Introduction

Physiological aging is a progressive process that involves morphological and functional changes in different systems of the human body. At the muscular level, it weakens the muscles, causing loss of strength, fragility, and an increased risk of falls. In the cardiovascular system, arterial stiffness and ventricular remodeling predispose individuals to hypertension and a reduced response to exercise. In the nervous system, decreased brain volume impacts memory and executive function. However, aging is not a uniform phenomenon, as it varies among individuals and can be influenced by genetic, environmental, and lifestyle factors [1]. In recent decades, population aging has become a global demographic and social challenge. In Latin America, Chile is projected to be one of the most aged countries by 2050, with approximately 22% of its population over 65 and 7% over 80 [2]. This demographic change imposes the need to prepare healthcare systems to provide adequate care free of stereotypes, prejudices, and discrimination toward the elderly population.

Ageism, defined by the World Health Organization (WHO) as the set of stereotypes, prejudices, and discrimination based on age, can occur at all stages of life, affecting both young and older people [3]. However, its impact is particularly harmful to older people, especially in the field of healthcare, where it represents a significant barrier to adequate care. This social phenomenon manifests itself at different levels: institutional, interpersonal, and intrapersonal, and can be expressed implicitly or explicitly. In clinical practice, ageism negatively influences the quality of treatment and professionals' perceptions of their older patients, which can have a significant impact on clinical outcomes [4]. Studies have shown that ageism can lead to the underestimation of symptoms, a lack of access to appropriate treatments, and reduced investment in the rehabilitation of older adults [5].

Training in geriatrics and gerontology is key to changing stereotypes and attitudes toward older adults. Research indicates that students with greater knowledge about aging have more positive attitudes [6,7]. In Chile, León et al. [8] analyzed the perceptions of students and teachers in health universities. They found neutral stereotypes toward aging, highlighting the influence of academic training and personal experience in shaping these perceptions. However, despite growing international evidence, research on ageism among physiotherapy students in Chile remains limited.

This research aligns with international initiatives, such as the WHO Decade of Healthy Aging (2020-2030) and the United Nations (UN) International Plan of Action on Aging, which aim to transform the social view of aging (Pan American Health Organization, PAHO, 2021). However, in Chile, scientific evidence on ageism is limited, which hinders its understanding and the development of effective strategies [9,10].

Given this problem, the question arises:

Is there a link between the level of knowledge in geriatrics and gerontology and the level of negative stereotypes toward older people?

To answer this question, this study has two objectives:

1. To estimate the frequency of negative stereotypes toward older adults among physiotherapy students at a university in the Valparaíso Region.

2. To compare these stereotypes based on the students' level of knowledge in gerontology and geriatrics.

This research will contribute to the understanding of ageism among future health professionals. Furthermore, it may inform strategies for mitigating ageism within academic physiotherapy training.

Methods

Design

This study employed a cross-sectional observational design, allowing for the description and analysis of negative stereotypes toward older adults in a single sample of physiotherapy students at a specific point in time. This design was chosen because it allows for the simultaneous collection of exposure and outcome variables. This makes it an efficient alternative in terms of time and resources for estimating the frequency of phenomena and exploring associations between variables, without requiring longitudinal follow-up [11]. The cross-sectional design allows us to quantify the prevalence and distribution of negative stereotypes, identifying what proportion of participants express certain perceptions about old age. At the same time, its analytical capacity facilitates the identification of associations between variables, allowing us to examine the relationship between negative stereotypes and the level of knowledge in geriatrics and gerontology. This approach makes it easier to detect possible differences between groups, providing an empirical basis for evaluating the influence of academic training on the perception of old age.

Background

This study was conducted at a private university in the Valparaíso Region, Chile, in the physiotherapy program. Recruitment took place between August and September 2024, through invitations sent to the personal and institutional email addresses of all students. The message included a link to the SurveyMonkey platform, where they could respond to the survey anonymously and voluntarily.

Participants

Active physiotherapy students enrolled in any year during the data collection period who voluntarily agreed to participate and provided their informed consent before responding to the survey were included.

Selection was carried out using census sampling, considering all students enrolled during the study period.

Variables

Results

The survey was sent to all physiotherapy students at the university (129 students), of whom 100 responded (response rate of 77.5%). Four students indicated that they did not wish to participate in the research, resulting in a sample of 96 students for this study. The average age of the participants was 21.9 years (standard deviation 3.6). As shown in Table 1, the gender distribution was slightly higher for women, who represented 54.2% of the students, compared to 45.8% for men. In terms of knowledge of geriatrics and gerontology, 56.3% of the students had not passed both subjects. In comparison, 22.9% had passed only the gerontology subject, and 32.5% of the students had passed both subjects.

The average score for negative stereotypes toward old age among the 96 students surveyed was 38.8 (standard deviation 5.8), ranging from a minimum of 26 to a maximum of 53 points. Table 2 reflects the categorization of levels of negative stereotypes toward older adults among the students surveyed, showing that half of the students had low levels of negative stereotypes toward old age. However, 42.7% had high levels. Finally, it should be noted that the questionnaire used showed high reliability (α = 0.84), indicating that its measurements are stable and consistent across the items in the instrument.

Table 3 presents the descriptive analysis of each item. It can be seen that a high percentage of respondents associate aging with cognitive decline, behavioral rigidity, irritability, and functional dependence, reflecting the persistence of negative stereotypes. According to the results, 67.7% of respondents agree or strongly agree that, after the age of 65, people begin to experience considerable memory impairment. Similarly, 81.3% agree or strongly agree that older people become more rigid and inflexible with age. In addition, 71.9% of students agree or strongly agree that older people are easily irritated and “grumpy.” Another relevant finding is that 64.6% of respondents agree or strongly agree that a large proportion of older people are “senile.” Finally, 58.3% of students agree or strongly agree that people over the age of 65 have many disabilities that make them dependent on others. Finally, 61.5% of respondents agree or strongly agree that older people have less interest in sex, while 60% agree or strongly agree that older adults are, in many cases, like children.

The results presented in Table 4 show the average scores for negative stereotypes toward older adults, according to the level of knowledge in geriatrics and gerontology. The group of students who did not pass any of the subjects obtained the highest score (40.7) and was used as the reference group. Compared to this group, students who passed only the gerontology subject obtained an average score 3.5 points lower (95% confidence interval: 0.43 to 6.51; p = 0.0255), while those who passed both subjects had a score 4.9 points lower (95% confidence interval: 2.35 to 7.35; p = 0.0002). Both differences were statistically significant, suggesting a lower presence of negative stereotypes among those who have studied both areas.

The crude and adjusted multiple linear regression analyses are presented in Table 5. Even after adjusting for students' gender and age, the model remained statistically significant, explaining approximately 16.3% of the variability in negative stereotypes. Along these lines, it was found that those who passed both geriatrics and gerontology courses had an average of 4.3 points less in the total negative stereotype score compared to those who did not pass these courses. This finding indicates a statistically significant association between training in geriatrics and gerontology and the reduction of negative stereotypes toward old age.

Discussion

Negative stereotypes toward older adults among physiotherapy students

The first objective was to determine the presence of negative stereotypes among physiotherapy students, obtaining an average score of 39, corresponding to a low level according to the classification used [15], although located at the upper limit of that category. This score is higher than that reported in previous studies in Chile with nursing students [9] and students in health-related fields in general [17]. Similarly, studies in Spain have reported lower scores in physical therapy students [15] and students in health-related fields [18]. These results suggest that physiotherapy students may be more predisposed to negative stereotypes than other groups of future healthcare professionals.

In addition, it was observed that 43% of the sample had a high level of negative stereotypes, while only 50% fell into the category of low negative stereotypes. Among the most prevalent stereotypes among physiotherapy students, a greater presence of beliefs reinforcing the idea that cognitive impairment, behavioral rigidity, irritability, lack of interest in sexuality, and dependence on others are common characteristics in older adults was identified. It is necessary to examine these results closely, as they reveal a significant discrepancy between social perception and the epidemiological reality of cognitive impairment in older adults. While 68% of physiotherapy students in our study believe that cognitive impairment is a common feature of old age, 65% of older adults in Chile also share this belief [19]. However, empirical evidence shows that the actual prevalence in people over 60 is only 10% [20]. Similarly, in this study, 58% of physiotherapy students and 54% of older adults in Chile [19] associate old age with disability and dependence. However, this contrasts with the 86% of older adults who have no difficulty performing basic and instrumental activities of daily living [21] or the 78% reported by the National Survey on Disability and Dependency [22].

Sexuality in old age continues to be an invisible issue, creating social and institutional barriers to the full exercise of sexual rights. Evidence shows the persistence of stereotypes that link sexuality solely to youth, reinforcing the misconception that older people have no sexual interest or capacity [23], a perception shared by 62% of the students in our study. However, this contrasts with 40% of older adults in the Metropolitan Region and O'Higgins Region in Chile, who, when interviewed, indicate that their sexuality is as important as when they were young [24]. It also differs from the one-third of the older adult population who report having an active sex life [19]. These misperceptions reinforce taboos and limit access to timely professional care and information. Therefore, it is essential that physiotherapy training not only provides up-to-date knowledge about aging but also promotes strategies to challenge stereotypes and foster a more realistic and diverse view of old age.

Level of knowledge in geriatrics-gerontology and influence on negative stereotypes

The second objective of this study sought to compare negative stereotypes toward older adults among students who had passed courses in geriatrics and/or gerontology and those who had not yet done so. The results confirm that students who have passed at least one of these subjects exhibit significantly fewer negative stereotypes compared to those who have not passed any of them. This effect is even more pronounced in students who have passed both subjects, and remains even after adjusting for covariates such as age and gender. These findings support previous research indicating that training in geriatrics and gerontology is associated with fewer negative attitudes and stereotypes toward old age among university students. A study conducted on nursing students in Chile and Mexico using the same questionnaire showed that the nursing course on gerontology-geriatrics significantly reduced negative stereotypes among students, lowering their scores from 35 to 30 after participating in the course. This result is attributed to the combination of up-to-date content on healthy aging, together with interaction with older adults in clinical practice. However, this was not found in Mexican students [9]. Similarly, in Saudi Arabia, knowledge about aging was identified as the main predictor of favorable attitudes toward older people [6]. Furthermore, evidence suggests that the duration and depth of academic training influence perceptions of aging. A 2016 study by Turan et al. of physical therapy and nursing students enrolled in four-year programs revealed significantly more positive attitudes compared to those enrolled in two-year programs. This suggests that more extensive training enables more comprehensive learning and greater exposure to older adults in clinical settings [25].

Similarly, a study in Spain showed that first-year physical therapy and occupational therapy students had higher levels of negative stereotypes compared to fourth-year students and professionals in the field, suggesting that education and professional experience contribute to the modification of stereotypes [15]. Therefore, the findings of this research underscore the importance of incorporating training in geriatrics and gerontology into physiotherapy curricula to mitigate the prevalence of negative stereotypes and enhance future care for the elderly population.

Practical implications

The results of this study support the need for educational interventions that reduce stereotypes, prejudices, and ageist attitudes among health students. Evidence indicates that combining theoretical training with clinical experiences is particularly effective. For example, integrating geriatric content with nursing home placements has significantly reduced stereotypes among nursing students [26].

In the case of physical therapy students, various interventions have sought to reduce ageism, particularly those involving direct contact with older adults. While formal programs tend to have limited and transient impact, practical experiences with meaningful interactions, such as community service or companionship, show more consistent effects. This highlights the importance of fostering human and empathetic connections, in addition to conveying theoretical content [27].

On the other hand, the use of simulations and narrative games has proven effective in promoting empathy and transforming perceptions of aging. Experiences such as the use of aging simulation suits have allowed physical therapy students to experience the physical limitations associated with old age, which translates into a more understanding attitude toward older people [28,29]. However, it is necessary to reflect critically on these approaches. From a predominantly biological and quantitative perspective on aging, these types of suits aim to evoke empathy by simulating the physical limitations of old age [30,31]. Despite their good intentions, these devices can reinforce a homogeneous and disabling view of aging, contributing to its stigmatization. By associating old age solely with functional decline, through restrictive collars, fatigue-inducing bands, or weighted accessories, there is a risk of perpetuating negative stereotypes that do not reflect the functional diversity of older people.

Along the same lines, strategies such as educational podcasts, playful narratives, and positive education about aging, combined with intergenerational contact, show potential for raising awareness among students and promoting more dynamic and less stereotypical representations of this stage of life [32,33,34,35]. However, although physical therapy students tend to have positive attitudes, they have little knowledge about aging and little intention of working with this population [36].

Therefore, it is essential to implement innovative and sustained educational methodologies that generate a profound and lasting change in the perception of older people in the healthcare field. Reducing negative stereotypes not only has ethical implications but also improves the quality of care and well-being of this population. To address population aging, comprehensive academic training is required that goes beyond biology and incorporates interdisciplinary approaches from geriatrics and gerontology. In this context, the Decade of Healthy Aging (2021 to 2030) represents a key opportunity to promote dignified, active, and healthy aging [37].

Strengths and limitations

This study has some limitations that should be considered when interpreting its results. Although a response rate of 77.5% was achieved, there may be non-response bias, as participants may differ from non-participants. However, the high participation rate improves the representativeness of the sample. The sample size may limit the generalizability of the findings and reduce the power to detect more subtle associations. However, a census sampling was used, including all students enrolled during the study period, which improves its representativeness within the institution. The cross-sectional design prevents establishing causality or evaluating changes over time. Therefore, future research should incorporate longitudinal designs to analyze the evolution of attitudes toward older adults and the sustained effects of gerontological training, as well as qualitative approaches to explore in greater depth the underlying perceptions, motivations, and experiences surrounding ageism. Another limitation was the exclusion of variables such as contact with older adults, socioeconomic status, or caregiving experience, which could have enriched the analysis of ageism among students. Furthermore, as the study was conducted at a single private university in the Valparaíso Region, the results cannot be generalized to other institutions or regions. It is recommended that future studies be expanded to different universities and health-related degree programs. Despite these limitations, the study has significant strengths. Among them, it used a validated instrument in Chile with high reliability and applied robust statistical analyses adjusted for age and gender. In addition, it addresses a topic that has been little explored in physiotherapy students, providing useful evidence to guide curricular improvements and training strategies that contribute to reducing ageism in healthcare.

Conclusions

This study shows the presence of negative stereotypes toward older adults among physiotherapy students, with a considerable prevalence among those who have not received formal training in geriatrics and gerontology. The association between greater knowledge in these disciplines and a lower prevalence of stereotypes reinforces the need to explicitly and systematically integrate gerontological content into professional health training. Reducing ageism toward older adults from the training stage not only contributes to more dignified, empathetic, and stereotype-free care but also prepares future professionals to face the challenges of population aging. These findings provide relevant evidence for redesigning curricula and promoting health training that aligns with the principles of the Decade of Healthy Aging, as promoted by international organizations such as the WHO.