Nurses' general attitudes and caregiving-specific perceptions toward the oldest-old: A nationwide survey.

BACKGROUND: Despite the growing population of older adults worldwide, nurses may harbor negative attitudes toward older patients that might risk patient safety. Most studies have investigated general attitudes toward older adults. Only a few have focused on nurses' perceptions of caring for older patients, and there has been little focus on the oldest-old (aged ≥80 years), an age group that is particularly affected by negative attitudes. Emerging models to combat this issue suggest that education about aging and interaction with older adults are key factors. These models have primarily been evaluated using students, not healthcare professionals. OBJECTIVE: To examine if and to what extent education (training and education about working with older people) and interaction (professional and personal contact with older adults) are associated with nurses' general attitudes toward older persons and their perceptions of caring for older patients (aged ≥80 years). DESIGN: A cross-sectional survey study. PARTICIPANTS: A nationwide sample of 2294 Swedish registered nurses with background characteristics reflective of the national nursing population. METHODS: Emails with study information and survey links were distributed via the Swedish Association of Health Professionals' registry. The survey contained one instrument that measures general attitudes toward older adults and one that measures perceptions of caring for older patients. Following the Positive Education about Aging and Contact Experiences model, items about participants' education and their professional and personal interaction with the oldest-old adults were also included. Descriptive and comparative analyses were conducted. Multiple regression models used general attitudes and caregiving-specific perceptions as dependent variables in each model. RESULTS: Nurses' general attitudes and caregiving-specific perceptions were correlated. Regression analyses revealed that the education and interaction variables were independently associated with general attitudes and caregiving-specific perceptions, but these associations followed different directions. An older family member/close friend, extensive work experience, and working primarily in administration were independently associated with more positive general attitudes toward the oldest-old adults. Working in home care or assisted living, having education in geriatrics/gerontology, and frequent interaction with older patients were associated with less favorable general attitudes but more positive perceptions of caring for the oldest-old patients. CONCLUSIONS: Our results highlight the complex relationship between nurses' general attitudes and their caregiving-specific perceptions toward the oldest-old persons. Education in geriatrics/gerontology and interaction with older adults are warranted to improve nurses' caregiving-specific perceptions. Appropriate scales that consider this complexity beyond general attitudes are needed to capture caregiving-specific and contextual perceptions.

Factors Associated with Healing Outcomes in Primary Care Patients with Diabetic Foot Ulcers: A Retrospective Study in a Multiethnic Sample.

OBJECTIVE: To identify and determine patient- and ulcer-related factors associated with healing outcomes within 3 months for patients with diabetic foot ulcer (DFU) in a multiethnic primary care sample. METHODS: Retrospective data were collected over 3 months from 520 primary care patients with a DFU between April 1, 2016 and March 31, 2017. Multivariable prevalence ratios (PRs) were calculated using Poisson regression to find associations between patient- and ulcer-related factors and healing outcomes. RESULTS: Most patients were male (66%) and Chinese (49.8%) and had a diabetes mellitus duration longer than 5 years (81.8%). Toe ulcers (64%) were most common. Healing occurred for 33.9% of participants; 19.1% and 1.5% underwent minor and major amputation, respectively. Wound sizes between 1 and 10 cm2 (PR, 0.61; 95% confidence interval [CI], 0.46-0.76; P < .001) and over 10 cm2 (PR, 0.55; 95% CI, 0.33-0.76; P = .003), ulcer duration 6 months or longer (PR, 0.36; 95% CI, 0.19-0.53; P < .001), ischemic ulcers (PR, 0.54; 95% CI, 0.22-0.86; P = .044), and neuroischemic ulcers (PR, 0.73; 95% CI, 0.53-0.93; P = .027) were negatively associated with healing outcomes. Women were more likely to experience healing (PR, 1.18; 95% CI, 0.91-1.45; P = .157). CONCLUSIONS: Ulcer healing varied by sex and was affected by wound size, wound duration, and ischemic etiology, regardless of ethnicity. Prompt attention to these risk factors may reduce healing time. Further studies are warranted to elucidate the mechanism underlying sex differences in association with DFU healing.