Skip to main content
Top
Published in: BMC Geriatrics 1/2019

Open Access 01-12-2019 | Care | Research article

Effects of age and cognitive function on data quality of standardized surveys in nursing home populations

Authors: Patrick Kutschar, Martin Weichbold, Jürgen Osterbrink

Published in: BMC Geriatrics | Issue 1/2019

Login to get access

Abstract

Background

Data quality is of special concern when it comes to survey research in nursing homes. Very little is known about specifics of cognitively impaired elderly in responding to survey questions. This study examines effects of cognitive impairment, age, gender, and interview duration on the data quality in a sample of 659 nursing home residents (NHR).

Methods

Within a cross-sectional design, survey methodology was used to evaluate the pain situation in 13 nursing homes. Residents were stratified into NHR with no/mild (Mini-Mental State Examination MMSE: 18–30) and NHR with moderate (MMSE: 10–17) cognitive impairment. Data quality is measured by item nonresponse (INR). Correlation analyses, ANCOVA, linear and logistic regression models are applied.

Results

Neither interview duration nor gender have effects on item nonresponse. Age accounts for higher INR (β = 0.12, p < 0.001). Cognitive impairment strongly predicts INR (β = − 0.40, p < 0.001). INR significantly differs between NHR with no/mild (3.98%) and moderate cognitive impairment (11.85%). The likelihood of INR > 5% for residents with moderate cognitive impairment is 3.8-times (p < 0.001) of that for those with no/mild impairment.

Conclusions

Surveys are adequate for residents with no/mild cognitive impairment but data quality is threatened in residents with moderate impairments. Precision and validity of responses from NHR with progressed cognitive impairment are potentially limited and results may be biased. The results clearly do support the need for a multidisciplinary ‘general theory’ of the question−/answer-process which has to be also inclusive for cognitively impaired elderly persons.
Appendix
Available only for authorised users
Literature
1.
go back to reference Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, et al. Dementia prevention, intervention, and care. Lancet. 2017;390(10113):2673–734.PubMedCrossRef Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, et al. Dementia prevention, intervention, and care. Lancet. 2017;390(10113):2673–734.PubMedCrossRef
2.
go back to reference Hoffmann F, Kaduszkiewicz H, Glaeske G, van den Bussche H, Koller D. Prevalence of dementia in nursing home and community-dwelling older adults in Germany. Aging Clin Exp Res. 2014;26(5):555–9.PubMedCrossRef Hoffmann F, Kaduszkiewicz H, Glaeske G, van den Bussche H, Koller D. Prevalence of dementia in nursing home and community-dwelling older adults in Germany. Aging Clin Exp Res. 2014;26(5):555–9.PubMedCrossRef
3.
go back to reference Clark P, Tucke SS, Whitlatch CJ. Consistency of information from persons with dementia: an analysis of differences by question type. Dementia. 2008;7(3):341–58.CrossRef Clark P, Tucke SS, Whitlatch CJ. Consistency of information from persons with dementia: an analysis of differences by question type. Dementia. 2008;7(3):341–58.CrossRef
4.
go back to reference Krestar ML, Looman W, Powers S, Dawson N, Judge KS. Including individuals with memory impairment in the research process: the importance of scales and response categories used in surveys. J Empir Res Hum Res Ethics. 2012;7(2):70–9.PubMedCrossRef Krestar ML, Looman W, Powers S, Dawson N, Judge KS. Including individuals with memory impairment in the research process: the importance of scales and response categories used in surveys. J Empir Res Hum Res Ethics. 2012;7(2):70–9.PubMedCrossRef
5.
go back to reference Whitlatch CJ, Feinberg LF, Tucke S. Accuracy and consistency of responses from persons with cognitive impairment. Dementia. 2005;4(2):171–83.CrossRef Whitlatch CJ, Feinberg LF, Tucke S. Accuracy and consistency of responses from persons with cognitive impairment. Dementia. 2005;4(2):171–83.CrossRef
6.
go back to reference Lechner C, Rammstedt B. Cognitive ability, acquiescence, and the structure of personality in a sample of older adults. Psychol Assess. 2015;27(4):1301–11.PubMedCrossRef Lechner C, Rammstedt B. Cognitive ability, acquiescence, and the structure of personality in a sample of older adults. Psychol Assess. 2015;27(4):1301–11.PubMedCrossRef
7.
go back to reference Schwarz N, Knäuper B. Cognition, aging, and self-reports. In: Park D, Schwarz N, editors. Cognitive aging - a primer. 2nd ed. Philadelphia: Psychology Press; 2005. p. 233–52. Schwarz N, Knäuper B. Cognition, aging, and self-reports. In: Park D, Schwarz N, editors. Cognitive aging - a primer. 2nd ed. Philadelphia: Psychology Press; 2005. p. 233–52.
8.
go back to reference Krosnick JA. The threat of satisficing in surveys: the shortcuts respondents take in answering questions. Surv Methods Newsl. 2000;20(1):4–9. Krosnick JA. The threat of satisficing in surveys: the shortcuts respondents take in answering questions. Surv Methods Newsl. 2000;20(1):4–9.
9.
go back to reference Tourangeau R. Cognitive science and survey methods. A cognitive perspective. In: Jabine T, editor. Cognitive aspects of survey methodology building a bridge between disciplines. Washington DC: National Academy Press; 1984. p. 73–100. Tourangeau R. Cognitive science and survey methods. A cognitive perspective. In: Jabine T, editor. Cognitive aspects of survey methodology building a bridge between disciplines. Washington DC: National Academy Press; 1984. p. 73–100.
10.
go back to reference Husebo B, Kunz M, Achterberg WP, Lobbezoo F, Kappesser J, Tudose C, et al. Pain assessment and treatment. Challenges in patients with dementia. Z Neuropsychol. 2012;23(4):237–46.CrossRef Husebo B, Kunz M, Achterberg WP, Lobbezoo F, Kappesser J, Tudose C, et al. Pain assessment and treatment. Challenges in patients with dementia. Z Neuropsychol. 2012;23(4):237–46.CrossRef
11.
go back to reference Craik FIM, Luo L, Sakuta Y. Effects of aging and divided attention on memory for items and their contexts. Psychol Aging. 2010;25(4):968–79.PubMedCrossRef Craik FIM, Luo L, Sakuta Y. Effects of aging and divided attention on memory for items and their contexts. Psychol Aging. 2010;25(4):968–79.PubMedCrossRef
12.
go back to reference Whitlatch CJ, Menne HL. Don’t forget about me! Decision making by people with dementia. Generations. 2009;33(1):66–73. Whitlatch CJ, Menne HL. Don’t forget about me! Decision making by people with dementia. Generations. 2009;33(1):66–73.
13.
go back to reference Smebye KL, Kirkevold M, Engedal K. How do persons with dementia participate in decision making related to health and daily care? A multi-case study. BMC Health Serv Res. 2012;12:241–52.PubMedPubMedCentralCrossRef Smebye KL, Kirkevold M, Engedal K. How do persons with dementia participate in decision making related to health and daily care? A multi-case study. BMC Health Serv Res. 2012;12:241–52.PubMedPubMedCentralCrossRef
14.
go back to reference Menne HL, Whitlatch CJ. Decision-making involvement of individuals with dementia. Gerontologist. 2007;47(6):810–9.PubMedCrossRef Menne HL, Whitlatch CJ. Decision-making involvement of individuals with dementia. Gerontologist. 2007;47(6):810–9.PubMedCrossRef
15.
go back to reference Menne HL, Whitlatch CJ. Decision-Making involvement of persons with dementia: caregiver perceptions and change over time. Gerontologist. 2012;52:12. Menne HL, Whitlatch CJ. Decision-Making involvement of persons with dementia: caregiver perceptions and change over time. Gerontologist. 2012;52:12.
16.
go back to reference Lukas A, Schuler M, Fischer TW, Gibson SJ, Savvas SM, Nikolaus T, et al. Pain and dementia: a diagnostic challenge. Z Gerontol Geriatr. 2012;45(1):45–9.PubMedCrossRef Lukas A, Schuler M, Fischer TW, Gibson SJ, Savvas SM, Nikolaus T, et al. Pain and dementia: a diagnostic challenge. Z Gerontol Geriatr. 2012;45(1):45–9.PubMedCrossRef
17.
go back to reference Husebo BS, Strand LI, Moe-Nilssen R, Borgehusebo S, Aarsland D, Ljunggren AE. Who suffers most? Dementia and pain in nursing home patients: a cross-sectional study. J Am Med Dir Assoc. 2008;9(6):427–33.PubMedCrossRef Husebo BS, Strand LI, Moe-Nilssen R, Borgehusebo S, Aarsland D, Ljunggren AE. Who suffers most? Dementia and pain in nursing home patients: a cross-sectional study. J Am Med Dir Assoc. 2008;9(6):427–33.PubMedCrossRef
18.
go back to reference Ni Thuathail A, Welford C. Pain assessment tools for older people with cognitive impairment. Nurs Stand. 2011;26(6):39–46.PubMedCrossRef Ni Thuathail A, Welford C. Pain assessment tools for older people with cognitive impairment. Nurs Stand. 2011;26(6):39–46.PubMedCrossRef
19.
go back to reference Clark P, Whitlatch C, Tucke S, Rose B. Reliability of information from persons with dementia. Gerontologist. 2005;45:132. Clark P, Whitlatch C, Tucke S, Rose B. Reliability of information from persons with dementia. Gerontologist. 2005;45:132.
20.
go back to reference Feinberg LF, Whitlatch CJ. Are persons with Cognitive impairment able to state consistent choices? Gerontologist. 2001;41(3):374–82.PubMedCrossRef Feinberg LF, Whitlatch CJ. Are persons with Cognitive impairment able to state consistent choices? Gerontologist. 2001;41(3):374–82.PubMedCrossRef
21.
go back to reference Czaja R, Blair J. Designing surveys. A guide to Decicions and procedures. 2. Ed. Thousand Oaks, London, New Delhi: Pine Forge Press; 2005. Czaja R, Blair J. Designing surveys. A guide to Decicions and procedures. 2. Ed. Thousand Oaks, London, New Delhi: Pine Forge Press; 2005.
22.
go back to reference Yan T, Curtin R. The relation between unit nonresponse and item nonresponse: a response continuum perspective. Int J Public Opin R. 2010;22(4):535–51.CrossRef Yan T, Curtin R. The relation between unit nonresponse and item nonresponse: a response continuum perspective. Int J Public Opin R. 2010;22(4):535–51.CrossRef
24.
go back to reference Osterbrink J, Ewers A, Nestler N, Pogatzki-Zahn E, Bauer Z, Gnass I, et al. Health services research project “action Alliance Pain-Free City Munster”. Schmerz. 2010;24(6):613–20.PubMedCrossRef Osterbrink J, Ewers A, Nestler N, Pogatzki-Zahn E, Bauer Z, Gnass I, et al. Health services research project “action Alliance Pain-Free City Munster”. Schmerz. 2010;24(6):613–20.PubMedCrossRef
25.
go back to reference Folstein MF, Folstein SE, McHugh PR. “mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.CrossRef Folstein MF, Folstein SE, McHugh PR. “mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.CrossRef
26.
go back to reference Lukas A, Niederecker T, Günther I, Mayer B, Nikolaus T. Self- and proxy report for the assessment of pain in patients with and without cognitive impairment. Experiences gained in a geriatric hospital. Z Gerontol Geriatr. 2013;46:214–21.PubMedCrossRef Lukas A, Niederecker T, Günther I, Mayer B, Nikolaus T. Self- and proxy report for the assessment of pain in patients with and without cognitive impairment. Experiences gained in a geriatric hospital. Z Gerontol Geriatr. 2013;46:214–21.PubMedCrossRef
27.
go back to reference Chibnall JT, Raymond CT. Pain assessment in cognitively impaired and unimpaired older adults: a comparison of four scales. Pain. 2001;92:175–86.CrossRef Chibnall JT, Raymond CT. Pain assessment in cognitively impaired and unimpaired older adults: a comparison of four scales. Pain. 2001;92:175–86.CrossRef
29.
go back to reference Elliott MN, Edwards C, Angeles J, Hambarsoomians K, Hays RD. Patterns of unit and item nonresponse in the CAHPS hospital survey. Health Serv Res. 2005;40(6 Pt 2):2096–119.PubMedPubMedCentralCrossRef Elliott MN, Edwards C, Angeles J, Hambarsoomians K, Hays RD. Patterns of unit and item nonresponse in the CAHPS hospital survey. Health Serv Res. 2005;40(6 Pt 2):2096–119.PubMedPubMedCentralCrossRef
30.
go back to reference Coste J, Quinquis L, Audureau E, Pouchot J. Non response, incomplete and inconsistent responses to self-administered health-related quality of life measures in the general population: patterns, determinants and impact on the validity of estimates - a population-based study in France using the MOS SF-36. Health Qual Life Outcomes. 2013;11:44.PubMedPubMedCentralCrossRef Coste J, Quinquis L, Audureau E, Pouchot J. Non response, incomplete and inconsistent responses to self-administered health-related quality of life measures in the general population: patterns, determinants and impact on the validity of estimates - a population-based study in France using the MOS SF-36. Health Qual Life Outcomes. 2013;11:44.PubMedPubMedCentralCrossRef
31.
go back to reference Koyama A, Fukunaga R, Abe Y, Nishi Y, Fujise N, Ikeda M. Item non-response on self-report depression screening questionnaire among community-dwelling elderly. J Affect Disord. 2014;162:30–3.PubMedCrossRef Koyama A, Fukunaga R, Abe Y, Nishi Y, Fujise N, Ikeda M. Item non-response on self-report depression screening questionnaire among community-dwelling elderly. J Affect Disord. 2014;162:30–3.PubMedCrossRef
32.
go back to reference Slymen DJ, Drew JA, Wright BL, Elder JP, Williams SJ. Item non-response to lifestyle assessment in an elderly cohort. Int J Epidemiol. 1994;23(3):583–91.PubMedCrossRef Slymen DJ, Drew JA, Wright BL, Elder JP, Williams SJ. Item non-response to lifestyle assessment in an elderly cohort. Int J Epidemiol. 1994;23(3):583–91.PubMedCrossRef
33.
go back to reference Colsher PL, Wallace RB. Data quality and age: health and psychobehavioral correlates of item nonresponse and inconsistent responses. J Gerontol. 1989;44(2):P45–52.PubMedCrossRef Colsher PL, Wallace RB. Data quality and age: health and psychobehavioral correlates of item nonresponse and inconsistent responses. J Gerontol. 1989;44(2):P45–52.PubMedCrossRef
34.
go back to reference Guadagnoli E, Cleary PD. Age-related item nonresponse in surveys of recently discharged patients. J Gerontol. 1992;47(3):206–12.CrossRef Guadagnoli E, Cleary PD. Age-related item nonresponse in surveys of recently discharged patients. J Gerontol. 1992;47(3):206–12.CrossRef
35.
go back to reference Sherbourne CD, Meredith LS. Quality of self-report data - a comparison of older and younger chronically ill patients. J Gerontol. 1992;47(4):S204–S11.PubMedCrossRef Sherbourne CD, Meredith LS. Quality of self-report data - a comparison of older and younger chronically ill patients. J Gerontol. 1992;47(4):S204–S11.PubMedCrossRef
36.
go back to reference Fuchs M. Item-Nonresponse in einer Befragung von Alten und Hochbetagten [Item-Nonresponse in a Survey among the Elderly. The Impact of Age and Cognitive Resources]. In: Weichbold M, Bacher J, Wolf C, editors. Umfrageforschung: Herausforderungen und Grenzen. Wiesbaden: VS Verlag für Sozialwissenschaften; 2009. p. 333–49.CrossRef Fuchs M. Item-Nonresponse in einer Befragung von Alten und Hochbetagten [Item-Nonresponse in a Survey among the Elderly. The Impact of Age and Cognitive Resources]. In: Weichbold M, Bacher J, Wolf C, editors. Umfrageforschung: Herausforderungen und Grenzen. Wiesbaden: VS Verlag für Sozialwissenschaften; 2009. p. 333–49.CrossRef
37.
go back to reference Knäuper B, Belli RF, Hill DH, Herzog RA. Question difficulty and Respondents’ Cognitive ability: the effect on data quality. J Off Stat. 1997;13(2):181–99. Knäuper B, Belli RF, Hill DH, Herzog RA. Question difficulty and Respondents’ Cognitive ability: the effect on data quality. J Off Stat. 1997;13(2):181–99.
38.
go back to reference Fisher SE, Burgio LD, Thorn BE, Hardin JM. Obtaining self-report data from cognitively impaired elders: methodological issues and clinical implications for nursing home pain assessment. Gerontologist. 2006;46(1):81–8.PubMedCrossRef Fisher SE, Burgio LD, Thorn BE, Hardin JM. Obtaining self-report data from cognitively impaired elders: methodological issues and clinical implications for nursing home pain assessment. Gerontologist. 2006;46(1):81–8.PubMedCrossRef
39.
go back to reference Krosnick JA, Holbrook AL, Berent MK, Carson RT, Hanemann WM, Kopp RJ, et al. The impact of “no opinion” response options on data quality - non-attitude reduction or an invitation to satisfice? Public Opin Q. 2002;66(3):371–403.CrossRef Krosnick JA, Holbrook AL, Berent MK, Carson RT, Hanemann WM, Kopp RJ, et al. The impact of “no opinion” response options on data quality - non-attitude reduction or an invitation to satisfice? Public Opin Q. 2002;66(3):371–403.CrossRef
40.
go back to reference Groves RM, Dillman DA, Eltinge JL, Little RJA. In: Groves RM, Kalton G, JNK R, Schwarz N, Skinner C, editors. Survey nonresponse. New York: John Wiley & Sons; 2002. Groves RM, Dillman DA, Eltinge JL, Little RJA. In: Groves RM, Kalton G, JNK R, Schwarz N, Skinner C, editors. Survey nonresponse. New York: John Wiley & Sons; 2002.
41.
go back to reference Callens M, Loosveldt G. ‘Don’t know’ responses to survey items on Trust in Police and Criminal Courts: a word of caution. Survey Methods: Insights from the Field; 2018. Callens M, Loosveldt G. ‘Don’t know’ responses to survey items on Trust in Police and Criminal Courts: a word of caution. Survey Methods: Insights from the Field; 2018.
42.
go back to reference Housen P, Shannon GR, Simon B, Edelen MO, Cadogan MP, Jones M, et al. Why not just ask the resident? J Gerontol Nurs. 2009;35(11):40–9.PubMedCrossRef Housen P, Shannon GR, Simon B, Edelen MO, Cadogan MP, Jones M, et al. Why not just ask the resident? J Gerontol Nurs. 2009;35(11):40–9.PubMedCrossRef
43.
go back to reference Franzmeier N, Hartmann JC, Taylor ANW, Araque Caballero MA, Simon-Vermot L, Buerger K, et al. Left frontal hub connectivity during memory performance supports Reserve in Aging and Mild Cognitive Impairment. J Alzheimers Dis. 2017;59(4):1381–92.PubMedPubMedCentralCrossRef Franzmeier N, Hartmann JC, Taylor ANW, Araque Caballero MA, Simon-Vermot L, Buerger K, et al. Left frontal hub connectivity during memory performance supports Reserve in Aging and Mild Cognitive Impairment. J Alzheimers Dis. 2017;59(4):1381–92.PubMedPubMedCentralCrossRef
44.
go back to reference Freret T, Gaudreau P, Schumann-Bard P, Billard JM, Popa-Wagner A. Mechanisms underlying the neuroprotective effect of brain reserve against late life depression. J Neural Transm. 2015;122(Suppl 1):S55–61.PubMedCrossRef Freret T, Gaudreau P, Schumann-Bard P, Billard JM, Popa-Wagner A. Mechanisms underlying the neuroprotective effect of brain reserve against late life depression. J Neural Transm. 2015;122(Suppl 1):S55–61.PubMedCrossRef
Metadata
Title
Effects of age and cognitive function on data quality of standardized surveys in nursing home populations
Authors
Patrick Kutschar
Martin Weichbold
Jürgen Osterbrink
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Care
Published in
BMC Geriatrics / Issue 1/2019
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-019-1258-0

Other articles of this Issue 1/2019

BMC Geriatrics 1/2019 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.