Research Article Attitude of the Youth Towards the Elderly People in the Selected Community in Lalitpur District of Nepal

Introduction: Global ageing is the success story of the 21 st century as a result of declining fertility, mortality and improved public health interventions. With the increased elderly population, the attitude of societies about ageing changes. Positive attitudes towards the elderly people are valued, respected and experienced but most of the literature shows negative perceptions towards elderly people among the youth, especially in the form of stereotypical behaviors and ageism which can result in social exclusion, isolation and ultimately the abuse of elderly people and disempowerment of elderly people. Methods: Cross sectional research design was used to assess the attitude of youth towards the elderly people in the selected community of Lalitpur, Nepal from August 12 to September 7, 2018. Total 380 youth were interviewed by using modified Kogan’s Old People Scale and structured questions. Systematic random sampling technique was used for data collection. Results: More than half of the youth (66.1%) had positive attitude level towards the elderly. With regards to the attitude towards the care of elderly almost of all of the youth (97.9%) had positive attitude towards the care of the elderly. There was significant association between gender and attitude towards elderly (p=0.04) and occupation and attitude towards the care of the elderly (p=0.02) at 95% of significance level. Conclusion: Although more than half of the youth have positive attitude toward the elderly people still there is need to provide awareness program regarding the physical, physiological and psychological changes that occurs during the ageing period which helps in enhancing the positive attitude of the youth and thus contributing towards overall quality of life of the elderly people.


INTRODUCTION
As a result of declining fertility, mortality and with the significant increase in life expectancy, people today are living longer which has increased the population of older adults in the world. 1 People aged 60 and older make up 12.3 percent of the global population, and by 2050, that number will rise to almost 22 percent. In terms of region, over half of the world's elderly resides in Asia. 2 According to the population census of Nepal (2011), 9.1 percent of total population was above the age of 60 years that was only 6.5 percent in 2001. 3 With the increased elderly population, the attitude of societies about ageing changes. 4 Most of the studies conducted on ageing reported that the people who displayed ageism were generally the young. 5,6 It became imperative to gain an insight into how our older people are perceived by the younger generation, as these perception and attitudes may create discrimination and mistreatment of elderly people. Research on aging is limited in Nepal in spite of a continued growth of elderly population. The objective of the study was to explore the youth's attitude towards elderly people in Lubhu 8, Mahalaxmi Municipality, Nepal.

MATERIALS AND METHODS
A Community based cross sectional research design was adopted to identify the attitude of the youth towards the elderly people in Lubhu 8, Mahalaxmi Municipality in Lalitpur, Nepal.The study was conducted from August 12 to September 7, 2018. All the youth of the Lubhu 8, Mahalaxmi Municipality who were in the voter list of National Election Commission 2074 from the age group 18 to 40 years were included in the study. Sample size was calculated by using Cochran's formula assuming 50% prevalence and data was collected from 380 youth by using structured interview schedule. Ward number 8, Lubhu, Mahalaxmi Municipality was purposively selected by the researcher then systematic random sampling was used in the household of Lubhu to collect data. The total houehold of Lubhu was 2,365 according to CBS 2011 and number was given to each house considering ward office centre. At first randomly one household was selected and youth was selected from selected household then, youth was selected from every 7 th household. If the youth was not available at systematically selected household then next consecutive household was used and if more than one youth was available in the house, then simple lottery method was used to select one youth from the house. The instruments covered three parts according to variables.
Part A: -Questions regarding sociodemographic characteristics which included age, gender, marital status, educational status, occupation, family types and living with elderly.
Part B: -Questions to assess attitude towards the elderly which was adopted and modified Kogan's Old People Scale (KOPS). The Kogan's Attitudes toward Old People Scale is a 34 item tool with a 6 point Likert-like scale format. The point descriptors range from strongly disagree (1) to strongly agree (6). The tool contains 17 positively rated and 17 negatively rated statements about older adults 7 .
Part C: -Questions to measure attitude towards the care of elderly by using a Likert scale which was prepared on the basis of research objective, literature review and consultation with research advisor. It consists of 15 items. Out of 15 items, 10 items were positive and 5 items were negative.
Scoring was done on the basis of mean score. Youth who scored greater than 50% was considered as having positive attitude and less than 50% was considered as having negative attitude.
In this study, pre-testing of the instrument was done in 10% of estimated sample size of Hari siddhi, ward no 29. For the standard tools Kogan 7 , reliabilities ranged from r = .66 to .77 on the positive scale and r = .73 to .83 on the negative scale in his original tools whereas in the present study, Cronbach's alpha was .73 for the total scale, .69 for the positive scale, and .77 for the negative scale which shows the tool was reliable. For the self -developed, Cronbach's alpha was .69 for the total scale which indicated tool was reliable. Validity of the tool was maintained by translating the tool into Nepali language and back translating into English language adhering to Wild et.al guidelines 8 .
Study was conducted only after obtaining the formal approval from Research committee of Lalitpur Nursing Campus, Institutional Review Committee of PAHS and ward secretary of ward no. 8, Lubhu of Mahalaxmi Municipality. Informed consent was obtained from each youth and objectives of the study were explained before collection of data. Each day 14-16 respondents were interviewed, 20-30 minutes each. Collected data were entered, coded and analyzed using SPSS 16.The descriptive statistics frequency, percentage, mean and standard deviation and inferential statistic chi square Test, Mann-Whitney U test and Kruskal-Wallis test was used to examine the association among dependent and independents variables where p-value < 0.05 considered significant.

RESULTS
Attitude score of the youth towards the elderly revealed the average value was 53.75% with standard deviation 8.71% ranging from 23.53% to 84.12%. Similarly in attitude score towards the care of the elderly the average value was 71.63 with standard deviation 10.70 ranging from 15.56% to 95.56% as shown in table-1.     Note: * p<0.05 significant at 95% confidence level

DISCUSSION
Present study showed that 66.1% of the respondents had positive attitude and 33.9 % of the respondents had negative attitude towards the elderly and mean attitude score was 53.75%. In a study involving nurses, Bastola S and Shrestha S found a positive attitude (i.e. 94%) of the nursing students had average attitude whereas only 6% had good attitude. 9 Mean attitude score was 126.94 (62.23%).
All the student nurses who belong to youth age group had positive attitude towards; the elderly may be due to the fact they belong to the serving occupation and they are in contact with the elderly at different levels of care and because of the culture we hold of caring and loving the elderly may have influenced their attitude. Likewise study conducted with 78 community-dwelling young people (aged 18-25 years) in Turkey 10 revealed young people's attitudes towards aging and ageism were positive which is in line with the present study but may not be connected with the finding of study in India by Sharma T. 11 Ageing and old age depicted youth had negative attitude towards the elderly people.
This study shows male respondents had positive attitude 73.62% (n=131) than female respondents and is significantly associated at 95% of significance level (p=0.04). In contrast, past study in India revealed females scored lower on ageism as compared to males. 11 This may be due to the fact that most of the caregiver of the family in context of our country are female and because of the burden they possessed their attitude might be negative.
Present study also showed that there was no significant association between attitude level and types of the family and occupation at 95% significance level (p=0.06).
Similarly, previous study in Nepal found evidence of overall men and women have less supportive of sons and daughters caring for parents in old age. 12 Additional years of education are associated with decreased support and care for elderly but in contrast, present study showed no any difference in attitude of youth towards the elderly care despite of change in educational level (p = 0.99). Past study also showed gender is significantly associated (p<0.05) with increased positive attitude towards the care of elderly 12 but in this study there was no significant association between gender and attitude at 95% of significance level (p=0.10).
Most of the literature only focused on the nurses and other health care professional's attitude towards the care of the elderly. Very limited research has been documented regarding the attitude of youth towards the care of elderly and this study helps in filling the gaps in the literature.
The study was confined within the single ward of the Mahalaxmi Municipality of Lalitpur district so these finding may not be viewed as a good representation of the overall attitude of the nation's youth. The study was done by interview method which may have difficulty to explore their feelings and attitude towards the elderly.

CONCLUSION
More than half of the youth had positive attitude level towards the elderly people and one third of the respondents had negative attitude level towards the elderly. With regards to the attitude towards the care of elderly, almost all of the youth had positive attitude towards the care of the elderly. There was significant association between gender and attitude towards elder and occupation and attitude towards the care of the elderly.