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PRIMARY CARE: Liam Smeeth, Astrid E Fletcher, Susan Stirling, Maria Nunes, Elizabeth Breeze, Edmond Ng, Christopher J Bulpitt, and Dee Jones Randomised comparison of three methods of administering a screening questionnaire to elderly people: findings from the MRC trial of the assessment and management of older people in the community BMJ 2001; 323: 1403 [Abstract] [Full text]

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Other factors may have influenced differences in rates of reporting

Rahul Rao, St Thomas Street, London SE1 9RT   (12 January 2002)

Other factors may have influenced differences in rates of reporting 12 January 2002
Rahul Rao, Consultant/Senior Lecturer in Old Age Psychiatry Guy's Hospital, St Thomas Street, London SE1 9RT Send response to journal: Re: Other factors may have influenced differences in rates of reporting	EDITOR- The study by Sneeth et al(1)raises the issue of low sensitivities in the detection of common disorders in later life when subjective measures of morbidity were validated against recognised screening tests for visual/hearing impairment, depression and cognitive impairment. Sensitivities are influenced by method of detection, with postal questionnaires demonstrating higher rates of morbidity for the majority of areas covered. However, two clinically relevant factors, not touched upon, may have contributed to differences according to method of administration. Firstly, the potential influence of embarrassment on self -reported health problems may be less relevant than subjective concern surrounding loss of independence. This may explain why older people with problems such as memory and physical problems affecting activities of daily living may be less likely to report these problems during face to face encounter with an interviewer. It is noticeable that more ‘neutral’ questions such as smoking/alcohol use/being on more than 7 drugs do not show such variation across method of administration. Secondly, the discussion does not comment upon the high proportion of participants (over 20 per cent) who received help in completing postal questionnaires. It would be useful to examine whether omitting this group of people leads to similar observed differences between postal questionnaire administration and face to face interviewing. It has been observed, for example, that friends/neighbours are more likely to be aware of dementia than the sufferer when problems are first apparent(2). It also likely that older people are also likely to deny memory problems when asked directly, viewing them instead as part of ‘old age’(3). Reporting such problems may change if assistance is given, as may be the case in the completion of postal questionnaires. There may be more to the completion of postal questionnaires than meets the eye. Controlling for any assistance in their completion may add to the interpretation of the results in the current study. 1 Smeeth L, Fletcher AE, Nunes M, Breeze E, Ng E, Bulpiit CJ, Jones D. Randomised comparison of three methods of administering a screening questionnaire to elderly people: findings from the MRC trial of the assessment and management of older people in the community. BMJ 2001; 323:1403-1407 2 Rao R. The role of carers in the information process in dementia. Psychiatric Bulletin 1997;21:264-266 3 Rao R, Dening T, Brayne C, Huppert FA. Suicidal thinking in community residents over eighty.International Journal of Geriatric Psychiatry 1997;12:337-343 COMPETING INTERESTS: None