Health Priorities and Attitudes of Older Western Australians to Screening
Colonoscopy: Results of the Screening Colonoscopy in Older People (SCOPE) study
Emang-Jok C,1 Chong CC,1 Ng SW,1 Tran ET,1 Sanfilippo FM2, Ayonrinde OT3,4
1Medical
students, University of Western Australia, 2School of Population Health, University of Western Australia, 3Department of Gastroenterology and
Hepatology, Fremantle Hospital, Western Australia, 4School of Medicine and Pharmacology, University of Western Australia.
BACKGROUND
• Australia has over 2.6 million older people (age 65
years and over), making up 13% of the population.1
• At age 65, older Australians frequently have up to
one quarter of their lives ahead of them (life
expectancy of 17.6 years for men and 21 years for
women plus average disability-free life expectancy of
• Ranking of screening preferences by participants (in
SETTING
Geographical catchment area of the SMAHS in
decreasing order of importance) were: hypertension (1),
Perth, Western Australia (covering an area of
diabetes (2), prostate/breast cancer (3), CRC (4),
8,136 km2, with a population of 706,000,
osteoporosis (5), dementia (6).
representing 36.3% of Western Australia’s
population). People aged 65 years and over in the
Medical conditions that participants were most afraid of developing
SMAHS form 10% of the population while those
aged over 84 years comprise 1%.
10 years).
• Common chronic conditions in old age that are
managed in general practice include hypertension,
arthritis, diabetes, osteoporosis and dementia.2
• Australians have a 1 in 21 lifetime risk of developing
colorectal cancer (CRC). CRC is most common in
people aged over 65 years (particularly over 80
years).3 This population is yet to be incorporated into
the national bowel cancer screening program that
commenced mid 2006.
• Whilst general practitioners (GPs) have a pivotal role
in the management of chronic conditions and the
success of screening programs, the health priorities
and value older people place on screening for
various health conditions (including CRC) in old age
has not previously been systematically examined.
AIMS
• To ascertain the self-expressed health priorities of
older Western Australians.
• To determine the age at which older Australians
cease to be receptive to screening colonoscopy.
• To investigate the effects of various health and
demographic factors on older people’s attitude
towards screening colonoscopy.
METHODS
RESULTS
Demographics of participants
n
%
145
110
1
56.6
43.0
0.4
59
54
62
43
25
7
3
3
23.0
21.1
24.2
16.8
9.8
2.7
1.2
1.2
82
150
23
1
32.0
58.6
9.0
0.4
130
78
29
10
9
50.8
30.5
11.3
3.9
3.5
53
181
22
20.7
70.7
8.6
Gender
Male
Female
Missing
Age-group (years)
65-69
70-74
75-79
80-84
85-89
90-94
≥95
Missing
Residence
Home alone
Home with other
Residential care
Missing
Place of birth
Australia
United Kingdom
Other Europe
Asia
New Zealand
Highest level of education
Primary
Secondary
Tertiary
82
174
32.0
68.0
English as a second language
Yes
No
45
211
17.6
82.4
208
48
81.3
18.7
Questionnaire completed at
Hospital
Community
screening colonoscopy if their GP recommended it. Of
these, 73% would have an operation if cancer was found.
Likelihood of colonoscopy (Logistic regression)
Variable
Adjusted odds ratio
Private Insurance/DVA
Yes
Education
(secondary vs primary)
Sex
Male
Previous Colonoscopy
Yes
95% CI
p value
3.97
1.51 to 10.44
0.005
2.36
1.00 to 5.57
0.050
2.32
1.12 to 4.83
0.024
3.28
1.53 to 7.03
0.002
1
•There was a non-significant decline in stated acceptance
of colonoscopy with age: 90% in 65-69 year olds to 71%
for ≥ 85 years (p=0.08).
Private insurance/DVA health cover
Yes
No
• 82% of respondents agreed that they would have a
DVA = Department of Veterans’ Affairs
CONCLUSION
• Screening preferences of older Western Australians
parallel the prevalence and management of chronic
conditions in general practice.
• Avoidance of cancer is a high priority in all age groups.
• Screening colonoscopy was generally acceptable to older
• Cross-sectional survey of 256 patients and potential
• Participants aged <80 years ranked avoidance
patients within the South Metropolitan Area Health
of cancer and being pain free equally as their
insurance, previous colonoscopy and male sex predicted
Service (SMAHS) of Western Australia.
most important health priorities.
those most likely to agree to colonoscopy.
• Inclusion criteria: age ≥ 65 years plus absence of
severe dementia.
• Questionnaires were self-administered or completed
• In participants aged ≥80, avoidance of cancer
people if referred by their GP. However, private health
• Older females and those without private health insurance
was ranked of highest importance followed by
may benefit from targeted discussion of screening for
avoidance of stroke.
CRC prior to or during early old age.
by semi-structured face-to-face interviews.
• This study is part of the ongoing multicentre
• Health priorities of older patients may differ from the
expectations of their GP. Incorporation of a knowledge of
Screening Colonoscopy in Older PEople (SCOPE)
individual health and screening priorities may enrich the
study conducted in Perth, Wollongong and Ballarat.
transaction between GPs and their older patients.
References:
1. Australian Institute of Health and Welfare 2007. Older Australia at a glance: 4th edition.Cat. no. AGE 52. Canberra: AIHW.
2. O’Halloran J, Britt H, Valenti L, Harrison C, Pan Y, Knox S. 2003. Older patients attending general practice in Australia 2000-02. AIHW Cat. No. GEP 12. Canberra: Australian Institute of Health and Welfare (General Practice Series No. 12).
3. Australian Institute of Health and Welfare & Australian Government Department of Health and Ageing 2008. National Bowel Cancer Screening Program monitoring report 2007. Cancer series no. 40. Cat no. CAN 35 Canberra: AIHW.
Acknowledgements: Survey respondents, Fremantle Hospital Human Research Ethics Committee (funding grant), Yong Yi Lee.
Correspondence to: Dr Oyekoya Ayonrinde, [email protected]