There is unprecedented growth in the number and proportion of older adults in the United States and many countries around the globe (Centers for Disease Control and Prevention, 2014). Consequently, there is an increased need for specialists in geriatrics across health professions. According to a recent report by the American Geriatrics Society (2013), fewer than 5% of RNs, social workers, and psychologists specialize or are certified in geriatrics, and few graduates of medical schools pursue advanced training in geriatrics. A small percentage of advanced practice nurses are licensed gerontological nurse practitioners (John A. Hartford Foundation, 2014). Based on the projected needs for the health care workforce, a focused effort on recruiting and retaining geriatric specialists is needed (Institute of Medicine, 2008; John A. Hartford Foundation, 2014; Mion, 2003). A clear understanding of the factors associated with interest in working with older adults is needed to develop curricula that promote specialization in geriatrics.
Several researchers have examined predictors of interest in working with older adults among the general undergraduate population. In their study of undergraduate students from three colleges, representing a variety of majors, Robert and Mosher-Ashley (2000) found that experience in taking care of an older adult during childhood was significantly associated with a desire to work with older adults. Eshbaugh, Gross, and Satrom (2010) found that previous work and volunteer experience, as well as self-rated quality of relationships with unrelated older adults were significant predictors of interest. In addition to the quality of formal contact with older adults, Bergman, Erickson, and Simons (2014) noted that coursework on aging, frequency of contact, and ageism were all related to interest in careers in geriatrics.
Researchers also have examined predictors of interest in geriatrics among health science students from professional programs including nursing, psychology, social work, and medicine. Studies focused on graduate social work students have uncovered that amount of contact, degree of rewarding experiences with older adults, and self-perceptions of skill level in working with older adults were significant predictors (Cummings & Galambos, 2002). Following graduation, many of the same factors persisted with regard to predicting employment in a geriatric setting including self-rated knowledge and skill level in geriatric practice, the frequency and quality of prior contact with older adults, and participation in gerontology courses and internships (Cummings, Galambos, & DeCoster, 2003). Koder and Helmes (2008) reported similar findings among postgraduate psychology students with regard to the importance of internships and confidence in skill level related to working with older adults. Although they found that the amount and quality of contact with older adults was not a significant predictor of interest level, noteworthy is that students were asked about contact with older family members, friends, and acquaintances rather than experiences with older adults in work and volunteer settings.
Among medical students, having a positive attitude toward older adults and having cared for an older person prior to attending medical school were associated with greater interest in geriatric medicine (Fitzgerald, Wray, Halter, Williams, & Supiano, 2003). A systematic review examining attitudes of nurses and nursing students toward older adults showed conflicting results with regard to the relevance of demographic factors (Liu, Norman, & White, 2013). However, consistent with the study by Fitzgerald et al. (2003), preference for work with older adults was related to positive attitudes toward older adults. Knowledge related to aging also was associated with interest in geriatric nursing practice (Lamet, Sonshine, Walsh, Molnar, & Rafalko, 2011).
Previous studies have focused on either undergraduate students regardless of professional interests or students enrolled in a specific professional program. In the current study, students with a variety of professional interests in the health sciences were included. Although previous studies have examined the role of age stereotypes, further examination of this construct (i.e., positive versus negative images of older adults) have not been explored, nor has the timing of interactions with older adults been considered.
The current study is based on the theoretical principles of Super’s vocational development theory (1953, 1980). According to Super, a person’s abilities, interests, and personalities make that individual qualified for a number of professions. In addition, an individual’s vocational preferences and competencies change with time and experience. Career development is viewed as stage-specific and includes exploration, establishment, maintenance, and decline. Development through these stages can be guided through reality testing and by the development of the self-concept. Role-playing, through both fantasy and real-life activities in school, work, and entry-level jobs, can contribute to self-concept development and career development (Super, 1953). Decision points in an individual’s career reflect encounters with a variety of personal (e.g., attitudes, interests, and specific aptitudes) and situational (e.g. employment, family, and school) determinants (Super, 1980). Previous studies examining factors that affect choice of specialization among health science students support the premise that both situational (e.g., experiences during training, role models, and financial status) and personal factors (e.g., values and interests) can have a significant impact on choice of practice specialization (Ward, Kamien, & Lopez, 2004; Xu et al., 1996).
The current study explored the importance of specific determinants as well as the timing of exposure on career interests and specialization in health sciences. Given that Super’s theory (1953, 1980) highlights the importance of both personal (e.g., attitudes) and situational factors (e.g., work experience), the relationship between interest in working with older adults and a number of factors, such as ethnicity, age, education level, and amount of contact with older adults, was explored. However, the focus of the analysis was on factors amenable to change through educational practices. Based on previous studies, it was hypothesized that image of older adults, as well as current and past amount of contact with older adults, would be significant predictors of college students’ interest level in working with older adults.
In this cross-sectional pilot study, baseline and pretest data (demographics and outcome measures) from an intervention study were used. Outcomes for the intervention study are reported elsewhere (Chippendale & Boltz, 2015a, 2015b). Prior to initiation of the study, an institutional review board application was submitted, and the study met the criteria for exemption. A simultaneous multiple regression analysis was used. A power analysis using a medium to large effect size revealed that for three predictors, a sample size of 44 participants was needed.
Forty-five students were recruited for the original intervention study from two universities and two community colleges. Inclusion criteria were: age 18 or older, English speaking, and either currently enrolled or planning to enroll in a health science program. Students were primarily in prehealth (i.e., students working on prerequisites for health science programs), premedical or postbaccalaureate programs (i.e., students with a bachelor’s degree working on prerequisites for medical school but not a graduate degree). However, medicine, nursing, graduate social work, and undergraduate applied psychology students also were enrolled. Student participants self-selected into the study.
Participant Demographics. The baseline questionnaire, which was developed by the author, included data on age, ethnicity, and education, as well as past and current type (i.e., none, family only, work/volunteer only, or family and work/volunteer) and amount of interaction with older adults (i.e., less than monthly, monthly, weekly, or daily).
Positive and Negative Perceptions of Older Adults. The Image of Aging Scale (Levy, Kasl, & Gill, 2004), which consists of Positive Image and Negative Image of Aging subscales, was used to measure perceptions of older adults. This measure was validated among older adult participants but was designed to be used with both the targets (older adults) and targeters (the young and older adults) of age stereotypes. Each subscale contains nine items, and the scores range from 0 to 54 on both subscales. In a sample of 20 individuals, test-retest reliability was demonstrated to be 0.92 for the negative image subscale and 0.79 for the positive image subscale during a 1-week period. In a sample of 68 individuals, Cronbach’s alpha was 0.84 for the positive images and 0.82 for the negative images subscales (Levy et al., 2004).
Interest in Working With Older Adults. Three Likert-type questions, designed by the author, were used to measure interest in working with older adults. The first question asked students to respond to the statement, “I am interested in working with older adults in a professional capacity,” using a scale that ranged from strongly disagree to strongly agree. The second question asked participants, “How would you rate your interest level in working with older adults on a scale of 0 (no interest) to 10 (strong interest)?” The third question asked students, “How likely are you to choose to specialize in working with older adults on a scale ranging from very unlikely to very likely?” Responses for the first and third questions were recoded into a numerical score ranging from 0 to 4, with a higher number indicating a stronger interest. A composite score was established for interest level by combining the scores from all three questions. Cronbach’s alpha for this three-item measure was 0.78, demonstrating strong internal consistency.
Super’s theory (1953, 1980) postulates that both personal and situational factors affect career development. Therefore, correlation matrices were used to examine the relationship between interest in working with older adults and the following factors: age, gender, ethnicity, education level, past and current amount of interaction, type of interaction (family, paid or volunteer work, or both), and positive and negative images of older adults. Data were analyzed using SPSS® version 21 with a significance level of p < 0.05. Multiple regression analysis then was used and squared part correlations were used to determine the unique contribution and importance of each predictor variable.
Descriptive statistics revealed that the majority of participants were women (n = 38, 84.4%) and were pursuing an undergraduate degree (n = 28, 62.2%). However, recent college graduates (n = 1, 2.2%) as well as students in graduate (n = 8, 17.8%), postbaccalaureate (n = 4, 8.9%), and community college programs (n = 4, 8.9%) also were enrolled in the study. Mean (SD) age of students was 22.5 (5.2). Although the largest percentage of participants was Caucasian (n = 18, 40%), different ethnicities were represented, including Asian, Middle Eastern, African American, and Hispanic. The majority of participants (n = 25, 55.6%) reported interacting with older adults on a less than monthly basis. On the composite measures of interest in working with older adults (i.e., the total score for the three-item measure described previously), the mean (SD) score was 12.3 (3.8), with a range of 1 to 18.
According to correlation matrices, there was a significant correlation between interest in working with older adults and positive images of older adults(r = 0.41, p < 0.01), and current amount of interaction with older adults (r = 0.36, p < 0.02). Negative images of older adults, past amount of interaction with older adults, gender, ethnicity, education level, and type of interaction were not significantly correlated with interest level. Age was correlated with interest in working with older adults (r = 0.35, p = 0.023). However, it also was correlated with positive images of older adults and therefore omitted from the regression model to avoid multicollinearity. Positive image of older adults was of greater interest than age as a predictor given that it is amenable to change through educational programming. The regression equation for the model predicting interest level in working with older adults using positive images of older adults and current amount of interaction with older adults as predictor variables was significant (F[2, 42] = 7.2, p = 0.002). According to the R2 value, the model explained 26.5% of the variance in interest in working with older adults. When the part correlations were squared, the unique contribution of current interaction with older adults was 10% and the positive images of older adults was 13.7%.
The results of this pilot study indicate that both positive images of older adults and current interaction with older adults are significant predictors of interest in working with older adults. Results of the study are consistent with those of Cummings and Galambos (2002), who found that amount of contact with older adults predicted interest in working with older adults. However, the current study adds new knowledge, with results indicating that the timing of the interaction (current rather than previous contact) also is relevant. In addition, consistent with past studies is the impact of ageism. Bergman et al. (2014) found that ageism impacted interest in working with older adults, but they did not distinguish between positive and negative perceptions of older adults. Previous studies have revealed that rewarding interactions (Cummings et al., 2003) and positive personal experiences with older adults are significant predictors. The type of positive personal experiences that have been shown to have an effect on a desire to work with older adults are internships, volunteer positions, summer employment, and clinical rotations (Robert & Mosher-Ashley, 2000). Positive experiences ultimately may have resulted in increased positive perceptions of older adults.
The results are consistent with Super’s theory (1953, 1980), which describes vocational preferences as changing with time and experience, subject to guidance. Personal and situational factors including one’s attitudes and work or school experiences can influence career decisions. In this study, attitudes in the form of positive perceptions of older adults were shown to impact interest in working with older adults. Current amount of contact with older adults, a situational factor, also affected interest level. Age was correlated significantly with both interest level and positive perceptions of older adults. Older students likely have experienced more opportunities to interact with active and engaged older adults through their personal and professional experiences.
Implications for educational practices include both the type and timing of programs designed to increase interest in working with older adults. Educational and experiential programs that increase positive perceptions of older adults are warranted. In previous studies, the opportunity for students to engage in meaningful activities with community-dwelling, healthy older adults has been shown to increase positive perceptions of older adults (Bernard, McAuley, Belzer, & Nel, 2003; Chippendale & Boltz, 2015b; Lamet et al., 2011). A program that promotes engagement with healthy older adults in the community during a 2-year period of professional study through regularly scheduled practice interviews has been shown to be effective. In this program, interaction with older adults included interviews focused on social history, physical and functional status, and values and beliefs regarding health care (Bernard et al., 2003). A multi-session creative bonding intervention, which includes joint participation in craft activities (e.g., self-portraits) was shown to enhance positive perceptions of older adults (Lamet et al., 2011). In a recent study, the opportunity for prehealth and health science students to hear the written life stories of community-dwelling older adults and share their own related experiences in the context of a group intergenerational program also was shown to be effective (Chippendale & Boltz, 2015b).
The results of this study indicate negative images of older adults are less relevant than positive images in predicting interest level. Although exposure to older adults who have significant functional impairments (e.g., nursing home residents who require total care) may result in some negative perceptions of older adults, this may be less relevant than the need for a balance in the types of fieldwork opportunities. Students must also be afforded the opportunity to engage with community-dwelling, high-functioning seniors during the course of their health science training.
According to Super’s theory (1953, 1980), vocational development is stage specific and subject to change through experience and time; therefore, programs to promote interest in working with older adults are appropriate during the exploratory (e.g., prehealth studies), establishment (e.g., professional education training), and maintenance (e.g., among practicing nurses, as a tool for retention in geriatric practice settings) phases of career development. Given that current rather than previous interaction with older adults is an important predictor of interest in working with older adults, programs implemented at the end of professional training as opposed to early in a professional program may be more effective in promoting interest in specializing or seeking employment in geriatrics. In previous studies, regular and repeated engagement with healthy older adults has been shown to be effective (Bernard et al., 2003). Therefore, engagement in several programs with healthy older adults during the course of health science education or in one longitudinal program may be beneficial.
Although the regression model was significant, the two variables explained 26.5% of the variance in interest in working with older adults. Exploration of additional factors is needed for a more complete picture of influences regarding a choice to work in geriatrics. According to Super’s theory (1953, 1980), additional factors that impact career development include role models and finances. These factors and their implications (e.g., strong representation of faculty with geriatrics expertise or scholarships for geriatrics specialists) should be considered in future studies. Limitations of this pilot study include the small sample size and self-selection of students into the study. Future research using large, representative samples of health science students is warranted to confirm the results of this study.
Current interaction with older adults and positive perceptions of older adults are significant predictors of interest in working with older adults. Implications for health science programs, including undergraduate nursing programs, are timing and type of experiential learning and fieldwork placements. Opportunities to engage with community-dwelling older adults through meaningful activities such as creative arts show promise with regard to promoting positive perceptions of older adults (Lamet et al., 2011).
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