Table 3.

Overarching theme- systemic context of attitudes to ageing

Theme subthemes	Illustrative quotation
(a) Resource shortfalls	“They are just very tangential…and I don’t have a ton of time for that. And I also sometimes don’t have patience for it.” (Resident) [20] pp. 479
(i) No time	“The work is so demanding. I have no time to ask questions of and talk to older people.” (Nurse) [23] pp. 63
	“I’d like to be able to talk to [older] people all day, but when you have seven other people to see, you don’t care if the little blue pill is this big or this shaped or what.” (Intern) [20] pp. 479
	“…I do not think that there are enough staff members here. Do we always treat the patients properly? No, we do not. Do I feel sorry about that? Yes, I do…We fail to do that due to our workloads. We do not have time. The number of nurses is quite low…” (Nurse) [15] pp. 182
(ii) No resources	“We can never find their relatives. We cannot ask them to purchase wet towels and diapers when required… We take these from other patients and use them. Sometimes, we end up purchasing them with our own money…” (Nurse) [15] pp. 182
	“senior care personnel is lacking, money is lacking… I cannot have positive aging without being able to afford good senior care…” (Psychologist) [17] pp. 2876
	“It’s hard when you don’t necessarily have a great plan for them when they leave hospital ….It’s a sense of disappointment in oneself and the system in not being able to provide a better outcome.” (Intern) [20] pp. 480
(iii) Inadequate training	“We could not identify what is wrong. We would just notice a change and express a concern. Because we haven’t got specific training in old age.” (Secure service nurse) [18] pp. 276
Opposing pole: well trained	“..most of us would have done some placement in elderly psychiatry as part of our training and ….feel competent to identify things like cognitive deficits.” (Secure service staff) [18] pp. 275
(b) Burnout and compassion fatigue	“I’m burning out. There’s a lot of sadness, there’s been a lot of goodbyes. When you work with the elderly, it doesn’t usually have a happy ending, you know? The goodbyes and uhm, dealing with poverty. Uh, it’s difficult and you seeing how much people suffer that are low income… so although I’d like to volunteer, I’d like to get away from that.” (Social Worker) [22] pp. 54
	“…we talk about compassion fatigue… after twenty-eight years of listening to client problems, caregiver problems, having been a caregiver myself… I’m tired.” (Geriatric community health worker) [22] pp. 54