Introduction Many of the tools developed for use in nursing and behavioral research were developed for adults, often those less than 65 years of age. While the concepts of interest when doing research with older adults are often the same as they are with younger individuals (i.e. quality of life, health status, pain), the measures developed for adults may not be appropriate for the older adult. For example, quality of life in older adults may focus on being able to perform activities of daily living, while for a younger individual it may be to run three miles daily. Specifically these measures may require significant revisions in wording, elimination of items and/or inclusion of alternative items, or a change in method of administration. Moreover, special consideration in measurement of older adults who may have some cognitive impairment, or even mild memory changes, needs to be considered. There are times, for example, that it may be appropriate to measure the cognitively impaired older adult and other times it may be sufficient and appropriate to survey the caregiver. The researcher must be able to defend their approach either way.
Common Problems with Using Previously Developed Measures with Older Adults Pilot testing of measures must be done to determine not only the reliability and validity, but the appropriateness of the use of the measure with the older adults. Three examples of use of conceptually significant tools with older adults and the problems associated with these tools, as well as the subsequent revisions will be presented. The three tools include the: (1) self-motivation inventory (Dishman, 1981); (2) Short-Form 12-Item Health Status Questionnaire (Ware, Kosinkski, & Keller); and (3) Barriers and Benefits of Exercise Scale (Steinhart & Dishman, 1989). In a sample of older adults in a rehabilitation setting, the self-motivation inventory was found to contain language that was misleading and irrelevant to the older adult. Moreover, this measure was developed to be a paper and pencil test, but the older adults were either unable or unwilling to complete a written test secondary to visual concerns and fatigue. They were, however, willing to participate and answer questions when interviewed. The SF-12, when tested with older adults, did not hold the same structure as the hypothesized model with adults. Therefore it was necessary to alter the factor structure and the scoring of the measure. In addition it was not appropriate to use the standardized method of scoring for the SF-12 as it was developed for younger individuals. Lastly, the Barriers and Benefits of Exercise scale asked about benefits and barriers to exercise for younger adults that were not relevant to the older adult such as lack of time, alteration in body image, and increasing life expectancy. The older participants also complained that the measure was redundant.
Recommendations for Revisions/Development of Age Specific Measures Based on these findings it is recommended that revisions of measures used with adults consider: (1) method of administration: so that if at all possible written testing is avoided; (2) item selection: qualitative research and/or focus groups should be used with pilot testing to help develop appropriate items; and (3) length: measures should be short, and to the point. The development of a new measure for outcome expectations for exercise specific to older adults will be used as an example of how each of these areas can be addressed. Assuring that the measures selected are appropriate for the older adult will increase the validity of these measures, improve the reliability and allow us to increase our base of knowledge in the many areas.
To Proxy or Not to Proxy… Discussions about the use of proxies to collect data on older adults is something the researcher must determine. This decision should be based on prior studies which have compared the reliability of the findings between different data collection methods, rather than the ease of cost of data collection. Specifically two areas of interest with regard to use of proxies will be address: the use of proxy for information related to functional performance in older adults and the use of proxy data with regard to quality of life.
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