Age-Related Changes in Decision Making

Participants' Utilitarian Choice Is Influenced by Gamble Presentation and Age

No prior behavioral science research has delved into the impact of gamble presentation (horizontal or vertical) on individuals' utilitarian behavior, despite evidence suggesting that such choices can be influenced by comparing attributes like probability and money in gambles. This article addresses this gap by exploring the influence of gamble presentation on utilitarian behavior. A two-factor independent measures design was employed to explore the influence of the type of gamble presentation and age on participants' utilitarian decision-making preferences. The findings showed a reduced likelihood of participants choosing the non-utilitarian gamble with vertically presented gambles compared to horizontal ones. Consequently, participants' utilitarian behavior was influenced by between-gamble comparisons of available attributes, with utilitarian choices (e.g., choosing Gamble A) being more prevalent in vertical presentations due to a straightforward comparison on the probability attribute. Furthermore, the results also revealed that older participants take more time than their younger counterparts when making utilitarian errors. We attribute this to their abundant knowledge and experience. Future research should explore the comparative psychological processing used by participants in risky decision-making tasks.

Increased Financial Altruism is Associated with Alzheimer's Disease Neurocognitive Profile in Older Adults

BACKGROUND

Older age is associated with an increase in altruistic behaviors such as charitable giving. However, few studies have investigated the cognitive correlates of financial altruism in older adults.

OBJECTIVE

This study investigated the cognitive correlates of financial altruism measured using an altruistic choice paradigm in a community-based sample of older adults.

METHODS

In the present study, a sample of older adults (N = 67; M age = 69.21, SD = 11.23; M education years = 15.97, SD = 2.51; 58.2% female; 71.6% Non-Hispanic White) completed a comprehensive neuropsychological assessment and an altruistic choice paradigm in which they made decisions about allocating money between themselves and an anonymous person.

RESULTS

In multiple linear regression analyses that controlled for age, education, and sex, financial altruism was negatively associated with performance on cognitive measures typically sensitive to early Alzheimer's disease (including word list learning and recall, delayed story recall, and animal fluency).

CONCLUSION

Findings of this study point to a negative relationship between financial altruism and cognitive functioning in older adults on measures known to be sensitive to Alzheimer's disease. Findings also point to a potential link between financial exploitation risk and Alzheimer's disease in older age.

Atypical interoception as a common risk factor for psychopathology: A review

The inadequacy of a categorial approach to mental health diagnosis is now well-recognised, with many authors, diagnostic manuals and funding bodies advocating a dimensional, trans-diagnostic approach to mental health research. Variance in interoception, the ability to perceive one's internal bodily state, is reported across diagnostic boundaries, and is associated with atypical functioning across symptom categories. Drawing on behavioural and neuroscientific evidence, we outline current research on the contribution of interoception to numerous cognitive and affective abilities (in both typical and clinical populations), and describe the interoceptive atypicalities seen in a range of psychiatric conditions. We discuss the role that interoception may play in the development and maintenance of psychopathology, as well as the ways in which interoception may differ across clinical presentations. A number of important areas for further research on the role of interoception in psychopathology are highlighted.

Impact of Early Life Socioeconomic Status on Decision Making in Older Adults Without Dementia

OBJECTIVES

A growing body of evidence points to the negative impact of early life socioeconomic status (SES) on health and cognitive outcomes in later life. However, the effect of early life SES on decision making in old age is not well understood. This study investigated the association of early life SES with decision making in a large community-based cohort of older adults without dementia from the Rush Memory and Aging Project.

MATERIALS AND METHODS

Cross-sectional data from the Rush Alzheimer's Disease Center Memory and Aging Project was analyzed. Participants were 1044 community-dwelling older adults without dementia (M age = 81.15, SD = 7.49; 75.8% female; 5.4% non-White). Measures of financial and healthcare decision making and early life SES were collected, along with demographics, global cognition, and financial and health literacy.

RESULTS

Early life SES was positively associated with decision making (estimate = 0.218, p = 0.027), after adjustments for demographic covariates and global cognition, such that a one-unit increase in early life SES was equivalent to the effect of being four years younger in age as it pertains to decision making. A subsequent model demonstrated that the relationship was strongest in those with low literacy, and weakest for those with high literacy (estimate = -0.013, p = 0.029).

CONCLUSIONS

Findings from this study suggest that early life SES is associated with late life decision making and that improving literacy, a modifiable target for intervention, may buffer the negative impact of low early life SES on decision making in older adulthood.

Effects of Community-Based Interventions on Medication Adherence and Hospitalization for Elderly Patients with Type 2 Diabetes at Primary Care Clinics in South Korea

Korean Disease Control and Prevention Agency launched Control and Prevention Community-based Registration and Management for Hypertension and Diabetes mellitus Project (CRMHDP) in Gwangmyeong city, 2009. This project has provided incentives on both patient and physician and has made private clinics and Public Health Center (PHC) in a community collaborate for effective chronic disease management among elderly people. This study aimed to evaluate the effects of CRMHDP on medication compliance and hospitalization due to diabetes-specific complications. The retrospective cohort study design was based on data of Korean National Health Insurance (KNHI) with 2 control areas (A & B) with usual primary care service similar to Gwangmyeong city regarding community health resources. The data on the study subjects were examined for the following 5 years since the baseline point. Medication adherence rates of CRMHDP-enrollees after the project was significantly higher than two control groups. For the hospitalization due to any complications, adjusted hazard ratio in the intervention group, compared to the control group A and B, were 0.76 (95% Confidence Interval: 0.65–0.78) and 0.52 (95% Confidence Interval 0.41–0.78), respectively. CRMHDP could successful in improving the management of type 2 diabetes mellitus among elderly people in South Korean primary care settings.

Is it time? Episodic imagining and the discounting of delayed and probabilistic rewards in young and older adults

Remembering and imagining specific, personal experiences can help shape our decisions. For example, cues to imagine future events can reduce delay discounting (i.e., increase the subjective value of future rewards). It is not known, however, whether such cues can also modulate other forms of reward discounting, such as probability discounting (i.e., the decrease in the subjective value of a possible reward as the odds against its occurrence increase). In addition, it is unclear whether there are age-related differences in the effects of cueing on either delay or probability discounting. Accordingly, young and older adult participants were administered delay and probability discounting tasks both with and without cues to imagine specific, personally meaningful events. As expected, cued episodic imagining decreased the discounting of delayed rewards. Notably, however, this effect was significantly less pronounced in older adults. In contrast to the effects of cueing on delay discounting, personally relevant event cues had little or no effect on the discounting of probabilistic rewards in either young or older adults; Bayesian analysis revealed compelling support for the null hypothesis that event cues do not modulate the subjective value of probabilistic rewards. In sum, imagining future events appears only to affect decisions involving delayed rewards. Although the cueing effect is smaller in older adults, nevertheless, it likely contributes to how adults of all ages evaluate delayed rewards and thus, it is, in fact, about time.

Examining delay of gratification in healthy aging

Delay of gratification (DofG) refers to the capacity to forego an immediate reward in order to receive a more desirable reward later. As a core executive function, it might be expected that DofG would follow the standard pattern of age-related decline observed in older adults for other executive tasks. However, there actually have been few studies of aging and DofG, and even these have shown mixed results, suggesting the need for further investigation and new approaches. The present study tested a novel reward-based decision-making paradigm enabling examination of age-related DofG effects in adult humans. Results showed that older adults earned fewer overall rewards than young adults, both before and after instruction regarding the optimal DofG strategy. Prior to instruction, learning this strategy was challenging for all participants, regardless of age. The finding of age-related impairments even after strategy instruction indicated that these impairments were not due to a failure to understand the task or follow the optimal strategy, but instead were related to self-reported difficulty in waiting for delayed rewards. These results suggest the presence of age-related changes in DofG capacity and highlight the advantages of this new experimental paradigm for use in future investigations, including both behavioral and neuroimaging studies.

Direct and indirect effects of age on interoceptive accuracy and awareness across the adult lifespan

Various aspects of physical and mental health have been linked to an individual’s ability to perceive the physical condition of their body (‘interoception’). In addition, numerous studies have demonstrated a role for interoception in higher-order cognitive abilities such as decision-making and emotion processing. The importance of interoception for health and typical cognitive functioning has prompted interest in how interoception varies over the lifespan. However, few studies have investigated interoception into older adulthood, and no studies account for the set of physiological changes that may influence task performance. The present study examined interoception from young to very late adulthood (until 90 years of age) utilising a self-report measure of interoception (Study One) and an objective measure of cardiac interoception (Study Two). Across both studies, interoception decreased with age, and changes in interoceptive accuracy were observed which were not explained by accompanying physiological changes. In addition to a direct effect of age on interoception, an indirect effect of ageing on cardiac interoceptive accuracy mediated by body mass index (BMI) was found, such that ageing was associated with increased BMI which was, in turn, associated with reduced interoceptive accuracy. Such findings support and extend previous research demonstrating interoceptive decline with advancing age, and highlight the importance of assessing whether decreasing interoceptive ability is responsible for some aspects of age-related ill-health and cognitive impairment.

Stroke survivor attitudes toward, and motivations for, considering experimental stem cell treatments

Purpose: Interest in stem cell treatments is increasing among some patient groups, but it is unclear whether this holds true for stroke survivors. This study examined stroke survivor attitudes toward stem cell treatments and identified a number of variables that may increase the likelihood that patients will consider these treatments.Methods: Adult stroke survivors (N = 183) were recruited (stroke advocacy/support groups, outpatient register) for a cross-sectional study. Attitudes to stem cell treatments were surveyed, guided by the Theory of Planned Behavior. Demographic information was collected, and a number of self-report medical, cognitive and psychological measures completed.Results: Twenty-five percent (n = 46) of respondents indicated they were considering undergoing stem cell treatments, although most were unsure about the safety/effectiveness and accessibility/affordability. Stroke survivors with positive attitudes toward stem cell treatments, longer post-stroke intervals, poorer physical functioning, younger age, and greater perceived caregiver burden were more likely to be considered experimental treatments (odds ratios = 1.22, 1.08, 0.95, 0.96, 1.07; respectively).Conclusions: Stroke survivors may consider undergoing experimental stem cell treatments despite uncertainty regarding the risks/benefits. Clinicians should be mindful of the factors that may increase the likelihood of patients considering these treatments and intervene, where appropriate, to clarify any misconceptions regarding the medical/financial risks.IMPLICATION FOR REHABILITATIONStem cell treatments offer a new focus for reducing stroke-related disability, although their safety and effectiveness have yet to be established.Despite uncertainty regarding the medical risks and benefits associated with stem cell injections, stroke survivors may still consider undergoing treatment in private, unregulated clinics.A number of factors, including younger age, longer post-stroke interval, poorer physical functioning, and perceived caregiver burden may place stroke survivors at an increased risk of considering these treatments.Clinicians should endeavor to educate stroke survivors regarding the risks and benefits of these experimental treatments and clarify any misconceptions, in order to reduce the likelihood that they will consider these as-yet unproven treatments.

The impact of natural aging on computational and neural indices of perceptual decision making: A review

It is well established that natural aging negatively impacts on a wide variety of cognitive functions and research has sought to identify core neural mechanisms that may account for these disparate changes. A central feature of any cognitive task is the requirement to translate sensory information into an appropriate action - a process commonly known as perceptual decision making. While computational, psychophysical, and neurophysiological research has made substantial progress in establishing the key computations and neural mechanisms underpinning decision making, it is only relatively recently that this knowledge has begun to be applied to research on aging. The purpose of this review is to provide an overview of this work which is beginning to offer new insights into the core psychological processes that mediate age-related cognitive decline in adults aged 65 years and over. Mathematical modelling studies have consistently reported that older adults display longer non-decisional processing times and implement more conservative decision policies than their younger counterparts. However, there are limits on what we can learn from behavioural modeling alone and neurophysiological analyses can play an essential role in empirically validating model predictions and in pinpointing the precise neural mechanisms that are impacted by aging. Although few studies to date have explicitly examined correspondences between computational models and neural data with respect to cognitive aging, neurophysiological studies have already highlighted age-related changes at multiple levels of the sensorimotor hierarchy that are likely to be consequential for decision making behaviour. Here, we provide an overview of this literature and suggest some future directions for the field.