Table 2.

Illustrative quotations for emergent themes

Theme subthemes	Illustrative quotation
Attitudes towards older persons
(i) Rewarding and revered	“Working with the elderly is a very rewarding job.” (Nurse educator) [21] pp. 4
	“It’s the people, one of the things that I love about it is that… they have been around longer than I have. They’ve learned, and they’ve had this wealth of experience and information…. They all have something to offer.” (Geriatric Community Health Worker) [22] pp. 53
	“The aged should be admired by the community…” (Nurse) [23] pp. 61
	“To accept the loss of several abilities and interpret it not as loss, but rather as a change in your lifestyle … to realize it does not function as it used to, but think that there are alternatives, it can work in another way.” (Occupational therapist) [15] pp. 2877
(ii)Unwanted, dependent, and difficult
(a) Unwanted and costly	“It is more pleasant to take care of a younger person. It is more aesthetic….Old age is not pretty…” (Nurse) [14] pp. 43
	“Having too many concomitant diseases in the same patient, prolonged treatment periods, the patient’s personality creating problems, failure to respond to treatment, and lacking the necessary treatment for a long time make a good medical treatment harder.” (Physician) [15] pp. 182
	“The first thing that comes to mind is…how to discharge or hospitalize the patient. I feel impatient.” (Physician) [15] pp. 183
	“…these old people don’t know what’s going on anyway. So they don’t know whether they’re clean or not, do they?” (Nurse) [24] pp. 4
	“They are like children. Most of them have Alzheimer’s disease or dementia… Older patients either do not understand or are unable to do as advised.” (Physician) [15] pp. 181
(b) Complex and challenging	“I felt really intimidated by older patients because they’re so complex and are usually on a whole bunch of drugs and have a lot of different medical problems.” (Trainee physician) [20] pp. 480
	“The elderly do not cooperate and their illnesses are complicated and care is also difficult and many are multifunctional…. Some colleagues sometimes say they do not like to take care of the elderly but others…. Saying things like ‘he is old, what can I do to him?’” (Nurse) [21] pp. 3
	“…working with elderly patients can get frustrating… often times there’s not a lot you can do.” (Intern) [20] pp. 479
	“….she is not willing to be helped at all. She can’t live by herself… She is so preoccupied with her rebellion that she won’t let anyone tell her what to do anymore. She won’t accept any help…” (Social worker) [14] pp. 43
Opposing pole: a welcome intellectual challenge	“I feel like I’ve had a really positive experience and am feeling more positive about geriatrics… dealing with their chronic illnesses and talking about what’s going to happen in the future, about falls risks, social supports, their home life- I just really enjoy that, and I feel more comfortable.” (Resident) [20] pp. 480
(c) Dependent	“a young person can take care of themself…. but the elderly… need a lot of care and all their daily tasks must be done for them.” (Nurse) [21] pp. 3
	“I always check how autonomous a person still is, how much does he or she depend on others for help.” (Psychologist) [17] pp. 2877
	“An older patient is a person over 65 years old, likely to require the assistance of either a health care or non-health care provider while performing everyday activities, a member of the most senior part of society, and requires more care following an illness, thereby causing an increase in the costs.” (Physician) [15] pp. 181
	“Young patients have enough strength to take care of themselves and to be assertive and self-assured with their physicians… this is not the case for older patients…. I will represent them and make sure they get the best possible treatment…” (Nurse) [14] pp. 43
Opposing pole: assertive and independent	“They are used to taking care of themselves.… the generation aging now is much more strong-minded.” (Occupational therapist) [17] pp. 2876
Role of the older persons’ family
(a) Meeting expectations	“…the patient’s relatives who do not respect the nurses, in turn, make the nurses neglect the patient…. We see sometimes that the family of the patient themselves like their relative to die and are not bothered very much. It’s affecting our performance.” (Nurse) [21] pp. 4
(b) Abandonment	“They [the children] do not want to [help]; they have no time….. they don’t want to make the effort.” (Physician) [2] pp. 483 “…in the old days the family used to take responsibility and care for the old, but nowadays this is not the case anymore so old people need to be more independent.” (Occupational therapist) [17] pp. 2876
(c) Advocacy	“There is also difficulty even if they know their rights and the ways to implement them….. If they don’t have a son or a daughter accompanying them to help in realizing these rights, or if we do not take it upon ourselves to accompany them closely in realizing their rights, it is very difficult for them to take the initiative…” (Social worker) [2] pp. 483
Behaviour of healthcare professionals towards older persons
(a) Dehumanising, discriminating and dismissing	“Sometimes people don’t talk much to older patients as they would a younger patient. People don’t explain as much to them, they kind of more just reassure and tell them they’re going to be OK… sometimes that’s totally app. ropriate… but at other times I think they want to know and …they could understand it and they’re not really given the chance.” (Intern) [20] pp. 478–9
	“Nurses can come and take out the catheter without even looking at or talking to the patient.” (Nurse) [14] pp. 44
	“…they [nursing carers] don’t speak to the old people… It’s like they aren’t worthy of communication.” (Nursing care staff) [24] pp. 3
	“Some colleagues who themselves have moral issues and may not prescribe the medication of elderly patients and keep that secret from everyone because it has consequences.” (Nurse) [21] pp. 3
	“One day the code was announced…. They said leave it, the patient is 90 years old, what else do you expect, leave them be…they delayed seeing to the patient and the patient died.” (Emergency worker) [21] pp. 3
	“I think there’s a certain amount of discrimination going on that those [older] patients may not get as good care as someone who comes in with a similar problem who’s 10–15 years younger, and can describe the problem well and establish a better rapport with the physician.” (Intern) [20] pp. 479
	“…older patients do not evoke the same attitude as younger patients… They [the older person] do not receive proper care in regard to how people talk to them or behave toward them.” (Physician) [2] pp. 483
Opposing pole: empowered role models	“We do not need to suggest or train them, just listen to them. “Phaya”, which is passed down from ancestors, can be used to apply health services to harmonize with the local context. The senior citizens have meetings to share what they do to stay healthy. We have an older person who is a health idol for the aged in other villages. We should support what older persons do.” (Community nurse) [23] pp. 62
(b) Unworthy of care	“Some of us see it all as a bit futile really so don’t bother. Futile because they [the nursing home residents] are going to die soon.” (Nurse) [24] pp. 4
	“Some staff say that what’s the point in spending time and money on this elderly patient? Of course the system, the family, and even the personnel do not say this publicly… they say it’s useless wasting energy on the elderly.” (Nursing educational supervisor) [21] pp. 4
	“…in the case of an elderly addict… he does not have mercy on himself, so why should I bother myself and care about him. If you don’t care about yourself and how old you are, why should we?” (Physician) [21] pp. 4
Behaviour of older persons towards healthcare professionals
Challenging behaviours	"We are dealing with people who have behavior problems. They curse and hit.” (Nurse) [14] pp. 43
	“…the ones [older patients] who don’t pay attention and are rude, they use bad language, they display a superiority attitude, they threaten they will complain to the authorities.” (General practitioner) [16] pp. 5
	“Some [older] patients are completely disabled, but they want attention and are demanding…” (Doctor) [14] pp. 43
	“She just said yes to everything I told her, but she did not understand, in the end she did not know what she needed to do, so I had to talk to other child and explain all to him again” (General practitioner) [16] pp. 6
	“[compared to younger patients] They are less likely to complain, and nobody speaks for them, so they just don’t have a voice.” (Staff member low security unit) [18] pp. 278
Opposing pole: respect for clinicians	“…with older patients…. If you’re taking care of them then you’re the doc. They’ll listen to you.” (Intern) [20] pp. 480
Definition of an older person
(a) More than chronological age	“There are people in their 80 s with all sorts of health problems… who are still active and others in their 70 s are very restricted in their actions… it is not a question of biological age anymore…” (Doctor) [17] pp. 2877
(b) Illness and dependency	“I think it should be more about ability than age. Cos the concept of age is very segregating whereas ability is more enabling. (Health Care Practitioner) [18] pp. 279
	“Old age is when you start depending on others, you start forgetting things, you cannot take care of yourself anymore, you forget your medicine, you have no appetite, and you start thinking about death and the life you had before.” (Doctor) [16] pp. 4
	"I believe you are old when your body is old, the illness is so bad that it cannot fight anymore and no medicine can help, not the age in years is relevant.” (Doctor) [16] pp. 4
	“Older patients are individuals who are 60–70 years old, on average, and have chronic diseases and complicated problems together with physical and mental distortions.” (Nurse) [15] pp. 181
	“…we know that when people are in a suboptimal state hormonally, their body drifts rapidly towards disease.” (Doctor) [19] pp. 950
	"Old is someone who is not healthy anymore and who experiences no joy in daily life… this makes one old… not having fun in life anymore… work and interests keep one young.” (Occupational therapist) [17] pp. 2875
	“Some of us see it all as a bit futile really so don’t bother. Futile because they [the residents] are going to die soon.” (Nurse) [24] pp. 4
Opposing pole: independent	“People with a good education level or a good job are normally more independent … those with poor education are more helpless …” (Social worker) [17] pp. 2876
(c) Taking responsibility for ageing	“Most of what they call age-related disease are things that come from lifestyle choices that have been made, and so I don’t think you have to get those diseases. I think they can be prevented….” (Nurse) [19] pp. 948
	“If you live better longer and don’t suffer from the infirmities associated with bad aging, like arthritis and diabetes and high blood pressure and cancer and Alzheimer’s, if you live without those illnesses, you’re going to feel better. You’re going to be more productive. Economically the country will benefit.” (Doctor) [19] pp. 951
	“[older people should not] wait for help to be given.” (Social worker) [17] pp. 2875
	“The key point is to accept changes… to perceive them as challenges not as loss.” (Occupational therapist) [17] pp. 2875