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Approximately half of the nursing students confirmed their willingness to participate in caring for older people: a systematic review and meta-analysis

BMC Geriatrics volume 24, Article number: 745 (2024) Cite this article

Abstract

Background

Global population aging poses a significant global challenge, necessitating an increased demand for proficient caregivers specialized in elderly care. In our study, a systematic review and meta-analysis were conducted to synthesize the evidence concerning nursing students’ willingness to participate in caring for older people.

Methods

Eligibility criteria focused on cross-sectional studies involving nursing students’ willingness to participate in caring for older people and were reported in English or Chinese. PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and WANFANG databases were searched from inception until July 24, 2022. The methodological quality assessment in the included studies was evaluated using the AHRQ instrument. The pooled effects of the nursing students’ willingness to participate in caring for older people were computed using a random-effects model. Funnel plots and Egger’s test were employed to evaluate publication bias. Meta-regression and subgroup analysis were performed to explore the sources of heterogeneity. Sensitivity analysis was conducted to verify the robustness of the meta-analysis findings. All statistical tests were conducted with Stata 16.0 software.

Results

A total of 68 studies of medium or high quality met the eligibility criteria, involving 30,328 nursing students. The rate of nursing students’ willingness to participate in caring for older people was 49.0% (95% CI = 46–53%, I2 = 98.1%, P = 0.000). The results of meta-regression analysis showed that the following four predictor variables were significantly associated with nursing students’ willingness to participate in caring for older people: experience of living with and caring for older people, nursing as their first choice and their year-level in education, respectively. Subgroup analyses for these four predictor variables revealed the following pooled estimates of nursing students’ willingness: having experience of living with older people (0.54, 95% CI = 0.46–0.62) vs. no such experience (0.38, 95% CI = 0.30–0.46), having experience of caring for older people (0.55, 95% CI = 0.48–0.63) vs. no such experience (0.38, 95% CI = 0.30–0.46), nursing as their first choice (0.54, 95% CI = 0.51–0.58) vs. not their first choice (0.44, 95% CI = 0.35–0.53), being in the first year of nursing education (0.44, 95% CI = 0.34–0.55), second year (0.45, 95% CI = 0.34–0.56), and third and fourth year (0.62, 95% CI = 0.53–0.71).

Conclusion

The study found that approximately half of the nursing students confirmed their willingness to participate in caring for older people.The present study can serve as a resource for policymakers to increase the willingness of nursing students to participate in caring for older people.

Peer Review reports

Introduction

Global aging has emerged as a critical global concern, with the older population expected to reach unprecedented levels in the forthcoming decades. As of 2022, the global population aged 65 years and older numbered 771 million, tripling since 1980 [1]. The United Nations predicts that the older population is expected to reach 994 million by 2030 and 1.6 billion by 2050 [1]. China is notably confronting a substantial challenge posed by its aging population, with over 190 million individuals aged 65 or older in 2020, constituting 13.5% of its total population [2]. This places China as the country with the largest elderly population and the fastest-growing aging demographic globally.

Health problems associated with an aging population, such as disability, dementia, depression, and chronic diseases, pose substantial challenges to health services globally. Approximately 1 billion people, constituting 15.6% of the global population, experience varying degrees of disability [3]. In Australia, half (49.6%) of all older Australians had a disability in 2019, with 1.3 million older Australians needing assistance with daily activities [4]. The rate of instrumental activities of daily living (IADL) disability among Japanese adults aged 65 and above reportedly ranges from 7.9 to 23.2% in different regions [5]. By 2040, more than 27.0% of older individuals are projected to experience limitations in performing three or more activities of daily living (ADL) and encounter restrictions in social functioning [5]. In China, the number of older people with disabilities or semi-disabilities reached 40 million in the year 2019. Further, there were 10 million individuals diagnosed with dementia [6]. The number of older individuals with disabilities and dementia is expected to further increase.

The growing population of disabled and semi-disabled older individuals, coupled with the rising prevalence of chronic diseases, has resulted in a substantial increase in demand for care services. These services encompass long-term care, medical treatment, rehabilitation, psychological support, emergency assistance, and end-of-life care for older adults [7, 8]. As such, there is a growing need for skilled service providers to deliver care services to older people. However, nursing students’ willingness to participate in caring for older people as a career remains relatively low due to the perceived low degree of specialization, high labor intensity, and lack of recognition in caring for older people. The proportion of nursing students from Hong Kong (7.7%) and Mainland China (3.6%) who are willing to take care of older people is deficient [9]. Moreover, 8.0% of nursing students in Australia [10], 5.1% of nursing students in Sri Lanka [11], and 1.6% of Baccalaureate Nursing Students in Western Pennsylvania are reportedly considering eldercare as a potential career path [12].

“Willingness” typically denotes a subjective intention to engage in an activity. Nonetheless, there is currently no universally agreed-upon definition regarding willingness to participate in caring for older people. Many experts and scholars emphasize that fostering willingness among students for employment requires close collaboration among governmental bodies, educational institutions, and the job market. Additionally, active engagement from students and their families is crucial in shaping this willingness [13]. In this study, based on the existing literature, nursing students’ willingness to participate in caring for older people is defined as their intention to provide care to older people, taking into account individual, familial, and environmental factors. Related concepts such as “attitude” and “interest” are also pertinent. “Attitude” refers to a psychological construct characterized by a learned and relatively stable tendency to react to people, ideas, and situations in an evaluative manner [10]. Culture, age, gender, education, experience, and previous relationships with older people have been identified as factors that influence nursing students’ attitudes toward older people [14]. “Interest,” within philosophy, education, and psychology, refers to an individual’s consciousness and psychological propensity that fosters learning. Ebbinghaus suggests that interest influences the objects of our attention and memory [15]. The interest in participating in eldercare reflects nursing students’ inclination towards providing care for older adults. Several studies suggest that positive attitudes towards older adults play a crucial role in fostering nursing students’ engagement in geriatric care post-graduation [11, 16, 17]. Cheng et al. demonstrated that personal interest among nursing students is a pivotal factor influencing their decision to pursue geriatric care as a career post-graduation [17]. Nursing students’ attitudes towards older people and their interest in eldercare can reflect their willingness to participate.

Negative perceptions towards older people among care providers can lead to the formation of negative attitudes. These attitudes, in turn, can significantly impact care providers’ willingness to participate in caring for older people [18]. Research has shown a positive relationship between nursing students’ attitudes toward older people and the willingness to participate in caring for older people. At the same time, positive perceptions and attitudes toward older people can be cultivated through education [19, 20]. Nursing students, with their specialized education, constitute a vital and indispensable segment of the nursing workforce dedicated to caring for older people. At this critical stage of their education, nursing students can be positively influenced and guided to cultivate empathetic attitudes towards older individuals through targeted educational initiatives. By addressing common misconceptions about older people in their education, nursing students can develop more accurate and positive perceptions of elderly individuals, enhancing their readiness to provide effective and compassionate care [21]. The willingness of nursing students to actively participate in caring for older people not only influences their post-graduation employment decisions but also significantly contributes to the quality of care delivered to older people [22].

With the global trend of population aging becoming more pronounced, researchers have increasingly focused on studying nursing students’ willingness to participate in caring for older people in recent years. This has led to numerous cross-sectional studies on the topic, but findings across these studies vary. As an example, Okuyan et al. surveyed 688 nursing students in Turkey, with only 29 expressing a willingness to pursue a career in caring for older people [18]. This resulted a low willingness rate of 4.2% among nursing students to care for older people, as observed by Okuyan et al. In contrast, Carlson et al. surveyed 183 nursing students in Sweden and found that 106 expressed a willingness to work with older people [23]. This reflects a relatively high willingness rate of 57.9% among nursing students to participate in caring for older people. Yet, significant global differences exist in nursing students’ willingness to participate in caring for older people, influenced by factors such as sample size, survey regions, and individual characteristics of respondents. Despite qualitative reviews of nursing students’ willingness to engage in geriatric care [21], there is still a lack of comprehensive and integrated analyses of nursing students’ willingness to participate in caring for older people and the related influencing factors. Understanding accurate data on willingness rates and the factors influencing them is crucial for governments and nurse educators to prioritize interventions effectively. As such, in this study, a systematic review and meta-analysis were conducted to synthesize nursing students’ willingness rates to participate in caring for older people. The aim was to explore potential factors influencing nursing students’ willingness to participate in caring for older people. This exploration is timely and necessary, given the anticipated surge in demand for caregivers for older populations worldwide due to aging demographics.

Materials and methods

Registration

This meta-analysis was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). The PRISMA 2020 checklist items are presented in Supplementary Table 1, detailing the specific reporting aspects considered in this study. The study protocol was registered with the Prospective Register for Systematic Reviews (PROSPERO) under the registration number CRD42022348244.

Search strategy

During the literature search phase, two researchers independently and comprehensively searched six English and Chinese databases, including PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and WANFANG from inception to July 24, 2022. The Medical Subject Headings (MESH) terms and keywords used in the search were as follows: (“Students, Nursing” OR “undergraduate nurs*” OR “nursing undergraduat*” OR “nursing student*” OR “student nurs*” OR “BSN student*” OR “bachelor of nursing student*” OR “baccalaureate nursing student*” OR “student nurse”) AND (“Geriatric Nursing” OR “geriatric care” OR “geriatric nurs*” OR “aged care” OR “gerontology nurs*” OR “old people” OR “elderly” OR “old age” OR “older adults” OR “older population” OR “elder care”) AND (“willingness” OR “intent*” OR “attitude” OR “perception*” OR “knowledge” OR “belief*” OR “opinion*” OR “preference*”). Detailed information on the complete search strategy, including the specific search terms and their combinations, can be found in Supplementary Table 2. To ensure a thorough exploration of relevant studies, a process of reference tracking was employed. This included reviewing the references cited in the included articles and consulting pertinent systematic reviews and meta-analyses to identify additional studies that met our inclusion criteria. This method helped to comprehensively gather relevant literature for the analysis.

Inclusion and exclusion criteria

The inclusion criteria for the study included: (1) cross-sectional studies; (2) studies that exclusively examined nursing students as the study population; and (3) the percentage of nursing students’ willingness to participate in caring for older people was explicitly reported in the study or could be calculated using the formula: willingness to participate = (number of students willing to participate / total number of students sampled) × 100.0%. The exclusion criteria included: (1) duplicate publications; (2) studies not published in English or Chinese; and (3) those lacking essential data. When multiple studies were available on the same population, only the most recent data were considered to avoid redundancy.

Study selection and data extraction

Two reviewers independently screened the aforementioned studies, extracted and cross-checked information, and consulted a third reviewer to resolve disagreements. For missing information from the included studies, the authors of the studies were contacted via email to obtain the necessary information. The screening process involved initial assessment through title and abstract reading, followed by exclusion of irrelevant articles, and subsequent full-text review to finalize inclusion based on predefined criteria. Two independent reviewers conducted data extraction from the selected studies, capturing key details such as first author, publication year, study location, investigation timeframe, sampling methodology, sample size, gender distribution, students’ origin, only-child status, year-level in education, and the number and percentage of nursing students’ willingness to participate in caring for older people.

Methodological quality assessment

The methodological quality of the included studies was assessed using the methodological checklist recommended by the Agency for Healthcare Research and Quality (AHRQ). The AHRQ methodology checklist is regarded as an exceptional tool for evaluating the quality of cross-sectional studies [24]. It is also a widely accepted tool that scholars use to assess the methodological quality of cross-sectional studies [25]. The checklist is available at http://www.ncbi.nlm.nih.gov/books/NBK35156/ [26]. The tool comprises 11 components encompassing data sources, criteria for inclusion and exclusion, timing and sequence of patient enrollment, subjective factors influencing evaluators, quality assurance assessments, explanation of exclusions, control of confounding variables, management of missing data, response rates, and follow-up procedures. The 11th component, pertaining to potential bias from loss to follow-up, was excluded as it applies specifically to prospective studies. Hence, the present investigation assessed the included studies based on the remaining 10 components. Each component was assessed a rating of “Yes,” “No,” or “Unclear,” with a score of 1 assigned for “Yes” and no score assigned otherwise. A cumulative score of < 4 indicated “Low” methodological quality, 4 to 7 indicated “Medium” methodological quality, and > 7 indicated “High” methodological quality. The evaluation was conducted independently by two reviewers, with discrepancies resolved through discussions involving a third reviewer.

Meta-regression

Univariate meta-regression analyses were used to explore potential predictors of nursing students’ willingness to participate in caring for older people. In developing the review protocol, members of the research team, through a comprehensive review of the literature and several rounds of expert consultation, concluded that gender [8, 23, 27,28,29], origin of students [8, 29,30,31], year-level [23, 32,33,34] and only-child status [8, 30, 35,36,37] may serve as predictors of nursing students’ willingness in caring for older people. These four predictor variables were predefined for analysis. The findings from numerous empirical studies suggest that several factors may influence nursing students’ willingness to participate in caring for older people. These factors include the experience of caring for older people [8, 38,39,40,41], the experience of living with older people [8, 30, 31, 42], have taken courses on elderly care [29, 38, 42, 43], nursing as their first choice [29, 44,45,46,47] and geographical location [8, 10, 19, 20]. Based on these insights, the research team incorporated these five predictor variables post hoc into our analysis. As such, the meta-regression analysis ultimately included nine predictor variables: gender (male vs. female), students’ origin (urban vs. rural), only-child status (yes vs. no), the experience of living with older people (yes vs. no), the experience of caring for older people (yes vs. no), have taken courses on elderly care (yes vs. no), nursing as their first choice (yes vs. no), year-level (first, second, third and fourth), country (China vs. others). Data on the sub-groups’ willingness to participate in caring for older people were extracted from the publications included in the study.

Subgroup analysis

Subgroup analyses focused on variables that showed statistical significance in univariate regression analyses. The goal was to ascertain pooled estimates of willingness among subgroups of students who demonstrated significant variations in their willingness to participate in caring for older people.

Data analysis and synthesis

Statistical analysis was conducted out using Stata 16.0 software. The percentage of nursing students willing to participate in caring for older people was extracted from the included studies. For studies that did not explicitly report a willingness rate, it was calculated by dividing the total number of nursing students willing to participate in caring for older people by the total number of nursing students. Moreover, 95% CIs were calculated for these proportions. The pooled results were reported using a weighted point estimate of the nursing willingness rate and 95% CIs. Heterogeneity among the included studies was assessed using the χ2 test with a significance level of α = 0.10, and the extent of heterogeneity was quantified using the I2 statistic. For the meta-analysis, I2 values > 50% and P-values < 0.10 indicated moderate or high heterogeneity, and the random effects model was used; otherwise, the fixed effects model was used. To test the stability of the findings, sensitivity analyses were conducted by systematically excluding one study at a time and observing the resulting changes in the pooled willingness rates from the remaining studies. Additionally, sensitivity analyses were restricted to studies of moderate quality to further validate the stability of the results. Publication bias was assessed using a funnel plot, and asymmetry in the funnel plot was determined using Egger’s test. A P-value above 0.05 indicated a low risk of publication bias. A significance level of P < 0.05 was considered statistically significant.

Results

Search results

A total of 4,961 studies were obtained by preliminary search. After removing 911 duplicates, 4,050 studies underwent further screening.Finally, 68 studies on the willingness of nursing students to participate in caring for older people were included [8, 10, 16, 19, 20, 22, 23, 27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87]. Figure 1 provides an overview of the search and selection process.

Fig. 1
figure 1

PRISMA flow diagram of literature search and selection

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Studies characteristics [8, 10, 16, 19, 20, 22, 23, 27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87]

The characteristics of the included studies are presented in Table 1. Sixty-eight articles were ultimately included. A total of 30,328 nursing students were surveyed, and 14,495 were willing to participate in caring for older people. Xiao et al. employed two questionnaires to investigate 256 Australian nursing students and 204 Chinese nursing students, respectively. As a result, each dataset from Xiao et al. was treated as distinct records in the present meta-analysis [32]. The sample sizes ranged from 51 to 1335. Among the 68 studies included, 46 studies were conducted in China [8, 27,28,29,30,31,32,33,34,35, 37,38,39,40,41, 43, 44, 47, 49, 50, 52, 57,58,59,60,61,62, 65,66,67,68,69,70,71,72, 76,77,78,79,80, 82,83,84,85,86,87], and eight studies originated from other countries [10, 16, 19, 20, 22, 23, 32, 48], such as Australia, Italy, Israel, Sweden, Nepal, and Turkey. For the remaining studies, while the geographic area was not explicitly reported, the countries were determined based on the affiliations of the first authors’ institutions [36, 42, 45, 46, 51, 53,54,55,56, 63, 64, 73,74,75, 81]. Sixteen studies reported the willingness rates for first-year-level nursing students to participate in caring for older people [23, 30,31,32,33, 37, 42, 44, 56, 58, 63,64,65, 68, 73, 76], 13 reported rates for second-year-level nursing students [30, 31, 37, 42, 44, 49, 63, 65, 68, 72, 74,75,76], nine reported rates for third year-level nursing students [30, 31, 37, 42, 44, 63, 65, 68, 76], and five reported rates for fourth year-level nursing students [30, 45, 58, 65, 70]. The quality assessment of all included studies exhibited a minimum score of 4 and a maximum score of 8.

Table 1 Summary characteristics of included studies about nursing students’ willingness to participate in caring for older people
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Methodological quality assessment results

The study quality assessment revealed that 1 (1.5%) study had high quality [59] and 67 (98.5%) studies had medium quality. All included studies clearly defined the source of information. In the majority of included studies, assessments for quality assurance purposes (98.5%) and summaries of response rates and data completeness (97.1%) were reported. However, none of the studies described the impact of evaluators’ subjective factors on their findings or detailed how missing data were handled in their analyses. Further details can be found in Supplementary Table 3.

Meta-analysis results

The random effects model analysis outcomes, conducted across the 68 included studies, indicated a nursing students’ willingness rate of 49.0% (95% CI = 46–53%, I2 = 98.1%, P = 0.000). A forest plot is shown in Fig. 2.

Fig. 2
figure 2

Meta-analysis for the nursing students’ willingness to participate in caring for older people

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Meta-regression

The outcomes of the meta-regression analyses reveal significant associations between nursing students’ willingness to participate in caring for older people and four out of the nine predictor variables examined: the experience of living with older people, the experience of caring for older people, nursing as their first choice and the year-level of nursing students (P < 0.05). Further details are shown in Table 2.

Table 2 Univariate meta–regression of nursing students’ willingness to participate in caring for older people
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Subgroup analysis

Subgroup analyses for the four predictor variables with significant associations in the meta-regression revealed the following pooled estimates of nursing students’ willingness to participate in caring for older people: having experience of living with older people (0.54, 95% CI = 0.46–0.62) vs. no such experience (0.38, 95% CI = 0.30–0.46), having experience of caring for older people (0.55, 95% CI = 0.48–0.63) vs. no such experience (0.38, 95% CI = 0.30–0.46), nursing as their first choice (0.54, 95% CI = 0.51–0.58) vs. not their first choice (0.44, 95% CI = 0.35–0.53), being in the first year of nursing education (0.44, 95% CI = 0.34–0.55), second year (0.45, 95% CI = 0.34–0.56), and third and fourth year (0.62, 95% CI = 0.53–0.71). Further details are provided in Table 3.

Table 3 Subgroup analysis of nursing students’ willingness to participate in caring for older people
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Sensitivity analysis

The robustness of the results was evaluated through leave-one-out analyses, where each study was individually excluded, resulting in a slight variation in the willingness rate of nursing students to participate in caring for older people, ranging from 49.0 to 49.9%. This minimal fluctuation around the overall combined willingness rate suggests the stability and reliability of the study findings. Further, sensitivity analysis was performed by including only 67 studies of moderate quality. In these studies, the willingness rate of nursing students to participate in caring for older people ranged from 49.3 to 50.3%. This reaffirms the stability and reliability of the study results across studies of moderate quality.

Publication bias

Egger’s test results show that publication bias was not present among the studies on the willingness rate of nursing students to participate in caring for older people (P = 0.121 > 0.05). A funnel plot is shown in Fig. 3.

Fig. 3
figure 3

Funnel plot of publication bias

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Discussion

Among the 68 studies included in the present review, the findings reveal that approximately half of the nursing students (49.0% (95% CI = 46–53%)) confirmed their willingness to participate in caring for older people. The following factors can influence nursing students’ willingness: the experience of living with older people, the experience of caring for older people, nursing as their first choice, and the year level of nursing students.

The subgroup analysis results reveal that nursing students with experience of living with and caring for older people tended to be more inclined to participate in caring for older people [17]. This suggests that direct interaction with older individuals positively influences nursing students’ willingness to participate in caring for older people. Previous studies have consistently supported this perspective [7, 88]. This demonstrates the advantages of practice-based learning in nursing education. Through such approaches, nursing students actively engage in real-world situations of caring for older individuals, allowing them to apply theoretical knowledge in clinical settings. Experiential teaching methods, like immersive simulations, role-playing, and educational games, are integral to practice-based learning. Research consistently supports these methods for improving nursing students’ attitudes, knowledge, and willingness to participate in caring for older people, thereby fostering competent and compassionate healthcare professionals [89, 90]. In addition, nursing educators should organize voluntary service activities for nursing students in nursing homes, health service stations to increase the opportunities for nursing students to engage with older people and increase their willingness to participate in caring for older people.

Third and fourth year-level nursing students exhibited the highest inclination to participate in caring for older people, followed by second year-level students and first year-level students. In general, third and fourth-year nursing students often have prior exposure to courses on elderly care. Studies suggest that educational programs focusing on aging can significantly influence students’ perceptions and willingness to participate in caring for older people [91]. A positive relationship has been observed wherein nursing students with a better grasp of aging tend to exhibit more favorable attitudes toward older people, leading to a heightened readiness to participate in caring for older people [10, 12]. Therefore, it is crucial to enhance nursing students’ understanding and mastery of aging knowledge. This includes developing comprehensive educational programs that equip students with a deeper understanding of the aging process and the complexities of eldercare. Additionally, the present review underscores that nursing students who select nursing as their primary career choice demonstrate a greater willingness to participate in caring for older people post-graduation. This inclination may stem from their inherent preference for the nursing profession and a more positive attitude towards older people [8].

Existing literature on “factors influencing students’ willingness to participate in caring for older people” categorizes relevant factors into five main groups: demographics, education, experience, family, and attitude [7, 10,11,12, 16]. Within the domain of attitude factors, nursing students with more positive attitudes toward older individuals are more likely to participate in caring for them [11, 16, 17]. Concurrently, upon comparing the evidence regarding “factors influencing students’ willingness to participate in caring for older people” and “factors influencing nursing students’ attitudes towards older people,” a notable similarity was identified in the influencing factors between the two. For example, positive experiences gained through interactions with older individuals and educational strategies focused on gerontology have been linked to a beneficial impact on nursing students’ attitudes towards older people [92]. Other studies have also indicated that positive attitudes were associated with education about caring for older people, knowledge about aging, contact with older family members and willingness to work with older people after graduation [93]. Based on existing evidence, nursing students with positive attitudes are more inclined to engage in caring for older individuals, and those with a strong willingness tend to develop more positive attitudes. Therefore, educators play a critical role in fostering these attributes among nursing students. They should focus on developing a comprehensive understanding of older people in nursing students through specialized courses and experiential learning. By enhancing students’ knowledge and empathy towards older populations, educators can effectively cultivate positive attitudes and increase their willingness to participate in caring for older people.

The results of this study reveal that among the 68 studies included, 88.2% studies were conducted within China. This suggests an unequal geographical distribution of studies on this topic across different countries. This disparity in nursing students’ willingness to participate in caring for older people across countries may stem from variations in the aging population and its growth rates worldwide. Additionally, discrepancies in levels of disability and prevalence of chronic diseases among older individuals globally could contribute to differential research emphasis on nursing students’ attitudes towards eldercare. Further analysis and exploration are needed to better understand the underlying reasons for these geographic differences. Future studies should delve into these factors to provide insights into how cultural, demographic, and health-related factors influence nursing students’ willingness to participate in caring for older people across diverse national contexts.

Limitations

The present meta-analysis had several limitations. The included studies in this analysis were predominantly cross-sectional and exhibited considerable heterogeneity. Uncertain confounding factors, such as survey methods, measurement instruments, timing of surveys, and geographical diversity, likely contributed to this variability. Despite analyzing various predictor variables, none effectively mitigated this heterogeneity. One possible explanation is that this study focused solely on studies explicitly reporting proportions of nursing students willing to participate in caring for older people, potentially overlooking studies employing more nuanced measurement instruments [91, 94]. However, heterogeneity is often unavoidable in meta-analyses of observational studies and does not necessarily invalidate meta-analysis results [95]. Notably, because the included studies were cross-sectional, mediators and moderators of nursing students’ willingness to participate in caring for older people could not be identified. Therefore, more studies are needed to explore this area in depth to provide guidance for future research on related concepts.

Conclusion

The findings indicate that approximately half of the nursing students confirmed their willingness to participate in caring for older people. The main predictor variables of nursing students’ willingness to participate in caring for older people are the experience of living with older people, the experience of caring for older people, nursing as their first choice and year-level. However, there remains a critical need for more high-quality studies with representative samples to further validate these findings. We suggest that future research could leverage the findings of this study as a foundation to conduct more sound experimental studies aimed at evaluating the targeted manipulation of crucial factors, such as “nursing students’ experience of caring for older people,” and identifying predictors, mediators, moderators, and their underlying mechanisms that influence nursing students’ willingness to participate in caring for older people. For example, through early supervised volunteer work of adolescents in social and care services for older people or by revising the syllabus of undergraduate nursing programmes. Furthermore, policymakers can utilize the insights from this study as a resource to develop targeted strategies aimed at increasing nursing students’ willingness to participate in caring for older people. By comprehensively addressing these factors, policymakers can effectively support and enhance eldercare within the nursing profession.

Data availability

The datasets and any other materials of our study are available from corresponding author on request.

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Acknowledgements

We thank all members of our study team for their whole-hearted cooperation and the original authors of the included studies for their wonderful work.

Funding

This work was supported by the National Natural Science Foundation of China (72264002), Gansu Provincial Science and Technology Programme for Outstanding PhD Students (24JRRA503), Key Grant Project of Chinese Medicine Education Association (2022KTZ010). The funders who supported this study had no role in study design, preparation of the paper, data collection and analysis, decision to publish.

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  1. School of Management, Lanzhou University, Lanzhou, 730000, China

    Yunhua Wang

  2. School of Public Health, Lanzhou University, Lanzhou, 730000, China

    Fengli Lv, Hongyu Zeng & Jiancheng Wang

  3. Gansu Health Vocational College, Lanzhou, 730000, China

    Jiancheng Wang

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  1. Yunhua Wang
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YHW and JCW planed and designed the research; YHW and FLL provided methodological support/advice; JCW and HYZ tested the feasibility of the study; YHW and HYZ extract data; JCW performed the statistical analysis; YHW wrote the manuscript; all authors approved the final version of the manuscript.

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Correspondence to Jiancheng Wang.

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Wang, Y., Lv, F., Zeng, H. et al. Approximately half of the nursing students confirmed their willingness to participate in caring for older people: a systematic review and meta-analysis. BMC Geriatr 24, 745 (2024). https://doi.org/10.1186/s12877-024-05321-6

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Keywords

BMC Geriatrics

ISSN: 1471-2318

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