Which older adults refuse to or dropout from participation in a trial of integrated care in Singapore and why? Insights from quantitative and qualitative data

Abstract

Study Objectives: Clinical trials with frail older adults are associated with low recruitment rates and high dropout rates. A review of major funded UK trials found that less than one-third recruited their original target within the time originally specified [1]. This paper aims to examine the recruitment and dropout rates of frail older Singaporeans in a trial of a three year integrated care program (EPICC). Methodology: The target was to recruit 80 frail patients aged 60+ prior to SGH and AH acute care discharge and randomly assigned to two arms, over four months. Logistics and administrative procedures for recruitment were studied. Profiles of recruited and dropout patients were collected. If patients refused to participate in the recruitment or were recruited and then dropped out, they were asked their reasons for doing so. Results: 113 patients had to be recruited over 13 months in order to meet the original target. Reasons for non-participation (n=37) included patients had difficulty understanding why there should be clinical trials in elder care (35.1%); ineligibility due to incorrect frailty assessment (27%); patients were on the nursing home waiting list (13.5%). Conclusion: Improved logistics and administrative procedures for recruitment in acute care; and effective communication with older patients will decrease exclusion of older adults from clinical research.