Critique of Selected Epidemiological

The research problem of the study has been stated in the abstracts whereby the objectives of the study have been stated as measuring the retention by age and visit type and to determine the characteristics associated with the visit types of older adults. In paragraph three in the introduction section, the research problem of the study has also been addressed. In this paragraph, the research questions have been specified. The research question has been well stated by mentioning that the study is evaluating whether older age was associated with returning to a clinic. The hypothesis has also been stated in the same paragraph and it is directional as it states that the type of clinic visit is affected by various factors and that the oldest population have the lowest retention. The hypothesis is complex as it involves various independent variables, The hypothesis was indeed tested in the study.

The intervention used in the study is the change in visit types based on various factors that are considered in the study. The study is a longitudinal cohort study whereby the study participants are studied for a long period. Observations are then recorded over time. In this study, the Cardiovascular Health study involved 5888 participants aged between 65 years and 100 year. They were then contacted for a period of every six months and assessed periodically. Longitudinal studies can occur for a long time be it months, or even years. This study took years. 

Based on the research goal which is to identify retention by age and visit type, the research design was appropriate as enabled the explanatory variables to have an impact on the response variables. Since clinic visits tend to change with age and other lifestyle factors, using a longitudinal study would enable enough time to analyze whether the age indeed affects clinic visit. Any other research design would be appropriate only if it is able to evaluate the effect of age on hospital visits. 

Power analysis procedure refers to using a set of formulas and procedures to determine the sample size. Power analysis procedure was used to determine the sample size requirements prior to the undertaking of the study. The sample was obtained based on the Medicare eligibility lists whereby individuals who were 65 years and above were enrolled. In the 1989-90 sampling, 5201 individuals were selected in this manner while 687 individuals were selected in 1992-93. Each center’s institutional review committee approved the study and the participants gave their consent. The presence of power analysis in this study imply that the necessary number of subjects needed to identify an effect were obtained. In addition, the power analysis is a good way of ensuring that every aspect of the study is considered before collecting data commences. 

The research methods used in the study include collecting information on the visit types by the individuals in the sample. Physiologic assessments and questionnaires were also used to identify psychosocial, medical factors, physical function and physical activity of the individuals. There were also phone visits, questionnaires on medication and split visit data collection. These research methods enabled the researchers to collect enough information needed to justify the findings. The characteristics of the individuals in the sample reflected the characteristics of individuals in the population as the sample size was collected in such a way that it represented the characteristics of the population. In addition, the sample population was large and so this makes it easy to make an inference about the population. Conducting a longitudinal study while considering a number of independent variables affecting the response variable also avails enough information to make an inference about the population.

The sampling criteria has collected a sample of individuals who are eligible in the Medicare list. This means that the individuals selected met a certain criteria or specific characteristics of the population. The samples came form 4 different US centers and the sample was made up of men and women including those of black origin aged between 65 and 100 years. The sampling criteria used therefore specified the characteristic that the population has. The individuals represented the rest of the population who were aged between 65 and 100 in the US. 

The only specification of what exactly the intervention was in the study is that the sample were observed on their retention over a long period of time, the characteristics of the clinical visits and how age affect retention. there were no control treatment conditions. Control treatment conditions are only used in experimental research design whereby a researcher manipulates a variable in order to observe a change in another variable. This is a cohort study and it only involves observing the population without intentionally influencing any variable. Since no control treatment conditions are present for this study, the way in which they should be administered is not applicable. 

A statistical test is used to determine whether there is enough information that would justify the rejection of a hypothesis. In this study, the hypothesis was that the type of clinic visit for this population set is influenced by various factors including demographic, lifestyle, health and function characteristics and that as people age, they have the poorest retention for clinic visits. A statistical test to be used here would be to reject that type of clinic visits and their characteristics are influenced by age. The study yielded enough information that age really influences the frequency of clinic visits and their characteristics. 

The inferences made in the study suggest that the oldest old adults who are above 80 years of age have an increased likelihood of missing clinic visits mainly because of age related factors. These inferences are based on the outcome of the longitudinal study that found out that individuals who were 80 years and above have fewer clinic visits and more phone or home visits compared to individuals who were below 80 years. These inferences are accurate well founded as they were collected from the individuals in the sample for a long period of time and the sample represented the characteristics of the population. The research study was designed to identify the retention by age and visit type of individual aged between 65 and 200 years and the instrument measured was it was supposed to measure. The clinic retention was measured and it was concluded that people who are 80 years and above miss clinic visits.

The study addresses a problem of significance in clinical practice as adults above 80 years of age are the fastest growing population strata. This population is also is important because there are many risk factors and health outcomes that come with old age. Studying retention by age and visit type of this population together with the characteristics of this population is important as it will shed more light on the impacts of age on clinical care for the aged. According to this study, as people get to 80 years and above, they tend to attend to fewer clinical visits and opt more for home and phone visits. The study shows that the oldest adults experience dynamic changes in risk factors and health outcome s and this may affect their ability to keep their clinical visits. 

The literature review of the study is a critical summary of research on the topic as it shed light on retention and its importance especially in longitudinal cohort studies. In addition, it shows the trend in retention in previous research and studies and explain why the loss to follow up on clinic visits. For the older people, it is mainly due to dementia, ill health, disability or even end stage disease. The reader can have the confidence that the review is relevant as it provides information regarding the topic of the study. It helps in explaining some of the outcomes of the study like why older people tend to miss clinic visits. The literature review is also timely well positioned at the introduction part and it is also well referenced. Most of the references are medical and nursing journals and this means that the information provided at the literature review is reliable.

The research method used involved collecting information regarding clinic, home or phone visits by individuals aged between 65 and 100 years. The information was collected on a large number of patients for a long period of time in the longitudinal study that took years. The information obtained through the research method are dependable and valid because they are collected from various sources and for a long period of time. It is easy to infer to the evidence produced because the clinical visits and types of visits as well as their characteristics are recorded for a long time and the results analyzed.

The study can be implemented in my own clinical practice as it provides important information regarding clinical interventions and provision of health care services in clinical practice. It provides vital information on how age might affect clinical intervention and ultimately the health outcome in a population. By using this information, one would be in a better position to address such issues as they come. The outcomes of this study are useful as they will enable healthcare providers to realize the importance of having phone and mobile visits for this population. The outcome will also help health care systems to provide better health care services to the aged. It also enables the prevention of various risk factors associated with age.

Some of the threats to validity in this study include the method of data collection by asking the respondents to fill in questionnaires. Older people often have dementia and so collecting information from them regarding clinic visits might yield results that are not reliable. However, the research method also involved following up on the population and confirming their clinic visits. Another factor affecting reliability of the research is the duration of the study, sample size and selection of sample. However, power analysis was used to select the sample and being a longitudinal study, there was enough time to get the relevant data. 


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