Bias in proxies' reports of disability: data from the National Health Interview Survey on disability

Todorov, Alexander; Kirchner, Corinne

doi:10.2105/ajph.90.8.1248

Cited by 137 publications

(21 citation statements)

References 14 publications

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“…However, although older adults and their proxies have been shown to hold similar conceptualizations of health (Lawrence, 1995), issues of bias remain even when proxy assessments are collected because of proxy-patient dyadic disagreement. Specifically, proxies tend to overreport older adults' disability (Dorevitch et al, 1992; Epstein, Hall, Tognetti, Son, & Conant, 1989; Lum, Lin, & Kane, 2005; Magaziner, Bassett, Hebel, & Gruber-Baldini, 1996; Magaziner, Simonsick, Kashner, & Hebel, 1988; Rothman, Hedrick, Bulcroft, Hickam, & Rubenstein, 1991; Santos-Eggimann, Zobel, & Berod, 1999; Todorov & Kirchner, 2000; Weinberger et al, 1992) and depressive symptoms (Bassett, Magaziner, & Hebel, 1990; Mackenzie, Robiner, & Knopman, 1989; Magaziner, Zimmerman, Gruber-Baldini, Hebel, & Fox, 1997; Teri & Wagner, 1991). In general, large discrepancies have been observed when measuring private, typically unobservable characteristics such as depressive symptoms (Epstein et al, 1989; Hung, Pickard, Witt, & Lambert, 2007; Snow et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Comparing Reports From Hip-Fracture Patients and Their Proxies

et al. 2011

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Objective This study compared sex differences in disability and depressive symptoms using reports from hip fracture patients and their proxies. Method Hip fracture patients (49 men, 183 women) aged ≥65 years and proxies were interviewed 1 year postfracture. Outcomes were Center for Epidemiological Studies Depression (CES-D) and number of dependencies in performing activities of daily living and instrumental activities of daily living. Results Mean ADL sex differences (men minus women) were 0.40 (p = .37) using proxy reports and 0.70 (p = .08) using patient self-reports. Mean CES-D sex differences were −3.60 (p = .02) using proxy reports and −1.26 (p = .38) using patient self-reports. Discrepancies between patients and proxies were smallest for proxies who have lived with the patient ≥ 1 year. Discussion Patients and proxies produced conflicting conclusions about sex differences. Results suggest that ideal proxies to recruit are those who have been cohabitating with the patients for an extended length of time.

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Section: Introductionmentioning

confidence: 99%

Comparing Reports From Hip-Fracture Patients and Their Proxies

et al. 2011

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“…Additionally, data cannot be construed as a national average. Furthermore, research indicates selective bias by age in over- and underreporting disabilities for others ( 7 ). Collecting data from proxies about household members may help paint a clearer picture about the characteristics of those experiencing cognitive decline and the potential burden faced by individuals and their families.…”

Section: Discussionmentioning

confidence: 99%

Proxy Reports About Household Members With Increased Confusion or Memory Loss, 2011 Behavioral Risk Factor Surveillance System

Edwards¹,

Anderson²,

Deokar³

2015

Prev. Chronic Dis.

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To provide information about the effects of increased confusion or memory loss (ICML) in households in the United States, we describe primary respondents’ reports (proxy reports) about another person in their household experiencing ICML, using 2011 Behavioral Risk Factor Surveillance System (BRFSS) data. We used proxy reports on type of assistance needed, effects on functioning in daily activities, and whether confusion or memory was discussed with a health care professional, stratifying by age of the household member with ICML (18–50 y vs ≥65 y). About 3% (n = 3,075 households) of primary respondents reported living with a household member with ICML; 75% of these household members needed some type of assistance, and nearly 60% had discussed ICML with a health care professional. Collecting proxy data about individuals in households may help paint a clearer picture of the characteristics of those experiencing cognitive decline and the potential needs of individuals and families.

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“…A study conducted in the United Kingdom in 1994 and 1995, based on the National Health Interview Survey on Disability, with 145,007 participants aged 18 years or over, concluded that the evaluations made by secondary informants underestimated the frequency of disability in individuals aged from 18 to 64 years, while the inverse occurred for individuals aged 65 years onwards. 15 A study that assessed the functional capacity of 287,540 individuals aged 14 years or over, using data from PNAD 2003, found that the prevalence of limitations on activities among the elderly individuals was systematically higher when the responses were provided by secondary informants. 2 Further studies are required in order to gain a better understanding of the infl uence of secondary informants on the perceptions of elderly individuals' functional capacity, since there may be differences in the perceptions of activities that are considered relevant for health assessments by the individuals themselves and by secondary informants.…”

Section: Discussionmentioning

confidence: 99%

Auto-relato e relato de informante secundário na avaliação da saúde em idosos

2010

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OBJECTIVE:To analyze whether the explanatory model for health assessments among elderly people based on self-reporting is comparable with the model based on secondary informant reporting, and whether the secondary informant's selfassessed health infl uences the health assessment among these elderly people. METHODS:This was a cross-sectional study on 230 pairs consisting of one elderly individual and one secondary informant, conducted in Belo Horizonte, Southeastern Brazil, in 2007. The sociodemographic and health variables of the elderly people were investigated by means of a structured interview. Multiple logistic regression was used to analyze associations with self-assessed poor health among the elderly individuals and with the information provided by the secondary informants. RESULTS:In the model based on self-reporting, the variable most strongly associated with poor health assessment among these elderly individuals was the presence of limitations or disabilities relating to performing activities of daily living and/or mobility. In the model based on the secondary informant, the most important explanatory variable was the number of chronic diseases presented by the elderly individual. Furthermore, the chance that the secondary informant would assess the elderly individual's health as poor was three times greater when this informant assessed his own health as poor. CONCLUSIONS:The results showed signifi cant differences between the health assessment model for elderly people based on the individual's own responses and the model based on a secondary informant's responses. The elderly individuals tended to place value on their limitations or disabilities relating to performing activities of daily living and mobility, while secondary informants tended to place value on the diagnoses of chronic diseases. Secondary informants with poor self-assessed health presented almost three times greater chance of reporting elderly individuals' health as the same as their own. Thus, self-reported information better refl ects individuals' health conditions than do reports from secondary informants.

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Bias in proxies' reports of disability: data from the National Health Interview Survey on disability

Abstract: Use of proxies in representative surveys on disability introduces systematic biases, affecting national disability estimates.

Cited by 137 publications

References 14 publications

Comparing Reports From Hip-Fracture Patients and Their Proxies

Comparing Reports From Hip-Fracture Patients and Their Proxies

Proxy Reports About Household Members With Increased Confusion or Memory Loss, 2011 Behavioral Risk Factor Surveillance System

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