Adult Age Differences in Dual Information Processes: Implications for the Role of Affective and Deliberative Processes in Older Adults' Decision Making

Age matters: The effect of regret and loss aversion on cultured meat acceptance

Cultured meat shows great promise as a more sustainable alternative to conventional meat consumption. However, consumer acceptance of cultured meat remains a great challenge as studies indicate a general reluctance to adopt this product. Notably, while existing literature has provided various factors influencing consumer acceptance of cultured meat, there is a limited focus on the use of affective cues. The present research examines the impact of regret appeal on consumers' willingness to try cultured meat. In two experimental studies, the authors investigate (1) the interactive effect between regret and age on willingness to try cultured meat, and (2) the role of loss aversion as a mediating factor between regret and willingness to try cultured meat. The results demonstrate the effectiveness of regret appeal in increasing consumers' willingness to try cultured meat, particularly among older populations. This is because older populations exhibit higher levels of loss aversion. The present study is the first to shed light on the interactive effect of regret and age in influencing sustainable product acceptance. Furthermore, the study establishes the first empirical evidence to demonstrate that loss aversion is a valid self-regulating strategy adopted to cope with the feeling of regret in a consumption context.

Cognitive and Emotional Factors Influencing the Incorporation of Advice Into Decision Making Across the Adult Lifespan

OBJECTIVES

The present study sought to investigate the influence of advice on decision making in older age, as well as the potential influence of depressive symptoms and age-related differences in the cognitively demanding emotion regulation on advice-taking.

METHOD

A nonclinical sample (N = 156; 50% female; 47 young: M age = 29.87, standard deviation [SD] = 5.58; 54 middle-aged: M age = 50.91, SD = 7.13; 55 older: M age = 72.51, SD = 5.33) completed a judge-advisor task to measure degree of advice-taking, as well as measures of fluid intelligence, depressive symptoms, confidence, perceived advice accuracy, and emotion regulation.

RESULTS

Age did not influence degree of advice-taking. Greater depressive symptoms were associated with more reliance on advice, but only among individuals who identified as emotion regulators. Interestingly, older age was associated with perceiving advice to be less accurate.

DISCUSSION

The study contributes to the sparse literature on advice-taking in older age. Cognitive and emotional factors influence the degree to which advice is incorporated into decision making in consistent ways across the adult lifespan. A key difference is that older adults take as much advice as younger adults despite perceiving the advice to be less accurate.

Who Gets Caught in the Web of Lies?: Understanding Susceptibility to Phishing Emails, Fake News Headlines, and Scam Text Messages

OBJECTIVE

The present study investigated if the same users are vulnerable to phishing emails, scam text messages, and fake news headlines and if there are universal predictors of susceptibility for all three tasks.

BACKGROUND

Theoretical research provides support for the notion that the same users likely fall for multiple forms of online deception. However, no research has directly compared susceptibility for various online deceptions (eg phishing, disinformation, scam text messages) within the same group of users.

METHOD

Participants completed an online survey consisting of demographic questions, the Cognitive Reflection Test (ie impulsivity), and the Digital Literacy Scale, and classified 90 legitimate and deceptive emails, text messages, and news headlines.

RESULTS

Results suggest that individuals who struggle to discriminate between deceptive and legitimate stimuli on one task experience similar difficulties on the other two tasks. Additionally, while lower levels of digital literacy and cognitive reflectiveness predicted poorer discrimination abilities across all three tasks, age did not predict performance. Interestingly, participants appeared to be the most susceptible to phishing emails.

CONCLUSION

Overall, individuals who fall for one form of online deception appear to be more likely to fall for other forms of deception, and digital literacy and cognitive reflectiveness can predict widespread vulnerability to online deception.

APPLICATION

Organizations may be able to identify potential vulnerabilities for a variety of online attacks by measuring digital literacy, cognitive reflectiveness, and performance in one online deception task. Additionally, training interventions may be the most needed for phishing emails.

The Importance of Cultural Awareness in the Management of Heart Failure: A Narrative Review

Heart failure is a commonly encountered clinical syndrome arising from a range of etiologic cardiovascular diseases and manifests in a phenotypic spectrum of varying degrees of systolic and diastolic ventricular dysfunction. Those affected by this life-limiting illness are subject to an array of burdensome symptoms, poor quality of life, prognostic uncertainty, and a relatively onerous and increasingly complex treatment regimen. This condition occurs in epidemic proportions worldwide, and given the demographic trend in societal ageing, the prevalence of heart failure is only likely to increase. The marked upturn in international migration has generated other demographic changes in recent years, and it is evident that we are living and working in ever more ethnically and culturally diverse communities. Professionals treating those with heart failure are now dealing with a much more culturally disparate clinical cohort. Given that the heart failure disease trajectory is unique to each individual, these clinicians need to ensure that their proposed treatment options and responses to the inevitable crises intrinsic to this condition are in keeping with the culturally determined values, preferences, and worldviews of these patients and their families. In this narrative review, we describe the importance of cultural awareness across a range of themes relevant to heart failure management and emphasize the centrality of cultural competence as the basis of appropriate care provision.

Adult age differences in value-based decision making

A better understanding of age-related differences in judgment and decision making is important from both theoretical and applied perspectives. In this review, we focus on value-based decisions across adulthood and specifically on how loss aversion (a relatively stronger weight of losses than gains on decisions) and the relative motivational impact of gains and losses may change with aging. In doing so, we will also cover recent findings about the effects of gain or loss incentives on performance in cognitive tasks that involve attention, learning, and remembering. We point out open questions and critical moderating variables for future theorizing and research.

Financial Fraud and Deception in Aging

Financial exploitation among older adults is a significant concern with often devastating consequences for individuals and society. Deception plays a critical role in financial exploitation, and detecting deception is challenging, especially for older adults. Susceptibility to deception in older adults is heightened by age-related changes in cognition, such as declines in processing speed and working memory, as well as socioemotional factors, including positive affect and social isolation. Additionally, neurobiological changes with age, such as reduced cortical volume and altered functional connectivity, are associated with declining deception detection and increased risk for financial exploitation among older adults. Furthermore, characteristics of deceptive messages, such as personal relevance and framing, as well as visual cues such as faces, can influence deception detection. Understanding the multifaceted factors that contribute to deception risk in aging is crucial for developing interventions and strategies to protect older adults from financial exploitation. Tailored approaches, including age-specific warnings and harmonizing artificial intelligence as well as human-centered approaches, can help mitigate the risks and protect older adults from fraud.

Facial Trustworthiness Influences Age Differences in Visual Attention Toward Credible Versus Non-credible Messages

Background and Objectives

The literature on consumer decision-making and aging suggests that older adults make less optimal buying decisions than younger adults do, partly because older adults tend to perceive salespersons' faces as more trustworthy. This study aims to directly test the difference in the effect of perceived facial trustworthiness on buying intention between younger and older adults. It also aims to reveal the underlying mechanisms of this age-related difference by testing whether a more trustworthy face disrupts older adults' attention toward credible (vs. non-credible) information to a higher degree compared with younger adults.

Research Design and Methods

A sample of 92 younger (aged 18-37 years) and 83 older (aged 60-82 years) adults viewed advertisements for 32 products while their eye movements were captured by an eye tracker to measure their fixation duration (as an indicator of attention). The advertisements varied in terms of the credibility of the content and the trustworthiness of the salesperson's face.

Results

Both age groups showed higher buying intentions for products featured in advertisements with higher credibility and facial trustworthiness. When facial trustworthiness was lower, both age groups showed greater attentional preferences for credible over non-credible content. However, this distinction in attention disappeared in older but not younger adults with an increase in facial trustworthiness.

Discussion and Implications

Our findings suggest that although facial trustworthiness generally increases buying intention of both younger and older adults, it only reduces older (but not younger) adults' attentional discrimination between credible and non-credible content. This paper offers a novel and promising mechanism for the increase in fraud vulnerability in late adulthood.

Is the information on infection prevention measures against COVID-19 reaching the target audience? A cross-sectional survey among eating and drinking services in Tokyo, Japan

Objectives

The study aims to evaluate information gathering behaviour (IGB) and its effectiveness in eating and drinking services for infection control during COVID-19.

Study design

A cross-sectional survey using anonymous self-administered questionnaires was conducted in October 2021. Participants were asked what IGB they use to obtain infection control measures, to what extent they understand the measures (and, if they do not understand them, what inhibits their comprehension), and which IGBs they do not currently use and why.

Methods

The sample included 957 eating and drinking services in Ota City, Tokyo. The response rate was 14.5%. Binomial logistic regression was used to analyse the factors associated with the baseline characteristics using Stata v.17.0.

Results

The highest proportion of respondents used television (88.0%); another large proportion (38.9%) used guidelines. Regarding difficulty in understanding the retrieved information, 'difficulty in coming up with specific actions' had the highest ratio for every IGB. Regarding reasons for not currently using IGB, 'it takes too much time to extract the necessary information' showed the highest ratios of all IGBs. Individuals over 60 years had a negative relationship with the use of guidelines and the Internet. Participants also advised that they did not use time-consuming guidelines.

Conclusion

Current information dissemination methods for information on COVID-19 infection control may not successfully convey information or reach their target populations. This study indicates the need for specific expressions and layouts to effectively share information on COVID-19. Also, special means of communication must be established to cater to individuals aged 60 and above.

Gambling and Aging: An Overview of a Risky Behavior

Gambling is a field of study that has grown since the 2000s. Much research has focused on adolescents and youth as a vulnerable population. The rate of aging gamblers is increasing; however, evidence-based knowledge of this population is still too sparse. After introducing the issue (1), this article provides a narrative review of older adults' gambling through three sections: (2) older adult gamblers (age, characteristics, and motivations), (3) gambling as a risky decision-making situation, and (4) gambling disorder related to older adults. By drawing on the existing literature from a problematization perspective, this type of review can highlight complex and original research topics and provoke thought and controversy to generate avenues for future research. This narrative review provides an overview of the existing literature on gambling among older adults and offers perspectives on how aging can affect decision-making and thus gambling for this population. Older adults are a specific population, not only in terms of the consequences of gambling disorders but also in terms of the motivations and cognitions underlying gambling behaviors. Studies on behavioral science focusing on decision-making in older adults could help in the development of public policy in terms of targeted prevention.

Strengths and Weaknesses of Everyday Financial Knowledge and Judgment Skills of Adults with ADHD

Adequate financial capability is crucial in everyday life. This capability might, however, not be given to adults with ADHD. The present study aims to determine strengths and weaknesses regarding everyday financial knowledge and judgment skills in adults with ADHD. In addition, the impact of income is explored. Forty-five adults with ADHD (M_age = 36.6, SD_age = 10.2) and 47 adults without ADHD (M_age = 38.5, SD_age = 13.0) were included and were assessed with the Financial Competence Assessment Inventory. Adults with ADHD showed decreased scores regarding awareness of the arrival of bills, knowledge of own income, having a reserve fund for unexpected expenses, the ability to state long-term financial goals, own preferences for estate management, understanding of assets, legal action for debt, access to financial advice/counseling, and the ability to compare medical insurance plans as compared with adults without ADHD (all p < 0.001). However, no effect of income was found. In conclusion, adults with ADHD have difficulties with many aspects of everyday financial knowledge and skills, which might result in a plethora of personal and legal consequences. It is, therefore, of the utmost importance that professionals who support adults with ADHD proactively ask about everyday financial functioning so that assessment, financial support, and coaching can be provided.

Pay One or Pay All? The Role of Incentive Schemes in Decision Making Across Adulthood

OBJECTIVES

This research addresses how younger and older adults' decisions and evaluations of gains and losses are affected by the way in which monetary incentives are provided. We compared 2 common incentive schemes in decision making: pay one (only a single decision is incentivized) and pay all (incentives across all decisions are accumulated).

METHOD

Younger adults (18-36 years; n = 147) and older adults (60-89 years; n = 139) participated in either a pay-one or pay-all condition and made binary choices between two-outcome monetary lotteries in gain, loss, and mixed domains. We analyzed participants' decision quality, risk taking, and psychometric test scores. Computational modeling of cumulative prospect theory served to measure sensitivity to outcomes and probabilities, loss aversion, and choice sensitivity.

RESULTS

Decision quality and risk aversion were higher in the gain than mixed or loss domain, but unaffected by age. Loss aversion was higher, and choice sensitivity was lower in older than younger adults. In the pay-one condition, the value functions were more strongly curved, and choice sensitivity was higher than in the pay-all condition.

DISCUSSION

An opportunity of accumulating incentives has similar portfolio effects on younger and older adults' decisions. In general, people appear to decide less cautiously in pay-all than pay-one scenarios. The impact of different incentive schemes should be carefully considered in aging and decision research.

Effects of Social Support and Loneliness on the Irrational Consumption Tendencies of Healthcare Products among the Elderly: A Structural Equation Model

BACKGROUND

In recent years, with the development of the social economy and an improvement in health consciousness, the levels of demand and consumption for healthcare products have been increasing rapidly among the elderly. However, the irrational consumption of healthcare products has caused widespread concern, as it can generate economic losses and have negative effects on psychological health. Therefore, it is critical to identify the variables that can reduce tendencies toward irrational consumption in the area of healthcare products. This study aimed to explore the relationship between the irrational consumption tendencies of healthcare products, social support, and loneliness among elderly people in Hangzhou, China.

METHODS

In 2021, a cross-sectional survey involving 485 elderly people from three districts in Hangzhou, China, was conducted. Descriptive statistics were calculated for socioeconomic status and demographic characteristics, level of loneliness, social support, and irrational consumption tendencies. A structural equation model was used to test the impact of social support on the irrational consumption tendencies of healthcare products among the elderly and to explore the mediating effects of loneliness.

RESULTS

The findings reveal that the average levels of social support and loneliness among the elderly were 30.63 points (total = 44 points) and 6.88 points (15 points), respectively. The average scores of the four subscales of irrational consumption tendencies, which were named susceptibility to persuasion, interpersonal influences, pursuit of added value, and fears of aging were 2.48, 2.93, 2.48, and 3.17 points (5 points), respectively. Social support had a significant effect on irrational consumption tendencies, and loneliness played a partial mediating role between social support and irrational consumption tendencies.

CONCLUSIONS

A relationship model was constructed to examine the association between loneliness, social support, and irrational consumption tendencies among older people in relation to healthcare products. From a social support and psychological perspective, advice and countermeasures are proposed to prevent the irrational consumption of healthcare products among older people.

The Influence of Message Framing on Elderly Tourists' Purchase Intentions of Health Services: A Case Study of Guangxi Bama

Traveling has become an increasingly important lifestyle for the elderly to realize active aging. The elderly are more inclined to pay attention to wellbeing-related products whilst on vacations, representing a market opportunity for providers of tourism health services. This study conducted an experiment to explore how message framing affects intentions to purchase health services in elderly tourists over the age of 59 years. A total of 216 elderly tourists from Bama, a famous wellness tourism destination in China, were recruited as participants for a single-factor (message framing: positive versus negative) experiment. Our results indicate the following: (1) message framing has a significant impact on elderly tourists' intentions to purchase health services. Compared with messages that are negatively framed, positive messages are more persuasive. (2) Perceived benefits mediate the above relationship. (3) Perceived susceptibility moderates the impact of message framing around perceived benefits, as well as the indirect effect of perceived benefits on purchase intention. Theoretically, this paper clarifies the mechanism and conditions of message framing in relation to its effects on consumer intentions, enriching knowledge about the intersection between tourism and health consumption. This paper also provides guidance for providers of health tourism who are seeking to capture the market of elderly tourists.

Aging is associated with maladaptive episodic memory-guided social decision-making

Older adults are frequent targets and victims of financial fraud. They may be especially susceptible to revictimization because of age-related changes in both episodic memory and social motivation. Here we examined these factors in a context where adaptive social decision-making requires intact associative memory for previous social interactions. Older adults made more maladaptive episodic memory-guided social decisions but not only because of poorer associative memory. Older adults were biased toward remembering people as being fair, while young adults were biased toward remembering people as being unfair. Holding memory constant, older adults engaged more with people that were familiar (regardless of the nature of the previous interaction), whereas young adults were prone to avoiding others that they remembered as being unfair. Finally, older adults were more influenced by facial appearances, choosing to interact with social partners that looked more generous, even though those perceptions were inconsistent with prior experience.

Age differences in option choice: Is the option framing effect observed among older adults?

Previous studies reported that consumers choose a higher number of options in subtractive framing (-OF), which delete the unnecessary options from the full model with all options chosen than in additive framing (+OF), which adds options to a simple base model. The purposes of this study are to examine the effect of age on option framing and the differences of product type on the option framing effect using two product scenarios (travel package and medical examination). Participants were 40 younger and 40 older adults. We measured the number of options chosen, total price, choice difficulty, and choice satisfaction. In addition, cognitive functions (coding, symbol search, digit span, arithmetic, and information) were assessed. Results revealed that older and younger adults chose more options in the -OF condition for both the scenarios. For the medical examination, older adults chose more options than did the younger adults in both -OF and +OF conditions. Developmental shift in goals and motivation related to life-span may explain the differences between the age differences.

Age differences in facial trustworthiness perception are diminished by affective processing

While perceptions of facial trustworthiness usually serve as our first references for social interactions, these impressions may ultimately turn out to be inaccurate or unreliable. Compared with younger adults, older adults generally face a higher risk of fraudulent exploitation; the characteristics of older adults' facial trustworthiness perception may play an important role in revealing the underlying mechanism of their being cheated. Previous studies have demonstrated that, in comparison with their younger counterparts, older adults tend to overestimate strangers' facial trustworthiness. In the present study, two experiments were conducted, aiming at testing (1) the age-related differences in facial trustworthiness perceptions (Experiment 1) and (2) whether any interventions (e.g., encouraging more deliberative processing or more affective processing) could be applied to help older adults reduce their tendency to overestimate trustworthiness, thus reducing their facial trustworthiness ratings to a lower level (Experiment 2). The results indicated that (1) consistent with previous studies, older adults provided higher trustworthiness ratings for unfamiliar faces than did younger adults (Experiment 1) and (2) more importantly, affective processing instead of deliberative processing could benefit older adults in their assessments of facial trustworthiness, leading them toward demonstrating similar-not significantly higher-levels of trust toward strange faces as younger adults (Experiment 2). A possible mechanism was offered, suggesting that affective processing might help older adults to detect negative cues in unfamiliar faces.

A meta-analysis of the weight of advice in decision-making

The degree to which people take advice, and the factors that influence advice-taking, are of broad interest to laypersons, professionals, and policy-makers. This meta-analysis on 346 effect sizes from 129 independent datasets (N = 17, 296) assessed the weight of advice in the judge-advisor system paradigm, as well as the influence of sample and task characteristics. Information about the advisor(s) that is suggestive of advice quality was the only unique predictor of the overall pooled weight of advice. Individuals adjusted estimates by 32%, 37%, and 48% in response to advisors described in ways that suggest low, neutral, or high quality advice, respectively. This indicates that the benefits of compromise and averaging may be lost if accurate advice is perceived to be low quality, or too much weight is given to inaccurate advice that is perceived to be high quality. When examining the three levels of perceived quality separately, advice-taking was greater for subjective and uncertain estimates, relative to objective estimates, when information about the advisor was neutral in terms of advice quality. Sample characteristics had no effect on advice-taking, thus providing no evidence that age, gender, or individualism influence the weight of advice. The findings contribute to current theoretical debates and provide direction for future research.

Conceptualization of Rice with Low Glycaemic Index: Perspectives from the Major European Consumers

Rice and cereal consumption has become a concern for consumers due to usually high glycaemic indexes (GI), which is a critical issue for a balanced and healthy diet. Therefore, the development of new products with low GI is an important target of the industry, particularly in countries with high consumption. This study assesses consumers’ perceptions about “rice” and “rice with low GI” and evaluates the effect of consumers’ rice consumption profiles through the application of a free word association technique in a structured self-administered electronic questionnaire with 256 Portuguese consumers (the European market with the highest per capita consumption of rice by far). The frequency of rice consumption was evaluated, and the consumption profile was determined through a hierarchical cluster analysis, with 9% identified as daily consumers. The response words were categorized by the triangulation technique, and the association between the word categories and dimensions, sociodemographic characteristics, and consumption profile were determined. Respondents most frequently associated “rice” with rice dishes, its sensory attributes, and nutrition, highlighting the satisfaction of nutritional and hedonic needs. Consumers revealed positive expectations in relation to the functionality of “rice with low GI”. The consumers’ rice consumption profiles, sex, age, and educational levels influenced their perception towards “rice“ and “rice with low GI”. This study provides important insights for the industry to develop a consumer-oriented, low GI rice product.

Testing the effects on information use by older versus younger women of modality and narration style in a hospital report card

BACKGROUND

Hospital report cards (HRCs) are usually presented in a textual and factual format, likely hampering information processing.

OBJECTIVE

This study aimed to investigate the effects of audiovisual and narrative information in HRCs on user responses, and to test differences between older and younger women.

DESIGN

A 2 (modality [textual vs. audiovisual]) × 3 (narration style [factual vs. process narrative vs. experience narrative]) online experiment was conducted. Information about breast cancer care was used as a case example. Age (younger [<65] vs. older [≥65]) was included as a potential effect modifier.

SETTING AND PARTICIPANTS

A total of 631 disease-naïve women (Mage  = 56.06) completed an online survey. The outcomes were perceived cognitive load, satisfaction, comprehension, information recall and decisional conflict. Data were analysed using AN(C)OVAs.

RESULTS

Audiovisual (vs. textual) information resulted in higher information satisfaction across age groups, but was associated with lower comprehension in older women. An experience narrative (vs. factual information) increased satisfaction with attractiveness and emotional support of the information only in older women. A three-way interaction effect was found, suggesting that older women were most satisfied with the comprehensibility of audiovisual factual or textual process narrative information. Younger women were most satisfied with the comprehensibility of audiovisual process narrative or textual factual information.

DISCUSSION AND CONCLUSION

Audiovisual and narrative information in an HRC showed beneficial effects on satisfaction measures. In particular, audiovisual information could be incorporated into HRCs to increase satisfaction with information.

PUBLIC CONTRIBUTION

Lay persons helped in optimizing the visuals used in the stimulus materials by checking for clarity.

The Effect of Trustor Age and Trustee Age on Trustworthiness Judgments: An Event-Related Potential Study

Perceived trustworthiness based on facial appearance plays an important role in interpersonal trust and cooperative behavior. Interpersonal trust behaviors involve both trustors and trustees. However, there is no clear conclusion on how the age of the two individuals affects interpersonal trust behaviors. Therefore, this study used the trust game task to explore the differences in trust behaviors between two different age groups in response to faces of different ages and analyzed whether such differences were apparent in the face processing stage. The behavioral results showed that only younger adults invested more money with older partners than younger ones; that is, younger adults trusted older faces more. The event-related potential (ERP) analyses showed that in the early stage of face processing, younger faces elicited more negative N170 than older faces; at the same time, older faces elicited more positive VPP than younger faces, and younger adults had more positive VPP than older adults. In the middle and late stages of face processing, younger faces elicited more negative FRN than older faces in younger adults but not in older adults. In addition, older faces elicited more positive LPP than younger faces in older adults but not in younger adults. The neural analyses suggested that age-related differences in facial trustworthiness judgments might occur in the later stages of face processing. Combining the behavioral and neural results, we found a dissociation between trustworthiness perceptions and trust behaviors in both younger and older adults, which may provide insight into how to prevent older adults from being deceived.

Testing the Foreign Language Effect on Cognitive Reflection in Older Adults

An increasing number of people around the world communicate in more than one language, resulting in them having to make decisions in a foreign language on a daily basis. Interestingly, a burgeoning body of literature suggests that people’s decision-making is affected by whether they are reasoning in their native language (NL) or their foreign language (FL). According to the foreign language effect (FLe), people are less susceptible to bias in many decision-making tasks and more likely to display utilitarian cost-benefit analysis in moral decision-making when reasoning in a FL. While these differences have often been attributed to a reduced emotionality in the FL, an emerging body of literature has started to test the extent to which these could be attributable to increased deliberation in the FL. The present study tests whether increased deliberation leads to a FLe on cognitive reflection in a population of older adults (M_age = 65.1), from the successful aging project in Umeå, Sweden. We explored whether performance on a 6-item version of the cognitive reflection test (CRT) adapted to Swedish would differ between participants for whom Swedish was their NL and those for whom Swedish was their FL. The CRT is a task designed to elicit an incorrect, intuitive answer. In order to override the intuitive answer, one requires engaging in deliberative, analytical thinking to determine the correct answer. Therefore, we hypothesized that if thinking in a FL increases deliberation, then those performing the task in their FL would exhibit higher accuracy rates than those performing in their NL. Our results showed that age and level of education predicted performance on the task but performance on the CRT did not differ between the NL and the FL groups. In addition, in the FL group, proficiency in the FL was not related to performance in the CRT. Our results, therefore, do not provide evidence that thinking in a FL increases deliberation in a group of older adults performing a logical reasoning task that is not typically associated with an emotional connotation.

Aging Impairs Inhibitory Control Over Incidental Cues: A Construal-Level Perspective

Age-related changes in decision making have been attributed to deterioration of cognitive skills, such as learning and memory. On the basis of past research showing age-related decreases in the ability to inhibit irrelevant information, we hypothesize that these changes occur, in part, because of older adults' tendency to give more weight to low-level, subordinate, and goal-irrelevant information than younger adults do. Consistent with this hypothesis, our findings demonstrated that young adults are willing to pay more for a product with superior end attributes than a product with superior means attributes (Study 1, N = 200) and are more satisfied after an experience with superior end than means attributes (Study 2, N = 399). Young adults are also more satisfied with a goal-relevant than with a goal-irrelevant product (Study 3, N = 201; Study 4, N = 200, preregistered). Importantly, these effects were attenuated with age. Implications for research on construal level and aging, as well as implications for policymakers, are discussed.

Getting to the Heart of the Matter in Later Life: The Central Role of Affect in Health Message Framing

BACKGROUND AND OBJECTIVES

Adopting healthy behaviors is often influenced by message framing; gain-framed messages emphasize the benefits of engaging in a behavior, whereas loss-framed messages highlight the consequences of not engaging in a behavior. Research has begun to uncover the underlying affective pathways involved in message framing. In the current study, we examined the role of affect in message framing to encourage exercise program enrollment among older adults.

RESEARCH DESIGN AND METHODS

We mailed flyers to 126 volunteers assigned to a gain- or loss-framed condition and measured their affective reactions to the flyer and enrollment intentions. After the call, participants had the opportunity to contact us to enroll.

RESULTS

Gain versus loss framing led to more positive affect toward the flyer, which predicted intentions and enrollment effort. In indirect effect analyses, frame indirectly influenced intentions and enrollment effort via positive affect.

DISCUSSION AND IMPLICATIONS

Although message framing plays an indirect role in influencing behavior, affect plays a central role.

Age Influences Loss Aversion Through Effects on Posterior Cingulate Cortical Thickness

Decision-making strategies shift during normal aging and can profoundly affect wellbeing. Although overweighing losses compared to gains, termed "loss aversion," plays an important role in choice selection, the age trajectory of this effect and how it may be influenced by associated changes in brain structure remain unclear. We therefore investigated the relationship between age and loss aversion, and tested for its mediation by cortical thinning in brain regions that are susceptible to age-related declines and are implicated in loss aversion - the insular, orbitofrontal, and anterior and posterior cingulate cortices. Healthy participants (n = 106, 17-54 years) performed the Loss Aversion Task. A subgroup (n = 78) provided structural magnetic resonance imaging scans. Loss aversion followed a curvilinear trajectory, declining in young adulthood and increasing in middle-age, and thinning of the posterior cingulate cortex mediated this trajectory. The findings suggest that beyond a threshold in middle adulthood, atrophy of the posterior cingulate cortex influences loss aversion.

Do Decision Aids Benefit Patients with Chronic Musculoskeletal Pain? A Systematic Review

OBJECTIVE

To review the effect of patient decision aids for adults making treatment decisions regarding the management of chronic musculoskeletal pain.

METHODS

We performed a systematic review of randomized controlled trials of adults using patient decision aids to make treatment decisions for chronic musculoskeletal pain in the outpatient setting.

RESULTS

Of 477 records screened, 17 met the inclusion criteria. Chronic musculoskeletal pain conditions included osteoarthritis of the hip, knee, or trapeziometacarpal joint and back pain. Thirteen studies evaluated the use of a decision aid for deciding between surgical and nonsurgical management. The remaining four studies evaluated decision aids for nonsurgical treatment options. Outcomes included decision quality, pain, function, and surgery utilization. The effects of decision aids on decision-making outcomes were mixed. Comparing decision aids with usual care, all five studies that examined knowledge scores found improvement in patient knowledge. None of the four studies that evaluated satisfaction with the decision-making process found a difference with use of a decision aid. There was limited and inconsistent data on other decision-related outcomes. Of the eight studies that evaluated surgery utilization, seven found no difference in surgery rates with use of a decision aid. Five studies made comparisons between different types of decision aids, and there was no clearly superior format.

CONCLUSIONS

Decision aids may improve patients' knowledge about treatment options for chronic musculoskeletal pain but largely did not impact other outcomes. Future efforts should focus on improving the effectiveness of decision aids and incorporating nonpharmacologic and nonsurgical management options.

Effect of stress and avoidant coping on depression and the moderating role of age among men who have sex with men: Findings from a 6-month prospective cohort study

BACKGROUND

Men who have sex with men (MSM) are at increased risk of mental health problems. Few studies have examined the risk factors for mental health problems of Chinese MSM and identified potential moderators using a longitudinal design.

OBJECTIVES

The present study examined the effect of stress and avoidant coping on depression among MSM, and the moderating role of age on such relationship.

METHODOLOGY

A 6-month observational prospective cohort study was conducted among Chinese MSM. Respectively 592 and 402 MSM completed a survey at baseline and 6-month follow-up.

RESULTS

The prevalence of probable depression was 36.1% at baseline and 34.1% at 6-month follow-up. After adjusting for background characteristics and baseline depression score, both stress (β = .22, p<.05) and avoidant coping (β = .14, p<.05) showed significant positive relationship with depression at 6-month follow-up. The interaction effect of age and stress / avoidant coping was also significant. The effect of stress on depression was stronger among younger MSM, and the effect of avoidant coping on depression was significant among younger MSM but non-significant among older MSM.

CONCLUSIONS

Mental health promotion for MSM should reduce stress and avoidant coping, and specific intervention should be designed for younger MSM.

Age differences in risk taking: now you see them, now you don't

Older age has often, but not always, been associated with less risk taking. Inconsistencies may be due to diversity in the risk-taking measures used and/or individual differences in cognitive abilities. We investigated the robustness of age differences in risk taking across three measures, and tested whether age differences in risk taking remained after accounting for cognitive abilities. Younger (aged 25-36) and older (aged 60+) adults completed behavioral (i.e., Balloon Analogue Risk Task, BART) and self-report (i.e., framing tasks and Choice Dilemmas Questionnaire) measures of risk, as well as several measures of cognitive ability (i.e., analytic thinking, numeracy, processing speed, memory, and attention). Older adults showed significantly less risk taking than younger adults on the behavioral measure of risk, but not on the two self-report measures. Older adults also had significantly lower analytic thinking, slower processing speed, and worse executive control compared to younger adults. Less risk taking on the BART was associated with lower analytic thinking and numeracy, slower processing speed, and worse shifting of attention. Age differences in risk taking on the BART remained after accounting for older adults' lower scores on tests of cognitive abilities. Implications for measuring age differences in risk taking are discussed.

Fostering Self-Management of Everyday Memory in Older Adults: A New Intervention Approach

Traditional memory strategy training interventions improve older adults' performance on tests of episodic memory, but have limited transfer to episodic memory tasks, let alone to everyday memory. We argue that an alternative approach is needed to assist older adults to compensate for age-related cognitive declines and to maintain functional capacity in their own natural ecologies. We outline a set of principles regarding how interventions can successfully train older adults to increase successful goal pursuit to reduce risks of everyday memory failures. We argue that training individuals to use metacognitive self-regulatory strategies to proactively manage formulation and pursuit of daily goals can compensate for age-related cognitive changes and increase the likelihood of goal attainment. We then describe an intervention approach that instantiates these principles in a multi-modal intervention that is unique in its three-phase approach: (1) individualized assessment of an individual's current approaches to self-regulation; (2) training memory strategies, self-management skills, and new habits of mind in a group training context; and (3) a behavioral shaping period in which individuals receive coaching and feedback on their efforts to use trained procedures to improve everyday cognition. A recently completed study conducted an initial test of the intervention, with highly encouraging results. We advocate further efforts to replicate, extend, and fine-tune this type of intervention. The ultimate goal is to be able to deliver the intervention in a way that increases its potential reach, including to subpopulations of older adults at risk for everyday cognitive impairments.

Financial decision-making in a community sample of adults with and without current symptoms of ADHD

Research found that adults with attention deficit hyperactivity disorder (ADHD) have more problems with financial decision-making than healthy controls. The present study investigates the impact of symptoms of ADHD on impulsive buying and the use of financial decision styles. Furthermore, the influence of personality, symptoms of depression and demographics on the association between ADHD and these aspects of financial decision-making is evaluated. A community sample of 1292 participants (age range 18–93 years, 45.4% male) completed questionnaires related to ADHD, impulsive buying, financial decision styles, personal financial situation, depression and personality. Four groups were formed based on self-reported ADHD symptoms: an ‘ADHD’ group (n = 45), an ‘Adult-only ADHD’ group (n = 57), a ‘Subthreshold ADHD’ group (n = 162) and a ‘No ADHD’ group (n = 265). Groups were compared using ANOVA and chi-square tests. Furthermore, multiple regression analyses in the complete sample were employed to examine the association between ADHD and financial decision-making. The ADHD and Adult-only ADHD groups reported significantly more impulsive buying, used more often an avoidant or spontaneous decision style and less often saved money compared to the No ADHD group. Regression analyses revealed that impulsive buying and financial decision styles were not significantly associated with ADHD symptoms when controlling for personality, symptoms of depression and demographics. The present study confirms previous research on adults with ADHD by indicating more impulsive buying and a more frequent use of disadvantageous financial decision styles (i.e., avoidant and spontaneous styles) in individuals with an elevated number of current symptoms of ADHD compared to individuals without symptoms of ADHD. Personality and demographic variables were found to be related to both impulsive buying and the use of specific financial decision styles and might be of influence on the association between impulsive buying, the use of financial decision styles and ADHD.

Adapting Online Patient Decision Aids: Effects of Modality and Narration Style on Patients' Satisfaction, Information Recall and Informed Decision Making

Audiovisual and narrative information are often used in online decision aids. However, few studies have tested whether these strategies are more effective compared to other types of information. We tested the effect of these strategies on satisfaction with the information, recall and informed decision-making in a 2 (Modality: audiovisual vs. textual) x 2 (Narration style: narrative vs. factual) experimental design. Data was collected in an online experiment among 262 analogue cancer patients. Since most cancer patients are older people, we also assessed if the effectiveness of these strategies differs depending on the patient's age. Data was analyzed using Structural Equation Modeling. Findings showed audiovisual modality had a positive effect on satisfaction. Moreover, audiovisual modality improved recall, both directly and indirectly via satisfaction, which subsequently resulted in better-informed decision-making. Narratives resulted in more satisfaction, but not better recall or informed decision-making. These effects were found in patients of all ages.

User-Centered Design and Evaluation of a Web-Based Decision Aid for Older Adults Living With Mild Cognitive Impairment and Their Health Care Providers: Mixed Methods Study

Background

Mild cognitive impairment (MCI) is often considered a transitional state between normal and pathologic (eg, dementia) cognitive aging. Although its prognosis varies largely, the diagnosis carries the risk of causing uncertainty and overtreatment of older adults with MCI who may never progress to dementia. Decision aids help people become better informed and more involved in decision making by providing evidence-based information about options and possible outcomes and by assisting them in clarifying their personal values in relation to the decision to be made.

Objective

This study aimed to incorporate features that best support values clarification and adjust the level of detail of a web-based decision aid for individuals with MCI.

Methods

We conducted a rapid review to identify options to maintain or improve cognitive functions in individuals with MCI. The evidence was structured into a novel web-based decision aid designed in collaboration with digital specialists and graphic designers. Qualitative and user-centered evaluations were used to draw on users’ knowledge, clarify values, and inform potential adoption in routine clinical practice. We invited clinicians, older adults with MCI, and their caregivers to evaluate the decision aid in 6 consecutive rounds, with new participants in each round. Quantitative data were collected using the Values Clarity and Informed subscales of the Decisional Conflict Scale, the System Usability Scale, the Ottawa Acceptability questionnaire, and a 5-point satisfaction rating scale. We verified their comprehension using a teach-back method and recorded usability issues. We recorded the audio and computer screen during the session. An inductive thematic qualitative analysis approach was used to identify and describe the issues that arose. After each round, an expert panel met to prioritize and find solutions to mitigate the issues. An integrated analysis was conducted to confirm our choices.

Results

A total of 7 clinicians (social workers, nurses, family physicians, psychologists) and 12 older (≥60 years) community-dwelling individuals with MCI, half of them women, with education levels going from none to university diploma, were recruited and completed testing. The thematic analysis revealed 3 major issues. First, the user should be guided through the decision-making process by tailoring the presentation of options to users’ priorities using the values clarification exercise. Second, its content should be simple, but not simplistic, notably by using information layering, plain language, and pictograms. Third, the interface should be intuitive and user friendly, utilize pop-up windows and information tips, avoid drop-down menus, and limit the need to scroll down. The quantitative assessments corroborated the qualitative findings.

Conclusions

This project resulted in a promising web-based decision aid that can support decision making for MCI intervention, based on the personal values and preferences of the users. Further ongoing research will allow its implementation to be tested in clinical settings.

The Age-related Neural Strategy Alterations in Decision Making Under Risk

Previous studies have shown that aging is associated with changes in decision behavior. However, the neural mechanisms that underpin such age differences are inadequately understood. In this study, we aim to characterize the optimal neural model underlying a dynamic decision making task in both young and older adults, and further examine the age differences from the perspective of effective connectivity. Twenty-five young and 23 older adults performed a dynamic risk taking task, i.e., the balloon analogue risk task, in the functional magnetic resonance imaging scanner. The dynamic causal modeling analysis, with the coupling between the ventromedial prefrontal cortex (VMPFC), dorsolateral prefrontal cortex (DLPFC) and anterior insula (AI) that were identified in our task-related activation and psychophysiological interaction analysis, was performed to address the best fitting neural model and characterize age differences. Although both age groups adopted the same optimal model with bidirectional connection between the VMPFC and DLPFC, older adults exhibited up-regulation in several connections and among which the increased modulatory effect of AI-to-VMPFC subserving their decision quality. Our finding suggests that older adults might utilize different neural strategy via compensation to counteract the impact of advanced age in risk taking process.

Pharmaceutical Benefit-Risk Perception and Age Differences in the USA and Germany

INTRODUCTION

Understanding how patients of all ages perceive the benefits and risks of medical treatments is vitally important. Yet, the role of older age on pharmaceutical benefit-risk perceptions has hardly been empirically investigated as a central focus of study.

OBJECTIVE

This study tested the generalizability of recent pilot findings to explore benefit-risk perception age differences between adults aged 65 years old and over (older group) and those aged 18-64 years old (younger group).

METHODS

An online survey representative for age, sex, and education was conducted in Ohio, USA (N = 1520) and Germany (N = 1536). A combination of benefit, risk, and affect questions measured respondents' perceptions of 18 medicines, tests, vaccines, and procedures. Further questions investigated general perceptions of side effects and effectiveness, as well as respondents' reliance on different sources of medicines information.

RESULTS

Clear age differences were found that strongly support recent pilot findings. Older adults perceived prescription medicines significantly more positively than their younger counterparts. They had significantly higher benefit and lower risk perceptions for most, but not all, medical treatments investigated. Older adults' benefit-risk perceptions were more strongly correlated with positive/negative affect, that is, their positive/negative experiences and feelings of "goodness" or "badness" they associated with each medical treatment investigated. They also perceived doctors and pharmacists as more competent and trustworthy. Contrary to popular belief, both age groups ranked their reliance on 15 different medical (e.g. doctors), societal (e.g. social media), industry (e.g. pharmaceutical company websites), and governmental (e.g. regulatory agencies) sources of medicines information remarkably similarly.

CONCLUSION

Age has an important role in patients' pharmaceutical benefit-risk perceptions. Findings show that, when designing messages, benefit-risk communicators should incorporate age differences. This includes older patients' positive perceptions of pharmaceuticals, greater reliance on affect, and information seeking versus scanning behaviour. Field experiments are now needed to test the effectiveness of such changes for improving benefit-risk communication practice.

Differential focus on probability and losses between young and older adults in risky decision-making

We examined young and older adults' use of descriptive information about risk (i.e., probability and expected value) in financial decision-making. In Experiment 1, participants chose between lotteries in pairs of bets that offered either two risky gains or one risky gain and one sure gain. Whereas they showed a strong and indiscriminate preference for high-probability gambles in risky-risky pairs, they selected sure options at high rates and risky options at low rates in risky-sure pairs, with slightly stronger effects in older relative to young adults due to age differences in ability. Experiment 2 involved the same task but in terms of losses. Participants, especially older adults, preferred low-probability gambles not accounted for by age differences in ability. Results suggest minimal consideration of expected value and a strong focus on probabilities in decision-making. They also suggest that cognitive ability and chronic goals differentially influence age effects depending on risk context.

Decision-making profile in older adults: the influence of cognitive impairment, premorbid intelligence and depressive symptoms

OBJECTIVE

Decision-making (DM) is a component of executive functioning. DM is essential to make proper decisions regarding important life and health issues. DM can be impaired in cognitive disorders among older adults, but current literature is scarce. The aim of this study was to evaluate the DM profile in participants with and without cognitive impairment.

DESIGN

Cross-sectional analysis of a cohort study on cognitive aging.

PARTICIPANTS

143 older adults.

SETTING

University-based memory clinic.

METHODS

Patients comprised three groups after inclusion and exclusion criteria: healthy controls (n=29), mild cognitive impairment (n=81) and dementia (n=33). Participants were evaluated using an extensive neuropsychological protocol. DM profile was evaluated by the Melbourne Decision Making Questionnaire. Multinomial logistic regression was used to evaluate associations between age, sex, educational level, estimated intelligence quotient (IQ), cognitive disorders, depressive or anxiety symptoms, and the DM profiles.

RESULTS

The most prevalent DM profile was the vigilant type, having a prevalence of 64.3%. The vigilant profile also predominated in all three groups. The multinomial logistic regression showed that the avoidance profile (i.e. buck-passing) was associated with a greater presence of dementia (p=0.046) and depressive symptoms (p=0.024), but with less anxious symptoms (p=0.047). The procrastination profile was also associated with depressive symptoms (p=0.048). Finally, the hypervigilant profile was associated with a lower pre-morbid IQ (p=0.007).

CONCLUSION

Older adults with cognitive impairment tended to make more unfavorable choices and have a more dysfunctional DM profile compared to healthy elders.

Cognitive Aging and Tests of Rationality

We investigated whether older adults are more likely than younger adults to violate a foundational property of rational decision making, the axiom of transitive preference. Our experiment consisted of two groups, older (ages 60-75; 21 participants) and younger (ages 18-30; 20 participants) adults. We used Bayesian model selection to investigate whether individuals were better described via (transitive) weak order-based decision strategies or (possibly intransitive) lexicographic semiorder decision strategies. We found weak evidence for the hypothesis that older adults violate transitivity at a higher rate than younger adults. At the same time, a hierarchical Bayesian analysis suggests that, in this study, the distribution of decision strategies across individuals is similar for both older and younger adults.

Information use in risky decision making: Do age differences depend on affective context?

The current study focused on the degree to which decision context (deliberative vs. affective) differentially impacted the use of available information about uncertainty (i.e., probability, positive and negative outcome magnitudes, expected value, and variance/risk) when older adults were faced with decisions under risk. In addition, we examined whether individual differences in general mental ability and executive function moderated the associations between age and information use. Participants (N = 96) completed a neuropsychological assessment and the hot (affective) and cold (deliberative) versions of an explicit risk task. Our results did not find a significant Age × Hot/Cold Condition interaction on overall risk-taking. However, we found that older adults were less likely to use the full decision information available regardless of the decision context. This finding suggested more global age differences in information use. Moreover, older adults were less likely to make expected-value sensitive decisions, regardless of the hot/cold context. Finally, we found that low performance on measures of executive functioning, but not general mental ability, appears to be a risk factor for lower information use. This pattern appears in middle age and progressively becomes stronger in older age. The current work provides evidence that common underlying decision processes may operate in risk tasks deemed either affective or deliberative. It further suggests that underlying mechanisms such as information use may be paramount, relative to differences in the affective context. Additionally, individual differences in neuropsychological function may act as a moderator in the tendency to use available information across affective context. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Neural mechanisms of decision-making in aging

The present review synthesizes findings on decision neuroscience and aging by focusing on decision processes that have been extensively studied in neuroeconomics and critically assessing the driving mechanisms of age-related change. The paper first highlights age-related changes to key brain structures that have been implicated in decision-making, then, reviews specific decision components and discusses investigations of age-related changes to their neural mechanisms. The review also weighs evidence for organic brain aging versus age-related changes to social and psychological factors in mediating age effects. Reviewed findings are discussed in the context of theories and frameworks that have been used to explain trajectories of change in decision-making across adulthood. This article is categorized under: Psychology > Development and Aging Psychology > Reasoning and Decision-Making Neuroscience > Cognition.

Susceptibility to Spear-Phishing Emails: Effects of Internet User Demographics and Email Content

Phishing is fundamental to cyber attacks. This research determined the effect of Internet user age and email content such as weapons of influence (persuasive techniques that attackers can use to lure individuals to fall for an attack) and life domains (a specific topic or aspect of an individual's life that attackers can focus an emails on) on spear-phishing (targeted phishing) susceptibility. One-hundred young and 58 older users received, without their knowledge, daily simulated phishing emails over 21 days. A browser plugin recorded their clicking on links in the emails as an indicator of their susceptibility. Forty-three percent of users fell for the simulated phishing emails, with older women showing the highest susceptibility. While susceptibility in young users declined across the study, susceptibility in older users remained stable. The relative effectiveness of the attacks differed by weapons of influence and life domains with age-group variability. In addition, older compared to young users reported lower susceptibility awareness. These findings support effects of Internet user demographics and email content on susceptibility to phishing and emphasize the need for personalization of the next generation of security solutions.

Taking the Biggest First: Age Differences in Preferences for Monetary and Hedonic Sequences

OBJECTIVES

People face decisions about how to sequence payments and events, including when to schedule bigger events relative to smaller ones. We examine age differences in these sequence preferences.

METHODS

We gave a national adult life-span sample (n = 1,296, mean = 53.06 years, standard deviation = 16.33) four scenarios describing a positive or negative hedonic (enjoyable weekends, painful dental procedures) or monetary (receiving versus paying money) event. We considered associations among age, sequence preferences, three self-reported decision-making processes-emphasizing experience, emotion, and reasoning-and two dimensions of future time perspective-focusing on future opportunities and limited time.

RESULTS

Older age was associated with taking the "biggest" event sooner instead of later, especially for receiving money, but also for the other three scenarios. Older age was associated with greater reported use of reason and experience and lesser reported use of emotion. These decision-making processes played a role in understanding age differences in sequence preferences, but future time perspective did not.

DISCUSSION

We discuss "taking the biggest first" preferences in light of prior mixed findings on age differences in sequence preferences. We highlight the distinct roles of experience- and emotion-based decision-making processes. We propose applications to financial and health-care settings.

Investigating the Robustness of the Illusory Truth Effect Across Individual Differences in Cognitive Ability, Need for Cognitive Closure, and Cognitive Style

People are more inclined to believe that information is true if they have encountered it before. Little is known about whether this illusory truth effect is influenced by individual differences in cognition. In seven studies (combined N = 2,196), using both trivia statements (Studies 1-6) and partisan news headlines (Study 7), we investigate moderation by three factors that have been shown to play a critical role in epistemic processes: cognitive ability (Studies 1, 2, 5), need for cognitive closure (Study 1), and cognitive style, that is, reliance on intuitive versus analytic thinking (Studies 1, 3-7). All studies showed a significant illusory truth effect, but there was no evidence for moderation by any of the cognitive measures across studies. These results indicate that the illusory truth effect is robust to individual differences in cognitive ability, need for cognitive closure, and cognitive style.

A Tool to Assess Patient and Surrogate Knowledge About the POLST (Physician Orders for Life-Sustaining Treatment) Program

CONTEXT

It is especially important that patients are well informed when making high-stakes, preference-sensitive decisions like those on the Physician Orders for Life-Sustaining Treatment (POLST) form. However, there is currently no way to easily evaluate whether patients understand key concepts when making these important decisions.

OBJECTIVES

To develop a POLST knowledge survey.

METHODS

Expert (n = 62) ratings of key POLST facts were used to select items for a POLST knowledge survey. The survey was administered to nursing facility residents (n = 97) and surrogate decision-makers (n = 112). A subset (n = 135) were re-administered the survey after a standardized advance care planning discussion to assess the scale's responsiveness to change.

RESULTS

The 19-item survey demonstrated adequate reliability (α = 0.72.). Residents' scores (x = 11.4, standard deviation 3.3) were significantly lower than surrogate scores (x = 14.7, standard deviation 2.5) (P < 0.001). Scores for both groups increased significantly after administration of a standardized advance care planning discussion (P < 0.001). Although being a surrogate, age, race, education, cognitive functioning, and health literacy were significantly associated with higher POLST Knowledge Survey scores in univariate analyses, only being a surrogate (P < 0.001) and being white (P = 0.028) remained significantly associated with higher scores in multivariate analyses.

CONCLUSION

The 19-item POLST Knowledge Survey demonstrated adequate reliability and responsiveness to change. Findings suggest the survey could be used to identify knowledge deficits and provide targeted education to ensure adequate understanding of key clinical decisions when completing POLST.

CISDA: Changes in Integration for Social Decisions in Aging

The aging of our population has been accompanied by increasing concerns about older adults' vulnerability to violations of trust and a growing interest in normative age-related changes to decision making involving social partners. This intersection has spurred research on age-related neurocognitive and affective changes underlying social decision making. Based on our review and synthesis of this literature, we propose a specification that targets social decision making in aging to the recently proposed Affect-Integration-Motivation (AIM) framework. Our framework specification, Changes in Integration for Social Decisions in Aging (CISDA), emphasizes three key components of value integration with particular relevance for social decisions in aging: theory of mind, emotion regulation, and memory for past experience. CISDA builds on converging research from economic decision making, cognitive neuroscience, and lifespan development to outline how age-related changes to neurocognition and behavior impact social decision making. We conclude with recommendations for future research based on CISDA's predictions, including implications for the development of interventions to enhance social decision outcomes in older adults. This article is categorized under: Economics > Individual Decision Making Psychology > Reasoning and Decision Making Psychology > Development and Aging Neuroscience > Cognition.

Shared decision-making about cardiovascular disease medication in older people: a qualitative study of patient experiences in general practice

OBJECTIVES

To explore older people's perspectives and experiences with shared decision-making (SDM) about medication for cardiovascular disease (CVD) prevention.

DESIGN, SETTING AND PARTICIPANTS

Semi-structured interviews with 30 general practice patients aged 75 years and older in New South Wales, Australia, who had elevated CVD risk factors (blood pressure, cholesterol) or had received CVD-related lifestyle advice. Data were analysed by multiple researchers using Framework analysis.

RESULTS

Twenty eight participants out of 30 were on CVD prevention medication, half with established CVD. We outlined patient experiences using the four steps of the SDM process, identifying key barriers and challenges: Step 1. Choice awareness: taking medication for CVD prevention was generally not recognised as a decision requiring patient input; Step 2. Discuss benefits/harms options: CVD prevention poorly understood with emphasis on benefits; Step 3. Explore preferences: goals, values and preferences (eg, length of life vs quality of life, reducing disease burden vs risk reduction) varied widely but generally not discussed with the general practitioner; Step 4. Making the decision: overall preference for directive approach, but some patients wanted more active involvement. Themes were similar across primary and secondary CVD prevention, different levels of self-reported health and people on and off medication.

CONCLUSIONS

Results demonstrate how older participants vary widely in their health goals and preferences for treatment outcomes, suggesting that CVD prevention decisions are preference sensitive. Combined with the fact that the vast majority of participants were taking medications, and few understood the aims and potential benefits and harms of CVD prevention, it seems that older patients are not always making an informed decision. Our findings highlight potentially modifiable barriers to greater participation of older people in SDM about CVD prevention medication and prevention in general.

Metacognitive-strategy training promotes decision-making ability in older adults

Research on decision making and aging has shown that some decision-making skills decrease with age. Despite these age-related declines, no study has yet investigated the possibility of promoting improvements in decision-making skills in older adults. The present study was designed to address this gap in literature by examining the efficacy of a metacognitive-strategy decision-making training on practiced and non-practiced tasks. The training was based on the use of specific metacognitive principles and analytical strategies for promoting an analytical mode of thinking in the decision-making process. We examined 66 older adults (Mage= 67.52 years, SD = 5.38; age range 60-81) assigned to two training groups: a metacognitive-strategy decision-making training group and an active control group involved in a strategic memory intervention. Both training groups attended four 2-hour training sessions conducted once a week. Results showed that, after intervention, the decision-making training group improved their decision-making skills significantly more than the active control training group. Crucially, the positive effect of the training was evident in both practiced and non-practiced decision-making tasks. This is the first study investigating the efficacy of a decision-making training in older adults based on metacognitive and strategic principles.

Increasing influenza and pneumococcal vaccine uptake in the elderly: study protocol for the multi-methods prospective intervention study Vaccination60

Background

Influenza and pneumococcal vaccination can prevent disease and potentially life-threatening complications like sepsis. Elderly people have an increased risk of severe disease and therefore constitute a major target group for vaccination. To increase vaccination coverage, targeted interventions are needed that take theory-based specific determinants of vaccination behaviour into account. Moreover, message and campaign design should consider specific age-related characteristics (e.g., information processing, media use). The aim of this study is (i) to identify the specific informational and interventional needs of this risk group, (ii) to design and implement a targeted intervention aiming to decrease vaccine hesitancy, increase vaccine uptake and decrease the health and economic burden due to the respective diseases, and (iii) to measure the effect of this evidence-informed intervention on various levels.

Methods

Prospective, multi-methods intervention study targeting individuals aged ≥60 years in a model region in Germany (federal state of Thuringia, 500,000 inhabitants ≥60 years old). The development of the intervention follows theory-based and evidence-informed principles: Data from a cross-sectional representative study provide insights into specific determinants of the target group’s vaccination behaviour. Additionally, media use is analysed to identify adequate communication channels for specific subgroups.

In pilot studies, the intervention materials are adapted to the specific cognitive requirements of the target group. For development and implementation of the intervention, an interdisciplinary and trans-sectoral approach is used, including psychology, communication science, design, medical science, epidemiology and various public health players. The intervention will be implemented in autumn and winter 2017/18 and 2018/19 and adjusted in between. Evaluation of the intervention includes: awareness, use and recall of intervention materials, effects on changes in determinants of vaccination behaviour, self-reported vaccine uptake, and vaccination coverage in the intervention area (primary outcomes), as well as disease incidences (secondary outcomes) and the economic burden of influenza, pneumonia, invasive pneumococcal disease and sepsis for the healthcare system (tertiary outcomes).

Discussion

The data will add to the body of evidence on the effectiveness of evidence-informed vaccination campaign development as well as on the clinical and economic effects of pneumococcal and influenza vaccination. The effect of the intervention will teach valuable lessons about the principles of campaign development and evaluation, and can motivate a subsequent nationwide intervention.

Trial registration

DRKS00012653. Registered 24.11.2017. Retrospectively registered.

Respond, don't react: The influence of mindfulness training on performance monitoring in older adults

A sizeable body of literature demonstrates positive effects of mindfulness training on brain, behavior, and psychological processes in both novice and expert practitioners as compared to non-meditators. However, only more recently has research begun to examine the specific mechanisms by which mindfulness exerts these effects. In the current study, we used event-related potentials (error-related negativity (ERN), error positivity (Pe)) to test the hypothesis that performance monitoring is one such mechanism. We conducted a randomized controlled trial in healthy older adults (n = 36), relevant because markers of performance monitoring are known to decline with normal aging. Compared to an active control condition, mindfulness participants showed an increase in the ERN, without an increase in the Pe. Participants in both groups reported a reduction in self-report of anxiety and self-judgment of one's own mental functioning, indicating the subjective impression of benefit from each intervention type. The current results are important insofar as they support the purported self-regulatory functions of mindfulness (i.e., learning to respond, not react), as well as demonstrating that such positive effects can be obtained in an older adult sample, both of which have important implications for intervention.

Use of feedback to improve mental number line representations in primary care clinics

BACKGROUND

As patients become more engaged in decisions regarding their medical care, they must weigh the potential benefits and harms of different treatments. Patients who are low in numeracy may be at a disadvantage when making these decisions, as low numeracy is correlated with less precise representations of numerical magnitude. The current study looks at the feasibility of improving number representations. The aim of this study was to evaluate whether providing a small amount of feedback to adult subjects could improve performance on a number line placement task and to determine characteristics of those individuals who respond best to this feedback.

METHODS

Subjects from two outpatient clinic waiting rooms participated in a three phase number line task. Participants were asked to place numbers on a computerized number line ranging from 0 to 1000 in pre-test, feedback, and post-test phases. Generalized estimating equations were used to model log-transformed scores and to test whether 1) performance improved after feedback, and 2) the degree of improvement was associated with age, education level or subjective numeracy.

RESULTS

There was an overall improvement in task performance following the feedback. The average percent absolute error was 7.32% (SD: 6.00) for the pre-test and 5.63% (SD: 3.71) for the post-test. There was a significant interaction between college education and post-test improvement. Only subjects without some college education improved with feedback.

CONCLUSIONS

Adults who do not have higher levels of education improve significantly on a number line task when given feedback.