The wording of questions health care providers use to detect patients at risk for developing Alzheimer’s disease may result in patients answering the same questions differently, for different reasons, according to a new study.
“When we ask people questions, we assume that they see the questions the same way we do…”
For example, when providers ask “Have you had problems with your memory recently?” one patient may interpret “recently” as within the same week while another may interpret it as within the month. Or, a third may be frightened by trouble with their memory and brush off the question altogether.
In the study, researchers asked older adults a variety of common screening questions and then followed up to learn more about how each participant felt about them.
The findings will help clinicians and researchers ask better questions and better interpret patient responses, says Nikki Hill, assistant professor of nursing at Penn State.
“If someone has concerns about their memory, that could be important for a lot of different reasons,” Hill says. “It could mean they have a problem that may continue to get worse, or maybe it’s impacting them emotionally, or maybe they just need more information.
“So we’re trying to learn the best questions to ask to really get at what our patients are experiencing and how best to respond.”
Previous research shows that older adults who report memory problems but score in the normal range on cognitive tests are up to twice as likely to develop Alzheimer’s disease later.
“What we might see as a straightforward question—like ‘Do you have problems with your memory?’—may mean something very different for older adults.”
Creating good questions is important not only for screening patients early for the disease, but also so researchers can ask good questions when studying these populations, says Jacqueline Mogle, assistant research professor.
“When we ask people questions, we assume that they see the questions the same way we do,” Mogle says. “However, that clearly isn’t the case. What we might see as a straightforward question—like ‘Do you have problems with your memory?’—may mean something very different for older adults. Right now it isn’t clear how they are deciding to answer the question.”
For the study, which appears in the Gerontologist, researchers recruited 49 older adults in central Pennsylvania who did not have dementia. They asked each participant a variety of questions providers commonly use to screen for Alzheimer’s disease. After the participant answered, the researchers asked them follow-ups about how and why they answered the way they did to help identify possible problems with the screening questions.
An analysis of the data revealed 13 different types of problems. The two most common problems were vagueness—”There are multiple ways to interpret the question”—and an assumption that the respondent’s behavior or experience is always the same. For example, older adults may sometimes have trouble remembering the day of the week but not always.
Further, the researchers found that some questions tended to provoke an emotional response. For example, one question asked the participant to “rate” themselves or their memory compared to others, which some participants associated with dips in confidence and feeling poorly about themselves.
Asking better questions
Learning to ask better questions about a person’s memory could help improve clinicians’ understanding of their patients’ unique experiences, Hill says.
“For older adults, problems with memory and thinking is something that’s experienced very differently from person to person,” Hill says. “However, in the research to date, we don’t tend to reflect how complicated of an experience that is.
“If we really want to understand how people are experiencing early symptoms and what is influencing their reporting of symptoms, we need to get at more of that individual experience, and our questions that we currently use aren’t capturing it.”
It would be helpful for future studies to examine the best ways to reword and standardize screening questions to help reduce cognitive biases, she adds.
“Now that we’ve identified the types of problems that people report, we can take those questions, refine them, and test them out again in a larger, more representative group of older adults,” Hill says. “Then we ask the new, refined questions and see if they perform better.”
Additional researchers are from Penn State and the University of Wisconsin-Madison. The Social Science Research Institute helped support the work.
Source: Penn State