Why older people refuse to participate in falls prevention trials: a qualitative study.
OBJECTIVE
Falls are a major public health problem. Older persons are frequently underrepresented in trials, including falls prevention trials. Insight into possible reasons for non-participation could help to improve trial designs and participation rates among this age-group. The aim of this study was to explore reasons why older people refuse to participate in falls prevention trials.


METHODS
A qualitative study.


METHODS
Community-dwelling adults aged ≥65 years who attended the Emergency Department due to a fall and refused to participate in a falls prevention trial (IMPROveFALL-study).


METHODS
A structured interview guide was used, and interview transcripts were subjected to an independent content analysis by two researchers.


RESULTS
15 interviews were conducted. A main reason to refuse trial participation was mobility impairment. In contrast, younger and more "active" and mobile seniors considered themselves "too healthy" to participate. Persons with multiple comorbidities mentioned that they attended a hospital too often, or experienced adequate follow-up by their own physicians already. Transport problems, including distance to the hospital, parking facilities, and travel expenses were another issue. During the interviews it was emphasized by the patients, that they knew the reason for their fall. However, they were not familiar with the positive effects of falls prevention programmes.


CONCLUSIONS
Older persons reported multiple reasons to refuse participation in a falls prevention study, such as health-related factors, several practical problems, and personal beliefs about the causes and preventability of falls. Anticipation of those issues might contribute to an improvement in participation rates of older fallers, shorter study duration, and a better generalizability of research findings.
Department of Internal Medicine, Section of Geriatric Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Annemijn B M
AB
Elskamp
Klaas A
KA
Hartholt
Peter
P
Patka
Ed F
EF
van Beeck
Tischa J M
TJ
van der Cammen
D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D001294:Attitude to Health; D004636:Emergency Service, Hospital; D006801:Humans; D007407:Interviews as Topic; D016032:Randomized Controlled Trials as Topic; D045808:Refusal to Participate / Q000523:psychology*; D012107:Research Design; D014187:Transportation of Patients