Giving voice to vulnerable older adults: Methodological changes

Saliba D, Katz IR, Parmelee PA, Shannon G, Housen P, Simon B. Giving voice to vulnerable older adults: Methodological changes. Paper presented at: VA HSR&D National Meeting; 2006 Feb 1; Arlington, VA.

Related HSR&D Project(s)

• SDR 03-217 – Pilot Testing and Validation of Changes to the Minimum Data Set (MDS) for VA Nursing Homes

Objectives:Vulnerable elders with significant cognitive, functional, and sensory deficits present particular assessment challenges for researchers. Direct interview is an important methodology for measuring key aspects of quality of life and quality of care. However, for vulnerable elders, high levels of cognitive and functional impairments might have a negative effect on the reliability and validity of interview items. A lack of understanding about how to classify and address these and other methodological challenges has, too often, resulted in the exclusion of self-report data from assessments of this population's outcomes and quality of care. This workshop will provide information that enhances researchers' use of patient interview in surveys and assessments. Workshop presenters will highlight challenges that are particularly important for assessing vulnerable elders such as the effect of cognitive ability, physical capacity, altered expectations, acquiescence bias, and decomposition. The workshop will address techniques to mitigate some of these challenges such as cognitive interviewing techniques, addressing item complexity, focusing queries on established performance standards, and use of different response scales. The presenters will use specific examples of interview items developed and tested for assessing preferences, mood disorders and under-treated pain in the particularly vulnerable population of nursing home residents and will consider how these examples generalize to interviews with other vulnerable elders.Methods:Workshop presenters represent regional teams from several different VA research centers who have collaborated in the development and testing of survey items for vulnerable elders. The workshop will explore the process of developing and evaluating survey items through (1) providing workshop participants with real examples of surveys and soliciting critiques of content and administration (2) conducting a brief demonstration of cognitive interviewing technique (3) presentation of challenges and methods related to ongoing survey development for assessing preferences, mood disorders, and pain in vulnerable elders. Sample surveys and a selected bibliography will be provided as handouts.Results:Researchers interested in developing valid survey items that will allow inclusion of more diverse populations such as frail or elderly patients in assessments of outcomes and quality of care.Implications:Basic familiarity and interest in issues associated with vulnerable and dependent populations.