Psychosocial determinants of intention to screen for Alzheimer's disease

There is little information about how receptive older adults are to discuss memory problems with healthcare providers. Here we test the psychosocial factors explaining older adults' intention to undergo screening for Alzheimer disease (AD).

A population-based, random-digit dialing strategy surveyed 1,039 older adults. The Behavioral Model of Health Services Use was used as a conceptual framework for a questionnaire testing constructs from several behavioral theories. Structural equation modeling assessed the relationship of latent variables to each construct with goodness-of-fit indices.

The study had an 82% response rate and 72% completer rate. The respondents' mean age was 62.7 +/- 10.2 years (range, 50 to 97 years). The sample was 67% women, 86% were white, and less than 40% had personal experience with AD. Respondents were nondemented (Short Blessed scores, 1.7 +/- 2.2). Predictors of intention to screen included perceived benefits (gamma = .35), knowledge of dementia (gamma = .26), self-efficacy (gamma = .23), preventive health behaviors (gamma = .17), and perceived susceptibility (gamma = .14). Knowledge was positively correlated with perceived benefits (phi = .29) and susceptibility (phi = .20). Preventive behaviors (phi = .20) were positively correlated with perceived benefits. Self-efficacy correlated positively with preventive behaviors (phi = .24) and perceived benefits (phi = .37) and negatively with perceived susceptibility (phi = -.11). Goodness-of-fit indices suggested a good fit of this model (root mean square error of approximation, .037; comparative fit index, 0.98; relative fit index; .96).

Older adults who have knowledge of dementia and perceive benefit from diagnosis and treatment are more likely to exhibit willingness and confidence to be tested for cognitive problems. Individuals with high self-efficacy, perceived susceptibility, and positive preventive health behaviors are also more likely to exhibit intention. These constructs can now be used to develop interventions to evaluate cognitive health in the elderly.