Exploring awareness of age-related changes among over 50s in the UK: findings from the PROTECT study

OBJECTIVES

Older people describe positive and negative age-related changes, but we do not know much about what contributes to make them aware of these changes. We used content analysis to categorize participants' written comments and explored the extent to which the identified categories mapped onto theoretical conceptualizations of influences on awareness of age-related change (AARC).

DESIGN

Cross-sectional observational study.

PARTICIPANTS

The study sample comprised 609 UK individuals aged 50 years or over (mean (SD) age = 67.9 (7.6) years), enrolled in the PROTECT study.

MEASUREMENTS

Between January and March 2019, participants provided demographic information, completed a questionnaire assessing awareness of age-related change (AARC-10 SF), and responded to an open-ended question asking them to comment on their responses.

RESULTS

While some of the emerging categories were in line with the existing conceptual framework of AARC (e.g. experiencing negative changes and attitudes toward aging), others were novel (e.g. engagement in purposeful activities or in activities that distract from age-related thoughts). Analysis revealed some of the thought processes involved in selecting responses to the questionnaire items, demonstrating different ways in which people make sense of specific items.

CONCLUSIONS

Results support the ability of the AARC questionnaire to capture perceived age-related changes in cognitive functioning, physical and mental health, and engagement in social activities and in healthy and adaptive behaviors. However, findings also suggest ways of enriching the theoretical conceptualization of how AARC develops and offer insights into interpretation of responses to measures of AARC.

Factors Affecting the Success of Pulmonary Rehabilitation in Asthma

Objective: The majority of patients with asthma limit their physical activity due to the fear of exercise dyspnea. Regular exercise, on the other hand, is currently suggested as one of the non-pharmaceutical treatment alternatives for patients with asthma since it improves their quality of life and symptom control. This study aimed to investigate the indicators of success in patients with asthma receiving pulmonary rehabilitation (PR). Methods: A total of 131 patients with the diagnosis of asthma were included in the study. All patients attended an 8-week comprehensive, multidisciplinary, outpatient and individualized PR program. Results: The factors related to the gains in dyspnea perception, exercise capacity, peripheral muscle strength, respiratory muscle strength and quality of life were evaluated. In the multivariate linear regression analysis, the gain in dyspnea perception is related to baseline dyspnea. The gain in exercise capacity is related to baseline exercise capacity and the amount of smoking. The gain in peripheral muscle strength is related to gender. The gain in respiratory muscle strength is related to age, and finally the gain in quality of life is related to baseline dyspnea and anxiety levels. Conclusion: Especially men, young people, heavy smokers, and those with low initial exercise capacity, high perception of dyspnea, and high anxiety are more likely to benefit from PR.

"The Internal Police Officer Has Not Retired but Has Slowed Down": Israeli Women Reframe Their Aging Experiences in the Second Half of Life

Compared with gains, losses have received a substantial amount of research and public attention. The present study aims to shed light on the positive gains associated with older age from the perspective of older women. Five focus groups with 19 Israeli women over the age of 54 were conducted. Trailers of three different films were used to stimulate discussion about old age and aging and allow for reflections on societal norms in light of personal experiences. Focus group interviews were analyzed thematically. Respondents identified four contexts, characterized by reframing their experiences against societal norms. These included gender stereotypes, physical appearance, interpersonal relations, and employment. This study represents an opening to a different discourse around old age, which is characterized by gains and possibilities brought about by changes in reframing one’s experiences, while distancing oneself and exerting free will vis à vis social norms.

Aged 70 and still a child: complexities, strains and gains of older children caring for their (near) centenarian mothers

BACKGROUND

Longer lives increase the possibility of caring duties, which means that older adults looking after their ageing parents-as well as their own partners-is becoming an increasingly common scenario in developed countries.

OBJECTIVE

To explore the caregiving demands of very old caregiving dyads and the experience of maintaining the identity of a child at such an advanced age.

DESIGN

Qualitative study.

SUBJECTS

15 participants (four males), all aged 70 or over and caring for their mothers, aged between 95 and 105 years old.

METHODS

Semi-structured interviews analysed thematically.

RESULTS

Caregivers are willing to care for their mothers 'until death tears them apart', despite the double strains they face, that is more self-limitations and added care receiver need. On a positive side, they feel 'happy, thankful and proud' for still having their mothers alive. They also describe that maintaining the identity of a child at such an advanced age was somewhat unthought of and unexpected but an important source of pride.

CONCLUSIONS

These findings suggest that these oldest-old caregiving dyads are characterised by a relationship shaped by strong feelings of extended filial love, constituting a family feature that needs further understanding. Findings also underscore the challenges these carers face in dealing with several agents (secondary caregivers) and entities in the care provision.

The Role of Payoff Valence on Voting: Egalitarian for Gains and Selfish for Losses

We study how payoff valence affects voting behavior on the distribution of monetary outcomes framed as gains or losses in a group when using standard plurality voting (PV) procedures and when using approval voting (AV). The latter method allows the subjects to approve of as many alternatives as they wish and has been shown to eliminate the incentives to vote strategically. For both methods, we observe that voters express higher support for egalitarian allocations (and lower support for selfish options) when sharing gains than when sharing losses. Moreover, the average number of approved alternatives per ballot is higher when distributions are framed in terms of gains than when they are framed in terms of losses. We also discuss under which circumstances the shift in voting behavior is more likely to produce changes in the electoral outcome. The results suggest that framing manipulations (payoff valence) can significantly impact voting behavior.

Sign effect in adolescents: Within-subject comparison of delay discounting of hypothetical monetary gains and losses

The purpose of this article is to contribute to the research on the sign effect, steeper discounting of gains compared to losses, by offering results from an experiment using a "double-delay" procedure on adolescents. Twenty-four 14-year-old schoolchildren completed a computer-based test consisting of choices of Smaller-Sooner (SS) and Larger-Later (LL) hypothetical monetary gains and losses. Within-subject comparison and analysis of the aggregated data were conducted. Current results were also examined in light of prior research with adult participants, and variations in behavioral patterns were identified. Although the sign effect appears to be more profound in adolescents compared to adults, the effect of immediacy persists regardless of the sign of the outcome, and zero discounting of losses is often the case, suggesting that the sign effect is driven largely by qualitative differences.

Losses tune differently than gains: how gains and losses shape attentional scope and influence goal pursuit

Research on the asymmetric effect of negative versus positive affective states (induced by gains or losses) on scope of attention, both at a perceptual and a conceptual level, is abundant. However, little is known about the moderating effect of anticipating gains or losses versus actually experiencing them and about any downstream consequences of these effects on goal-directed behaviour. In two studies, we show that gains versus losses induce qualitatively different processes. In Experiment 1, we demonstrate that the anticipation of monetary gains results in a narrowing of attentional scope, while experiencing gains broadens the scope of attention. We find the reverse pattern concerning monetary losses - while anticipation of monetary losses results in broadening of attentional scope, the actual experience of losses results in narrowing of attentional scope. Additionally, Experiment 2 replicates these findings and shows how differential attentional tuning as a function of the anticipation versus experience of gains versus losses modulates priming-induced goal-directed behaviour.

Predicting self-esteem in informal caregivers of people with dementia: Modifiable and non-modifiable factors

While informal caregivers often feel burdened by the care for a person with dementia, they can also experience positive consequences due to caregiving; caregiver gains. One of these, relatively overlooked, caregiver gains is heightened self-esteem. We assessed the predictive ability of non-modifiable (caregiver sociodemographic- and dementia related-) and modifiable (psychological-) factors for caregiver self-esteem). A cross-sectional study in which 201 caregivers, who spent at least eight hours a week on caring for a community-residing person with dementia, completed a semi-structured interview and five questionnaires. One two-block (1: non-modifiable-; 2: modifiable variables) hierarchic multiple regression analysis was used to assess which variables predicted self-esteem. None of the non-modifiable variables significantly predicted self-esteem. Regarding the modifiable variables, depression and relationship quality with the person with dementia significantly predicted self-esteem (adjusted R² = .460, β = -.207, p = .015 and β = .632, p < .001 respectively). Caregivers who experience a better relationship quality with the person with dementia, and fewer depression symptoms, experience a higher level of self-esteem. Interventions focused on heightening self-esteem should strive to optimize these factors to enhance the lives of informal dementia caregivers.

Influence of Positive and Negative Dimensions of Dementia Caregiving on Caregiver Well-Being and Satisfaction With Life: Findings From the IDEAL Study

OBJECTIVE

The aim of this study was to identify the potential impact of positive and negative dimensions of caregiving on caregiver well-being and satisfaction with life (SwL).

METHODS

This study used time-point one data from the Improving the experience of Dementia and Enhancing Active Life (also known as IDEAL)cohort study that involved 1,283 informal caregivers of people in the mild-to-moderate stages of dementia recruited from 29 sites within Great Britain. Multivariate linear regression modeling was used to investigate the associations between positive dimensions of caregiving (measured by caregiving competence and perceptions of positive aspects of caregiving), negative dimensions of caregiving (measured by caregiving stress and role captivity), and caregiver well-being and SwL.

RESULTS

Lower well-being was associated with low caregiving competence (-13.77; 95% confidence interval [CI]:-16.67, -10.87), perceiving fewer positive aspects of caregiving (-7.67; 95% CI:-10.26, -5.07), high caregiving stress (-24.45; 95% CI:-26.94, -21.96), and high role captivity (-15.61; 95% CI:-18.33, -12.89). Lower SwL was associated with low caregiving competence (-4.61; 95% CI:-5.57, -3.66), perceiving fewer positive aspects of caregiving (-3.09; 95% CI:-3.94, -2.25), high caregiving stress (-7.88; 95% CI:-8.71, -7.06), and high role captivity (-6.41; 95% CI:-7.27, -5.54). When these four measures were combined within the same model, only positive aspects of caregiving and caregiving stress retained independent associations with well-being and SwL.

CONCLUSION

Both positive and negative dimensions of caregiving were associated with caregiver well-being and SwL. Psychological therapies and interventions need to consider not only the negative aspects of caregiving but also positive caregiving experiences and their implications for caregiver well-being and SwL.

Can the Video Head Impulse Test Define Severity of Bilateral Vestibular Hypofunction?

OBJECTIVE

The objective of the study was to compare rotary chair and video head impulse test (vHIT) findings in patients with bilateral vestibular hypofunction (BVH) to determine whether vHIT can: 1) define severity of BVH and 2) accurately predict rotary chair findings in patients with BVH.

STUDY DESIGN

Retrospective chart review.

SETTING

Research hospital.

PATIENTS

Twenty subjects with bilateral vestibular hypofunction as assessed by rotary chair.

INTERVENTION

Rotary chair and vHIT.

MAIN OUTCOME MEASURES

The main outcome measures were rotary chair phase, gain, and symmetry and vHIT vestibulo-ocular reflex (VOR) gain. Rotary chair and vHIT results were assessed and subjects were stratified into groups according to the severity of their vestibular hypofunction. For rotary chair, subjects were classified as mild, moderate, or severe BVH. For vHIT, subjects were classified as normal, unilateral, or bilateral.

RESULTS

Average lateral canal vHIT VOR gain: 1) significantly increased as severity of BVH decreased, and 2) demonstrated a significant and positive, linear relationship with rotary chair gains. vHIT was in disagreement with rotary chair in the classification of five subjects, which could be due to right-left asymmetry of BVH.

CONCLUSION

vHIT can serve as an initial tool for identifying patients with BVH. Lower vHIT gains are consistent with having severe BVH. There was disagreement between vHIT and rotary chair, though not for any patients with severe BVH. Compared with rotary chair, the clinical gold standard for identifying BVH, vHIT possesses 100% sensitivity for excluding severe BVH when average vHIT gains are greater than 0.46.

ALK gene copy number in lung cancer: Unspecific polyploidy versus specific amplification visible as double minutes

BACKGROUND

Gains of a gene due to DNA polyploidy versus amplification of the specific locus are distinct molecular alterations in tumors.

OBJECTIVE

We quantified copy number gains of ALK gene due to unspecific polyploidy versus amplifications of the specific locus in a series of non-small cell lung cancers.

METHODS

The locus specific ALK copy (LSI) number status was evaluated in 205 cases by FISH. Ratio LSI ALK copy number corrected for control probes CEP2, CEP3 and CEP17 (CEPs) was scored. Amplification of the specific ALK locus was defined when ratio set to ≥ 2 while polyploidy was interpreted when the increase in gene copy resulted < 2 in ratio (LSI/control CEPs).

RESULTS

Twenty one cases (10.2%) showed ≥ 8 ALK signals, 68 cases (33.2%) 3-7 signals and 116 cases (56.6%) a mean of 2 signals. Only 2/21 cases of the cohort harboring ≥ 8 signals showed a ratio ≥ 2 after CEPs correction interpretable as amplified, showing numerous doubled fluorescent spots. All the remaining cases showed a mirrored number of fluorescent spots per each CEPs, interpretable as polyploidy.

CONCLUSION

We detected a high prevalence of ALK gene copy number usually due to polyploidy rather than ALK locus amplification, the latter visible prevalently as double minutes.

Neural Mechanisms of the Transformation from Objective Value to Subjective Utility: Converting from Count to Worth

When deciding, we aim to choose the “best” possible outcome. This is not just selection of the option that is the most numerous or physically largest, as options are translated from objective value (count) to subjective value (worth or utility). We localized the neural instantiation of the value-to-utility transformation to the dorsal anterior midcingulate cortex (daMCC), with independent replication. The daMCC encodes the context-specific information necessary to convert from count to worth. This encoding is not simply a representation of utility or preference, but the interaction of the two. Specifically, the relationship of brain activation to value is dependent on individual preference, with both positive and negative slopes across the population depending on whether each individual's preference results in enhancement or diminishment of the valuation. For a given value, across participants, enhanced daMCC activation corresponds to diminished subjective valuation, deactivation to enhanced subjective valuation, and non-modulated activation with non-modulated subjective valuation. Further, functional connectivity analyses identified brain regions (positive connectivity with the inferior frontal gyrus and negative connectivity with the nucleus accumbens) through which contextual information may be integrated into the daMCC and allow for outputs to modulate valuation signals. All analyses were replicated through an independent within-study replication, with initial testing in the gains domain and replication in the intermixed and mirrored losses trials. We also present and discuss an ancillary finding: we were unable to identify parametric value signals for losses through whole-brain analyses, and ROI analyses of the vmPFC presented non-modulation across loss value levels. These results identify the neural locus of the value-to-utility transformation, and provide a specific computational function for the daMCC in the production of subjective valuation through the integration of value, context, and preferences.

Divergence and Convergence of Risky Decision Making Across Prospective Gains and Losses: Preferences and Strategies

People choose differently when facing potential gains than when facing potential losses. Clear gross differences in decision making between gains and losses have been empirically demonstrated in numerous studies (e.g., framing effect, risk preference, loss aversion). However, theories maintain that there are strong underlying connections (e.g., reflection effect). We investigated the relationship between gains and losses decision making, examining risk preferences, and choice strategies (the reliance on option information) using a monetary gamble task with interleaved trials. For risk preferences, participants were on average risk averse in the gains domain and risk neutral/seeking in the losses domain. We specifically tested for a theoretically hypothesized correlation between individual risk preferences across the gains and losses domains (the reflection effect), but found no significant relationship in the predicted direction. Interestingly, despite the lack of reflected risk preferences, cross-domain risk preferences were still informative of individual choice behavior. For choice strategies, in both domains participants relied more heavily on the maximizing strategy than the satisficing strategy, with increased reliance on the maximizing strategy in the losses domain. Additionally, while there is no mathematical reliance between the risk preference and strategy metrics, within both domains there were significant relationships between risk preferences and strategies-the more participants relied upon the maximizing strategy the more risk neutral they were (equating value and utility maximization). These results demonstrate the complexity of gains and losses decision making, indicating the apparent contradiction that their underlying cognitive/neural processes are both dissociable and overlapping.

Aging and loss decision making: increased risk aversion and decreased use of maximizing information, with correlated rationality and value maximization

We investigated how adult aging specifically alters economic decision-making, focusing on examining alterations in uncertainty preferences (willingness to gamble) and choice strategies (what gamble information influences choices) within both the gains and losses domains. Within each domain, participants chose between certain monetary outcomes and gambles with uncertain outcomes. We examined preferences by quantifying how uncertainty modulates choice behavior as if altering the subjective valuation of gambles. We explored age-related preferences for two types of uncertainty, risk, and ambiguity. Additionally, we explored how aging may alter what information participants utilize to make their choices by comparing the relative utilization of maximizing and satisficing information types through a choice strategy metric. Maximizing information was the ratio of the expected value of the two options, while satisficing information was the probability of winning. We found age-related alterations of economic preferences within the losses domain, but no alterations within the gains domain. Older adults (OA; 61–80 years old) were significantly more uncertainty averse for both risky and ambiguous choices. OA also exhibited choice strategies with decreased use of maximizing information. Within OA, we found a significant correlation between risk preferences and choice strategy. This linkage between preferences and strategy appears to derive from a convergence to risk neutrality driven by greater use of the effortful maximizing strategy. As utility maximization and value maximization intersect at risk neutrality, this result suggests that OA are exhibiting a relationship between enhanced rationality and enhanced value maximization. While there was variability in economic decision-making measures within OA, these individual differences were unrelated to variability within examined measures of cognitive ability. Our results demonstrate that aging alters economic decision-making for losses through changes in both individual preferences and the strategies individuals employ.

Neural correlates of risky decision making in anxious youth and healthy controls

BACKGROUND

Pediatric anxiety disorders are chronic and impairing conditions that are characterized by risk aversion and avoidance; however, the neural correlates of decision making under risk in anxious youth remain poorly understood.

METHODS

Youth with a primary diagnosis of separation anxiety, social phobia, or generalized anxiety disorder (n = 16) and healthy controls (n = 15), performed a risky decision-making task under conditions of potential gain or loss while undergoing a functional magnetic resonance imaging (fMRI) scan.

RESULTS

Analyses were conducted to examine neural response to risky versus nonrisky choices in each condition. Anxious youth made fewer risky choices during potential loss compared to controls. Both groups elicited strong frontostriatal activation during risky choice. During risky choice in the gain condition, controls exhibited greater activation in ventral putamen during risky choice than during nonrisky choice and than anxious youth. In the loss condition, controls exhibited greater activation in medial prefrontal cortex during risk-taking while anxious youth exhibited greater engagement of amygdala and insula. Neural activation during risky choice was associated with individual differences in anxiety symptom severity, such that as anxiety symptomatology increased, there was decreased recruitment of the ventral striatum in the gain condition and increasing recruitment of the amygdala in the loss condition.

CONCLUSIONS

Youth with anxiety disorders differ from their nonanxious peers on both behavioral and neurobiological indices during risky decision making; these differences are exacerbated by symptom severity and they shed light on the pathophysiology of pediatric anxiety. Neural correlates of risky decision making in anxious youth and healthy controls.

Perceptions of gain following spinal cord injury: a qualitative analysis

BACKGROUND

Significant research has focused on psychological difficulties following spinal cord injury (SCI), and there is a small prevalence of individuals who experience distress after injury. However, the converse is that many adjust well to injury and rate their quality of life highly. Despite this, there has been a comparative dearth of research investigating positive psychological outcomes after SCI, perceived by individuals living with this disability.

OBJECTIVE

To explore individuals' perceptions of gain following the experience of SCI.

METHODS

Participants, who had sustained an SCI between the ages 16 and 83, responded to an open-ended written question: "What do you think you have gained from the experience of spinal cord injury?" This was administered at 4 time points post injury: 6 weeks, 12 weeks, 1 year, and 2 years.

RESULTS

Participants' responses were analyzed qualitatively using the framework of thematic analysis. Thirteen themes were identified: relationships, appreciation of relationships, perspective and appreciation of life, new goals or priorities, understanding of SCI or disability, appreciation of health or health care, changed personality, opportunity or challenge, knowledge of SCI or body, newly acquired skills, spirituality, acceptance, and nothing. Descriptive statistics were incorporated in the presentation of the data.

CONCLUSIONS

This study provides evidence that a broad range of positive as well as negative psychological outcomes are possible following SCI. More research is needed to better understand the process through which these outcomes arise and to inform how such outcomes may be communicated to persons experiencing this type of injury.

Estimation of accuracies and expected genetic change from selection for selection indexes that use multiple-trait predictions of breeding values

Procedures are described for estimating selection index accuracies for individual animals and expected genetic change from selection for the general case where indexes of EBVs predict an aggregate breeding objective of traits that may or may not have been measured. Index accuracies for the breeding objective are shown to take an important general form, being able to be expressed as the product of the accuracy of the index function of true breeding values and the accuracy with which that function predicts the breeding objective. When the accuracies of the individual EBVs of the index are known, prediction error variances (PEVs) and covariances (PECs) for the EBVs within animal are able to be well approximated, and index accuracies and expected genetic change from selection estimated with high accuracy. The procedures are suited to routine use in estimating index accuracies in genetic evaluation, and for providing important information, without additional modelling, on the directions in which a population will move under selection.

Costs and gains of complex procedures to rehabilitate end stage ocular surface disease

BACKGROUND

The management of patients with end stage ocular surface disease sometimes requires extensive surgical treatment that can only be provided by specialised ophthalmology. The authors discuss the costs and gains of such complex techniques based on a case of bilateral corneal blindness secondary to Stevens-Johnson syndrome.

METHODS AND RESULTS

Despite multiple lid surgery for trichiasis and repeated corneal grafting for perforations a white female patient became bilaterally blind at the age of 29 years. She also suffered from disabling discomfort in the right dry eye. At the age of 52 a two stage osteo-odonto-keratoprosthesis achieved visual rehabilitation in the left eye and microvascular transplantation of an autologous, submandibular gland resulted in sufficient lubrication to alleviate her severe discomfort in the right eye. As a result of these procedures she was able to take up a regular job again. The total costs of rehabilitation were pound 13 661 which compare with annual gains and regains for society of pound 13 497. An additional pound 4625 was saved annually in guide dog costs.

CONCLUSION

This estimate shows that despite the expense of these complex techniques gains are made well within the second year after rehabilitation. In view of the benefit in quality of life for the patient and monetary savings for society these procedures should be funded by national health services at specialist centres.

Chromosomal gains and losses in primary colorectal carcinomas detected by CGH and their associations with tumour DNA ploidy, genotypes and phenotypes

Comparative genomic hybridization (CGH) is used to detect amplified and/or deleted chromosomal regions in tumours by mapping their locations on normal metaphase chromosomes. Forty-five sporadic colorectal carcinomas were screened for chromosomal aberrations using direct CGH. The median number of chromosomal aberrations per tumour was 7.0 (range 0-19). Gains of 20q (67%) and losses of 18q (49%) were the most frequent aberrations. Other recurrent gains of 5p, 6p, 7, 8q, 13q, 17q, 19, X and losses of 1p, 3p, 4, 5q. 6q, 8p, 9p, 10, 15q, 17p were found in > 10% of colorectal tumours. High-level gains (ratio > 1.5) were seen only on 8q, 13q, 20 and X, and only in DNA aneuploid tumours. DNA aneuploid tumours had significantly more chromosomal aberrations (median number per tumour of 9.0) compared to diploid tumours (median of 1.0) (P < 0.0001). The median numbers of aberrations seen in DNA hyperdiploid and highly aneuploid tumours were not significantly different (8.5 and 11.0 respectively; P = 0.58). Four tumours had no detectable chromosomal aberrations and these were DNA diploid. A higher percentage of tumours from male patients showed Xq gain and 18q loss compared to tumours from female patients (P = 0.05 and 0.01 respectively). High tumour S phase fractions were associated with gain of 20q13 (P = 0.03), and low tumour apoptotic indices were associated with loss of 4q (P = 0.05). Tumours with TP53 mutations had more aberrations (median of 9.0 per tumour) compared to those without (median of 2.0) (P = 0.002), and gain of 8q23-24 and loss of 18qcen-21 were significantly associated with TP53 mutations (P = 0.04 and 0.02 respectively). Dukes' C/D stage tumours tended to have a higher number of aberrations per tumour (median of 10.0) compared to Dukes' B tumours (median of 3.0) (P = 0.06). The low number of aberrations observed in DNA diploid tumours compared to aneuploid tumours suggests that genomic instability and possible growth advantages in diploid tumours do not result from acquisition of gross chromosomal aberrations but rather from selection for other types of mutations. Our study is consistent with the idea that these two groups of tumours evolve along separate genetic pathways and that gross genomic instability is associated with TP53 gene aberrations.