This paper critically analyzes Strotmeyer et al.'s (2010) longitudinal study on the retention of older adults in the Cardiovascular Health Study. The review examines the study's hypothesis, research design, sampling criteria, statistical methods, and conclusions regarding how visit type—clinic, in-home, or telephone—affects follow-up retention among patients aged 65 to 102. The analysis evaluates the appropriateness of the longitudinal epidemiological design, the representativeness of the sample with respect to age, sex, and race, and the validity of the statistical tests employed. It concludes that in-home and phone follow-ups are effective alternatives for maintaining clinical care in aging populations who face physical and cognitive barriers to in-person visits.
Older patients over the age of 80, due to health complications such as dementia and depressive symptoms, often do not attend additional follow-up appointments. The authors of the study under review explain that repeated in-person visits help better identify risk factors in this population. Although no explicit research question is stated, the authors highlight the use of a study to confirm the hypothesis of whether repeated in-person follow-ups help address problems experienced as patients age. As Strotmeyer et al. (2010) explain, "We hypothesized that the type of visit would be related to key demographic, lifestyle, health and function characteristics and that the oldest aged participants would have the poorest retention for in-person visits, particularly clinic visits" (p. 697).
This is a directional hypothesis because retention rates are directly associated with increasing age. It is also a simple hypothesis because it directly states a cause-and-effect relationship. When tested, the hypothesis revealed that in-home visits could help improve retention of follow-up care for older patients.
There was an intervention in the study: "All annual contacts through 1999 (N=43,772) and for the 2005–06 visit (N=1,942)" (Strotmeyer et al., 2010, p. 696). This is a longitudinal epidemiological study. The research design is appropriate because it measures how specific types of visits affect the retention rates of patients within a particular age group. The design follows acceptable protocol and there does not appear to be a more suitable alternative approach.
No power analysis procedure was used to determine whether the sample size was sufficiently large. This implies that sample size was either not formally measured or that the authors were not concerned with establishing its adequacy through this method. However, given that the sample size ran into the thousands, it is reasonable to conclude that the sample was large enough to support meaningful analysis.
The study enrolled a diverse but predominantly white and female sample: "(N=5,888; aged 65–100 years at 1989–90 or 1992–93 enrollment; 58% women; 16% Black) were contacted every 6 months, with annual assessments through 1999 and in 2005–06 for the All Stars Study visit of the CHS cohort (aged 77–102 years; 67% women; 17% Black)" (Strotmeyer et al., 2010, p. 696). The authors explained that the patient composition, with respect to gender, age, and race, correlates with the general population of the United States.
The sampling criteria indicate that most of the aging population represented in follow-up studies will be white and female, with approximately two-thirds being female and over 80% being white. However, the criteria do not identify other ethnic groups that exist within the broader population, such as Hispanic, Asian, or Middle Eastern individuals. The only specifications stated for the intervention and control treatment conditions are the annual contact figures noted above.
"Tests used and appropriateness of analytical models"
"Conclusions on alternative visits and clinical care"
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