Effects of aging on visual attentional focusing

Keeping an eye on cost: What can eye tracking tell us about attention to cost information in discrete choice experiments?

Concern has been expressed about including a cost attribute within discrete choice experiments (DCEs) when individuals do not have to pay at the point of consumption. We use eye tracking to investigate attention to cost when valuing publicly financed health care. One-hundred and four individuals completed a DCE concerned with preferences for UK general practitioner appointments: 51 responded to a DCE with cost included and 53 to the same DCE without cost. Eye-movements were tracked whilst respondents completed the DCE. We assessed if respondents pay attention to cost. We then compare fixation time (FT) on attributes, eye movement patterns and mental effort across the experimental groups. Results are encouraging for the inclusion of cost in DCEs valuing publicly provided healthcare. Most respondents gave visual attention to the cost attribute most of the time. Average FT on multi-attribute tasks increased by 44% in the cost DCE, with attention to non-monetary attributes increasing by 22%. Including cost led to more structured decision-making and did not increase mental effort. Acceptability of the cost attribute and difficulty of choice tasks were predictors of cost information processing, highlighting the importance of both motivating the cost attribute and considering difficulty of the tasks when developing DCEs.

Changes in the spatial spread of attention with ageing

Spatial attention is a necessary cognitive process, allowing for the direction of limited capacity resources to varying locations in the visual field for improved visual processing. Thus, understanding how ageing influences these processes is vital. The current study explored the relationship between the spatial spread of attention and healthy ageing using an inhibition of return task to tap visual attention processing. This task allowed us to measure the spatial distribution of inhibition, and thus acted as a marker for attentional spread. Past research has indicated minimal age differences in inhibitory spread. However, these studies used placeholder stimuli, which may have restricted the range over which age differences could be reliably measured. To address this, in Experiment One, we measured the relationship between the spatial spread of inhibition and healthy ageing using a method which did not employ placeholders. In contrast to past research, an age difference in inhibitory spread was observed, where in comparison to younger adults, older adults exhibited a relatively restricted spread of attention. Experiment Two then confirmed these findings, by directly comparing inhibitory spread for placeholder present and placeholder absent conditions, across younger and older adults. Again, it was found that age differences in inhibitory spread emerged, but only in the placeholder absent condition. Possible reasons for the observed age differences in attention are discussed.

Improving visual spatial working memory in younger and older adults: effects of cross-modal cues

Spatially informative auditory and vibrotactile (cross-modal) cues can facilitate attention but little is known about how similar cues influence visual spatial working memory (WM) across the adult lifespan. We investigated the effects of cues (spatially informative or alerting pre-cues vs. no cues), cue modality (auditory vs. vibrotactile vs. visual), memory array size (four vs. six items), and maintenance delay (900 vs. 1800 ms) on visual spatial location WM recognition accuracy in younger adults (YA) and older adults (OA). We observed a significant interaction between spatially informative pre-cue type, array size, and delay. OA and YA benefitted equally from spatially informative pre-cues, suggesting that attentional orienting prior to WM encoding, regardless of cue modality, is preserved with age.  Contrary to predictions, alerting pre-cues generally impaired performance in both age groups, suggesting that maintaining a vigilant state of arousal by facilitating the alerting attention system does not help visual spatial location WM.

Steps to Health in Cognitive Aging: Effects of Physical Activity on Spatial Attention and Executive Control in the Elderly

The purpose of this study was to investigate whether physical activity (PA) habits may positively impact performance of the orienting and executive control networks in community-dwelling aging individuals and diabetics, who are at risk of cognitive dysfunction. To this aim, we tested cross-sectionally whether age, ranging from late middle-age to old adulthood, and PA level independently or interactively predict different facets of the attentional performance. Hundred and thirty female and male individuals and 22 adults with type 2 diabetes aged 55–84 years were recruited and their daily PA (steps) was objectively measured by means of armband monitors. Participants performed a multifunctional attentional go/no-go reaction time (RT) task in which spatial attention was cued by means of informative direct cues of different sizes followed by compound stimuli with local and global target features. The performance efficiency of the orienting networks was estimated by computing RT differences between validly and invalidly cued trials, that of the executive control networks by computing local switch costs that are RT differences between switch and non-switch trials in mixed blocks of global and local target trials. In regression analyses performed on the data of non-diabetic elderlies, overall RTs and orienting effects resulted jointly predicted by age and steps. Age predicted overall RTs in low-active individuals, but orienting effects and response errors in high-active individuals. Switch costs were predicted by age only, with larger costs at older age. In the analysis conducted with the 22 diabetics and 22 matched non-diabetic elderlies, diabetic status and daily steps predicted longer and shorter RTs, respectively. Results suggest that high PA levels exert beneficial, but differentiated effects on processing speed and attentional networks performance in aging individuals that partially counteract the detrimental effects of advancing age and diabetic status. In conclusion, adequate levels of overall PA may positively impinge on brain efficiency and attentional control and should be therefore promoted by actions that support lifelong PA participation and impact the built environment to render it more conducive to PA.

Feasibility of Implementing a Patient-Centered Postoperative Wound Monitoring Program Using Smartphone Images: A Pilot Protocol

Background

Surgical site infections (SSI) represent a significant public health problem as the most common nosocomial infection and a leading cause of unplanned hospital readmissions among surgical patients. Many develop following hospital discharge and often go unrecognized by patients. Telemedicine offers the opportunity to leverage the mobile technology to remotely monitor wound recovery in the transitional period between hospital discharge and routine clinic follow-up. However, many existing telemedicine platforms are episodic, replacing routine follow-up, rather than equipped for continued monitoring; they include only low-risk patient populations and those who already have access to and comfort with the necessary technology; and transmit no visual information.

Objective

Drawing upon the Coleman model for care transitions and the Proctor model for implementation, we propose a protocol of postoperative wound monitoring using smartphone digital images. In this study, we will establish the feasibility of such a program, both for patients and for the clinical care team.

Methods

We will recruit 40 patients or patient/caregiver pairs from our inpatient vascular surgery service. Eligible patients will be English-speaking, 18 years of age or older, and have an incision at least 3 cm in length. Participants will receive a training session, during which they will learn to use the device and the wound monitoring smartphone app. Following hospital discharge, they will submit digital images of their wound and responses to a survey about their recovery for 14 days. Experienced health care providers on the vascular surgery inpatient service will review transmitted data daily and contact patients for any concerning findings.

Results

Primary outcomes will include participant adherence to the protocol, time required for providers to review submissions, time from submission to provider review, and participant satisfaction. Secondary outcomes will include SSI detection and hospital readmission.

Conclusions

Health systems are increasingly dedicating efforts to transitional care improvement programs. This feasibility trial will confirm whether patients and their caregivers can learn to use a postdischarge wound monitoring smartphone app and will assess patient and provider satisfaction. This protocol will provide preliminary evidence for a shift in the delivery of postdischarge care in a patient-centered and cost-effective manner.

Trial Registration

Clinicaltrials.gov NCT02735525; https://clinicaltrials.gov/ct2/show/NCT02735525 (Archived by WebCite at http://www.webcitation.org/6oIvN4Mab)

Evaluating Patient Usability of an Image-Based Mobile Health Platform for Postoperative Wound Monitoring

Background

Surgical patients are increasingly using mobile health (mHealth) platforms to monitor recovery and communicate with their providers in the postdischarge period. Despite widespread enthusiasm for mHealth, few studies evaluate the usability or user experience of these platforms.

Objective

Our objectives were to (1) develop a novel image-based smartphone app for postdischarge surgical wound monitoring, and (2) rigorously user test it with a representative population of vascular and general surgery patients.

Methods

A total of 9 vascular and general surgery inpatients undertook usability testing of an internally developed smartphone app that allows patients to take digital images of their wound and answer a survey about their recovery. We followed the International Organization for Standardization (ISO) 9241-11 guidelines, focusing on effectiveness, efficiency, and user satisfaction. An accompanying training module was developed by applying tenets of adult learning. Sessions were audio-recorded, and the smartphone screen was mirrored onto a study computer. Digital image quality was evaluated by a physician panel to determine usefulness for clinical decision making.

Results

The mean length of time spent was 4.7 (2.1-12.8) minutes on the training session and 5.0 (1.4-16.6) minutes on app completion. 55.5% (5/9) of patients were able to complete the app independently with the most difficulty experienced in taking digital images of surgical wounds. Novice patients who were older, obese, or had groin wounds had the most difficulty. 81.8% of images were sufficient for diagnostic purposes. User satisfaction was high, with an average usability score of 83.3 out of 100.

Conclusion

Surgical patients can learn to use a smartphone app for postoperative wound monitoring with high user satisfaction. We identified design features and training approaches that can facilitate ease of use. This protocol illustrates an important, often overlooked, aspect of mHealth development to improve surgical care.

Developmental Improvement and Age-Related Decline in Unfamiliar Face Matching

Age-related changes have been documented widely in studies of face recognition and eyewitness identification. However, it is not clear whether these changes arise from general developmental differences in memory or occur specifically during the perceptual processing of faces. We report two experiments to track such perceptual changes using a 1-in-10 (experiment 1) and 1-in-1 (experiment 2) matching task for unfamiliar faces. Both experiments showed improvements in face matching during childhood and adult-like accuracy levels by adolescence. In addition, face-matching performance declined in adults of the age of 65 years. These findings indicate that developmental improvements and aging-related differences in face processing arise from changes in the perceptual encoding of faces. A clear face inversion effect was also present in all age groups. This indicates that those age-related changes in face matching reflect a quantitative effect, whereby typical face processes are engaged but do not operate at the best-possible level. These data suggest that part of the problem of eyewitness identification in children and elderly persons might reflect impairments in the perceptual processing of unfamiliar faces.

Selective Age Effects on Visual Attention and Motor Attention during a Cued Saccade Task

Objective. Visual information is often used to guide purposeful movement. However, older adults have impaired responses to visual information, leading to increased risk for injuries and potential loss of independence. We evaluated distinct visual and motor attention contributions to a cued saccade task to determine the extent to which aging selectively affects these processes. Methods. Nineteen healthy young (18–28 years) and 20 older (60–90 years) participants performed a cued saccade task under two conditions. We challenged motor attention by changing the number of possible saccade targets (1 or 6). Results. Older adults had difficulty in inhibiting unwanted eye movements and had greater eye movement inaccuracy in the hard condition when compared to the younger adults and to the easy condition. Also, an inverse relation existed between performance on the visual and motor components of the task in older adults, unlike younger adults. Conclusions. Older adults demonstrated difficulty in both inhibiting irrelevant saccade targets and selecting correct saccade endpoints during more complex tasks. The shift in relations among attention measures between the younger and older participants may indicate a need to prioritize attentional resources with age. These changes may impact an older adult's ability to function in complex environments.

Bateria Psicológica para Avaliação da Atenção (BPA): desempenho de diferentes faixas etárias

O objetivo do estudo foi analisar o desempenho atencional em diferentes momentos da vida. Participaram 1.759 pessoas, de ambos os sexos, e com idades variando de 6 até 82 anos. O instrumento utilizado foi a Bateria Psicológica para Avaliação da Atenção (BPA), composta pelos testes de Atenção Concentrada, Atenção Dividida e Atenção Alternada. Os resultados estão de acordo com o apontado pela literatura ao relacionar a atenção com as diferentes etapas do desenvolvimento. Nesse sentido, observou-se que houve um aumento de desempenho até o início da vida adulta, com um leve decréscimo a partir dos 30 anos, que fica mais evidente a partir dos 50 anos. Ainda, a ANOVA permitiu identificar seis faixas etárias que se diferenciaram claramente. Por fim, identificou-se que o desempenho em atenção dividida é inferior aos outros tipos de atenção. Sugerem-se novos estudos que permitam identificar e diferenciar um maior número de idades.

The Tölz Temporal Topography Study: mapping the visual field across the life span. Part II: cognitive factors shaping visual field maps

Part I described the topography of visual performance over the life span. Performance decline was explained only partly by deterioration of the optical apparatus. Part II therefore examines the influence of higher visual and cognitive functions. Visual field maps for 95 healthy observers of static perimetry, double-pulse resolution (DPR), reaction times, and contrast thresholds, were correlated with measures of visual attention (alertness, divided attention, spatial cueing), visual search, and the size of the attention focus. Correlations with the attentional variables were substantial, particularly for variables of temporal processing. DPR thresholds depended on the size of the attention focus. The extraction of cognitive variables from the correlations between topographical variables and participant age substantially reduced those correlations. There is a systematic top-down influence on the aging of visual functions, particularly of temporal variables, that largely explains performance decline and the change of the topography over the life span.

Os efeitos da idade na seleção de carga perceptual

Algumas pesquisas sugerem a existência de momentos distintos de maturação do sistema atentivo. O presente estudo investigou os padrões de seleção da informação visual através de uma tarefa de carga perceptual executada por três grupos etários: crianças, adultos e idosos. De maneira geral os resultados obtidos indicaram uma diminuição da eficiência no processo de seleção da informação em condições de baixa carga perceptual na população de idosos e uma diminuição da eficiência da seleção em condições de alta e baixa carga perceptual na população composta por crianças. Estes resultados sugerem a existência de padrões específicos na seleção da informação visual em função da idade e da carga perceptual a ser processada pelo sistema visual.

Desempenho no teste de atenção dividida como resultado da idade das pessoas

A literatura sobre atenção assinala acréscimo do desempenho atencional até a idade de adulto jovem, seguido de perdas significativas decorrentes do processo de envelhecimento. Dentro desse contexto, o objetivo desta pesquisa foi verificar evidência de validade em função da variável idade para o Teste de Atenção Dividida, partindo da hipótese de que ao aumento da idade corresponderia uma diminuição da capacidade de dividir a atenção. Participaram da pesquisa 878 indivíduos dos Estados da Bahia e Sergipe, sendo eles estudantes universitários ou pessoas que passaram por avaliação psicológica para motorista, com idade entre 18 e 72 anos (M=26,74, DP=8,14). Do total, 51,82% eram homens. O instrumento foi aplicado coletivamente no Estado de Sergipe, e de forma individual na Bahia. Os resultados mostraram correlação negativa e significativa entre a pontuação do Teste de Atenção Dividida e a idade das pessoas. A análise de variância mostrou diferenças significativas entre as idades, permitindo agrupar três faixas etárias, diferenciadas pela prova de Tukey. Com base nos resultados concluiu-se por evidência de validade para o Teste de Atenção Dividida com base na diferenciação das idades.

Age-related changes in processing faces from detection to identification: ERP evidence

We examined the ability of people 70 to 90 years old to apply global, configural, and featural face-processing strategies. In addition we investigated age-related changes in the ability to categorize faces at basic, subordinate, and individual levels. Using the N170 potential as index of early face processing and the P300 component as index of categorical decision making and effort, we found significant age-related perceptual changes which slowed and somewhat impaired face processing. Specifically, older participants had problems integrating face features into global structures, demonstrating enhanced dependence on distal global information. They did not apply configural computations by default while processing faces which suggests that, unless identification is required, they process faces only at a basic level. These perceptual changes could be the cause for slower and less accurate subordinate categorization, particularly when it is based on details. At the neural levels face processing was not right-lateralized, reflecting excessive involvement of the left hemisphere in perception leading to a more general reduction of interhemispheric asymmetry. In addition we found excessive but nonselective activation of frontal regions adding support to the view that executive control and particularly inhibition of irrelevant input are reduced in the elderly.

Enhanced and bilateralized visual sensory processing in the ventral stream may be a feature of normal aging

Evidence has emerged for age-related amplification of basic sensory processing indexed by early components of the visual evoked potential (VEP). However, since these age-related effects have been incidental to the main focus of these studies, it is unclear whether they are performance dependent or alternately, represent intrinsic sensory processing changes. High-density VEPs were acquired from 19 healthy elderly and 15 young control participants who viewed alphanumeric stimuli in the absence of any active task. The data show both enhanced and delayed neural responses within structures of the ventral visual stream, with reduced hemispheric asymmetry in the elderly that may be indicative of a decline in hemispheric specialization. Additionally, considerably enhanced early frontal cortical activation was observed in the elderly, suggesting frontal hyper-activation. These age-related differences in early sensory processing are discussed in terms of recent proposals that normal aging involves large-scale compensatory reorganization. Our results suggest that such compensatory mechanisms are not restricted to later higher-order cognitive processes but may also be a feature of early sensory-perceptual processes.