Qualitative research in midlife health.

Madam,

Midlife health now receives an increasing amount of attention and justifiably so. A justifiable interest in geroprotection,[1] the global increase in life expectancy, a parallel rise in chronic disease, an enhanced understanding of the unique features of the elderly, and availability of better diagnostic and therapeutic modalities, all create a situation where midlife, or geriatric, health, is at center stage of societal health. This is true in both clinical practice as well as academic research settings, where attention is paid to the subtle differences that set the elderly apart from younger peers. While the biological, i.e., anatomical, biochemical, and physiological, factors that define geriatrics are well-characterized in quantitative terms, the psychological issues present a major challenge.

It is relatively easy to define biological characteristics, quantify, measure, compare, and then try to improve them. This statement is true for virtually all parameters related to biophysical and biochemical health. For psychological variates, however, measurement may be difficult and while the psychometrics has developed to produce a multitude of instruments, useful for screening, diagnosis, and follow-up of various psychological and mental conditions, their utility in geriatrics may be limited. Sub-optimal cognitive, visual and sensorimotor function may hamper the use of self-administered questionnaires, while cognitive and hearing impairment makes clinician-administered psychometrics difficult to practice. Existing instruments were studied for use in younger adults, may not necessarily have been validated in the elderly. Approved translations may not be available, and may not be appropriate for specific dialects or figures of speech used by the geriatric age group.

In such a scenario, qualitative research plays an important role in filling the gaps in our knowledge of geriatric health, related especially, to psychological issues. Qualitative health research, defined in various manners,[23] aims to understand the social or human dimension of health, and the quality of human health, something that is very important in geriatrics. It does not reduce this analysis to statistics, but can be combined with quantitative research to create mixed methods research.[4]

Both quantitative research and mixed research are well-developed specialties of science, with basic rules and framework, and defined methodology. Their multi-disciplinary utility is based upon practical application of well-researched theoretical concepts, which have evolved with time. It is surprising, however, that though qualitative health research is emerging as a distinct subject, it has not been utilized fully in midlife health. It is unfortunate as well, because the very essence of midlife health achieving optimal quality of life, i.e., adding life to years, is by definition, qualitative. Reducing the symptoms of menopause to a check list, discussing women in terms of their FRAX scores, T scores or Pap smears, or assessing the proportion of women with early surgical menopause, is unable to capture the concerns and worries of these individuals.

To achieve a more-in-depth understanding of midlife health issues, and their relationship with psychological factors, one needs to carry out qualitative research. This will also be needed if one wishes to explore an area where little work has been carried out, e.g., sexuality in the elderly women,[5] gain a new perspective, e.g., violence against elderly, or analyze small study populations, e.g., elderly men exposed to human immunodeficiency virus.

For qualitative research to be useful, however, it must be performed scientifically. Objectively, reliability, and validity are hallmarks of all types of research, whether qualitative, quantitative or mixed methods. Qualitative researchers, however, display flexibility and creativity in research designs, and take advantage of theoretical plurality as well as methodological plurality. Multiple methods of data collection and data analysis can be used, though the scientific rigor are always kept paramount.

While the Journal of Midlife Health, as other biomedical journals, publishes quantitative research, it is heartening to note the inclusion of editorials and commentaries on qualitative issues relevant to midlife and geriatrics.[678] This healthy trend should continue, and should encourage clinical researchers to include qualitative methods in their work.