Ageism among postgraduate medical trainees: A mixed-method study from Karachi, Pakistan

Abstract

Background & Objectives: Ageism - stereotyping, prejudice, and discrimination against older adults – can negatively impact health care delivery. In Pakistan, the aging population is growing yet little is known about the attitudes of postgraduate medical trainees towards older patients. The objective was to assess the prevalence of ageist attitudes among postgraduate trainees in Karachi and explore underlying perceptions influencing these views.

Methodology: A convergent mixed-method cross-sectional study was conducted from September 2022 till September 2023 in Karachi, Pakistan, among trainees enrolled in CPSP programs. Quantitative data were collected using modified University of California, Los Angeles (UCLA) Geriatric Attitude Scale, and qualitative insights were obtained through two focus group discussions (FGDs). Descriptive statistics and logistic regression analyzed survey data, while thematic analysis explored FGD transcripts.

Results: Of 218 respondents (mean age 29 years, 74% women), 88% frequently encountered older patients, yet 55% found their care challenging. The median attitude score was 45/65, with 46% scoring above the median. Trainees who opposed geriatric education or government-run geriatric centers were significantly three times more likely to exhibit ageist attitudes (p<0.05). FGDs revealed limited awareness of ageism, perceived complexity of geriatric care due to multimorbidity and communication barriers, and strong support for capacity building through structured education and infrastructure.

Conclusion: Despite frequent geriatric encounters, ageist attitudes persist among trainees, driven by inadequate training and systemic constraints. Integrating standardized geriatric education and establishing dedicated care facilities are essential to improve attitudes and enhance care for older adults.