Introduction
Due to the increase in aged population in the world, there has been a greater need for social services and health care. Evidence shows that health care providers in Iran are not only disinterested in geriatric care, but also provide elderly with less services than younger patients. The rising trend of population aging, along with the lack of interest of health care providers in geriatric care, increases the need to examine the attitude of medical students towards the elderly. This study aims to investigate Iranian dental students’ willingness to provide services to the elderly and the related factors.

Methods
This descriptive-analytical study was conducted in 2021. The study population consists of all female and male dental students from the Islamic Azad University of Tehran Dental Banch. Of these, 287 were selected by a purposive sampling method. Data were collected online (due to the COVID-19) pandemic using a demographic form and the Willingness to Work with Elderly People Scale, with 20 items and 4 subscales, designed by Mollaei et al. It has acceptable validity and reliability (α=0.81). The collected data were analyzed in SPSS software version 23 using independent t-test, multiple linear regression analysis, and one-way ANOVA.

Results
Among participants, 58.6% were female and 41.4% were male. About 10.8% of the students had participated in conferences related to gerontology, and 10.5% were living with their grandparents. About a fifth of the students reported their father's age to be ≥60 years. Regarding the willingness to work with the elderly, the mean score was 51.69±13.004. The students who had taken the gerontology course had less willingness than students who had not taken the course. The students who had the experience of visiting a nursing home were more willing to work with the elderly. 
The results of the independent t-test showed a significant difference in dental students' willingness to work with the elderly based on marital status (P<0.05), having a mother over 60 years old (P<0.05), living with grandparents (P<0.05), experience working with the elderly (P<0.05), volunteer activities to help the elderly (P<0.001), research in the field of gerontology (P<0.05), attending conferences on gerontology (P<0.05), attending educational workshops about gerontology (P<0.05), visiting the senior rehabilitation centers (P<0.05), and visiting nursing homes (P<0.05). 
The results of multiple linear regression showed that these independent variables significantly explained 13% of willingness to work with the elderly (F=4, P<0.001). The two variables of volunteer activities to help the elderly (t=2.80, P<0.01) and visiting the senior rehabilitation centers (t=2.04, P<0.05) were more significant. The results of one-way ANOVA showed no significant difference in dental students’ willingness to work with the elderly based on their age (F=1.03, P=0.3) and academic semester (F=1.05, P=0.34).

Conclusion
The willingness to work with the elderly among Iranian dental students is influenced by various factors. Having experience working with the elderly, designing educational courses for the students during their studies, attending conferences on gerontology, volunteering to help the elderly, and visiting senior rehabilitation centers can play a very effective role in increasing their willingness to work with the elderly. Future plans to increase such activities are recommended.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (Code: IR.USWR.REC.1400.225).

Funding
This article was extracted from a thesis and the study was funded by the University of Social Welfare and Rehabilitation Sciences.

Authors' contributions
Conceptualization, methodology, writing initial draft: Malihe Saboor; Investigation: Farhan Ghanbari and Pardis Kashiri; Editing & review: Fatemeh Shahsavari.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank the Iranian Research Center on Aging and all participants for their cooperation.


References

1. Rasel M, Ardalan A.  [The future of ageing and its health care costs: A warning for health system (Persian)]. Iranian Journal of Ageing. 2007; 2(2):300-5. [Link]
2. Sadaf A, Yazdanie N. Attitude of dental students towards elderly. Pakistan Oral & Dental Journal. 2012; 32(1):176-9. [Link]
3. Rathnayake S, Athukorala Y, Siop S. Attitudes toward and willingness to work with older people among undergraduate nursing students in a public university in Sri Lanka: A cross sectional study. Nurse Education Today. 2016; 36:439-44. [DOI:10.1016/j.nedt.2015.10.007] [PMID]
4. Mollaei P, Momtaz YA, Shirazi FM, Delbari A. Willingness to work with older adults in the medical field in Iran-2017. International Journal of Health Studies. 2018; 4(2):30-4. [Link]  
5. Riahi F, Izadi-mazidi M, khajedin N, Norouzi S.  [Does education of geriatric medicine effect on the Medical Students’ Attitude toward Elderlies and Their Care? (Persian)]. Iranian Journal of Medical Education. 2014; 14(7) 651-2. [Link]
6. Ahmadi A, Sahaf R, Rashedi V, Akbari Kamrani AA, Shati M, Delbari A. [Relationship between oral health and demographic characteristics in retired elderly people in Iran (Persian)]. Salmand: Iranian Journal of Ageing. 2019; 13(4):452-63. [DOI:10.32598/SIJA.13.4.452]
7. Moreira AN, Rocha ES, Popoff DA, Vilaça EL, Castilho LS, de Magalhães CS. Knowledge and attitudes of dentists regarding ageing and the elderly. Gerodontology. 2012; 29(2):e624-31. [DOI: 10.1111/j.1741-2358.2011.00534.x] [PMID]
8. Devaki T, Mallikapuram KP, Simha BV, Chandu VC, Pavani NP, Srinivas R. Attitudes and perceived barriers in geriatric dental care among undergraduate dental students in capital region of Andhra Pradesh. Journal of Indian Association of Public Health Dentistry. 2020; 18(2):134-8. [DOI: 10. 4103/jiaphd. jiaphd_210_18]
9. Hatami B, Ahmady E, Khoshnevisan MH, Lando HA. Dental students’ perceived barriers in geriatric dental care active involvement. Oral Health and Dental Management. 2014; 13(3):675-9. [PMID]
10. De Visschere LM, Vanobbergen JN. Oral health care for frail elderly people: Actual state and opinions of dentists towards a well‐organised community approach. Gerodontology. 2006; 23(3):170-6. [DOI:10.1111/j.1741-2358.2006.00126.x] [PMID]
11. Nitschke I, Clarenbach-Tran TH, Schlegel D, Reiber T, Sobotta BA. Attitudes of German undergraduate dental students towards the aged. Gerodontology. 2015;  32(1):3-12. [DOI:10.1111/ger.12043] [PMID]
12. Sarstedt M, Bengart P, Shaltoni AM, Lehmann S. The use of sampling methods in advertising research: A gap between theory and practice. International Journal of Advertising. 2018; 37(4):650-63. [DOI:10.1080/02650487.2017.1348329]
13. Mousavi-Shirazi SF, Taheri-Tanjani P, Abolfathi-Momtaz Y, Ramezankhani A. [The effect of education based on the theory of planned behavior on willingness to work with older adults in students of Shahid Beheshti University of Medical Sciences, Tehran, Iran (Persian)]. Journal of Health System Research. 2020; 16(1):1-6. [Link]

14. Carlson E, Idvall E. Who wants to work with older people? Swedish student nurses' willingness to work in elderly care--a questionnaire study. Nurse Education Today. 2015; 35(7):849-53.[DOI:10.1016/j.nedt.2015.03.002] [PMID]
15. Chi MJ, Shyu ML, Wang SY, Chuang HC, Chuang YH. Nursing students’ willingness to care for older adults in Taiwan. Journal of Nursing Scholarship : An Official Publication of Sigma Theta Tau International Honor Society of Nursing. 2016; 48(2):172-8. [PMID]