Chapter 8 Aging, Self-Regulation, and Learning from Text

Memory Abilities Are Selectively Related to Food Label and Numeracy Nutrition Skills

OBJECTIVE

We investigated the relationship between nutrition literacy, diet quality, carotenoid status, and cognition.

METHODS

Adults aged 37.5 ± 17.0 years (n = 52) completed the 42-item Nutrition Literacy Assessment Instrument (NLit). The Dietary History Questionnaire III was analyzed to determine the Healthy Eating Index. Skin carotenoids were assessed as a diet quality biomarker. Selective attention, relational memory, and pattern separation abilities were assessed using the flanker, spatial reconstruction, and mnemonic similarity tasks, respectively. Statistical adjustments included age, sex, education, and body mass index.

RESULTS

No correlations were observed for NLit scores and NLit subscales with Healthy Eating Index and skin carotenoid status. However, the NLit's food label and numeracy subscale was related to greater pattern separation abilities (ρ = 0.33, r2 = 0.11, P = 0.03).

CONCLUSIONS AND IMPLICATIONS

Comprehension of food labels and numeracy information was associated with memory abilities. Future work is needed to test whether targeting working memory and attentional processes during memory retrieval in larger samples may facilitate the acquisition of nutrition knowledge.

A Multi-faceted Approach to Promote Comprehension of Online Health Information Among Older Adults

Purpose of the Study

Older adults' self-care often depends on understanding and utilizing health information. Inadequate health literacy among older adults poses a barrier to self-care because it hampers comprehension of this information, particularly when the information is not well-designed. Our goal was to improve comprehension of online health information among older adults with hypertension who varied in health literacy abilities.

Design and Methods

We identified passages about hypertension self-care from credible websites (typical passages). We used a multi-faceted approach to redesign these passages, revising their content, language, organization and format (revised passages). Older participants read both versions of the passages at their own pace. After each passage, they summarized the passage and then answered questions about the passage.

Results

Participants better remembered the revised than the typical passages, summarizing the passages more accurately and uptaking information more efficiently (less reading time needed per unit of information remembered). The benefits for reading efficiency were greater for older adults with more health knowledge, suggesting knowledge facilitated comprehension of information in the revised passages.

Implications

A systematic, multi-faceted approach to designing health documents can promote online learning among older adults with diverse health literacy abilities.

Cognition and Health Literacy in Older Adults' Recall of Self-Care Information

Purpose of the Study

Health literacy is associated with health outcomes presumably because it influences the understanding of information needed for self-care. However, little is known about the language comprehension mechanisms that underpin health literacy.

Design and Methods

We explored the relationship between a commonly used measure of health literacy (Short Test of Functional Health Literacy in Adults [STOFHLA]) and comprehension of health information among 145 older adults.

Results

Results showed that performance on the STOFHLA was associated with recall of health information. Consistent with the Process-Knowledge Model of Health Literacy, mediation analysis showed that both processing capacity and knowledge mediated the association between health literacy and recall of health information. In addition, knowledge moderated the effects of processing capacity limits, such that processing capacity was less likely to be associated with recall for older adults with higher levels of knowledge.

Implications

These findings suggest that knowledge contributes to health literacy and can compensate for deficits in processing capacity to support comprehension of health information among older adults. The implications of these findings for improving patient education materials for older adults with inadequate health literacy are discussed.

Behavioral evidence for a differential modulation of semantic processing and lexical production by aging: a full linear mixed-effects modeling approach

The effect of normal aging on lexical production and semantic processing was evaluated in 72 healthy participants. Four tasks were used, picture naming (PN), picture categorization (PC), numerical judgment (NJ), and color judgment (CJ). The dependence of reaction time (RT) and correct responses with age was accounted by mixed-effects models. Participants underwent neuropsychological testing for verbal, executive, and memory functions. The RTs increase significantly with age for all tasks. After parceling out the non-specific cognitive decline, as reflected by the NJ task, the RT for the PN task decreases with age. Behavioral data were interpreted in relation with neuropsychological scores. Our results suggest that (a) naming becomes more automatic and semantic processing slightly more difficult with age, and (b) a non-specific general slowdown of cognitive processing occurs with age. Lexical production remained unaltered, based on compensatory automatic processes. This study also suggests a possible slowdown of semantic processing, even in normal aging.

Risk for Mild Cognitive Impairment Is Associated With Semantic Integration Deficits in Sentence Processing and Memory

OBJECTIVES

We examined the degree to which online sentence processing and offline sentence memory differed among older adults who showed risk for amnestic and nonamnestic varieties of mild cognitive impairment (MCI), based on psychometric classification.

METHOD

Participants (N = 439) read a series of sentences in a self-paced word-by-word reading paradigm for subsequent recall and completed a standardized cognitive test battery. Participants were classified into 3 groups: unimpaired controls (N = 281), amnestic MCI (N = 94), or nonamnestic MCI (N = 64).

RESULTS

Relative to controls, both MCI groups had poorer sentence memory and showed reduced sentence wrap-up effects, indicating reduced allocation to semantic integration processes. Wrap-up effects predicted subsequent recall in the control and nonamnestic groups. The amnestic MCI group showed poorer recall than the nonamnestic MCI group, and only the amnestic MCI group showed no relationship between sentence wrap-up and recall.

DISCUSSION

Our findings suggest that psychometrically defined sub-types of MCI are associated with unique deficits in sentence processing and can differentiate between the engagement of attentional resources during reading and the effectiveness of engaging attentional resources in producing improved memory.

How aging and bilingualism influence language processing: theoretical and neural models

Healthy non-pathological aging is characterized by cognitive and neural decline, and although language is one of the more stable areas of cognition, older adults often show deficits in language production, showing word finding failures, increased slips of the tongue, and increased pauses in speech. Overall, research on language comprehension in older healthy adults show that it is more preserved than language production. Bilingualism has been shown to confer a great deal of neuroplasticity across the life span, including a number of cognitive benefits especially in executive functions such as cognitive control. Many models of bilingual language processing have been proposed to explain bilingual language processing. However, the question remains open of how such models might be modulated by age-related changes in language. Here, we discuss how current models of language processing in non-pathological aging, and models of bilingual language processing can be integrated to provide new research directions.

Aging and individual differences in binding during sentence understanding: evidence from temporary and global syntactic attachment ambiguities

We report an investigation of aging and individual differences in binding information during sentence understanding. An age-continuous sample of adults (N=91), ranging from 18 to 81 years of age, read sentences in which a relative clause could be attached high to a head noun NP1, attached low to its modifying prepositional phrase NP2 (e.g., The son of the princess who scratched himself/herself in public was humiliated), or in which the attachment site of the relative clause was ultimately indeterminate (e.g., The maid of the princess who scratched herself in public was humiliated). Word-by-word reading times and comprehension (e.g., who scratched?) were measured. A series of mixed-effects models were fit to the data, revealing: (1) that, on average, NP1-attached sentences were harder to process and comprehend than NP2-attached sentences; (2) that these average effects were independently moderated by verbal working memory capacity and reading experience, with effects that were most pronounced in the oldest participants and; (3) that readers on average did not allocate extra time to resolve global ambiguities, though older adults with higher working memory span did. Findings are discussed in relation to current models of lifespan cognitive development, working memory, language experience, and the role of prosodic segmentation strategies in reading. Collectively, these data suggest that aging brings differences in sentence understanding, and these differences may depend on independent influences of verbal working memory capacity and reading experience.

Knowledge differentially supports memory for nutrition information in later life

We examined the extent to which prior knowledge about nutrition moderates age differences in remembering newly learned nutrition information. Younger and older adults with varying levels of knowledge read an article on fats and cholesterol and then completed a memory task. Participants responded to statements that were-or were not-presented in the text, which enabled us to examine memory accuracy overall as well as hits and memory errors. Results showed age differences were present in the low-knowledge group but not in the high-knowledge group. Findings illustrate the importance of knowledge for older adults' memory for health information.

The Effects of Ageing and Visual Noise on Conceptual Integration during Sentence Reading

The effortfulness hypothesis implies that difficulty in decoding the surface form, as in the case of age-related sensory limitations or background noise, consumes the attentional resources that are then unavailable for semantic integration in language comprehension. Because ageing is associated with sensory declines, degrading of the surface form by a noisy background can pose an extra challenge for older adults. In two experiments, this hypothesis was tested in a self-paced moving window paradigm in which younger and older readers’ online allocation of attentional resources to surface decoding and semantic integration was measured as they read sentences embedded in varying levels of visual noise. When visual noise was moderate (Experiment 1), resource allocation among young adults was unaffected but older adults allocated more resources to decode the surface form at the cost of resources that would otherwise be available for semantic processing; when visual noise was relatively intense (Experiment 2), both younger and older participants allocated more attention to the surface form and less attention to semantic processing. The decrease in attentional allocation to semantic integration resulted in reduced recall of core ideas in both experiments, suggesting that a less organized semantic representation was constructed in noise. The greater vulnerability of older adults at relatively low levels of noise is consistent with the effortfulness hypothesis.

The effects of print exposure on sentence processing and memory in older adults: Evidence for efficiency and reserve

The present study was an examination of how exposure to print affects sentence processing and memory in older readers. A sample of older adults (N = 139; Mean age = 72) completed a battery of cognitive and linguistic tests and read a series of sentences for recall. Word-by-word reading times were recorded and generalized linear mixed effects models were used to estimate components representing attentional allocation to word-level and textbase-level processes. Older adults with higher levels of print exposure showed greater efficiency in word-level processing and in the immediate instantiation of new concepts, but allocated more time to semantic integration at clause boundaries. While lower levels of working memory were associated with smaller wrap-up effects, individuals with higher levels of print exposure showed a reduced effect of working memory on sentence wrap-up. Importantly, print exposure was not only positively associated with sentence memory, but was also found to buffer the effects of working memory on sentence recall. These findings suggest that the increased efficiency of component reading processes that come with life-long habits of literacy buffer the effects of working memory decline on comprehension and contribute to maintaining skilled reading among older adults.

Mechanisms underlying comprehension of health information in adulthood: the roles of prior knowledge and working memory capacity

Prior knowledge, working memory capacity (WMC), and conceptual integration (attention allocated to integrating concepts in text) are critical within many contexts; however, their impact on the acquisition of health information (i.e. learning) is relatively unexplored.We examined how these factors impact learning about nutrition within a cross-sectional study of adults ages 18 to 81. Results showed that conceptual integration mediated the effects of knowledge and WMC on learning, confirming that attention to concepts while reading is important for learning about health. We also found that when knowledge was controlled, age declines in learning increased, suggesting that knowledge mitigates the effects of age on learning about nutrition.