Send to:

Choose Destination
See comment in PubMed Commons below
J Am Med Dir Assoc. 2012 Jan;13(1):11-23.e1-2. doi: 10.1016/j.jamda.2010.11.004. Epub 2010 Dec 30.

A conceptual framework for rejection of care behaviors: review of literature and analysis of role of dementia severity.

Author information

  • 1VA Geriatrics Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA.


Rejection of care behaviors is common in the geriatric population, especially among patients with dementia. Nonetheless, the concept of rejection of care is not well defined and existing psychosocial theoretical models fall short of capturing complex relationships between factors associated with rejection of care. We propose a definition of rejection of care and develop a conceptual framework of rejection of care incorporating 7 components: intrinsic factors, match between needs and environmental resources, behavior state, antecedents, individual preferences, rejection of care behaviors, and consequences. A literature search yielded 55 studies that examined the associations between rejection of care and factors of the conceptual framework. We quantitatively synthesized studies focused on dementia severity and rejection of care. The literature review demonstrated that rejection of care is more prevalent among patients with dementia or functional impairment, associated with some mutable factors, and is triggered by specific antecedents in the context of daily personal care provision and associated with various adverse outcomes. The meta-analysis provided evidence that severe dementia is associated with higher likelihood of developing rejection of care behaviors compared with mild to moderate dementia. We also found that research on unmet needs, antecedents, and individual preferences has been scarce. The direction of further research is discussed.

Published by Elsevier Inc.

[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Write to the Help Desk