Predictors of Patient Refusal to Participate in Ambulatory-based Comprehensive Geriatric Assessment

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Abstract
Comprehensive geriatric assessment (CGA) in ambulatory settings can be effective only if patients who need this intervention are willing to participate in the evaluation and follow the indicated therapy. To learn whether older persons' health beliefs and perceptions influence participation in ambulatory-based CGA, we studied subjects who failed a screening assessment offered through a community-based outreach program and were deemed appropriate for CGA. All subjects were interviewed in person following a structured sequence including questions from the RAND Current Health (CH) and Health Worry/Concern (HWC) scales, the Health Locus Of Control Scale (HLC), and scales developed to measure health risks and perceived benefits of geriatric assessment. In univariate analysis, the following variables were associated with refusal to participate in CGA status at the p ≤ .05 level: increased worry on hwc and higher scores on three new scales constructed to measure global health risk (GHR), perceived global health benefits (PGHB), and perceived specific health benefits (PSHB). For GHR, higher scores indicate greater risk; for PGHB and PSHB, higher scores indicate greater perceived benefit. In multivariate analysis, only educational level, GHR, PGHB, and PSHB scores were independently predictive of refuser status. Correlations with other established health perceptions scales provided support that global health risk and perceived global and specific health benefits are unique constructs. Furthermore, high scores on these scales predicted participation in health improvement programs. Patients' beliefs about perceived risk and benefit can be measured and predict willingness to participate in ambulatory-based CGA.

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