Differing Perceptions of Older Adults’ Reasons for Refusing Services Among Staff, Caregivers, and Older Adults
Bibliographic record
Abstract
Context: Among the populations of the United States and Canada, 1 in 6 are older adults aged 65 years or older. While older adults strongly prefer to age in their own homes, they often refuse home- and community-based services (HCBS) which can support their ability to age in place, prevent health decline, mitigate functional problems in living, and ease burden on caregivers. This community-based participatory study explored factors influencing older adults’ choices not to use HCBS to inform development of interventions to strengthen service utilization. Objective: Describe differences and similarities among older adults, caregivers, and HCBS staff in their perceptions of factors influencing older adults’ choices not to use HCBS. Mixed Methods Design: Focus group discussion and ranking of strength of influence and modifiability of 12 themes of HCBS refusal. Setting: South-central United States. Participants: Older adults with a chronic health condition or a functional disability who have considered using a HCBS (n=15; 80% female, ages 65-77 years), caregivers for older adults (n=17, 88% female, ages 45 to 77 years), HCBS staff (n=17, 76% female, ages 39 to 72 years). Results: Older adults’ top ranked reasons for refusing HCBS are lack of knowledge, lack of accessibility, and financial barriers. Kruskal-Wallis tests with Bonferroni correction on post-hoc comparisons were conducted on the three groups. Relative to older adults’ perspectives, caregivers underestimated the influence of accessibility (p = .039) and HCBS staff overestimated the influence of independence and self-reliance (p = .039). All three groups agreed that lack of knowledge was the most modifiable. Older adults perceived accessibility of services as less modifiable relative to the other 2 groups, though this was not statistically significant. Conclusions: Older adults, caregivers, and HCBS staff demonstrated some important differences in perceived factors influencing older adults’ refusal of HCBS. The three groups were largely in agreement on the extent to which these factors are modifiable. Findings have important implications for patient-centered interventions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.016 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.000 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".