DETERMINANTS OF PATIENT ADHERENCE TO CONSULTATIVE COMPREHENSIVE GERIATRIC ASSESSMENT RECOMMENDATIONS

Background. In consultative models of Comprehensive Geriatric Assessme nt (CGA), lack of implementation of CGA recommendations is well docume nted and appears to be a potential explanation for negative findings. The purpose of this study is to identify patient determinants of adher ence to recommendations received from a community-based CGA consultati ve model program. Methods. Subjects (N = 139) received self-care and/o r physician-initiated CGA recommendations and were interviewed three m onths later to determine adherence with the most important recommendat ion, and health belief, communication, and social support factors asso ciated with adherence. Independent variables were organized into the A nderson Behavioral Model for analysis. Results. At the bivariate level , one predisposing factor (intention) and six enabling factors (low di fficulty level, high support, high utility, high self-efficacy, agreem ent on the importance of the recommendation and good specific communic ation about the recommendation) were significant determinants of adher ence. Two functional health measures and seriousness of the target con dition of the recommendation were significant need factors. In the fin al logistic regression model, one predisposing variable (intention), o ne enabling variable (utility), and one need factor (high functional s tatus), and two interaction terms significantly predicted adherence. C onclusion. CGA recommendations that are seen as worthwhile, not too mu ch trouble, and able to be accomplished are the most likely to be init iated. Older adults with relatively higher functional levels are also more likely to follow through with CGA recommendations even though the ir needs may be lower. We found the Anderson Behavioral Model useful i n the analysis of factors associated with adherence behavior to consul tative CGA recommendations.