Application of Semi Structured Interviews with Older Adults

Each of the semi-structured interviews has been subjected to extensive empirical evaluation, but their use has been most common among adult respondents. The literature regarding specific application of these instruments with older adults is relatively sparse. A few clinical reports have provided evidence that they can be successfully applied to older adults (e.g., Abrams, Alexopoulos, & Young, 1987; Abrams, Rosendahl, Card, & Alexopoulos, 1994; Schneider, Zemansky, Bender, & Sloane, 1992; Thompson et al., 1988). However, larger reliability and validity studies are warranted, especially with more diverse older adult populations (e.g., medical patients, minorities, or psychiatric inpatients).

Several additional concerns about the application of these semi-structured interviews with older adults should be noted. A common feature among the interviews is that respondents are encouraged to describe their "typical or usual" functioning rather than their possibly altered personality functioning during times of acute psychiatric illness. During the course of the interview, respondents are sometimes asked to describe their behaviors at different points in time, possibly spanning several decades. Such distinctions may be difficult for some older patients to make given their longer histories and the normal cognitive changes associated with aging. In cases where cognitive impairment or a dementing illness is apparent, the task is further complicated.

Another problem with the utilization of structured interviews with older patients is the length of time required for completion. With young patients, administration time for the various interviews typically ranges from 1 to 3 hours. However, administration may take considerably longer with older patients. One reason for this is that older individuals simply have more extensive and complicated histories to review. Some older people also require breaks that may not be needed by younger people: Many older adults fatigue more quickly, and this must be monitored because their responses may become less accurate or rich if they become inattentive or unmotivated. Older adults typically perform their best when given frequent opportunities to stretch, take a brief walk, rest, or use the bathroom. Sometimes, it may be helpful to divide the interview session into several shorter sessions. The length of time required for full administration of structured interviews with older adults impacts the viability of using these instruments in routine clinical practice.

Sensory impairments can also affect the interview evaluation. Older persons with hearing difficulties may misunderstand parts of the query or fail to answer the question entirely. It is often helpful to sit closer to the older patient, face him or her directly, speak slowly and clearly, and reduce background noise in the evaluation room. Lastly, some older adults may respond negatively to the structure imposed by the interviews. In these cases, it is advisable to spend more time developing rapport; reflect more feelings during the interview; allow for more elaboration, venting, and storytelling from the patient about troublesome symptoms or experiences; and explain the purpose and format of the structured interview. Judicious amounts of flexibility and sensitivity are needed during the structured interview with older adults, and this is especially important when personality disorder pathology is also present.

Despite the potential concerns we have noted, semi-structured interviews can and should have an important place in the assessment process. For example, a semi-structured interview may be used with all patients at the beginning of treatment, or it may be administered after a more unstructured clinical interview or self-report objective personality inventory is completed. As noted previously, this requires a significant investment in time and expertise. Using sections of an interview to clarify specific diagnostic hypotheses generated from a clinical interview or a self-report inventory (e.g., only the Borderline Personality Disorder module of the SCID-II may be administered to enable a more comprehensive evaluation of the borderline pathology) is a less time-consuming option. With their premium on diagnostic reliability and comprehensive assessment of criteria, structured interviews can be valuable resources for the geropsychological clinician and researcher.

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