A layperson, by providing FA, can have a significant impact on improving health and survival in a medical emergency [8,9,10]. However, an FA intervention can only be effective if provided by a layperson with the confidence, willingness, skills and knowledge to do so . As such, our finding that all respondents rated FA knowledge as being very important for all age groups is encouraging and in line with previous research suggesting that, in present day Slovenia, providing FA is considered a high moral duty . Most respondents assessed that they were personally responsible for obtaining awareness of FA measures, as well as traditional organisations such as the Red Cross, with less responsibility attributed to either the media or physicians. Nevertheless, a notable finding in this study was that most responders reported that FA knowledge was less important for older retirees compared to the rest of the adult population. Furthermore, older individuals are typically more vulnerable (psychologically/medically/socially), especially in emergencies, such as a pandemic [22,23,24,25].
Most adults in Slovenia correctly recognised the signs and symptoms of a stroke and heart attack and were aware of the correct FA measures in these situations. This finding is in accordance with similar surveys from Europe [26, 27] and New Zealand . Our finding that respondents under the age of 30 possessed a high degree of FA knowledge contrasts with the results of a study conducted in 9 European countries reporting that younger individuals recognised fewer heart attack symptoms than individuals in older age groups . Cardiac patients (who are common among the elderly population) had broader knowledge about stroke symptoms and risk factors than the general population , which was again consistent with our findings that elderly individuals are not inferior in recognising and responding to stroke and heart attack.
The findings regarding the recognition of a stroke and heart attack contrast with those regarding hypoglycaemia; the latter is less well recognised by elderly individuals in comparison to younger respondents, although they tend to apply the correct FA countermeasures. Interestingly, individuals younger than 30 recognised the symptoms of hypoglycaemia but were less well equipped in applying the correct FA measures. Other studies [29, 30] also suggested poor general knowledge about diabetes as well as of the causes and care of hypoglycaemia among the elderly population. In a related study, Turk et al.  concluded that diabetic people in Slovenia (who are most often elderly) reported a relatively low level of general knowledge about their disease.
When faced with a person who shows no signs of life, the overwhelming majority of respondents in Slovenia had difficulty determining the correct CPR procedure to follow. Most respondents incorrectly answered to use an AED instead of chest compressions . Heard et al.  determined that while belief in one’s skills was high (70%), their actual knowledge was lower, particularly for CPR-related knowledge and skills, as evidenced by the fact that only 5% of trained individuals knew the correct compression-to-ventilation ratio. Another study  that compared bleeding control and CPR revealed that while most respondents had a good understanding of bleeding control (87%), few were familiar with CPR (21%). Similarly, in the present study, only 16% of the respondents were aware of the correct CPR measures when faced with a person showing no signs of life. Richman et al.  reported that those in a senior living community had poor understanding of the use of AEDs in CPR. Poor CPR knowledge among the elderly population was also confirmed by others [34, 35]. Of note OHCA patients in 2020 were typically older and suffered from chronic medical conditions such as hypertension, diabetes and physical limitations . The use of medical emergency services was significantly reduced in March 2020 , as was as the proportion of OHCA patients who survived until their emergency admission during the pandemic period [23, 38]. Factors associated with a reduced OHCA survival rate were a prolonged time of arrival of emergency medical services, a higher proportion of OHCAs occurring at home and a low proportion of individuals nearby who were capable of providing adequate CPR.
If we examine the knowledge of people over the age of 60 years in more detail, the proportions of correct answers about the recognition of hypoglycaemia and heart attack in our survey were statistically significantly smaller among the oldest respondents (over 80 years old). Because the oldest people are the most vulnerable and fragile [24, 25] and are often left to fend for themselves, this can lead to adverse health outcomes. Although elderly individuals are aware of the importance of FA knowledge, their (too) low self-confidence about this knowledge is often a problem [13, 34]. A reason may be that they are less likely to be trained or show a willingness to be trained in FA measures. Regardless of the reason for their lower readiness to participate in FA courses, longer periods of time since the last participation in an FA course correlate with poor FA knowledge, which follows the results of our study. Notably, Caap and colleagues  linked the low level of CPR knowledge to the fact that the majority (57%) of the respondents had not yet attended a CPR course. Accordingly, in our survey, 55% and 73% of all respondents and those older than 60 years, respectively, attended their most recent FA course more than 10 years ago. Furthermore, 5% and 10% of them, respectively, had never attended an FA course.
One of the limitations of our research is that we only studied the theoretical knowledge of FA. Behaviour in real situations could be different. In real situations of cardiac arrest, Park et al.  found that people over 60 years of age performed lower quality CPR. Notably, Takei and colleagues  confirmed that, in reality, older eyewitnesses are less likely to perform CPR. The reasons and sources of acquiring FA knowledge in other medical situations could also be explored in more detail. The non-validated questionnaire is another limitation of our research. In addition, one might argue that we did not focus on a representative sample of the elderly population, although the total number of respondents older than 60 years was not small (n = 402). In contrast, we deliberately conducted a survey with the entire adult Slovenian population because it allowed us to compare different age groups.