Knowledge, Attitudes and Treatment Practices of Medical Doctors towards Care of Elderly Patients Accessing Clinical Care at Hospitals in Kampala Uganda

Abstract

Background: The global trend towards an increasing aging population demands for adequate geriatric medical care services to cater for health needs of the aging population seeking clinical care in hospitals. In Uganda, geriatric care as a specialty in medicine is still at infancy stage, and this is further worsened by the fact that the current curricula followed in training health workers lacks a component dedicated to elderly care. There is therefore need to assess knowledge, attitudes and treatment practices of medical doctors towards clinical care for elderly persons. Objective: We aimed to assess knowledge, attitudes and treatment practices of medical doctors towards care for elderly persons accessing clinical care services at hospitals in Kampala. Methods: We conducted a cross sectional descriptive study between April and June 2019 at outpatient’s clinics, inpatients wards and non-communicable disease clinics at selected hospitals in Kampala Capital City Authority Uganda. All medical doctors providing direct clinical care to elderly persons at the selected hospitals and meeting the inclusion criteria were selected using a multi stage clusters ampling method. Those who consented were interviewed using a pre-tested semi structured questionnaire. The Knowledge about Older Persons-Q (KOP-Q) scale and the Older People in Acute Care Survey-United States (OPACSUS) scale were utilized, and responses measured on a Likert scale coded and entered into Microsoft Excel 2010, cleaned and then exported to STATA 13 for analysis. A generalized linear model was used with the family of Poisson and log link with robust standard error to provide prevalence ratio as a measure of association with corresponding 95% confidence intervals and p-values. Ethical clearance was obtained from the respective hospital Institutional Review Boards, Higher Degrees Research and Ethics Committee at Makerere University School of Public Health, and Uganda National Council of Science and Technology. Results: Among the 110 respondents, 73 (66.4%) medical doctors had suboptimal knowledge on clinical care of elderly patients, majority of medical doctors demonstrated a positive attitude towards care of elderly persons and over threequarters 82 (74.5%) of medical doctors did not routinely observe recommended treatment practices when caring for elderly patients. Factors found to be significantly associated with knowledge on clinical care of elderly persons were level of education of medical doctors and frequency of refresher trainings on geriatric care. Similarly, level of education of medical doctors and hospital affiliation were significantly associated with treatment practices when caring for elderly patients. Conclusions: Majority of medical doctors had suboptimal knowledge on geriatric care, with a majority failing to follow routine recommended treatment practices when caring for elderly patients. Recommendations: Therefore, the higher education division of Ministry of Education should enforce integration *Corresponding author: Daniel Orit, Department of Community Health, School of Public Health, College of Health Sciences, Makerere University, P.O. BOX 7072 Kampala, Uganda, Tel: +256777322263 ISSN: 2469-5858 DOI: 10.23937/2469-5858/1510114 Orit et al. J Geriatr Med Gerontol 2021, 7:114 • Page 2 of 9 • in clinical care, but more worryingly health workers trained in health institutions with no defined curriculum on geriatric medicine and hence limited knowledge and treatment practices when caring for elderly persons. Previous studies done in the past by Topaz and Doran; Dacey, et al. [7,8] have all revealed insufficient knowledge on elderly person’s clinical care amongst health workers. Also, studies carried out since the 1950s have identified negative attitudes of health care workers toward the hospitalized elderly persons or those seeking health care services at the health facilities. Those attitudes have prevailed into the 1990s and highlight the low status associated with working with elderly patients [9]. Research also showed that the quality of health care services provided by health workers to elderly persons is strongly influenced by their knowledge and attitudes towards elderly people [10]. Furthermore, knowledge of ageing and attitude towards the elderly are important in promoting good clinical care practices in the healthcare delivery systems [11]. Even though the above studies have provided some information on clinical care of elderly persons by health professionals, a majority of these studies have either not solely focused on medical doctors, or have been done in countries with a different health care system compared to the Ugandan health care system. There is therefore need to assess knowledge, attitudes and treatment practices of medical doctors towards clinical care for elderly persons. Results from this study will help provide basic information for designing structures and programs for the care of elderly persons in the health facilities as well as drafting of training curriculum designs on geriatric care to be used in the training of health professionals both in training institutions and during inservices training programs. Materials and Methods Study design and population A descriptive cross-sectional study was conducted between April and June 2019 among medical doctors who provide clinical health care to elderly persons in the outpatient’s clinics, inpatients wards and special disease clinics at selected hospitals in Kampala Capital City Authority Uganda.