Attitudes towards the Elderly: A Qualitative Study of Adults in Malaysia ()
1. Introduction
The global population of the elderly increases every year (Lu, Kao, & Hsieh, 2010). There is an estimated 703 million elderly around the world as of mid-2019 (World Population Aging, 2019). The increase in the population of the elderly occurs due to declining annual birth rate, changes in life expectancy (Tkatch et al., 2016), and the development of better health care technology (World Health Organization, 2019). This phenomenon occurs not only in most developed countries but also in developing countries, including Malaysia. The latest statistic from the Department of Statistics Malaysia (2021) shows the population of Malaysia at 32 million people, where 2.37 million (11%) are in categorized elderly, 60 years old and above (Department of Social Welfare, 2021). The statistic gives the impression that Malaysia will be an aging country by 2030, with the elderly constitutes 15% of its population (Bakeri, 2020).
However, the increase in the population of the elderly in Malaysia has a significant impact on the society and country, especially from their acceptance will lead to attitude because they are mainly will take care of this community (Mohamad, Alavi, Mohamad, & Aun, 2017). Attitude is an evaluation of someone or something on a continuum of like or dislike (Doherty, Mitchell, & O’Neill, 2011), consisting of three components, namely affective, cognitive, and behavioural (Soderhamn, Lindencrona, & Gustavsson, 2000). Thus, the attitude towards the elderly can be defined as the feelings (affective), thoughts (cognitive), and behaviour of an individual towards elderly (Gilbert & Rickets, 2008). For example, the attitude of adults towards the elderly in terms of thoughts is the belief that the elderly are far-sighted, experienced, and highly knowledgeable individuals. On the other hand, the aspects of feelings or affective are seen in the respect, compassion, and love towards the elderly. Similarly, behavioural aspects can be seen from a good relationship with the elderly, treatment and manners, and politeness towards them.
Attitude can also be assessed as either positive or negative (Hess, 2006). Examples of negative attitudes towards the elderly are considering them as incompetent (Alavi, Karim, & Sakri, 2017), burdening (Ugargol & Bailey, 2018), and subsequently discriminating against the rights of the elderly (Husin & Alavi, 2016). At the same time, positive attitudes towards the elderly include respecting them as someone older in community (Ismail, 2015) and have a lot of experience in life (Ali & Aziz, 2018).
There are many studies of adult attitudes toward the elderly in the West and Asia. Most studies have found that Western societies tend to have more negative attitudes towards the elderly (Tam, Chandran, Yu, Nair, & Visvanathan, 2014; Gallagher, Bennett, & Halford, 2006: & Kearney, Miller, Paul, & Smith, 2000) than Asian societies which have more positive attitudes towards the elderly (Kiliç & Adibelli, 2011; Momtaz, Mousavi-Shirazi, Mollaei, & Delbari, 2019). The difference in attitude towards the elderly between the societies is due to cultural differences. The inter-generational relationship between the elderly and adults is part of the collective Asian cultures (Mohd Faudzi, Armitage, Bryant, & Brown, 2018). On the other hand, the individualistic nature of the Western cultures led to self-independence without the involvement of other individuals (Grossmann & Santos, 2016). Thus, it is not surprising that as they grow old, many of the elderly in Asia lived with their children (Russell & Breaux, 2019) compared to those in the West who are more comfortable living alone or in formal institutions for the elderly (Tkatch et al., 2016).
It is common in Malaysia for the elderly to stay with their adult children. The adults are often given the responsibility to informally provide care for the elderly (Abdullah, Hajar, & Mohamad, 2015). This responsibility may cause the adults to feel burdened (Normah, Sing, & Ibrahim, 2009) because caring for the elderly is not easy and requires physical and mental strengths (Musich, Wang, Kraemer, Hawkins, & Wicker, 2016). However, Malaysians are taught to respect older people (Patrick, Arieselia, & Rukmini, 2014) because the elderly are perceived to have much more experience (Alavi & Mahbob, 2017).
Most of the studies on attitudes and the elderly in Malaysia have found that adults have positive attitudes towards elderly people (Ali & Aziz, 2018; Alavi, Sail, Idris, Samah, & Chan, 2011; Alavi & Sail, 2010; Singh, Subramaniam, Rahman, Rusly, & Ghazali, 2018) as compared to negative attitudes (Damulak, Minhat, & Rahman, 2015). However, the studies only focused on the positive or negative aspects of attitude towards the elderly, not thoroughly on each component of attitudes, namely affective, cognitive and behavioural (Soderhamn et al., 2000). Each component needs to be deeply examined to understand the real attitudes of adults towards the elderly in Malaysia. Moreover, most of the studies focused on the attitudes of medical students towards the elderly, but less attention was given to understand the attitudes of the wider adult population between the age of 20 years to 59 years towards the elderly.
2. Methodology
Focus group interviews and discussions have been employed for the study. Focus group method is used to get more new themes that will emerge based on open question in the interviews (Shuib, 2019). In addition, focus group also involves group discussions to discuss a specific topic (Nyumba, Wilson, Derrick, & Mukherjee, 2018) that is to identify the personal experiences of group members, beliefs, perceptions and behaviors of group members about attitudes to old person.
According to Fuad Muhamed Berawi (2017) minimum number of respondent for focus group (n = 4) and maximum up to (n = 3). In this study, (n = 20) respondents were selected according to age requirement which is 20 years to 59 years, based on the definition of adult by the World Health Organization (2019). The respondents were divided into 4 groups of 5, according to age categories, namely 20 - 29 years (n = 5), 30 - 39 years (n = 5), 40 - 49 years (n = 5) and 50 - 59 years (n = 5). The Online interview has been done due to the limitation of the Movement Control Order (MCO) in March 2020.
The purpose of the discussion was to get new perspective of respondent about older people in Malaysia. The discussion of the focus group revolved around the attitudes of the respondents towards the elderly, aged 60 years and above. The attitudes were examined from three aspects, as stated by Soderhamn et al. (2000), which includes emotions, thoughts, and behaviours of respondents towards the elderly. Thus, each respondent was able to present his or her personal opinions based on the questions given, without being influenced by answers from other respondents during the focus group discussion session. Each discussion took between one to two hours per focus group and conducted entirely in Bahasa Malaysia.
Analysis Data
The discussions from the focus groups were recorded to assist in transcribing and form thematic analyses. The transcripts from the discussions were read repeatedly to form a specific code and new themes on attitudes towards the elderly. The method to perform content analysis in this study is according to the method recommended by Alavi, Hazlan, & Fauze (2019) as shown in Figure 1 below.
3. Result
The focus group discussion involved 20 respondents consisting of adults aged between 20 years to 59 years. Table 1 shows the demographics of the respondents namely gender, ethnicity, marital status and occupation.
All respondents in this study are Malays. There were 13 female and 7 male respondents involved in the study. The result on marital status shows 12 of the respondents is married and 8 respondents are single. The respondents come from different occupational backgrounds with professionals such as doctors and accountants, lecturers and counsellors made up the biggest number (n = 7) followed
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Table 1. Demographics of respondents by age category (n = 20).
by support groups namely nurses, soldiers and operators (n = 6), students (n = 4) and management (n = 3).
The findings of this study detailed the objective of the study, namely the three aspects of attitude towards the elderly: affective, cognitive and behavioural.
3.1. Affective aspects (Emotion)
3.1.1. Positive
The theme that can be identified from the aspect of affective is the expression of respect or affection among adults towards the elderly. The findings showed that 14 out of 20 respondents have a positive affective attitude towards the elderly. Some of the positive feelings are empathy, affection, concern, and comfortable being with the elderly. A respondent from (30 years) illustrates the positive feeling towards the elderly: “My mother passed away 5 years ago. Now, whenever I see old ladies selling food or tissues along the pavement in front of banks, I would feel sorry and think of my mother…. I miss my mother”. Besides, findings from respondent (35 years) respondent (23 years), and respondent (25 years) focused on the feelings of happiness, love, and understanding, as illustrated by the following responses:
“When I was young, my dad was very fierce that I was afraid to say anything, I was naughty then, but now I like to converse with dad…”
(35 years)
“As a grandchild, I can feel the endless affection shown by my grandparents to us…their affection made me feel comfortable and respect them”.
(23 years)
“I am very close to my parents, I feel at ease in sharing any problems with them…I think mom understand whatever I tell her…”
(25 years old)
3.1.2. Negative
The study also found negative affective attitudes towards the elderly, such as adults who are impatient and get easily upset with the elderly. This is because the elderly can be cantankerous, which demands attention from their children. Six respondents responded negatively towards the elderly. Among their responses are as follows:
“To tell you the truth, sometimes I feel stressed with my mother, who speaks the same thing again and again.”
(29 years)
“I always retaliate or protest if my parents reprimand me for making a mistake…I do not think they understand my feelings.”
(22 years)
“You can lose your patience with the elderly because they can be very demanding…sometimes I cannot help but get angry….”
(43 years)
3.2. Cognitive Aspects (Thoughts)
3.2.1. Positive
From a cognitive point of view, the adults believe that the elderly are far-sighted, experienced, and highly knowledgeable people. A total of 11 people out of the total respondents think that the elderly are far-sighted individuals in all aspects and have many life experiences due to a difficult life in the past.
“They like to think about things that might happen, sometimes it never crosses our mind but our parents are always among the people who remind us…”
(32 years old)
“The way the elderly think is quite different, maybe because they were young once, they tend to think ahead…the future…”
(47 years old)
“Elderly people do not run away from life challenges, they have gone through many things…. It used to be hard times, but they still survive.…”
(24 years old)
“Our parents or the elderly are among the individuals who have a lot of experience that we can take as an example, to learn for the future…”
(35 years old)
3.2.2. Negative
This study also found negative attitudes from the cognitive aspect (thoughts) where younger people believe that the elderly mostly suffer from memory impairment or physical changes that cause them to be more sensitive in many things. This is because the elderly experience a decrease in the ability to use their memory, thus making them prone to diseases such as Alzheimer’s and dementia. In addition, elderly people have wrinkles and grey hair. Nine respondents expressed negative attitudes toward the elderly from a cognitive aspect. Among the responses from the respondents are as follows:
“In my opinion, the elderly can forget easily, sometimes we just told them a story and later they will ask the same thing again…we are still young, sometimes we tend to lose our patience too.”
(43 years old)
“From what I see, my mother often forgets the names of her grandchildren, that is why I always tell my children when they say hello to grandma, say their name at the same time so that my mother is not confused and forces herself to remember….”
(55 years old)
“In my opinion, elderly people are sensitive…we have to speak kindly, otherwise they will suddenly get angry or avoid talking to us….”
(45 years old)
3.3. Behavioural Aspects
3.3.1. Positive
The results of the study found that out of 20 respondents, a total of 16 people showed positive behaviour towards the elderly. A positive attitude from the behavioural aspect includes providing services and social interactions, helping and respecting the elderly as best as possible. This is because, as they age, the elderly wanted the attention of those around them so that they do not feel lonely or excluded from society. Among the answers from the respondents are as follows:
“My grandmother keeps telling me the stories of her younger days, I do not mind listening even though she keeps repeating them…it is sad to see especially when she tells them with spirit”
(23 years old)
“In many cases I tried to meet my parents’ wishes, even with a meager salary I will try my best to give them what I can afford….”
(35 years old)
“My siblings and I save some money every month so that we can use them to take our parents on vacation or eat out together…”
(30 years old)
“I live far away from my family…when I go back to my hometown, I like to spend time with my parents…give them foot massages and cook what they want to eat”
(42 years old)
3.3.2. Negative
The negative attitude of adults, in terms of behaviour, can be seen from the act of isolating themselves and being rude to the elderly. This is because adults consider the elderly are troublesome and expect help from others to take care of themselves. Four respondents responded with negative attitudes from the behavioural aspect. Among the answers from the respondents are as below:
“Usually when my mom calls me, I often take some time to answer or meet her needs…sometimes I quickly go and see what she wants”
(25 years old)
“Sometimes I raise my voice to my mother when she repeatedly says I am lazy to help take care of my grandparents…then I feel sorry”
(24 years old)
“My grandfather likes to talk, but I’m too lazy to listen. Usually, I would create some excuse to avoid entertaining him”
(30 years old)
“Once, I have tried to help my grandmother to clean up…the elderly got their own smell, right…it made me nauseous, I could not do it”
(25 years old)
4. Summary of Findings
Overall, this study found that most respondents have a positive attitude towards the elderly, as opposed to a negative attitude towards them. Table 2 shows the attitude responses to the elderly based on affective, cognitive and behavioural components.
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Table 2. Components of attitude based on affective, cognitive and behavioural.
5. Discussion
Overall, the study found that adults under the age of 60 mostly had a positive attitude toward the elderly. Out of 20 respondents, 14 respondents gave a positive affective attitude response while another six respondents gave a negative affective response. As for the cognitive component, a total of 11 respondents gave a positive attitude response compared to nine negative responses. And finally, the behavioural component showed that 16 respondents have a positive attitude and the rest showed a negative attitude. The findings of this study are supported by other studies conducted in Malaysia, which found that the adult community in Malaysia has a positive attitude towards the elderly (Ali & Aziz, 2018; Khadijah et al., 2011; Alavi & Sail, 2010; Singh et al., 2018).
Besides, the results obtained in this study are also in line with studies conducted in the West, which also touched on affective, cognitive, and behavioural aspects. For example, a study by Mendonça, Marques, & Abrams (2018) showed that an affective aspect was assessed from feelings of prejudice, cognitive was seen in terms of individual beliefs and stereotypes towards the elderly. While behavioural is a way of expressing oneself through actions. Moreover, the study from Robinson, Zurcher, & Callahan (2015) only touched on two aspects, namely the affective and cognitive attitudes towards the elderly. The study showed that 94.8 percent of respondents had a positive attitude towards the elderly, such as feeling happy being with the elderly, and believe that the elderly are healthy and active individuals.
Next, several positive attitudes towards the elderly were identified in this study. These include attitudes such as having feelings of concern, affection, compassion, and even comfortable with the elderly (affective); believes that the elderly are human beings who need to be respected, have a lot of experience, far-sighted, and love to give advice (cognitive); focusing and paying attention the elderly, giving kind treatment to the elderly such as massaging, spending time and chatting with them or doing leisure activities and giving good feedback to them (behaviour). The findings of positive attitudes in this study clearly showed that elderly people are still highly respected and regarded by adults aged between 20 to 59 years in Malaysia who practice good family values and respect for the elderly (Ali & Aziz, 2018).
This positive affective attitude towards the elderly is because adults in Malaysia emphasize the importance of family relationships and the responsibility to repay the elderly. After all, they have been brought up from an early age about the noble values of the elderly (Abdullah et al., 2015). From the aspects of cognitive attitude, elderly people are considered to have a lot of knowledge and life experience because they have lived longer than others. This is because the elderly has diverse life experiences (Alavi & Mahbob, 2017), as well as being far-sighted, knowledgeable, and experienced in life (Alavi et al., 2019). This causes adults to regard the elderly as a source of reference and guidance for making decisions in their lives.
Furthermore, the behaviour component also showed a positive attitude of adults to the elderly. According to Ismail (2015), the positive behaviour of adults towards the elderly can further enhance the quality of moral values in the community at various age levels. Robinson et al. (2015) found that adults who practice good values towards the elderly tend to have a good personality. This is because sometimes it is difficult to meet the demands or needs of the elderly, but when family values and love are given priority, it can influence individuals to continue to behave appropriately. Moreover, Alavi & Mahbob (2017) argued that good behaviour towards the elderly can be assessed in terms of the amount of focus or attention given to them. For example, the elderly would feel confident that they are valued by society when they are given more attention by their caregivers or children (Alavi & Mahbob, 2017).
Although most of the respondents in this study gave positive attitude feedback towards the elderly, there were also a handful of respondents who responded negatively towards them. Examples of negative attitudes towards the elderly that were obtained in this study were attitudes such as feeling bored, impatient, irritable, and depressed with the elderly (affective); believe that the elderly, as a person, is always forgetful, sensitive and fussy, have health problems and significant physical impairment (cognitive); and constantly complaining about the elderly, not being comfortable with the elderly, avoiding, being rude and not able to understand them (behavioural).
From an affective point of view, the respondents felt impatient and easily got angry at the elderly due to the elderly’s limitations to manage themselves, causing the adults to feel depressed with the burden of caring for complicated and fussy elderly in many ways. This causes adults to unintentionally lose their patience and sometimes release their anger towards the elderly (Husin & Alavi, 2016).
Besides, negative attitudes, from a cognitive aspect, can be seen among some respondents who have a negative perception of the elderly. This is in line with the views of Ali & Azizi (2018), who stated that elderly people are sensitive to their environment, thus, they are easily offended by their children and the like. The elderly also experiences significant mental changes such as becoming senile because some brain cells can no longer function properly as they age. As a result, the brain efficiency of the elderly begins to decline. Elderly people also experience slurred speech, act unnaturally and behave like children (Rahman et al., 2018). Furthermore, negative attitudes for the behavioural component were also obtained in this study. Respondents behaved such as refusing to be involved with the elderly or being rude to them because adults are prone to problems and feeling burdened to care for the elderly (Cheong, Wong, & Koh, 2009), which caused them to have a negative attitude towards the elderly (Doherty et al., 2011).
6. Conclusion
In conclusion, this study found that adults in Malaysia still possess a positive attitude towards the elderly. Such an attitude will certainly have a positive effect on the intergenerational relationship between the elderly and the young in the future. However, future research should investigate attitudes towards the elderly in a more comprehensive manner, such as examining attitudes towards the elderly at various age groups, not just limited to adults. In addition, differences in attitudes towards the elderly, based on age, should also be studied so that people who tend to have a negative attitude towards them can be identified, and intervention can be implemented to this target group.
The results of this study serve as a benchmark for adult attitudes towards the elderly in Malaysia, in a broader context and not just limited to early adulthood as many previous studies have done (Eiamkanchanalai, Assarut, & Surasiengsunk, 2017). Identifying the attitudes of adults towards the elderly is important to do because most adults will play a role in caring for the elderly in the future. This will help in the process of caring for the elderly more effectively and efficiently.
Relevant parties, especially the government such as the Department of Social Welfare can also benefit from the results of this study. Information or results from this study is important so that the responsible body can design appropriate programs or interventions if the results of the study obtained on the attitudes of young people to the elderly in Malaysia are negative. Examples are a guide to planning programs and interventions towards healthier and positive aging.
Fund
This research was supported by Ministry of Higher Education (MoHE) of Malaysia through the Fundamental Research Grant Scheme for Research Acculturation of Early Career Researchers (RACER/1/2019/SS05/UUM/3).