Ageing leads to changes that affect movement and sensory and psychosocial functions and, in short, the capacity to interact with one’s surrounding environment. Older people who live in care homes need long-term care that may vary, depending on how the ageing process evolves, with regard to the quantity and type of help necessary. 

The attitude of personnel who attend to and care for older people plays a special and determining role in care quality, in which it is necessary to take into account aspects such as empathy. This is fundamental for implementing person-centred practice, therefore the goal of humanising the treatment of older people requires an analysis of empathy and its implication in the care process. It is a general skill that enables an understanding of the point of view, feelings and emotions of the other person and communication to them of that understanding. Empathy brings with it, among others, understanding, respect, and active listening: skills that must be transmitted correctly to the other person through communication that is verbal (the contents of what we say) and non-verbal (our gestures, direct eye contact, facial expression, tone of voice or personal distance, among others). It has cognitive and emotional aspects. The first are associated with attitudes and skills that consider the capacity for putting oneself in the situation of the other person, their circumstances, and their thoughts, while the emotional aspects are related with skills for considering personal aspects through identification of the other person’s emotions.

Attitude and an empathic relationship towards older people among healthcare professionals can bring benefits for both. Prior studies reflect that empathy among healthcare professionals is a factor that significantly influences the satisfaction of the older person, as it improves clinical data, with repercussions on their physical, social and emotional well-being. 

For their part, among healthcare professionals an increase in empathy levels has led to a reduction of levels of anxiety, depression, and hostility, as well as an increase in satisfaction and an improvement of the older person’s self-concept.

Given the importance that empathy has for humanised treatment, it is necessary to develop specific training methods and strategies that increase self-awareness and attitudes towards the care of older people living in institutions among care home professionals. The aim of the project is to analyse the impact made by experiencing, through an old age simulation suit, the limitations and problems associated with age in relation with the empathy of professionals towards the older person.

Empathy is an inherent skill that can be improved. It has been shown that training in it among healthcare professionals is related with better clinical results, such as reduction of depression and anxiety, as well as an increase in levels of quality of life for users.

Although it is true that in the training of healthcare professionals, teaching methods are increasingly being introduced that contemplate empathy, currently there are no specific protocols for training in it. Among the methods most used are educational talks, practising skills through role-playing or with real patients, as well as the analysis of recordings of interactions with patients.

Simulation is a method widely used and recognised in healthcare training that enables a large variety of situations to be replicated. It imitates real-life experiences through different media or technology. In this sense, the old age simulation suit enables experiencing of the limitations of older people in a personal way and in one’s own body. With its use, it is possible to achieve an effect that is much closer to the limitations of sensory and motor capacities typical of old age. It is also possible to experience difficulties in walking and mobility, leading to a better understanding of older people’s behaviour. However, there is scarce scientific evidence on the efficacy of the old age simulation equipment to improve understanding, attitude and empathy towards older people (Gholamzadeh et al., 2018; Reid-Searl et al., 2020).

In this project, the old age simulation suit was used as a method to increase the level of empathy among professionals giving direct care to institutionalised older people. For this, it involved the participation of healthcare professionals from older care homes from the Principality of Asturias and the Autonomous Community of Madrid. All received an educational session about empathy and, subsequently, half of them additionally undertook different activities with the old age simulation suit. The components used in this suit simulate mobility restrictions, muscular weakness, limitations in dexterity and in sensory perception to offer an experience of “whole body” ageing. To measure the level of empathy, the Jefferson Scale of Empathy (version for health professions) was used.

After using the old age simulation suit, general empathy towards older adults increased significantly, in comparison with the group that only received theoretical training. 

Furthermore, an additional increase was observed in the dimensions that evaluate cognitive and emotional aspects. With regard to the first, the capacity to put oneself in the situation of another person, of their circumstances, of their thoughts is taken into account (e.g.: “Patients feel better when the professional understands their feelings”), while emotional aspects are related with the skills of the professional in identifying the other person’s emotions, during the care of the older person (e.g.: “Paying attention to the personal experiences of patients does not influence the treatment results”).

Después de utilizar el traje de simulación de envejecimiento, la empatía general hacia los adultos mayores aumentó de manera significativa, en comparación con el grupo que solo recibió la formación teórica. 

Además, se observó un incremento adicional en las dimensiones que evalúan los aspectos cognitivos y emocionales. En cuanto a los primeros, se valora la capacidad para ponerse en la situación de otra persona, de sus circunstancias, de sus pensamientos (p. ej.: «Los pacientes se sienten mejor cuando el profesional comprende sus sentimientos»), mientras que los aspectos emocionales se relacionan con las habilidades del profesional para identificar las emociones de la otra persona, durante la atención a la persona mayor (p. ej.: «Prestar atención a las experiencias personales de los pacientes no influye en los resultados del tratamiento»).

It is important to highlight that the prior levels of empathy showed adequate empathic skills among healthcare professionals who undertake care interventions with older people. These results have been observed previously and coincide with those published in prior literature (Yu & Chen, 2012).

In this study, a significant improvement was observed in empathy levels after participants experienced, through an old age simulation suit, the impact of increasing age. In line with our results, current literature (Bowden et al., 2020) has identified that the use of simulation suits is related with an improvement in attitude, knowledge about ageing, confidence and disposition towards caring for older people. Furthermore, its experimental nature and versatility facilitates the professional being involved in active learning and showing more positive results than participants who only receive theoretical training (Saleh et al., 2017). However, despite improvements in the cognitive and emotional dimensions and general empathy being observed, no statistically significant differences were found in the dimension that evaluates empathic skills associated with putting oneself in the other’s place. This dimension implies skills associated with being able to maintain an emotional and personal distance towards the person, to prevent this from interfering in their professional treatment of them. These results may be due to a large majority of healthcare professionals carrying out their care work with the same people for a prolonged period, therefore ongoing treatment and close care may make it more difficult to maintain an empathic attitude.

In this project, experiencing ageing enabled significant changes to be observed in the measures of cognitive empathy and emotional empathy in care professionals. The use of a simulation methodology such as the old age simulation suit may help to develop better empathic skills among health and care professionals who work at centres for older care. Future studies aimed at justifying empathic skills in professionals from other care spheres would be appropriate. The results are encouraging for continuing to explore the use of interactive and experiential methodologies to improve the treatment and attitude of health and care professionals towards different populations.

Bowden, A., Chang, HR., Wilson, V., & Traynor, V. (2021): “The impact of ageing simulation education on healthcare professionals to promote person-centred care towards older people: A literature review”, Nurse Education in Practice, 53. [doi: 10.1016/j.nepr.2021.103077]

Gholamzadeh, S., Khastavaneh, M., Khademian, Z., Ghadakpour, S. (2018): “The effects of empathy skills training on nursing students' empathy and attitudes toward elderly people”, BMC Medical Education, 18(1). [doi: 10.1186/s12909-018-1297-9]

Reid-Searl, K., Levett-Jones, T., Lapkin, S,. Jakimowicz, S., Hunter, J., & Rawlings-Anderson K. (2020): “Evaluation of the 'Empathic Care of a Vulnerable Older Person' e-simulation”, Nurse Education Today. 88. [doi: 10.1016/j.nedt.2020.104375]

Saleh, N., Meawad, E., Abd El-Aziz, H., & El-Gilany, A. (2017): “Effect of Simulated Aging Game versus Traditional Lecture on Nursing Students' Knowledge and Attitude towards Elderly”, Alexandria Scientific Nursing Journal, 19(1). [doi: 10.21608/asalexu.2017.208346]

Yu, CY., & Chen, KM. (2012): “Experiencing simulated aging improves knowledge of and attitudes toward aging”, Journal of the American Geriatrics Society, 60(5) [doi: 10.1111/j.1532-5415.2012.03950.x.]