Methodologic issues in conducting research on hospitalized older people.
OBJECTIVE
To describe challenges in conducting research with hospitalized geriatric patients.


METHODS
Quasi-experimental longitudinal study with inperson interviews at baseline and discharge and a three-month postdischarge telephone interview. Study protocol required baseline interviews within 48 hours of admission for patients or 72 hours for proxies.


METHODS
813-bed urban teaching hospital.


METHODS
240 patients, mean age 83.8 years, at moderate to high risk for functional decline during hospitalization, admitted from the emergency room to a general medical unit.


METHODS
Delays starting or interruptions continuing interviews; patient and environmental conditions potentially affecting data quality; and information on proxy use.


RESULTS
Timely access to patients or proxies was a major difficulty, resulting in the screening of only 53.1% of 867 potentially eligible patients. Multiple patient contacts and visits were required to complete interviews. Only 61.3% of baseline and 28.1% of follow-up interviews were completed on the initial day of contact. Despite having on-site interviewers 7 days a week, 29% of discharge interviews were conducted by telephone. Interviews were >90% complete in 487 of 503 of encounters (97%). Baseline delays and interruptions were usually due to the presence of medical staff, off-unit tests, patient illness, nurse unavailability for interview, and need for a proxy. Most in-hospital interviews were conducted with others present. Proxies were required for approximately one-third of patients at all three interviews.


CONCLUSIONS
Conducting clinical research with older adults in the current inpatient setting, where patients are more severely ill yet have shorter lengths of stay now than in the past, proves a challenging yet achievable goal. Effective procedures for negotiating the acute care environment are critical to successful studies.
Berkman
C S
CS
Fordham University, Graduate School of Social Service, New York, NY 10023, USA.
Leipzig
R M
RM
Greenberg
S A
SA
Inouye
S K
SK
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003625:Data Collection / Q000379:methods; D005069:Evaluation Studies as Topic; D005853:Geriatrics / Q000592:standards; D017408:Guidelines as Topic; D006302:Health Services Research / Q000379:methods*; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D007407:Interviews as Topic / Q000379:methods; D007902:Length of Stay; D008137:Longitudinal Studies; D009519:New York City; D017063:Outcome Assessment, Health Care / Q000458:organization & administration*; D018579:Patient Selection; D011787:Quality of Health Care; D012107:Research Design / Q000592:standards*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires