing staff in both institutions.

Negativism toward old age is the result of beliefs that are factually incorrect. Within the area of social gerontology, older individuals have been traditionally perceived as belonging to a group that has been ascribed negative characteristics.

Although the notion of "stereotype" did not originally begin with the study of the elderly, it has become a central point of view in the explanation of the status and role of the aged in North American society. Seltzer and Atchley' define stereotypes as "sets of beliefs which purport to describe typical members of a category of people, objects, or ideas. These beliefs are then acted upon as if they were true, regardless of the empirical facts." Stereotypes are not necessarily negative or positive, rather these perceptions of a class of people or objects enable individuals to attribute characteristics that give structure to everyday situations. The elderly, however, have had trails of a derogatory nature imposed upon them.

The social roots of old age stereotyping in Western society are deep seated. The condition of the aged in a society depends upon the socioeconomic structure of that country. The aged, as a social category, have been accorded status dependent upon the value system of the society in which they are found. Simone de Beauvoir2 writes, "by the way in which a society behaves towards its old people it uncovers the naked, and often carefully hidden, truth about its real principles and aims."

A shift in the focus of gerontology from the health care system to the broader scope of a general societal concern has been a slow one. It still remains the primary responsibility of health professionals to care for those who have been labeled as no longer productive and must be segregated in special housing or institutions.

This study focuses on the degree of old age stereotyping by nursing staff within two such geriatric settings. The disposal of the old into specialized institutions is a crucial outcome of negativism toward the aged. Society's prejudice of the elderly has a great impact on the staff who are assigned to their care. In some geriatric institutions there is a shift from custodial type settings to rehabilitative programs for the purpose of counteracting the deleterious effects of aging within an institutionalized environment. In spite of this recent trend, these settings are operating within a social system that has attached negative labels such as "senile" and "disoriented" to those for whom these new programs are intended. The health team workers so placed in these more progressive institutions are faced with a cultural double bind. On the one hand they are encouraged to treat the elderly with a positive attitude. Simultaneously, they are aware of societal stereotyping of the elderly as a useless demeaned group.

Working with the elderly has not been considered to be one of the higher status jobs in nursing. However, the trend in the 1980s will continue to be toward changing societal attitudes regarding the elderly. Nurses who deal with the aged in the community and in institutions will be affected by these societal norms.

Because attitudes toward the elderly are becoming more positive, studies have continued to focus on the degree of misperceptions and stereotyping regarding old people.

It is nevertheless important to explore to what extent the values of the institution may bean important factor in contributing toward lessening the degree of old age stereotyping. To answer this question, attitudes of nursing staff toward the elderly in two geriatric settings will be compared and analyzed.

Literature Review

Stereotyping by Social Theorists

Throughout the history and evolution of social gerontology there have emerged various lines of inquiry. Most of the research from the 1930s to the 1950s was atheoretical, the research being primarily of a descriptive nature. In the 1960s, with great medical advances raising the life expectancy of Western society, social scientists were quick to recognize that the elderly were about to become a serious concern in the last half of the century. It was common practice at this time to stereotype the elderly. It was generally assumed that mental deterioration accompanied the aging process, which rendered the aged incapable of remaining productive members of society.

In the 1950s and 1960s theory construction began with great vigor. The most important of these was the disengagement approach of Cumming and Henry.6 Modified by Neugarten7 and Williams and Wirths,* this functionalist perspective maintains that the elderly are excluded from roles and status by a process in which there is an increased social and psychological distancing; the roles and status can then be occupied by younger persons. The importance of disengagement theory to the field of social gerontology cannot be estimated. It became a catchall for the problems facing the elderly.

New theories were developed and modified. The earlier activity theory of Havighurst and Albrecht,9 which considered the type of activities an individual was engaged in as a precursor to the aging process, was expanded to the continuity theory. I0~13 This orientation emphasized studying life style patterns of the elderly in an effort to understand the aging process.

All of these theories assumed an individualistic character. It was implied that the elderly themselves were responsible for the social consequences of aging; the structure of society was not seen as accountable. This microscopic view tended to be primarily responsible for the methodology of the social psychological studies that followed. They too reinforced the negative status that demeaned and stereotyped the elderly as a social category.

Memory function and aging was a very popular concern in the 1960s, much of the research being carried out with institutionalized elderly. The interest in the "deficits" of the elderly provided momentum toward utilizing a battery of tests for memory, judgment, perceptions, and adaptations. A never ending supply of subjects was available in institutions and communities of bored, captive, elderly people. This led to the beginning of some of the most intensive tests ever given to a particular group of people since the intelligence tests given to children.

A literature review cites some of the following tests given to as many elderly as could possibly be examined: Revised Babcock Test of Mental Efficiency, Berkeley Growth Study, Owen's Army Alpha scores, The Time Metaphor Test, Digit Span, WAIS Information, Spelling Backwards. . .the list appears endless. Social psychologists tested and modified theories dependent upon the results from data.

The newer trend in social gerontology has been toward a macroscopic orientation. Conflict theorists, for example, are beginning to develop theories that suggest that a broader societal view must be advanced before the social conditions of the aged can be understood.14

Nonsupporti ve environments for the elderly will be slower to change if the aged themselves remain ignorant of their own potentialities and self-worth.

There are many studies that suggest that not only are the elderly perceived by others to be a demeaned group, but older people themselves have the most negative attitudes of aging.15'9

A study by Labouvie-Vief and Baltes20 found that after a training period, adolescents tended to view the elderly more favorably. Younger persons appear to attribute more negative characteristics to the elderly than middle-age persons.

Keith21 suggests that the attitudes of professionals affect not only social policy but the quality of care that clients in geriatric settings will receive. Futrell and Jones22 maintain that health professionals do not have positive attitudes toward the elderly. Their study of physicians, nurses, and social workers using correlates of years of experience, age, and education, found that nurses with longer work experience with the elderly portrayed more favorable attitudes.

There are varying degrees of treatment and care available in different types of geriatric settings. Some institutions have developed programs intended to counteract the disintegrative processes of sociopsychological aging. Others give only custodial type treatment to the clients. Most of the more innovative have developed programs intended to change disoriented behavior of the aged.

In the late 1960s the University of Michigan, Institute of Gerontology, devised a treatment program entitled "milieu therapy" that utilizes the total environment, including physical surroundings, and a program of activities to provide an environment in which the resident has opportunities for life continuity. Milieu therapy has been written about extensively.23"26

Residents are now being taught to interact, make decisions with regard to their social environment, and think of themselves as being of social worth in this new therapeutic environment. Simultaneously, it is expected that nurses' attitudes will change; milieu therapy will foster positive attitudes toward the aged.

The Study

The Setting and Population

The data for this study were taken from a larger study that was being conducted in six geriatric units of a government funded veterans hospital. For the purpose of this paper, data were also collected from the nursing staff of a privately owned nursing home.

The settings differ in various ways. The governmentoperated hospital has a client population that is primarily male and all of the residents are veterans. Several years ago the units were modernized to become more homelike, colorful, and convenient to staff and patients. The physical structure of the building was reconstructed as an important component of the new milieu therapy program. Nursing staff have been encouraged to become leaders and teachers of the residents in lieu of their previously defined roles as caretakers of the elderly. As a result, the old system of stereotyping the aged as senile and useless has become antithetical to the program.

The nursing home is an attractive modern building that houses both male and female residents. The surroundings are pleasant and spacious. As a program treatment, milieu therapy was only in the planning stages but had been discussed frequently with all nursing staff.

Nursing staff in both settings consists of registered nurses, certified nursing assistants, and nursing orderlies. They vary in age, education, sex, and nursing experience.

Study Design

An instrument,* developed by Ontario Welfare Council, Section on Aging, was administered to a random sample of 50 nursing staff in the governmentoperated hospital, and the total nursing staff of the privately operated hospital. (Response rate was 70%. This resulted in 47 responses.) A portion of this instrument deals specifically with stereotyping of the elderly. The questionnaire has been used extensively throughout Canada and the US to measure the opinions of health professionals about the aged.

Table

TABLE ITHREE-FACTOR ANALYSIS OF VARIANCE OF ATTITUDE SEVEN BY POPULATION, EDUCATION, OCCUPATION WITH AGE AS A COVARIABLE

TABLE I

THREE-FACTOR ANALYSIS OF VARIANCE OF ATTITUDE SEVEN BY POPULATION, EDUCATION, OCCUPATION WITH AGE AS A COVARIABLE

FIGURE 1

FIGURE 1

Table

TABLE IIA COMPARISON OF RANGE OF SCORES FOR ATTITUDE SEVEN FOR TWO POPULATIONS*

TABLE II

A COMPARISON OF RANGE OF SCORES FOR ATTITUDE SEVEN FOR TWO POPULATIONS*

Hypotheses

Because it is postulated that there is a cultural double bind for the nursing staff that is caused by a conflict between society and the institution, it is hypothesized that there will be a high degree of uncertainty with regard to socially described traits of the elderly. Because the nursing staff in both settings have developed a value set indicative of a desire to change care for the elderly, it is further hypothesized that there will be similarities in attitudes of both populations toward the elderly in spite of the greater progress in development of milieu therapy in one setting.

Data Analysis

Data were subjected to statistical analysis by computer in relation to a three-factor (hospital, education, and occupation) analysis of variance with age as a co variate.

The instrument consists of seven attitude dimensions. They are: (1) realistic toughness (verging on cynicism) toward aging; (2) denial of the effects of aging; (3) anxiety about aging; (4) social distance to (or self-contempt of) the old; (5) family responsibility; (6) public responsibility for the rights and well-being of the aged vs unconcern for the aged as a group; and (7) unfavorable stereotype of the old (as inferior) vs acceptance of the old as equals.

All of the seven attitudes were computed for differences between two populations by means of a ttesl.

Scattergrams were obtained for the values of attitude seven vs age, education, and occupation (respectively). There was very little indication of the attitude seven score changing with these variables.

Results

The results from a three-factor analysis of variance with age as a covariate did not indicate any statistically significant difference in altitudes toward the elderly between the nursing staff in both institutions. This study was, however, most particularly interested in attitude seven (Table I).

As with all of the attitudes, Table I did not indicate that there are significant differences in attitudes between the two populations.

A t-test for attitude seven again revealed that the two groups did not significantly differ (t value = -1.08, DF 95, p-values (ANOVA) = 283).

Attitudes regarding stereotyping included such questions as: "You can't expect old people to exert themselves," and "Retired people are happiest in the company of people who are their own age."

The respondent signifies agreement or disagreement by circling some number between one and nine. An example of this scale is as outlined in Figure 1. The range of scores for most altitudes centered in the intermediary (uncertain) action of the scale.

Discussion

Total population scores on strong negative stereotyping of the elderly were low (8). While the findings were not significant in terms of differences between the attitudes of the two populations, there was a tendency for the total population to focus around the intermediary position on the scale (Table II). This could indicate that the majority of the population are somewhat uncertain as to whether the elderly have positive or negative social desirability traits or, the resondents could have difficulty with the semantics of the instrument.

Variables considered as possible correlates toward attitudes of the elderly did not support relationships. However, it is probable that there are commonalities of values between nursing staffs of both settings. Although population one had not yet initiated milieu therapy, plans were underway to begin the program. The fact that this nursing home was receptive to the idea of rehabilitation for the elderly probably was related to the progressive values and attitudes among the staff at the outset. Bell,27 compared the data on attitudes of population before and after beginning milieu therapy. Using the Tuckmann-Lorge attitude scale, similar patterns to this study were found, that is, in her study attitudes did not change after milieu therapy had been put into effect. Similarly in this study attitudes were not different in two populations, one of whom had initiated change while the other planned to change. Most likely, staff who have a sincere desire to improve the quality of life for the institutionalized geriatric resident had developed value sets that were conducive to progressive programs.

The data tend to support the hypothesis that there are similarities in the degree of stereotyping of the elderly in both settings and that there is a high degree of responses in the intermediary range as a result of a cultural double bind for the nursing staff. It is difficult, however, to rule out the possibility of confusion with the semantics of the instrument. It is also possible that the respondents avoided extreme ends of the scale in an effort to remain "safe." It is recognized that attitude research has been plagued with the problem of whether the respondents are indicating their actual opinions or those that are considered to be socially desirable. Moreover, it is often erroneously assumed that there is consistency between attitudes and behavior. Further studies in this area should focus on a change in methodology from questionnaires to observations to gain richer insights into the relationship between attitude and behavior.

References

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TABLE I

THREE-FACTOR ANALYSIS OF VARIANCE OF ATTITUDE SEVEN BY POPULATION, EDUCATION, OCCUPATION WITH AGE AS A COVARIABLE

TABLE II

A COMPARISON OF RANGE OF SCORES FOR ATTITUDE SEVEN FOR TWO POPULATIONS*

10.3928/0098-9134-19800101-07

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