Study Limitations and Delimitations Sample Clauses

Study Limitations and Delimitations. This retrospective observational study has a number of potential limitations and delimitations that should be considered. An important delimitation of the study is that the study cohort includes only persons who were widowed. There is no comparison group of persons who were not widowed. The reason for this delimitation is that the primary objective of the study is to evaluate the context of the predeceased spouse’s death on the subsequent survival of the bereaved spouse. Specifically, the study seeks to evaluate the importance of the predeceased spouse’s place of death, hospice use, and end-of-life health trajectory pattern. These variables can only be assessed for decedents. A consequence of this delimitation is that this study cannot compare the survival of married and widowed persons to evaluate the main effect of bereavement itself on survival. The study may also be subject to some degree of selection bias due to the nature of the PACE population from which the study cohort was drawn. The PACE sample is limited only to elderly Pennsylvania residents, so the results of this study may not be generalizable to younger persons or to those living in other geographic regions. The PACE population is also not representative of the general U.S. elderly population, because, due to PACE’s income eligibility requirements, PACE cardholders have lower incomes and are older on average than the general non-Medicaid elderly population enrolled in Medicare. A large body of research has demonstrated that individuals with poorer socioeconomic resources over their life course are more likely to have poorer health (142). In addition, individuals who choose to enroll in PACE may be more likely to have high medication needs and thus may be sicker or more frail than persons who are income-eligible but who choose not to enroll in the program, reflecting adverse selection into the program. A related limitation is that the study sample includes only persons who were enrolled in the Medicare Fee-for-Service program, and excludes individuals if either they or their spouse were enrolled in a Medicare Advantage managed care plan during the pre-index baseline period. Prior research has demonstrated a historical pattern of favorable risk selection of healthier Medicare beneficiaries into Medicare Advantage plans (143). Although recent research suggests that changes in Medicare’s risk adjustment methods since 2004 have reduced the selection of healthier elderly into Medicare managed care...

Study Limitations and Delimitations. 1. The number of days allocated to the study was not sufficient to conduct interviews, and translate and provide detailed notes. This issue was further aggravated by the frequent power failures in Mchinji district which hindered completion of the work as per the schedule. As a result not all the notes received were complete and typed.