Factors Associated with the Intention to Work with Older Adults Among First Year Social Work Students in Israel

ABSTRACT

This study examined a model based on the Terror Management Theory and the Theory of Planned Behavior (TPB) to identify factors associated with social work students` intention to work with older adults. A cross-sectional study with a sample of 375 first-year Israeli social work students was undertaken. Attitudes, subjective norms and perceived behavioral control were directly associated with this intention. Contact with older adults was related to anxiety about older adults, which along with anxiety about self-aging, was related to the TPB constructs. The model explained 63% of the variance of the students` intention to work with older adults.

KEYWORDS:

• Social work students
• older adults
• attitudes
• anxiety
• perceived behavioral control

The population of older adults, defined as people aged 65 and over, has grown in recent decades (OECD, 2023). As of 2022, this population comprised 10% of the total world population, and is expected to increase to about 16% by the year 2050 (WHO, 2023). The increase in life expectancy brings with it challenges for older adults, their families and caregivers, including the need for medical, psychological, social, and financial assistance. The COVID-19 pandemic amplified the need to address the health, mental, social, and economic needs of older adults (Ayalon et al., 2021; Mushtaq & Khan, 2023). As such, there is a growing demand for various helping professionals to provide adequate services to older adults in order to increase their quality of life, inclusion and ability to deal with the challenges facing them.

However, research has shown a persistent global problem of low motivation among members of diverse helping professions to specialize in working with older adults during training (Carlson & Idvall, 2015; Meiboom et al., 2015; Øster et al., 2019) or to work with them after graduation (Ferguson, 2012). The growing numbers of older adults, on the one hand, and the low willingness to work with them, on the other hand, have led to a shortage of professionals in the diverse services for older adults in many countries (Baik & Davitt, 2022).

Social work is a crucial profession for ensuring the well-being of older adults, their families and caregivers, and for influencing their capacity to address their problems and challenges. Social workers in many countries provide older adults with a wide range of psychosocial services, both in the community and in institutions. The problems of low willingness to work with older adults and shortage of social workers in this field are also substantial in different countries (Ayguler & Buz, 2022; Chonody & Wang, 2014; Salsberg et al., 2018) as well as in Israel, where the current study was conducted (Ben-Harush et al., 2017; Even-Zohar & Werner, 2020).

Not surprisingly, the need to better understand the factors associated with the willingness of students to work with older adults has led scholars from different fields and countries to explore this issue (Ben Natan et al., 2015; Duque et al., 2003; Syed Elias et al., 2020). However, only a limited number of studies have explored factors associated with social work students’ willingness to work with older adults (Cummings & Galambos, 2002; Cummings et al., 2005; Krumer-Nevo & Weiss, 2005) or with actual employment in aging-related jobs after graduation (Cummings & Adler, 2007; Schnall & Weiss-Gal, 2023). These studies identified a number of factors that influence social work students’ willingness to work with older adults or their actual employment in the aging field. These include emotional (negative feelings, such as aversion toward older adults or positive feelings toward older adults), cognitive (perceived potential contribution of working with older adults to students` professional growth), social (contact frequency with older adults) and educational factors (the students’ perceptions of their own level of skills in dealing with older clients and the degree of reward they experienced in working with older adults).

However, a comprehensive theoretical model has yet to be proposed to explain the intention to work with older adults, which examines combination of social, emotional and cognitive dimensions. The present study aimed to contribute to this limited body of knowledge by investigating the factors that are associated with the intention to work with older adults among first-year social work students in Israel. By employing a comprehensive theoretical model, we endeavor to better understand these factors among students at the onset of their professional socialization process.

Intention to work with older adults: the theoretical foundation

The intention to work with older adults can be defined as an expression of the individual’s willingness to work with older adults or as a statement of a decision to work in this field in the future (Graham et al., 2020).

Two main theories can serve as a basis for understanding the factors that influence an intention to work in the field of old age among social work students who are in their first stage of professional socialization: The Terror Management Theory (TMT) and the Theory of Planned Behavior (TPB). Although not developed explicitly to explain behaviors toward older adults or the intention to work with them, these theories have been found relevant to this field (Chonody & Wang, 2014; Lee et al., 2007; Martens et al., 2005).

Terror Management Theory (TMT) sought to explain human beliefs and the adoption of prejudices, through an individual’s desire to control the fear of death (Greenberg et al., 1986). The theory was based on Becker’s work (1973) on the fear of death, in which he claimed that it is an anxiety unique to humans, who are aware of being mortal. The source of prejudices according to TMT, is human’s biological need for self-preservation, which stems from an awareness of the finitude of life and the anxiety accompanying it.

When thoughts related to death enter awareness, individuals adopt defenses such as the use of techniques to strengthen self-worth by adopting cultural ideas that allow spiritual existence even after death. Another defense is the adoption of prejudices against various out- groups that differ from the group to which the individual belongs, which gives a sense of superiority and continuity after death (Schimel et al., 2007). The use of these defenses creates a buffer in the face of death, thereby reducing the level of anxiety.

While this theory refers to the emergence of prejudices toward any out-group, the application of the theory to the field of aging is clear. As humans are aware of their own mortality, they are driven to avoid the anxiety associated with this by distancing themselves from older adults and by developing negative attitudes toward them. In other words, since the encounter with older adults and personal aging are strong reminders of the inevitability of aging and decline, in the form of the loss of beauty and health, and ultimately death (Chonody & Wang, 2014; Greenberg et al., 1986), humans will seek to protect themselves by distancing themselves from older adults.

A variety of studies has found that the claims of this theory are useful in explaining disinterest in working with older adults. They found that anxiety about old age and aging are related to negative attitudes toward older adults among young people (Ben-Harush et al., 2017; Chonody & Wang, 2014; Cooney et al., 2020). In contrast, rewarding interactions with older clients and contact frequency enhance the desire of social work students to pursue aging-related employment (Cummings & Galambos, 2002).

The theoretical model developed in the current study to explain the intention of social work students to work in the field of aging for this study, includes four variables that emerge from TMT. The first two involve previous informal contact with older adults, within and outside the family (Dorfman et al., 2004). This contact has been examined with reference to its frequency and quality (Drury et al., 2016). In support of this, it was found that the interaction of young people with older people resulted in a decrease in the levels of these prejudices, mediated by the reduction in the levels of anxiety about old age and aging (Drury et al., 2016). The third variable is anxiety about interaction with older adults. This is defined as a fear of being in the company of old people. The fourth variable is anxiety about self-aging, which is the anxiety about the various losses that one may experience during the aging process, including changes in physical appearance, and the psychological, social, and emotional aspects of this process.

The current model further comprises constructs proposed by the TPB. This theory was developed by Ajzen (1985), who proposed that behavioral intention is a product of three cognitive structures. The first structure, attitude toward the behavior, includes individuals’ assessment of whether the planned behavior is positive or negative. The second, subjective norm, includes individuals’ belief about which behavior is expected of them by significant others and the extent to which individuals deem it important to behave in a way that matches those expectations. The third cognitive structure, perceived behavioral control, is individuals’ perceived self-efficacy regarding the behavior, and the belief about whether they have the resources to engage in the behavior. Indeed, studies based on the TPB, which examined the intention of students of helping professions in different countries to work with older adults, found that the three cognitive structures were related to the intention to work in the field of aging (Ben Natan et al., 2015; Lee et al., 2007; Masud et al., 2022). Drawing upon this theory, our theoretical model also comprised of attitudes toward working with older adults, perceived behavioral control with regard to working with older adults and the subjective norm – the students’ belief that working with older adults is expected of them by significant others.

Studies have also indicated an association between the way in which individuals perceive their level of knowledge concerning older adults and their interest in postgraduate work with older adults (Cummings & Galambos, 2002). Hence, we include another variable in our tested model – perceived subjective knowledge concerning older adults (Meiboom et al., 2015).

In sum, the aim of the present study is to fill the theoretical gap in explaining social work students` intention to work with older adults, by examining a theoretical model based on the theories described above (see Figure 1). The research’s model not only predicts the intention from the predictors from the TPB but also suggests variables that underlie these predictors.

Figure 1. The study’s theoretical model.

It concentrated on first year social work students, since we sought to understand their fears, knowledge and attitudes at the onset of their social work socialization process. At this stage, students have hardly been exposed to professional knowledge on aging and to practical training with older adults. Four hypotheses were examined:

1. Informal contact with older adults within and outside the family, and subjective knowledge about older age will be negatively associated with anxiety about older adults and with anxiety about self-aging.

2. Higher levels of anxiety about older adults and anxiety about self-aging will be negatively associated with attitudes toward working with older adults and perceived behavioral control;

3. More subjective knowledge about older age will be positively associated with attitudes toward working with older adults and perceived behavioral control;

4. Attitudes, perceived behavioral control and subjective norm will be positively associated with the intention to work with older adults, and will mediate the effects of the contact, knowledge, and anxiety variables;

Materials and methods

Target population and participants

The target population consisted of first-year undergraduate social work students from all 13 schools of social work in Israel that offer a bachelor’s degree program in social work. In 2022, the year of data collection, this population included 1399 students. The sample included 356 first year undergraduate social work students who agreed to participate in the study, 25.4% of the entire study population. Most of them were women (85%), and Jewish (95%; the remainder were Arabs). The gender distribution corresponds to the gender distribution of the social work student population in Israel. Data on the nationality distribution of social work students is not available. Their mean age was 25.5 (SD = 5.00).

Procedure

The study was approved by the Tel Aviv University Ethics Committee (approval #0003861). The questionnaires were distributed through a secure Qualtrics survey platform. Convenience sampling was performed, since there is no list of social work students, and the schools are not allowed to provide their names or contact details. In order to reach as many participants as possible, we recruited participants through the following strategies: 1) The first author of the study explained the topic of the research and its goals face-to-face in classes for first-year students in various schools of social work. During the presentation of the research, the students were shown a QR code that led them to a link to the questionnaire; 2) The research topic and its goals were introduced through social media (Facebook, WhatsApp), including a link to the questionnaire; 3) Student council representatives at the schools of social work received the link to the questionnaire along with a written description of the study and were asked to distribute it among the first year students in their closed groups on social networks. Data collection took place between February 2022 and July 2022.

The questionnaire included an explanation that made it explicit that participation was voluntary, that the student could stop participating in the study at any point, and that the questionnaire was anonymous. After reading the explanation, the participants were asked to confirm their consent to participate in the study before they could continue to fill out the questionnaire. In order to incentivize students to participate in the research, a raffle of vouchers for coffee and a pastry was held among the participants.

Of the 431 students who started to fill out the questionnaires, 375 students completed them. The highly skewed age distribution led us to compare the older participants (>45 years old) to the younger ones. Analyses of variance (ANOVA) revealed large effect sizes for the differences between age groups with regard to the study variables (particularly a much higher intention to work with older adults among the students > 45). Consequently, we removed 19 participants who were over 45 years old, leaving a final analysis sample of 356 students.

Measures

Informal contact with older adults within the family was assessed with two questions, based on Drury et al. (2016). One question asked the participant to rate the quality of their relationships with older adults within their family on a scale ranging from 1 (very low) to 5 (very high), and the other referred to the frequency of these relationships on a scale ranging from 1 (not at all) to 5 (very frequently). The question did not specify the mode of these relationships in terms of contact in-person and/or virtually. These questions were translated into Hebrew and then back-translated. The score for each participant was calculated by averaging the two answers. A higher score indicated more frequent and higher quality contacts (α = 0.73).

Informal contact with older adults outside the family was measured by the same two questions as above, only here the participants were asked to refer to older adults outside their family. The score for each participant was calculated similarly (α = 0.65).

Aging anxiety was measured using the Hebrew version of the Anxiety About Aging questionnaire (AAS) (Bergman et al., 2013; Lasher & Faulkender, 1993). The questionnaire includes 20 items rated on a 5-point Likert scale ranging from 1 (disagree) to 5 (strongly agree). The questionnaire contains four subscales, with 5 statements each: 1) fear of old people – e.g., “I enjoy being around old people” (reverse coded); 2) psychological concerns – e.g., “I fear it will be hard for me to find contentment in old age;” 3) fear of physical appearance – e.g., “I have never dreaded looking old” (reverse coded); 4) fear of loss – e.g., “I fear that when I am old all my friends will be gone.” The first dimension, fear of old age, refers to anxiety about old age and old people, while the other three dimensions refer to anxiety about self-aging. Before calculating summary scores, reverse coding was undertaken where needed so that high scores in all items indicate greater anxiety. Two scores were produced for each participant: a score of anxiety about old age and old people (α = 0.83), and a score of anxiety about one’s own aging, by averaging the three dimensions that refer to it (α = 0.83). This division was adopted in light of the contents of the items, so that it reflected the difference between statements that related to the more personal aspects, that is, anxiety about one’s own aging, and the statements related to anxiety about older adults who are not oneself. In addition, computing a single total score resulted in unacceptably low internal reliability, which was resolved with the division into two scales. The correlation between the two scales was low (r = 0.13), which supports the separation to two different scales: anxiety of old age and anxiety about self-aging.

Subjective knowledge about older age was measured with a single question: The participants were asked to rate their level of knowledge about advanced age and aging on a 5-point scale from 1 (very low) to 5 (very high) (Cummings & Galambos, 2002).

Attitudes toward older adults, subjective norm, perceived behavioral control, and intention to work in the field of aging were measured by the Working with Older Adults (WOAS) questionnaire (Graham et al., 2020), which was translated into Hebrew by the researchers and back translated into English. The questionnaire includes 20 questions in total, in four 5-item subscales, one for each variable. Sample questions include: “Working with older adults is pleasant” (attitudes), “I am capable of working with older adults” (perceived behavioral control), “Most people want me to work with older adults” (subjective norm), “I intend to work with older adults” (intention). The participants were asked to indicate the extent of their agreement with each statement on a Likert scale from 1 (strongly disagree) to 7 (strongly agree). The scores were calculated as the mean of the answers to the items in each of the four scales. A higher score indicated a more positive attitude toward older adults (α = 0.80), better subjective norm (that is, the student believes that the people significant to her perceive work with older adults as more positive) (α = .85), higher perceived behavioral control (α = .83), and higher intention to work in the field of aging (α = .93). Reverse worded items were recoded so that all items were in the directions noted above.

The participants were also asked to report demographic characteristics: Their gender, age and nationality.

Statistical analyses

We first examined basic descriptive statistics and Pearson correlations among the study variables using SPSS version 28. Next, we assessed the model in Figure 1 using Structural Equation Modeling with Mplus software version 8 (Muthén & Muthén, 1998–2021). Little’s MCAR Test showed that the data were missing randomly, between 0–1.6% of the values in the various variables were missing; χ2(12) = 13.32; p = .649. To take advantage of all available data, the model was fit using full-information maximum likelihood estimation with robust standard errors (Little & Rubin, 2019). Following the recommendations of Hu and Bentler (1999), model goodness-of fit was evaluated with two fit indices, The Tucker- Lewis index (TLI) and the Comparative Fit index (CFI), and two indices of misfit, root mean square error of approximation (RMSEA) and standardized root mean square residual (SRMR). According to the recommendations of Hu & Bentler, the former two should be close to .95, RMSEA should be < .06 and sRMR should be < .08.

Results

Descriptive statistics and intercorrelations between the study variables are presented in Table 1. The TPB variables: attitudes toward working with older adults, perceived behavioral control, and subjective norm, were strongly associated with intention to work with older adults. Greater contact with older adults inside and outside the family and subjective knowledge were intercorrelated and associated with anxiety about older adults. Subjective knowledge was positively associated with the TPB variables, and negatively associated with anxiety about old people. Contact with older adults inside and outside the family were correlated with the TPB variables, and with both types of anxiety.

Table 1. Descriptive statistics and Pearson correlations between the study variables (N = 356).

	Mean (SD)	SD	(2)	(3)	(4)	(5)	(6)	(7)	(8)	(9)	(10)	(11)
(1) Contact with older adults within the family*	3.54	1.09	.29**	.16**	−.43***	−.05	.23**	.24**	.15**	.25**	−.19**	−.12**
(2) Contact with older adults outside the family*	2.59	1.03	1	.26**	−.48***	−.10*	.37**	.36*	.25**	.40**	.17**	.02
(3) Subjective knowledge*	2.56	0.87		1	−.19**	−.05	.20**	.51**	.27**	.22**	.17**	−.01
(4) Anxiety about old people*	2.14	0.84			1	.13*	−.58**	−.38**	−.28**	−.60***	−.38	.02
(5) Anxiety about self- aging*	2.37	0.70				1	−.19**	−.22**	0.00	−.13*	−.01	−.15**
(6) Attitude toward working with older adults**	5.15	0.94					1	.33***	.30***	.61***	.07	−.04
(7) Perceived behavioral control**	4.25	1.22						1	.24***	.40***	.18**	.04
(8) Subjective norm**	2.92	1.13							1	.53***	.08	−.00
(9) Intention to work with older adults**	3.44	1.48								1	.05	−.06
(10) Age	25.47	5.0									1	.20**
(11) Gender***	1.1	0.29										1

*p < .05 **p < .01 ***p < .001.

Range: * 1–5; ** 1–7; 1 = Female, 2 = Male.

SEM was used to test the fit of the hypothesized model (Figure 1) to the data. The initial test suggested the need for several minor modifications, (e.g., the path between contact outside the family and anxiety about self-aging was eliminated, and a path was added between contact outside the family and perceived behavioral control). This resulted in acceptable to good fit for the final model presented in Figure 2: χ² (235) = 571.76, p < .001, TLI = .921, CFI = .933, RMSEA = .059, SRMR = .053. The model explained 63% of the variance in the intention to engage in the field of aging. The direct predictors of the intention were the TPB variables, as hypothesized: Attitudes, perceived behavioral control, and subjective norm. These three variables mediated the effects of subjective knowledge, the prior contact variables, and the anxiety variables, on intention. More positive attitudes toward working with older adults were predicted by less anxiety about older adults and about self-aging. Perceived behavioral control was predicted by less anxiety about older adults, less anxiety about self-aging, greater subjective knowledge, and more contact with older adults outside the family. Subjective norms favoring working with older adults were predicted by less anxiety about older adults and greater subjective knowledge. Contact with older adults within and outside the family were found to be correlated with each other and both predicted less anxiety about old people. Contact with older adults outside the family correlated with greater subjective knowledge.

Figure 2. The modified model thorough SEM*.

All paths were tested according to the hypotheses, and only significant paths and correlations are shown. All correlations and paths were found be significant at p < .01, except for the path between subjective knowledge and attitudes, p = .04. All possible mediation paths seen in the model were tested and found to be significant at p < .05. Significant paths were found between age and contact with older adults within and outside the family and between age and subjective knowledge. These paths are not shown for the sake of brevity. A significant path was also found between female gender and anxiety about self-aging.

Discussion

This study examined a theoretical model to explain the intention of first year social work student to work with older adults using a set of constructs derived from the TMT and TPB. Together, the model variables explained 63% of the variance of the first-year social work students` intention, meaning that the findings support the importance of the combination of variables that derive from both theories to explain this intention.

More specifically, the findings indicate that the three TPB cognitive structures are directly associated with the intention to work with older adults. When social work students have more favorable attitudes toward working with older adults (“working with older adults is pleasant, valuable and enjoyable”); when the people who are important to them expect and want them to work with older adults; and when they feel they have the competency, skills, and knowledge to do so, their intention to work with older adults is stronger. These findings support previous studies on the intention to work with older adults among students of different helping professions, among them social work students (Cummings & Adler, 2007; Graham et al., 2020).

The TMT provides us with the understanding that these three cognitive structure are associated with emotional and social factors. All three TPB predictors were associated with anxiety about older adults, and two of them – perceived behavioral control and attitudes – were associated with self-aging anxiety. These two dimensions of anxiety, as claimed by the theory, were associated with a social factor- contact with older adults within and beyond the family. These findings suggest that the social and the emotional aspects may contribute to the cognitive factors that directly affect the intention to work with older adults. In other words, social contact and anxiety may have affected the intention indirectly, mediated by their effects on the three cognitive structures. When combined, these social, emotional, and cognitive factors create the dynamic that leads young social work students to distance themselves from working with older adults.

Different researchers emphasized the importance of the social dimension – contact with older adults within and beyond the family – in reducing negative attitudes toward older adults and in increasing willingness to work with them (Cummings & Galambos, 2002; Cummings et al., 2005). This contact may enhance young peoples’ opportunities to interact with a wide variety of older adults with different characteristics and enable them to observe healthy, productive, and meaningful aspects of older age, which can decrease their anxiety. When their anxiety is lower, the students will be less likely to draw upon negative attitudes toward working with older adults in order to cope with their anxiety.

In contrast with our hypothesis, informal contact with older adults within and outside the family was not associated with anxiety about self-aging. This may be due to the way young people perceive self-aging. Findings from a large survey suggested that the youngest age group (18–39) think about old age in a general and vague way and have difficulty imagining their personal aging process in a tangible way (Lynch, 2000). Therefore, when self-aging anxiety is based on a self-report tool, it is unclear whether it does indeed succeed in reflecting this variable in all its complexities. Further investigation is required to understand the nuanced nature of individual perceptions of self-aging and then test the correlations with the contact variables.

The study has four main limitations. First, it was based on a convenience sample. Second, despite our efforts to recruit Arab students, only five percent of the sample are Arabs. Third, the research was undertaken in a single country. Further studies should explore the research model among samples that are more diverse and in different national contexts. Fourth, this study was cross-sectional and the conclusions that emerge from the findings indicate associations but not necessarily causal links. Longitudinal and experimental studies are required in order to understand the causal links between contact, anxiety, attitudes, perceived behavioral control, subjective norm and intention to work with older adults.

With these limitations in mind, the findings of this study have direct implications for social work academic and continuing education in aging, and for the efforts to narrow the gap between older adults’ needs and professional availability across social services. The study joins the growing body of work by social work scholars (Curl et al., 2010; Ortiz et al., 2012; Schnall & Weiss-Gal, 2023) who have sought to understand how the educational system can generate professionals who are more willing and competent to work with older adults, and have less negative attitudes toward them. The findings of this study underscore the need to deal with anxiety about older adults and about self-aging. Since contact with older adults is crucial in shaping this anxiety, schools of social work should create spaces, both in the explicit and implicit curriculum, for students to interact with diverse older adults, to expand their opportunities for positive experiences. If the field placements require students to deal with older adults in severe situations of illness, disability, poverty, or risk, which may increase anxiety, schools need to create opportunities for students to form personal relationships with equal status and mutual sharing of life experiences with older adults (Ortiz et al., 2012). These experiences will offer a wider perspective about old age that can enable students to better understand that older adults are a heterogeneous group (Hoge et al., 2015), and this may decrease anxiety. For example, schools can establish joint projects, in which students work with older adults as equal partners, and thus emphasize the value and contribution of older adults (Kane, 2004). This may require schools to create projects beyond the formal boundaries of social services, such as a project in the community, in addition to formal internship in social work settings.

Schools also need to consider strategies to affect the three cognitive structures: negative attitudes, social influences, and competency. The first challenge is to enable students to establish positive attitudes toward social work with older adults, which emerged as the strongest predictor in this study of the intention to work with older adults. Schools can identify field placements that can serve as enriching environments (Brown et al., 2008) that can change the narrative surrounding aging. They can endeavor to show students that social work with older people can give them a sense of belonging, purpose, fulfillment, and an understanding that they can make a difference. The schools can also consider employing the guidelines set by The National Center to Reframe Ageing that seek to alter the narrative surrounding aging and promote the use of well-framed language advocating for neutral and inclusive terminology (e.g “older people”) instead of terms with a negative connotation (https://www.reframingaging.org/). This is a considerable challenge since educators cannot control the experiences to which the students are exposed in their field placements, and they cannot entirely avoid cases of poor standards of treatment, poor working conditions and low pay, or negative staff attitudes toward their jobs and the use of terms that stoke stereotypes and that may create negative attitudes toward working with older adults (Brown et al., 2008; Øster et al., 2019).

A second challenge is finding role models who attribute value, prestige and meaning to social work with older adults, and who can transmit to students their expectation to work with older adults. As Graham et al. (2020) note, the challenge here is to understand “the importance of assessing, acknowledging, and changing social influences and norms within training settings” (p. e429). This is also a considerable challenge when most social work education faculty members have minimal special training and education in relation to aging and gerontology (Curl et al., 2010).

Finally, social work educators need to increase the self-efficacy and self-perceived competency of students to work with older adults by providing them with knowledge about older adults, their families and care givers, and by enabling students to develop the skills and professional practice competencies needed for practice with older adults (Curl et al., 2010).

Through greater efforts to affect social contacts with older adults, to address anxiety about older adults and self-aging, and to change attitudes, subjective norms and perceived behavioral control, academic and continuing social work education will be able to better deal with the tendency of social work students and practitioners to distance themselves from working with older adults.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The study was supported by the Healthy Longevity Research Center, the Sara Peleg Foundation Tel Aviv University. The study was also supported by the State President’s house scholarship for excellence.