The Attitude of Egyptian Physicians Toward Geriatric Medicine

Abstract

To the Editor: While the population of elderly Egyptians continues to climb, the healthcare system is becoming increasingly strained. The attitude of health workers may be detrimental to the care of elderly people.1 Four hundred physicians (not geriatricians) from six hospitals were involved in a cross-sectional study. Physicians were asked to complete a self-administered questionnaire (28 items devised to explore the attitude of Egyptian physicians toward geriatric medicine) consisting of four components: cognitive (8 items), behavioral (8 items), emotional (4 items), and medical ageism (8 items). Participants were asked whether they agreed, felt neutral, or disagreed with each item. A positive attitude was given a score of 2, neutral a score of 1, and negative a score of 0, for a total score out of 56. Each physician's score was divided by 56 to obtain the percentage of the total attitude score. Survey construct and the researchers' previous experience ensured face and content validity. Expert opinions were taken into consideration. A high Cronbach alpha value (0.81) indicated high reliability and internal consistency of the questionnaire. There is much talk about the uncovered obstacles for practicing geriatric medicine. In Egypt, geriatrics is not included in the curricula of undergraduate or advanced medical training in most medical schools despite the fact that geriatric patients constitute many of the critically ill patients. Care of elderly people is an unpopular field in most clinical careers, including clinical psychology and medicine.2 Only 40.7% of the physicians completed the questionnaire. Most of them were men (77.9%); the men had higher mean percentage of total attitude score than women, but the difference was not statistically significant. Two-thirds (64.4%) of physicians were from governmental general hospitals and 35.6% from private insurance hospitals. Mean number of years since graduation was 10.1 (range 1–44 years). One-third (34.3%) were internal medicine physicians, 16.6% were general surgeons, 15.3% were neuropsychiatrists, 6.7% were gynecologists, 5.5% were orthopedic surgeons, and 21.5% were from other specialties. The highest scores were among neuropsychiatrists (more familiar with psychogeriatrics and usually feeling the urge to seek medical advice in management of different medical comorbidities); orthopedic surgeons had the lowest scores (this may be because of lack of knowledge about geriatrics), but the difference was not significant statistically. Physicians in leadership positions (12.3%) had a more-positive attitude toward geriatric medicine than physicians not in leading positions, with a statistically significant difference between the two groups (P=.02). Physicians in insurance hospitals had statistically significantly more-positive attitudes toward geriatric medicine than physicians in general hospitals (P=.02); this may be because of the positive influence of the hospital management leaders and because the physicians are afraid to bear the whole responsibility in management of critically ill elderly patients. One-third (35.6%) of the study population had only a bachelors degree in medicine and surgery, 16.6% had a diploma, 36.2% had a masters degree, and 11.7% had an MD, with a higher mean percentage of total attitude score among physicians with an MD (the difference was not statistically significant). One-quarter (26.4%) of the study population believed that the difference between geriatric medicine and internal medicine is clear enough. More than half (57.0%) believed that they need more orientation to geriatric medicine. Only 39.9% were ready to join a training course in geriatrics. The physicians expressed low scores on medical ageism, especially among senior doctors. There was a positive correlation between total attitude score and years since graduation (older physicians feel more need to consult a geriatrician). There was a statistically significant difference between junior (≤5 years) and senior physicians with regard to mean percentage of total attitude score (Table 1). This difference was only in the cognitive component score (lack of perception about the importance of geriatric medicine) and in the absence of the medical ageism score (presence of some degree of medical ageism among juniors). Healthcare professionals are known to be particularly susceptible to ageist stereotyping because of greater exposure to elderly and infirm individuals.3 The question is whether ageism is only due to devaluation of older persons, or could be due to lack of knowledge.4 Apparently, poor education and poor understanding of elderly people reinforce some of these attitudes.5 Junior physicians had less-favorable attitudes toward geriatrics. Inclusion of geriatric medicine in the curricula of undergraduates or in advanced medical training for the postgraduates may provide more geriatric medicine orientation and more-favorable attitudes toward it. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Muhammad F. Abd-Al-Atty: study concept and design, acquisition of subjects and data, interpretation of data, and preparation of the manuscript. Khaled M. Abd Elaziz: analysis and interpretation of data. Sponsor's Role: None.