Research in Nursing & Health, 2007, 30, 468–481 Focus on Research Methods Using Standardized Survey Items With Older Adults Hospitalized for Chronic Illness Mary T. Fox, 1,2,3,4 ,,{,z Souraya Sidani, 4§ David Streiner 5,6 },}} 1 Collaborative Research Program: Rehabilitation & Long-Term Care, Baycrest 2 Canadian Institutes of Health Research, Institute of Aging, Canada 3 Faculty of Health, School of Nursing, York University, Canada 4 Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada 5 Kunin-Lunenfeld Applied Research Unit, Baycrest 6 Department of Psychiatry, University of Toronto,Toronto, Ontario, Canada Accepted 21 January 2007 Abstract: We used the stages of the question response model as a framework to discuss the challenges in administering standardized measures to older adults hospitalized with chronic illnesses. Items with complex content and those with negative stems were associated with difficulties during the comprehension stage. Present experience with the subject of the item was a barrier to retrieving past experiences. The lack of relevance of an item’s content to the respondent’s situation was associated with problems during the judgment stage. The numeric response format of the items was an obstacle during the response stage. Strategies to enhance the validity of the surveys included breaking up, rephrasing, and contextualizing items, and using descriptive response options. ß 2007 Wiley Periodicals, Inc. Res Nurs Health 30:468–481, 2007 Keywords: standardized instruments; measures; hospitalized elderly; question response model; cognitive interview; comprehension; retrieval; judgment; numeric response With an aging population, hospital admissions of older adults have increased at a disproportionate rate. Although Americans aged 65 and over made up only 12% of the population in 2002, they accounted for 35% of all hospital admissions (Merrill & Elixhauser, 2005). The situation is Contract grant sponsor: Canadian Institutes of Health Research. Contract grant sponsor: Nursing Care Partnership of the Canadian Nurses Foundation and the Collaborative Research Program: Rehabilitation & Long-Term Care, Canadian Health Services Research Foundation. Correspondence to Mary T. Fox, Faculty of Health, School of Nursing, York University, 4700 Keele St., Toronto, Ont., Canada M3J 1P3. *Director. **Health Professional Fellow. { Lecturer. z Doctoral candidate. § Professor. } Assistant Vice-President, Director. }} Professor of Psychiatry. Published online in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/nur.20201 ß 2007 Wiley Periodicals, Inc.