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Christoph E. Minder, PhD, Tobias Müller, MD, Gerhard Gillmann, John C. Beck, MD and Andreas E. Stuck, MD

Christophe E. Minder and Gerhard Gillmann are with the Division of Biostatistics, Department of Social and Preventive Medicine, University of Bern, Switzerland. Tobias Müller and Andreas E. Stuck are with the Geriatric Research Unit, Department of Geriatrics and Rehabilitation, Zieglerspital, Bern, Switzerland. John C. Beck is with the School of Medicine, University of California, Los Angeles.

Correspondence: Requests for reprints should be sent to Andreas E. Stuck, MD, Geriatrics Research Unit, Spital Bern Ziegler, Morillonstr 75, CH-3001 Bern, Switzerland (e-mail: andreas.stuck{at}spitalbern.ch).

Objectives. This study explored differences between refusers and participants in a longitudinal study with extensive baseline and follow-up information.

Methods. Results of a trial comparing 791 participants and 401 community-residing older adults who refused to participate in a study concerning preventive home visits were examined. Information was collected from interviews, insurance records, and government files.

Results. Despite similarities in terms of age, sex, and self-perceived health at baseline, 3-year follow-up data indicated that refusers had a 1.58-fold higher risk of entering a nursing home than participants. There were additional differences between refusers and participants when refusers were categorized in 4 subgroups based on self-reported reason for refusal (too ill, too healthy, no interest, and other reasons).

Conclusions. Future studies should include follow-up data to allow comparisons between refusers and participants and should address the presence of multiple subgroups of refusers. (Am J Public Health. 2002;92:445–450)

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