Ageism and Neuropsychological Tests

What do we really know about age-related stereotypes and well-being of older adults? A commentary on the state of the art

There is a considerable body of literature on harmful consequences of age-related stereotypes-including consequences on physical and mental health. However, this commentary critically argues that the current state of the art disregards consequences of these stereotypes specifically for the well-being of older adults (i.e., outcome that is not to be confounded with mental health). To this end, the content of age-related stereotypes and the mechanisms through which they operate on physical and mental health are first outlined. The commentary then focuses on the very scarce evidence documenting how and when the well-being of older adults (as assessed directly and not as inferred from other indicators) is influenced by self-directed stereotypes. After setting out possible ways well-being may be involved in the relationship between self-directed stereotypes and physical and mental health of older adults, the present commentary argues that a better understanding of well-being would benefit strategies targeting the reduction of age-related stereotypes. Overall, this commentary on the state of the art highlights that future research is still needed to better understand both the direct and indirect relationships between age-related stereotypes and well-being that is not reducible to positive experiences of life (or hedonic well-being) but also comprises an eudaimonic component.

Age-based stereotype threat and neuropsychological performance in older adults

The current study investigated the effects of age-based stereotype threat on neuropsychological assessment outcomes in an older adult population. Community volunteers (n = 49) age 65 and older were screened for cognitive impairment, depression, and anticholinergic medication use. Screened individuals were randomly stratified into either an ABST or a Control group. All participants were administered a broad range of neuropsychological measures of cognition as well as a self-rating measure assessing subjective concern about cognitive ability. A main effect of ABST on subjective concern about cognitive ability was supported. Specifically, individuals in the ABST group were significantly more likely to attribute their memory errors to the onset of dementia (F(1,41) = 5.334, p = .026). However, results showed no significant difference between groups on objective neuropsychological performance measures. The current study discusses the importance of considering ABST effects in the context of neuropsychological assessment in older adult populations.

COVID-19 Booster Vaccination Bellwethers: Factors Predictive of Older Adults' Adoption of the Second Booster COVID-19 Vaccine in Israel: A Longitudinal Study

Israel became the first country to offer the second COVID-19 booster vaccination. The study tested for the first time, the predictive role of booster-related sense of control (SOC_B), trust and vaccination hesitancy (VH) on adoption of the second-booster among older adults, 7 months later. Four hundred Israelis (≥60 years-old), eligible for the first booster, responded online, two weeks into the first booster campaign. They completed demographics, self-reports, and first booster vaccination status (early-adopters or not). Second booster vaccination status was collected for 280 eligible responders: early- and late-adopters, vaccinated four and 75 days into the second booster campaign, respectively, versus non-adopters. Multinomial logistic regression was conducted with pseudo R² = .385. Higher SOC_B, and first booster early-adoption were predictive of second booster early-vs.-non-adoption, 1.934 [1.148-3.257], 4.861 [1.847-12.791]; and late-vs.-non-adoption, 2.031 [1.294-3.188], 2.092 [0.979-4.472]. Higher trust was only predictive of late-vs.-non-adoption (1.981 [1.03-3.81]), whereas VH was non-predictive. We suggest that older-adult bellwethers, second booster early-adopters, could be predicted by higher SOC_B, and first booster early-adoption, 7 months earlier.

Auditory Biases in Cognitive Assessment: Insights from a Hearing-Loss Simulation for the Screening of Dementia due to Alzheimer's Disease

Cognitive-screening tests are used to detect pathological changes in mental abilities. Many use orally presented instructions and test items. Hence, hearing loss (HL), whose prevalence increases with age, may bias cognitive-test performance in the target population for the screening of dementia due to Alzheimer's disease. To study the effect of the auditory test format, an impairment-simulation approach was used in normal-hearing listeners to compare performance on the Hopkins Verbal Learning Test, a memory task employed in dementia screening and research, when test items were unprocessed and processed to simulate age-related HL. Immediate verbal recall declined with simulated HL, suggesting that auditory factors are confounding variables in cognitive assessment and result in the underestimation of cognitive functioning.

Immediate Effects of (Simulated) Age-Related Hearing Loss on Cognitive Processing and Performance for the Backward-Digit-Span Task

The recall of auditorily presented sequences of digits in reverse order (also known as the Backward Digit Span, BDS) is considered to reflect a person's information storage and processing abilities which have been linked to speech-in-noise intelligibility. However, especially in aging research and audiology, persons who are administered the BDS task are often affected by hearing loss (HL). If uncorrected, HL can have immediate assessment-format-related effects on cognitive-test performance and can result, in the long term, in neuroplastic changes impacting cognitive functioning. In the present study, an impairment-simulation approach, mimicking mild-to-moderate age-related HLs typical for persons aged 65, 75, and 85 years, was used in 19 young normal-hearing participants to evaluate the impact of HL on cognitive performance and the cognitive processes probed by the BDS task. Participants completed the BDS task in several listening conditions, as well as several commonly used visual tests of short-term and working memory. The results indicated that BDS performance was impaired by a simulated HL representing that of persons aged 75 years and above. In the normal-hearing condition, BDS performance correlated positively with both performance on tests of short-term memory and performance on tests of working memory. In the listening condition simulating moderate HL (as experienced by the average 85-year-old person), BDS performance only correlated with performance on working-memory tests. In conclusion, simulated (and, by extrapolation, actual) age-related HL negatively affects cognitive-test performance and may change the composition of the cognitive processes associated with the completion of a cognitive task.

Health practitioner beliefs regarding the impact of age-based stereotype threat on performance in the cognitive assessment of older adults

OBJECTIVES

Health practitioners' understanding of the impact of age-based stereotype threat (ABST) on the cognitive test performance of older adults is not well understood. This study aimed to investigate health practitioners' ability to recognize the influence of ABST in the cognitive assessment of older adults and their perceptions of its impact in practice.

METHODS

One-hundred and twenty-nine health practitioners (86% female; M age = 39.75, SD = 11.50) with experience in conducting cognitive assessments with older adults (mainly psychologists and occupational therapists) completed an online survey assessing demographic and practice characteristics, aging beliefs, a hypothetical cognitive assessment scenario, and perceived impact of ABST on practice.

RESULTS

Overall, health practitioners rated ABST factors in the assessment scenario as less detrimental to cognitive performance than internal and external factors. In a hierarchical regression model, lower recognition of ABST and negative aging beliefs significantly accounted for lower perceived impact of ABST on older adults' cognitive test performance in practice (R² = .37, p < .001).

CONCLUSION

Health practitioners may not recognize the influence of ABST on assessment findings, especially if they hold negative aging beliefs. The findings highlight the need to improve health practitioners' knowledge of ABST to increase the validity of cognitive testing in older adults.

Challenges in Conducting Sexual Health and Violence Research in Older Adults Beyond the General Data Protection Regulation: A Belgian Case Study

Because of a growing older population, the sexual health (SH) of older adults, including sexual violence (SV), is becoming an increasingly important public health concern. Yet, reliable SV prevalence rates and risk factors are lacking, due to methodological shortcomings in current studies. SV research involves challenges regarding safety and disclosure, especially in older adults. In this paper, we reflect on the methods used in a sexual health and violence (SH&V) study in older adults balancing between privacy rules imposed by the General Data Protection Regulation (GDPR) and ethical and safety guidelines.To ensure the acceptability of the questionnaire, it was tested in a two-phase pilot study. To maximize SV disclosure, the questionnaire built up gradually towards the more sensitive SV modules. Interviewers were trained to approach participants in a non-judgmental manner. Due to GDPR, our data collection method was changed from a random sampling via the National Register to a cluster random probability sampling with a random walk finding approach.Older adults were willing to discuss SH&V during a structured face-to-face interview with trained interviewers. Following strict safety guidelines, no major incidents were reported. The cluster random probability sampling with random walk finding approach provided an adequate sampling frame, but was inefficient and time-consuming.Doing research on SH&V in older adults is feasible but requires a substantial investment of time and the challenges involved may incur greater costs. In order to guarantee further research on sensitive topics in older adults, we recommend that an interdisciplinary expert group consisting of researchers, donors, and policymakers investigates how GDPR and public health research in hard-to-reach populations can be better matched.

One Size Does Not Fit All: Examining the Effects of Working Memory Capacity on Spoken Word Recognition in Older Adults Using Eye Tracking

Difficulties understanding speech form one of the most prevalent complaints among older adults. Successful speech perception depends on top-down linguistic and cognitive processes that interact with the bottom-up sensory processing of the incoming acoustic information. The relative roles of these processes in age-related difficulties in speech perception, especially when listening conditions are not ideal, are still unclear. In the current study, we asked whether older adults with a larger working memory capacity process speech more efficiently than peers with lower capacity when speech is presented in noise, with another task performed in tandem. Using the Eye-tracking of Word Identification in Noise Under Memory Increased Load (E-WINDMIL) an adapted version of the "visual world" paradigm, 36 older listeners were asked to follow spoken instructions presented in background noise, while retaining digits for later recall under low (single-digit) or high (four-digits) memory load. In critical trials, instructions (e.g., "point at the candle") directed listeners' gaze to pictures of objects whose names shared onset or offset sounds with the name of a competitor that was displayed on the screen at the same time (e.g., candy or sandal). We compared listeners with different memory capacities on the time course for spoken word recognition under the two memory loads by testing eye-fixations on a named object, relative to fixations on an object whose name shared phonology with the named object. Results indicated two trends. (1) For older adults with lower working memory capacity, increased memory load did not affect online speech processing, however, it impaired offline word recognition accuracy. (2) The reverse pattern was observed for older adults with higher working memory capacity: increased task difficulty significantly decreases online speech processing efficiency but had no effect on offline word recognition accuracy. Results suggest that in older adults, adaptation to adverse listening conditions is at least partially supported by cognitive reserve. Therefore, additional cognitive capacity may lead to greater resilience of older listeners to adverse listening conditions. The differential effects documented by eye movements and accuracy highlight the importance of using both online and offline measures of speech processing to explore age-related changes in speech perception.

Vaccine and Psychological Booster: Factors Associated With Older Adults’ Compliance to the Booster COVID-19 Vaccine in Israel

Israel became the first country to offer the booster COVID-19 vaccination. The study tested for the first time the role of sense of control (SOC) due to vaccinations, trust and vaccination hesitancy (VH), and their association with compliance to the booster COVID-19 vaccine among older adults, during the first 2 weeks of the campaign. 400 Israeli citizens (≥ 6 years old), eligible for the booster vaccine, responded online. They completed demographics, self-reports, and booster vaccination status (already vaccinated, booked-a-slot, vaccination intent, and vaccination opposers). Multinomial logistic regression was conducted with pseudo R 2 = .498. Higher SOC and lower VH were related to the difference between early and delayed vaccination (booked-a-slot, OR = 0.7 [0.49‐0.99]; 2.2 [1.32‐3.62], intent OR = 0.6 [0.42‐0.98]; 2.7 [1.52‐4.86]), as well as to rejection ( OR = 0.3 [0.11‐0.89]; 8.5 [3.39‐21.16]). Increased trust was only related to the difference between early vaccinations and vaccine rejection ( OR = 0.3 [0.11‐0.89]). We suggest that SOC, as well as low VH, can be used as positive motivators, encouraging earlier vaccinations in older age.

Synchrony in Old Age: Playing the Mirror Game Improves Cognitive Performance

OBJECTIVES

Studies have shown that synchronized motion between people positively affects a range of emotional and social functions. The mirror-game is a synchrony-based paradigm, common to theater, performance arts, and therapy, which includes dyadic synchronized motion, playfulness, and spontaneity. The goal of the current study is to examine the effects of the mirror-game on subjective and cognitive indices in late life.

METHODS

Thirty-four older adults (aged 71-98) participated in a within-group study design. Participants conducted two sessions of 9-minute movement activities: the mirror-game and the control condition - a physical exercise class. Several measures were taken before and after experimental sessions to assess socio-emotional and attentional functions.

RESULTS

The mirror-game enhanced performance on the attention sub-scale and led to faster detections of spoken words in noise. Further, it enhanced perceived partner responsiveness and led to an increase in positive reported experience.

CONCLUSIONS

Our preliminary findings suggest that the mirror-game, rather than the exercise class, may have an immediate impact on mood and some attentional functions.

CLINICAL IMPLICATIONS

The mirror-game is a novel intervention, with potential benefits of social-emotional and cognitive functioning, which can be easily implemented into the daily routine care of older adults. Future studies should explore the effect of the mirror-game on additional cognitive and socio-emotional aspects.

Safe and Sound: The Effects of Experimentally Priming the Sense of Attachment Security on Pure-Tone Audiometric Thresholds Among Young and Older Adults

Attachment security has consistently been found to correlate with relaxed exploration, openness, and mindful attention to incoming information. The present studies explored whether contextually infusing a sense of attachment security (security priming) can improve hearing in young and older adults. In Study 1, participants (29 young, 30 older) performed a standardized pure-tone audiometric-thresholds test twice. In the security-priming condition, a picture of a participant's security-enhancing figure was presented throughout the task. In the control condition, a picture of an unknown person (matched in sex, age, and facial expression) was used as a neutral prime. Study 2 (14 young, 14 older) was almost identical, except that it was preregistered and the neutral prime was a circle. In both studies, participants performed better (had lower hearing thresholds) in the security-priming condition. The current study is the first to show that attachment security improves sensory perception, and these results have meaningful implications for theory and clinical hearing tests.

Normative and Equated Data of the Original and Basic Versions of the Montreal Cognitive Assessment among Community Dwelling Saudi Arabians

Introduction

Currently, there are standard and basic versions of the MoCA, the latter designed for those with lower educational achievements. Community-based normative data on these versions of the MoCA from Arabic populations are deficient, and there is little data demonstrating how both scales perform in comparison. We aim to obtain normative performances from both versions and equate the measures of both scales.

Methods

Community-based recruitment of healthy volunteers ≥ 18 years of age. Participants underwent testing with both versions. Demographic data was collected with regard to age, gender, years of education, diabetes, and hypertension. Regression analysis was performed to determine significance of variables, and the circle-arc equating method was used to equate the two scores from each scale.

Results

311 participants were included in the study. The mean (sd) age was 45.8 (15.96), females were 184 (59.16%), and the duration of education was 12.7 (5.67) years. The mean scores on the MoCA-A and MoCA-B were 21.47 (4.53) and 24.37 (4.71) (P < 0.0001), respectively. Multivariate regression showed significance of age and years of education in both versions (both variables with P < 0.0001). Correlation coefficient between the two scales was 0.77 (P < 0.0001). The largest equated difference between both MoCA versions was four points in those scoring from 10-20 on the MoCA-A.

Conclusion

We present normative data from a large Saudi Arabian community-based sample with two different MoCA tests, and an equating graph is presented to determine the corresponding expected performance between the two scales.

Focusing on Emotional and Social Intelligence Stimulation of People With Dementia by Playing a Serious Game—Proof of Concept Study

Context: Dementia is one of the top five chronic diseases, which has an overwhelming impact on patients' life quality, family, and caregivers. Currently, research relating to people with dementia (PwD) focuses on the deterioration of cognitive abilities. A more innovative approach, and the one taken by this paper, is focusing on methods to maintain and improve functionality, communication and quality of life of PwD by building on remaining capacities in the yet unexplored domain of emotional and social intelligence (ESI). The use of serious games for PwD (SG4D) aimed at building social and emotional capacity is a budding field of research.

Objectives: Proof of concept that the, low cost, easy to deploy SG4D, called “My Brain Works” (MBW), co-designed with PwD, enhances ESI, based on the Bar-On ESI model.

Methods: 27 PwD, clients at MELABEV dementia day center, participated in a mixed methods 12 weeks pilot, proof of concept study using a tablet SG4D co-designed with PwD. Quantitative performance data was collected automatically by the tablet during game sessions. In this paper we focus on the analysis of the qualitative and quantitative data related to ESI, observed by 10 different researchers, during each game session.

Results: Quantitative data revealed: both the PwD with high and low MoCA scores had similar average ESI scores. Qualitative analysis revealed that the PwD demonstrated 9 sub-components of the Bar-On ESI Model.

Conclusion: While there is no drug to stop cognitive decline associated with dementia, interventions related to ESI, on the other hand, may improve functioning and quality of life. Despite declines in cognitive abilities, our study shows that a tablet based SG4D can stimulate their ESI and evoke responses in self-awareness, empathy, social and communication capacities. Using SG4D to exercise and maintain social skills is an area that may be promising in the future and may help counter the negative effects of social isolation and loneliness. Such games, while not focusing on cognitive improvement, may also impact on cognitive functioning and help bridge the gap between caregiver and PwD. More research is needed with larger sample sizes.

Overcoming Age-Based Stereotypes to Optimise Cognitive Performance in Older Adults: A Systematic Review of Methodology and Existing Evidence

BACKGROUND AND OBJECTIVES

Age-based stereotype threat (ABST) poses serious risks for the cognitive screening of older adults. This review aimed to identify and critically appraise the methodology and existing evidence of studies investigating the use of threat-removal (TR) strategies to overcome the effects of ABST on the cognitive performance of older adults. The types of strategies, their effectiveness in optimising cognitive performance, and factors influencing their effectiveness were examined.

RESEARCH DESIGN AND METHODS

A systematic review was conducted following PRISMA guidelines. PsycINFO, PubMed, Embase, Web of Science, and Scopus were searched from 1st January 1995 to 6th November 2019. Two authors independently assessed article eligibility and appraised methodological quality of eligible articles using an adaptation of the STROBE guidelines. Narrative synthesis was used to summarise results.

RESULTS

Thirty articles, reporting on 36 studies, were eligible and included. Overall, evidence for the effectiveness of TR was mixed and varied according to the explicitness of strategies and comparison conditions used. Studies examining blatant TR strategies, and those using a combination of blatant and subtle TR strategies, provided limited support for their effectiveness in overcoming ABST. However, studies evaluating subtle TR strategies provided preliminary support for their effectiveness in overcoming ABST.

DISCUSSION AND IMPLICATIONS

Existing studies provide limited evidence regarding the effectiveness of TR strategies in overcoming ABST due to methodological limitations. Recommendations are made for the design of future studies to differentiate the benefits of TR strategies from the detrimental effects of ABST, thus potentially informing their use in clinical practice.

Inclusion of Older Adults in the Research and Design of Digital Technology

Digital technology holds a promise to improve older adults' well-being and promote ageing in place. However, there seems to be a discrepancy between digital technologies that are developed and what older adults actually want and need. Ageing is stereotypically framed as a problem needed to be fixed, and older adults are considered to be frail and incompetent. Not surprisingly, many of the technologies developed for the use of older adults focus on care. The exclusion of older adults from the research and design of digital technology is often based on such negative stereotypes. In this opinion article, we argue that the inclusion rather than exclusion of older adults in the design process and research of digital technology is essential if technology is to fulfill the promise of improving well-being. We emphasize why this is important while also providing guidelines, evidence from the literature, and examples on how to do so. We unequivocally state that designers and researchers should make every effort to ensure the involvement of older adults in the design process and research of digital technology. Based on this paper, we suggest that ageism in the design process of digital technology might play a role as a possible barrier of adopting technology.