Abstract
BackgroundProxy respondents are frequently used in health surveys, and the proxy is most often the spouse. Longstanding concerns linger, however, about the validity of using spousal proxies, especially for older adults. The purpose of this pilot study was to evaluate the concordance between self-reports and spousal proxy reports to a standard health survey in a small convenience sample of older married couples.MethodsWe used the Seniors Together in Aging Research (STAR) volunteer registry at the University of Iowa to identify and consent a cross-sectional, convenience sample of 28 married husband and wife couples. Private, personal interviews with each member of the married couple using a detailed health survey based on the 2012 Health and Retirement Study (HRS) instrument were conducted using computer assisted personal interviewing software. Within couples, each wife completed the health survey first for herself and then for her husband, and each husband completed the health survey first for himself and then for his wife. The health survey topics included health ratings, health conditions, mobility, instrumental activities of daily living (IADLs), health services use, and preventative services. Percent of agreement and prevalence and bias adjusted kappa statistics (PABAKs) were used to evaluate concordance.ResultsPABAK coefficients indicated moderate to excellent concordance (PABAKs >0.60) for most of the IADL, health condition, hospitalization, surgery, preventative service, and mobility questions, but only slight to fair concordance (PABAKs = −0.21 to 0.60) for health ratings, and physician and dental visits.ConclusionsThese results do not allay longstanding concerns about the validity of routinely using spousal proxies in health surveys to obtain health ratings or the number of physician and dental visits among older adults. Further research is needed in a nationally representative sample of older couples in which each wife completes the health survey first for herself and then for her husband, each husband completes the health survey first for himself and then for his wife, and both spouses’ Medicare claims are linked to their health survey responses to determine not just the concordance between spousal reports, but the concordance of those survey responses to the medical record.
Highlights
Proxy respondents are frequently used in health surveys, and the proxy is most often the spouse
We found that proxy-respondents were significantly less likely than self-respondents to under-report, but were significantly more likely to overreport on a variety of health conditions, preventative procedures, and health services [11]
On a modified version of the Telephone Interview for Cognitive Status (TICS; including the 10-word immediate and delayed recall tests, serial 7 s, and mental status items; range = 0–35), the mean score was 25.7, which is noticeably better than national norms [16]
Summary
Proxy respondents are frequently used in health surveys, and the proxy is most often the spouse. 5.1 % of the 12,652 baseline interviews conducted for the (1992) Health and Retirement Study (HRS) that targeted a nationally representative sample of 51–61 year olds (born in 1931–1941) as well as their spouses or partners regardless of age (mean age = 55.6, range = 23–85) were conducted with proxies, of which 90.1 % were spousal proxies. Of the 8,179 baseline interviews (1993) conducted for the companion Survey on Assets and Health Dynamics of the Oldest Old (AHEAD) study that targeted a nationally representative sample of those 70 years old and older (born in 1923 or before) as well as their spouses or partners regardless of age (mean age = 76.5, range = 38–103), 10.3 % were conducted with proxies, of which 46.3 % were spousal proxies. Recent reports have questioned the accuracy of proxy interviews [5–8] and much remains unknown about their effects on total survey error
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