Young People’s Perception of the Elderly and its Likely Impact on Healthcare Delivery Service

Young people are at the vanguard of most healthcare delivery services to the elderly. Their attitudes on healthcare delivery service could be influenced by the perceptions they hold of elderly persons. Slevin (1991) noted that young people’s negative attitudes toward the elderly might be implicated in the slow growth of gerontological nursing in the UK. A study of young people (undergraduates) from both developing and developed nations identified elderly traits that they perceived to be “Unattractive.” Participants were from Nigeria (n=86); Brazil (n=232); the USA (n=221); and Ireland (n=194). Unattractive traits fell into the categories of Personal; Interpersonal; and Need. With the unattractive traits in mind, participants were asked to rate their tendencies to not help: 1) their elderly parents, and 2) the elderly persons. Results found that no significant differences between respondents from the developing and the developed countries: Unattractive traits could not prevent the participants from wanting to help elderly parents (Developing Countries: Mean = 3.74; SD = 1.23; Developed Countries: Mean = 3.84; SD = 1.27; t = 1.03; df = 611.112; P = 0.302). Also, results found that no significant differences between participants from the developing and developed countries: Unattractive traits could prevent participants from wanting to help elderly persons who are not parents (Developing Countries: Mean = 2.73; SD = 1.22; Developed Countries: Mean = 2.75; SD = 1.34; t = 0.137; df = 643.98; P = 0.891). While unattractive traits could not prevent young people from helping elderly parents, it would prevent them from wanting to help elderly people who are not parents. The results have implications for intergenerational helping relationships.

For example, in a study of three cultural groups (Caucasian-Canadians, Chinese-Canadians and Hong Kong-Chinese) Chappell and Funk (2012) reported that attitude did not predict certain aspects of behavior such as assistance with basic and instrumental activities of daily living to elderly persons [1,2]. It did, however, predict emotional support (among the two Chinese groups), companionship (among Hong Kong-Chinese) and financial support (among Chinese-Canadians). So, while an attitude could predict certain behaviors it may not predict others (as mentioned above), or while an attitude could predict different behaviors, it depends on who is involved (parent or not parent).
In order for attitude to more accurately predict behavior, Ajzen (1991) Theory of Planned Behavior (TPB), noted that both Intentions and Perceived Behavioral Control (PBC) are required to determine behavior. Intention is measured by plans or the motive to act; and PBC by the perceived control or confidence (or self-efficacy) the person has in performing the behavior [3].
The plan or motive to act (Intention) might be influenced by the perceived control or confidence to act (PBC) that a person has over a situation, resulting in behavior. While Intention can be influenced by subjective values and cultural norms, it could be at variance with the Perceived Behavioral Control (e.g., negative attitude about elderly persons may be at variance with the ability to help). Therefore, the ability to help could be present but not the compassion. The theory of planned behavior (TPB) has been helpful in predicting health behaviors (e.g., McEachan, Connor, Taylor, & Lawton, 2011) and is based more on the cognitive aspect and less on the emotional side of predicting behavior(e.g., Manstead & Parker, 1995). However, both cognitive and emotional dimensions are important in predicting behavior from attitudes (e.g., Ajzen & Fishbein, 2005) [4,5]. Triandis and Bhawuk(1997) (Triandis 1988;Shwartz 1992Shwartz , 1994. Triandis(1994) defined the in-group as "sets of individuals with whom a person feels similar" (p. 43). In general, collectivist ingroups are ascribed (e.g., caste, kin, caste, race, tribute, religion, village, nation) where as individual is tin-groups are achieved (e.g., similar beliefs, attitudes, values, actions, programs, occupations) [8][9][10][11]. c. Emphasis on norms versus attitudes: In individualist cultures attitudes, personal needs, perceived rights, and contracts determine social behavior norms; in collectivist cultures duties and obligations determine social behavior instead (Miller 1984(Miller , 1994Davidson et al.1976) [12][13][14]. d. Emphasis on relatedness versus rationality: In individualist cultures, rationality is emphasized but in collectivist cultures relatedness is most important. In rationality emphasisis on costs/benefits of relationships, but in relatedness, priority is on relationships even if not to the person's advantage (Kim et al.1994) [15].

Individualism and Collectivism
Due to the influences of globalization, however, the individualism and collectivism dichotomy is not so clear cut between developed and developing societies. For example, Eyetsemitan, et al (2002) identified in developing societies, the following three environmental dimensions: Global, Developed (Western) and Developing (non-Western). Acculturation patterns could occur between an individual and any one or more of these dimensions. For example, a person can embrace western values only; another person non-western values only; and yet another, both western and non-western values combined. Furthermore s/he can exhibit those values either consistently or situationally [16].  between individualist and collectivist cultures [17,18].

Relationship between Life Satisfaction and Job Satisfaction
In general, life satisfaction could affect job satisfaction (e.g., Judge et al, 1998;Judge and Watanabe, 1993;and Tait et al, 1989) [19][20][21]. Therefore, young people who are not satisfied with elderly people (based on perceived unattractive traits) may not be satisfied working with them. They could experience a lack of personorganization fit if in the healthcare delivery field.
In a study of people who are chronically dissatisfied and those who are occasionally dissatisfied Judge (1993) noted a difference in employee turnover. Turnover was more with the latter [22]. People who are chronically discomfited will be dissatisfied whether in or out of a job. But turnover is only one aspect that demonstrates poor commitment to a job. Absenteeism, tardiness, low productivity and calling in sick are others; and chronically dissatisfied employees could demonstrate all of those while keeping their jobs.
The participants' majors in this study were not indicated, but a good number of them might end up in the healthcare delivery field--the fastest growing industry in the developed world. Therefore, the attitude young people bring to the health care delivery industry might be of future concern. Hypotheses 1. Respondents from developed societies with individualist cultures (U.S. and Ireland) will have stronger tendency to not help elderly persons based on percei ved negative traits, than respondents from developing societies with collectivist cultures (Brazil and Nigeria).
2. Respondents from developed societies with individualist cultures (U.S. and Ireland) will have stronger tendency to not help elderly parents based on negative traits, than respondents from developing societies with collectivist cultures (Brazil and Nigeria).

Participants
The total sample of 732 respondents is made up of the following: 221 from the U.
Respondents in this study were told to generate elderly traits (in order of importance) tha t they considered to be "unattractive." Based on these unattractive traits, they were then asked to rate their tendencies to not help their elderly parent sand elderly persons, respectively. Respondents' ratings of their tendencies to not help based on the traits they themselves had provided, was to assess the behavioral dimension of their attitudes. The questionnaire, however, did not determine what factors other than unattractive traits could influence their tendencies to not help the elderly.

Materials
The material was a 12-item questionnaire that included background information like institution, age, sex, and whether respondents had previously helped the elderly or not. Th e understanding and type of help was left to the respondents' interpretation, as help could vary from society to society. At least "help" indicated doing something positive for the elderly in the past.
Also, the questionnaire requested the respondents to list (in order of importance) elderly behavior traits that they perceived a s "unattractive". Respondents were also to rate their tendencies to not help their elderly parents and the elderly persons who are not their parents, based on the unattractive traits. Based on a Likert scale of 1 (strongly agree) to5 (strongly disagree) participants responded to the statements: "These behavior traits can prevent me from wanting to help my elderly parents" and "These behavior traits can prevent me from wanting to help an elderly person.

Procedure
The U.S.A. sample was collected by the author by administering the questionnaire to his students in a small mid-western college, while his associate shelped with data collect ion in the other countries by administering the same questionnaire to their respective students. The Nigerian sample comprised of students from an urban university located in the northern part of the country; the Irish sample comprised of students also from an urban university located on neither the northern part of that country, while the Brazilian sample from drawn from a university located in alargecity.
Undergraduates, given their shared background in formal education, make an ideal population for crosscultural comparisons.
In all of the countries except Brazil, the questionnaire was administered in English. In Brazil, however, the questionnaire was translated from English to Portuguese and then back-translated to English by the collaborating instructor and her graduate student, and then an agreement was reached between them as to the accurate Portuguese version. The questionnaire had a brief description of the nature of the study, and respondents were informed that their names were not required and that they should feel free to not respond to any or all of the questions.

Results
Only the first "unattractive" trait was able to be analyzed due to the unequal number of traitst h a t e a c h r e s p o n d e n t c a m e u p w i t h . Not all the respondents came up with five "unattractive" traits. From a qualitative analysis of "unattractive" traits (based on agreement between the author and his research assistant), three broad categories emerged: Personal, Interpersonal, and Need (seeTable1).A fourth category, Supernatural, was too negligible for analysis. These are loose categories as some items could fit into more than one category.
The Personal traits were made up of those traits that describe the elderly as a person; the Interpersonal traits describes the relationship that elderly people have with the younger generation (and with their peers); and the Need traits describes the deficiencies that elderly person shave (e.g., physical).The table below shows for each country, the number of respondents and the percentages of respondents for each trait category identified.

Discussions and Conclusions
Respondents from both developing and developed societies, all agreed that "unattractive" traits could prevent them from wanting to help elderly persons, but not elderly parents. While in developing societies (collectivist cultures) helping parents might beseenasan obligation, in developed societies (individualist cultures) it might be more of voluntarily rendering help tone 'sin-group member without an obligation. Unfortunately, the reasoning behind young peoples' kind dispositions toward their parents despite the perceived negative traits, were not explored but assumed. Future studies should be done to explore this.
For elderly persons (not parents), however, "unattractive" traits could prevent young people from wanting to help them, in both collectivist and individualist cultures. While this was expected in developed societies (with individualist tendencies), this represents a shift for young people in developing societies (collectivist cultures) where norm sand relatedness and respect for the elderly are valued (cf. Triandis 1994) [11]. Again, further studies are required. With acculturation influences, young people in developing societies may be embracing Western values of rationality and cost/benefit analysis in social relationships.
Future studies should also provide respondents with different scenarios: While "unattractive" traits could prevent a helping tendency in one situation, they may not in another. Furthermore, not all "unattractive" elderly traits might have the same strengths to prevent helping tendencies.
Also, young people's commitment to working with elderly persons in the healthcare delivery industry should not be measured by turnovers only. Other indices of commitment should be taken into consideration as well e.g., absenteeism, tardiness, productivity levels and quality and calling in sick.
With Ajzen's (1991) theory of planned behavior (TPB), both Intention (influenced by attitudes, subjective values and cultural norms) and perceived behavioral control (PBC) (e.g., resources and ability to help) do determine behavior [3]. But, as noted earlier, Intention and PBC can run at cross purposes to not determine behavior. This study provides an important step for future studies to explore the saliency of unattractive elderly traits that could impede helping behaviors; and the circumstances under which it would happen. Also, how unattractive elderly traits have impacted on employed young people in the healthcare delivery service industry.