Cognitive Function and the Concordance Between Survey Reports and Medicare Claims in a Nationally Representative Cohort of Older Adults

Abstract

We recommend that future surveys of older adults include an objective measure of mental status (rather than memory), especially when those survey reports cannot be verified by access to Medicare claims or chart review.

A pilot study among older adults of the concordance between their self-reports to a health survey and spousal proxy reports on their behalf

“…Thus, sample is clearly neither nationally representative nor representative of couples of all ages, race and ethnic groups, or marital statuses. That said, given these characteristics of our convenience sample, we expected high levels of concordance between self and spousal proxy responses based on previous reports linking one or more of these characteristics with concordance rates [1–8, 11–13]. For the most part that is what we found.…”

“…This approach allowed us to go beyond assessing accuracy simply by comparing survey reports from different respondent status categories (self-respondents, self-respondents with the assistance of another person, and proxy-respondents of various types) with administrative claims data [11–13]. In particular, it allowed us to assess the actual agreement between self and spousal proxy responses, and to include in those assessments questions that cannot be compared to Medicare claims (health ratings, mobility, IADLs, dental visits).…”

“…In contrast, we expected rather frequent and less salient outcomes would have the lowest concordance. Finally, based on our prior work [11–13], we explored whether the concordance between self and spousal proxy reports differed based on the sex of the spousal proxy or the cognitive ability of the self-respondent using chi-square tests.…”

“…After disaggregating proxies, we found that spousal proxies were about as accurate as self-respondents in reporting health services use, but that daughter or son proxies were the most accurate reporters [12]. We hypothesized that their greater accuracy stemmed from their parents’ age-related cognitive decline (as self-respondents or spousal proxies), and found support for this interpretation in the direct relationship between performance on objective cognitive function tests and greater accuracy among self-respondents [13]. …”

“…Our earlier studies [11–13], however, focused on the concordance between the survey reports and Medicare claims, and thus assessed the accuracy of self vs. proxy respondents compared to administrative data. Those studies were unable to directly examine the agreement between the target person and spousal proxy reports, because the AHEAD does not ask both spouses to report for themselves, and then for their spouses.…”