Methodological and Interventional Issues and Considerations in Studies of Older Adults: Attrition, Missing Data, and Feasibility Trials.

Abstract

Older adults are a rapidly growing segment of the population with unique healthcare needs. As people age, they are more likely to become susceptible to diseases and develop complex health conditions that require tailored strategies to address. These vulnerabilities could also impact different stages of the research process to generate evidence that promote healthy aging and better quality of life for this population.

Attrition and missing data are some of the common methodological challenges in research with older adults. These issues could affect the quality of evidence generated if not properly addressed. There is also limited evidence to guide the development of interventions in specific populations of older adults with frailty, who have reduced function and are at higher risk for poor health outcomes.

Across six chapters, this thesis addresses these methodological and interventional gaps in research with older adults. Using different research methodologies including a systematic literature survey, secondary data analysis of a cohort study, and two randomized feasibility trials, this thesis provides some important considerations for practice. In particular, we (i) evaluated the magnitude, pattern, and factors associated with attrition in the Global Longitudinal Study of Osteoporosis in Women (GLOW) Hamilton cohort of older adults; (ii) performed a systematic survey of the reporting and handling of missing data in longitudinal observational studies of older adults; (iii) conducted a randomized controlled feasibility trial of the Geras virtual frailty rehabilitation program to build resilience in vulnerable older adults during the COVID-19 pandemic; and (iv) evaluated the feasibility of the FitJoints randomized controlled trial of a multimodal intervention in frail older patients with osteoarthritis awaiting hip and knee replacement.