Refusal and information bias associated with postal questionnaires and face-to-face interviews in very elderly subjects

doi:10.1016/0895-4356(95)00527-7

Journal of Clinical Epidemiology

Volume 49, Issue 3, March 1996, Pages 373-381

https://doi.org/10.1016/0895-4356(95)00527-7 Get rights and content

Abstract

Our objectives were (1) to analyze the refusal bias associated with postal questionnaires and face-to-face interviews and (2) to compare responses elicited from a postal questionnaire with those provided by a face-to-face interview in subjects over 75 years of age. Our methods included a postal questionnaire sent to a representative sample of community-dwelling elderly individuals (n = 842). All subjects were also invited to participate in an in-home interview conducted by a trained nurse. One hundred and six subjects (12.6%) were nonrespondents to the postal questionnaire. These nonrespondents were more cognitively impaired, more disabled, and showed a higher 1-year mortality rate (13.2 versus 5.2%) than respondents. Late respondents who needed a reminder letter were similar to nonrespondents. One hundred and eighty-seven subjects (22.2%) refused to participate in the home interview. These nonparticipants were similar to the participants on age, sex, 1-year mortality rate, and responses given to all but two postal questions. Comparison of postal questionnaire responses and face-to-face responses revealed that agreement was substantial to moderate for factual information (κ = 0.41 to 0.80) but poor for clinical information (depression, cognitive impairment, disability). A short index including age, sex, and six questions on disability was useful in identifying disabled subjects by a postal questionnaire. Our conclusion is that nonresponse bias is evidenced when postal questionnaires are utilized in the very elderly population and caution should be used when interpreting health data obtained by this technique. Refusal bias from face-to-face interviewing is less important in this population.

References (56)

MF Folstein et al.
“Mini-Mental State”: A practical method for grading the cognitive state of patients for the clinician
J Psychiat Res
(1975)
JA Yesavage et al.
Development and validation of a geriatric depression scale: A preliminary report
J Psychiatric Res
(1983)
H Doll et al.
Reliability of questionnaire responses as compared with interview in the elderly: Views of the outcome of transurethral resection of the prostate
Soc Sci Med
(1991)
DC Miller
JH Barber et al.
A postal screening questionnaire in preventive geriatric care
J R Coll Gen Pract
(1980)
AR Herzog et al.
Age and response rates to interview sample surveys
J Gerontol
(1988)
J Goyder
Face-to-face interview and mailed questionnaires: The net difference in response rate
Public Opin Q
(1985)
JM Last
Duke Center for the Study of Aging and Human Development
Canada Statistics

AMD Porter

The Edinburgh birthday card scheme

DS Dillman

R Hébert et al.

Le Système de mesure de l'autonomie fonctionnelle (SMAF)

Revue Gériatrie

(1988)

R Hébert et al.

The Functional Autonomy Measurement System (SMAF): Description and validation of an instrument for the measurement of handicaps

Age Ageing

(1988)

R Hébert et al.

Profil d'autonomie fonctionnelle de personnes âgées en institution

Cahiers I'ACFAS

(1986)

EL Teng et al.

The modified Mini-Mental State (3MS) Examination

J Clin Psychiat

(1987)

EL Teng et al.

The Modified Mini-Mental State (The 3MS) Test

Clin Neuropsychol

(1987)

R Hébert et al.

Validation de l'adaptation française du Modified Mini-Mental State (3MS)

Revue Gériatrie

(1992)

J Vézina et al.

Comparison de la performance diagnostique de l'Inventaire de dépression gériatrique de Beck et de l'Échelle de dépression gériatrique: utilisation des courbes caractéristiques

L Hyer et al.

Concurrent and discriminant validities of the Geriatric Depression Scale with older psychiatric inpatients

Psychol Rep

(1984)

TL Brink et al.

Geriatric depression scale reliability: Order, examiner and reminiscence effects

Clin Gerontol

(1985)

JI Sheikh et al.

Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version

JT Norris et al.

Assessment of depression in the geriatric medical outpatients: The validity of two screening measures

J Am Geriatr Soc

(1987)

P Bourque et al.

Étude psychométrique de l'Échelle de dépression gériatrique

Revue Canadienne du Vieillissement

(1990)

D Clayton et al.

J Cohen

A coefficient of agreement for nominal scales

Educ Psychol Meas

(1960)

JR Landis et al.

The measurement of observer agreement for categorical data

Biometrics

(1977)

FC Pannill et al.

Functional Assessment Screening

Cited by (101)

Static or dynamic predictors of physical activity (PA)? A tracking study based on 12- and 38-month follow-ups in older adults
2014, Archives of Gerontology and Geriatrics
Studies that investigated stability of PA in older populations are scarce. Moreover, no studies used dynamic indicators to predict PA trajectories. The purpose of the present study were to investigate PA stability overtime, and to examine if changes in self-reported physical function (dynamic indicator) are better predictors of trajectories of PA than baseline measures of physical function (static indicator). This is a prospective postal survey with two time-point follow-ups: 12 and 38 months. Participants were older adults aged ≥60 years, and members of the medical insurance scheme of the French national education system. They responded to a self-report questionnaire on PA and general health status at three different times: baseline, 12- and 38-month follow-ups (n = 243 for the 12-month follow-up; n = 164 for the 38-month follow-up). Overtime analyses of PA showed a moderate-to-good stability with regard to both duration and volume of PA; however, a decrease in stability for vigorous PA was found between 12- and 38-month follow-ups. Both baseline measure and changes in physical function predicted PA trajectories, but magnitudes of associations were stronger for the dynamic indicator. Moreover, change in physical function was the only predictor of both becoming active compared with Inactive (reduced probability) and becoming inactive compared to Active (increased probability). In conclusion, a dynamic indicator of physical function is a better predictor of PA variation than static indicators.
Participation bias in postal surveys among older adults: The role played by self-reported health, physical functional decline and frailty
2012, Archives of Gerontology and Geriatrics
Citation Excerpt :
Moreover, in the presence of self-reported health, physical functional decline was no longer associated to the dependent variable. This seems to indicate that limitation in physical function is not the best predictor of non-participation in a postal survey as suggested by Hébert et al.’s results (1996b): individuals’ perception about their health status can constitute a better predictor of future participation. It is also possible that self-reported health captures other health aspects than our measure of physical functional decline.
Postal survey is a simple and efficient way to collect information in large study samples. The purpose of this study was to find out differences between older adults who responded to a postal survey on health outcomes and those who did not, and to examine the importance of frailty, physical functional decline and poor self-reported health in determining non-response. We mailed out a questionnaire on general health twice at a year's interval to 1000 individuals ≥60 years, and members of the medical insurance scheme of the French national education system. At Year1, 535 persons responded to the questionnaire (65% women, 70.9 ± 8.4 years). A year later (Year2), we obtained 384 responses (63.3% women, 70.5 ± 7.8 years). Compared to respondents, non-respondents at Year2 were more frequently categorized as frail, reported more often to be in bad health, and had more physical functional declines. Frailty, physical functional decline and poor self-reported health increased the likelihood of not responding to Year2 questionnaire, with poor self-reported health weakening the association of physical functional decline and non-response. Respondents of this postal survey are fitter and healthier than non-respondents. This participation bias precludes the generalization of postal surveys results.
Yearly transitions of disability profiles in older people living at home
2012, Archives of Gerontology and Geriatrics
Planning home services for older people requires extensive knowledge about the progression of disabilities. Disability-based case-mix classifications identify meaningful groups of older people; yet transitions between profiles are mostly unknown.
Disability was assessed annually over four years with the Functional Autonomy Measurement System (SMAF) in 1410 older people at risk of functional decline aged 75 and over and living at home. The SMAF generates a case-mix classification of 14 Iso-SMAF profiles with progressive mean disability levels. Transitions made by older people were analyzed using a continuous-time, multi-state Markov model to estimate the probabilities of annual transitions into and out of each profile as well as the mean sojourn time in each profile.
The probability of staying in a profile tended to decrease as profile severity increased. For profiles 5 and above, recovery to mild profiles 1, 2 and 3 was low, while annual probabilities of death and institutionalization were high (>0.10). The lower disability profiles (1 and 2) evidenced a mean profile sojourn time of over two years, contrary to sojourn times of 18 months or less with the other profiles.
The probabilities are identifiable, indicating that a disability-based classification can characterize progression in older people. Since the required resources and costs are known for each profile, these probabilities are very helpful in planning home services for elderly populations.
Morbidity in aged Finns: A systematic review
2012, Archives of Gerontology and Geriatrics
Citation Excerpt :
Non-response reduces the effective sample size, may cause bias, and affects the interpretation and generalization of results (Freedman et al., 1996; Jylhä and Hervonen, 1999; Edwards et al., 2002; Drivsholm et al., 2006; Edwards et al., 2009). Non-response analyses for general surveys among the aged have shown a greater morbidity in non-respondents than in respondents (Launer et al., 1994; Hebert et al., 1996; Hoeymans et al., 1998). According to Goebeler (2009), clearly defined conditions such as diabetes or cancer were reported more accurately than diseases which are easily mixed with similar conditions.
Aim: The aim was to carry out a systematic review of original studies about morbidity in the aged in Finland. Methods: Publications with data on morbidity in the aged (≥65 years) in peer-reviewed scientific journals in Finnish and English were systematically searched for in literature databases, websites of National Institute of Health and Welfare (NIHW), National Public Health Institute (NPHI), and Stakes and reference lists of retrieved articles. Publications from 1990 onwards were included. Results: The search produced 39 publications about morbidity in the aged in Finland fulfilling the inclusion criteria. The most common disease categories in the aged were cardiovascular diseases (CVDs), musculoskeletal disorders (MSDs), hypertension, orthostatic hypotension (OH), insomnia, diabetes, articular diseases, diseases causing cognitive decline, and depression. The prevalence of many of these diseases increased with age. Conclusions: The morbidity increases with aging, and even the oldest-old are not exceptionally healthy. Because of the increasing number of aged people, the absolute use of health and social services by this population sector will most probably increase in Finland and other developed countries.
Personality and participation in mass health checkups among Japanese community-dwelling elderly
2009, Journal of Psychosomatic Research
Citation Excerpt :
One solution to this problem of restricted efficacy of mass health checkups is to identify the characteristics of nonparticipants and apply them toward improving the checkup participation rate. Various studies have reported that individuals who do not undergo health surveys are generally of higher age [1,3,4], lower education [1,5,6], lower cognitive function [6–8], poorer health status [1,3,9], lower mental health status [1,3], and lower functional capacity [1,9]; are likely to have chronic diseases, [1,10] vision and hearing problems [9], and undesirable health-related behaviors (i.e., smoking, unfavorable eating habits, lack of physical activity) [9–11]; and are unlikely to be socially integrated [12] compared to those who do. As mentioned above, there has been many findings regarding the factors associated with participation status in health surveys, but little is known about the relationship between personality and participation status.
The aim of this study is to examine the relationship between personality traits and participation in mass health checkups among Japanese community-dwelling elderly.
A data set of 327 men and 519 women aged 70 years and over was used in the analysis. The NEO Five-Factor Inventory was administered to assess the “big five” personality traits: neuroticism, extraversion, openness, agreeableness, and conscientiousness.
In multivariate logistic regression analysis adjusted for gender, age, number of years of education, living alone, presence of psychiatric diseases, presence of chronic diseases, and history of hospitalization during a 1-year period, openness was independently associated with participation in mass health checkups [odds ratio (OR)=1.51, 95% confidence interval (CI)=1.08–2.12, P<.01 and OR=1.38, 95% CI=0.96–1.97, P=.07 for the middle and highest tertile, respectively]. No other domains of personality were related to participation in the checkups.
The results of the present study suggest that older individuals high in openness are likely to take part in checkups for the elderly. Our findings could help improve the participation rate in mass health checkups for the prevention of long-term care dependence in later life.
The relationship between coping, self-esteem and health on outdoor walking ability among older adults in Norway
2010, Ageing and Society

View all citing articles on Scopus

^☆: Presented at the 49th Annual Scientific Meeting of the American Geriatrics Society, Washington D.C., November 16, 1992.

^☆☆: Funded by the National Health Research and Development Program, Health and Welfare, Canada.

View full text

Original articleRefusal and information bias associated with postal questionnaires and face-to-face interviews in very elderly subjects☆,☆☆

Abstract

J Psychiat Res

J Psychiatric Res

Soc Sci Med

A postal screening questionnaire in preventive geriatric care

J R Coll Gen Pract

Age and response rates to interview sample surveys

J Gerontol

Face-to-face interview and mailed questionnaires: The net difference in response rate

Public Opin Q

The Edinburgh birthday card scheme

Le Système de mesure de l'autonomie fonctionnelle (SMAF)

Revue Gériatrie

The Functional Autonomy Measurement System (SMAF): Description and validation of an instrument for the measurement of handicaps

Age Ageing

Profil d'autonomie fonctionnelle de personnes âgées en institution

Cahiers I'ACFAS

The modified Mini-Mental State (3MS) Examination

J Clin Psychiat

The Modified Mini-Mental State (The 3MS) Test

Clin Neuropsychol

Validation de l'adaptation française du Modified Mini-Mental State (3MS)

Revue Gériatrie

Comparison de la performance diagnostique de l'Inventaire de dépression gériatrique de Beck et de l'Échelle de dépression gériatrique: utilisation des courbes caractéristiques

Concurrent and discriminant validities of the Geriatric Depression Scale with older psychiatric inpatients

Psychol Rep

Geriatric depression scale reliability: Order, examiner and reminiscence effects

Clin Gerontol

Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version

Assessment of depression in the geriatric medical outpatients: The validity of two screening measures

J Am Geriatr Soc

Étude psychométrique de l'Échelle de dépression gériatrique

Revue Canadienne du Vieillissement

A coefficient of agreement for nominal scales

Educ Psychol Meas

The measurement of observer agreement for categorical data

Biometrics

Functional Assessment Screening

Original article
Refusal and information bias associated with postal questionnaires and face-to-face interviews in very elderly subjects☆,☆☆