Interventions for caregivers of older and dependent adults: a review

Studies of intervention for caregivers of older and dependent relatives are reviewed. National (PortalMayores, Psicodoc, Psyke) and international (Ageline, Cochrane Library, Medline, Psycinfo) databases were searched for randomized studies, published from 1980 to 2004, that attempt to reduce emotional distress in caregivers. Most intervention studies focus on caregivers of dementia patients and these caregivers are usually females. Caregivers are not an easy group to access. Intervention objectives and contents vary widely and they are not always well defined. The reported effects are moderate. Studies achieve significant outcomes in reducing distress from behavioural problems, but it is difficult to improve depression levels. Psychotherapeutic interventions have shown moderate efficacy. To conclude, future intervention studies should determine the theoretical framework clearly, as well as the goals, and should use more extensive followup periods.     

Development of and change in cognitive control: A comparison of children, young adults, and older adults

Cognitive control involves adjustments in behavior to conflicting information, develops throughout childhood, and declines in aging. Accordingly, developmental and age-related changes in cognitive control and response-conflict detection were assessed in a response-compatibility task. We recorded performance measures, pre-response time (pre-RT) activity and medial frontal negativity (MFN)—sequentially occurring, putative event-related potential (ERP) indexes, respectively, of cognitive control and response-conflict detection. When response conflict reached the highest levels by requiring incompatible responses on posterror trials, children and older adults showed the greatest performance decrements. ERPs indicated that young adults implemented control (pre-RT) and detected the increased conflict (MFN) only when that conflict was at the highest levels, whereas children and older adults did so at lower levels (e.g., posterror, compatible responses). Consequently, the developmental and age-related performance decrements observed here may be due to the undifferentiated and inefficient manner in which children and older adults recruited the processes associated with both cognitive control and response-conflict detection.     

Fitness effects on the cognitive function of older adults: a meta-analytic study

A meta-analytic study was conducted to examine the hypothesis that aerobic fitness training enhances the cognitive vitality of healthy but sedentary older adults. Eighteen intervention studies published between 1966 and 2001 were entered into the analysis. Several theoretically and practically important results were obtained. Most important, fitness training was found to have robust but selective benefits for cognition, with the largest fitness-induced benefits occurring for executive-control processes. The magnitude of fitness effects on cognition was also moderated by a number of programmatic and methodological factors, including the length of the fitness-training intervention, the type of the intervention, the duration of training sessions, and the gender of the study participants. The results are discussed in terms of recent neuroscientific and psychological data that indicate cognitive and neural plasticity is maintained throughout the life span.     

Judgments of blame and forgiveness: A comparison of young adults,older adults,and older adults with dementia

IntroductionAlzheimer's disease may modify moral judgment.ObjectiveIn two studies, we assessed the impact of dementia on blame and forgiveness. Study 1 compared the ways in which young adults, older adults, and older adults with dementia cognitively integrated two factors. Study 2 assessed the number of different factors that older adults with dementia were able to integrate during these moral judgments.MethodThe participants recorded their moral judgements in a blame task and in a forgiveness task. In study 1, the two questionnaires contained scenarios built from the combination of two factors. In study 2, the participants were confronted with the same tasks under three different conditions with scenarios that combined three, four or five factors.ResultsThe data from study 1 showed that the older adults with dementia did not combine the two factors in the same way as young adults did: the combination depended on the type of moral judgment. Study 2 revealed differences in moral judgment between older adults with dementia and adults without dementia in all tasks (i.e. with three, four or five factors combined).ConclusionDementia has an impact on moral judgments. Moral judgment among people with dementia is both task- and condition-dependant.     

Adjustment of caregivers to depressed older adults.

In this research, older adults (N = 150) hospitalized for major depression and their wife, husband, daughter, or son caregivers were interviewed. The primary purpose of the research was to evaluate the ability of caregiver background characteristics, patient illness characteristics, caregiver coping, and strategies for managing the patient at home to predict caregiver adjustment. Among the caregiver characteristics, being in functional health, being male, and being a spouse caregiver were associated with better adjustment. Husbands evidenced the best adaptation to caregiving and daughters the poorest. Patient illness characteristics were not related to caregiver adjustment. Coping with caregiving stresses by using tension reduction and deliberate effort behaviors and managing the patient with criticism and guidance were related to poorer caregiver adjustment.     

Autobiographical remembering and hypermnesia: a comparison of older and younger adults

This study examined age differences in autobiographical memory and extended findings concerning hypermnesia in laboratory tasks to a real world event, the announcement of the verdict in the O. J. Simpson murder trial. Older and younger adults repeatedly recalled the event in a single session. Interviews were coded for amount and type of accurate information and for errors. The age groups did not differ in ability to recall the gist of the event or in the number of errors made. Younger adults were better at remembering when the event had occurred. Both age groups showed hypermnesia. The results are discussed in terms of the importance of autobiographical memory across the life span and the phenomenon of hypermnesia in everyday memory.     

Assessment of anxiety in older adults: a community-based survey and comparison with younger adults

The reliability and validity of existing anxiety self-report scales in elderly adults has not been adequately established, and the phenomenology of anxiety in older adults is largely unknown. In the present study, three anxiety scales and measures of depression and somatization were used to compare symptoms between older (n = 84, mean age = 75.3) and younger (n = 48, mean age = 40.3) community-dwelling adults. Results showed that the anxiety scales demonstrated good internal consistency in both age groups, although the reliabilities of the Fear Questionnaire subscales ranged from poor to good. Convergent and divergent validity were found to be variable in the older group, but this may reflect differences in anxiety as it occurs in older persons rather than psychometric problems. Anxiety symptoms did not vary with age, and levels of anxiety also remained constant. However, gender differences were found only within the older age group, with women reporting more anxiety than men. Findings are discussed with respect to current conceptualizations of anxiety in older people, as well as implications for future research.     

Memory for emotionally arousing stimuli: a comparison of younger and older adults

The authors compared emotional memory in younger (aged 18-32 years) and older (aged 59-84 years) adults. Previous researchers who investigated the emotionmemory relationship in younger adults consistently showed that emotional arousal enhances memory for central detail. The present authors' goal was to determine whether a similar effect could be found with older adults. Younger and older adults viewed a series of 12 slides, accompanied by a taped narrative, that showed emotionally arousing or neutral scenes in the middle phase (Slides 5-8). Participants then completed recognition tests that were scored for central detail, peripheral detail, and gist. The results indicated that, although younger adults showed higher performance than older adults did, both groups showed increased memory for central detail. In contrast, the authors found no such enhancement for peripheral detail or gist in either group. These results indicated that the arousal manipulation produced a similar effect on memory in younger and older adults. Furthermore, these results were consistent with the notion of poststimulus elaboration, which is the continued processing of central detail after the termination of an arousing event.     

Evidence-based psychological treatments for distress in family caregivers of older adults

This review identifies evidence-based psychological treatments (EBTs) for reducing distress, and improving well-being, of family members caring for an older relative with significant cognitive and/or physical impairment. Three categories of psychologically derived treatments met EBT criteria: psychoeducational programs (N = 14 studies), psychotherapy (N = 3 studies), and multicomponent interventions (N = 2 studies). Specifically, support within the psychoeducational category was found for skill-training programs focused on behavior management, depression management, and anger management and for the progressively lowered threshold model. Within the psychotherapy category, cognitive-behavioral therapy enjoys strong empirical support. Within the multicomponent category, programs using a combination of at least 2 distinct theoretical approaches (e.g., individual counseling and support group attendance) were also found to be effective. Suggestions for future research include the development of more well-integrated multicomponent approaches, greater inclusion of ethnically diverse family caregivers in research protocols, and greater incorporation of new technologies for treatment delivery.     

Learning rule-described and non-rule-described categories: a comparison of children and adults

Three experiments investigated the ability of 3-, 5-, and 8-year-old children as well as adults to learn sets of perceptual categories. Adults and children performed comparably on categories that could be learned by either a single-dimensional rule or by associative learning mechanisms. However, children showed poorer performance relative to adults in learning categories defined by a disjunctive rule and categories that were nonlinearly separable. Increasing the task demands for adults resulted in child-like performance on the disjunctive categories. Decreasing the task demands for children resulted in more adult-like performance on the disjunctive categories. The authors interpret these results within a multiple-systems approach to category learning and suggest that children have not fully developed the same explicit category learning system as adults.     

Holistic face processing among school children,younger and older adults

While previous studies have mostly examined holistic face processing in childhood and young adulthood, the present study investigated developmental changes of holistic face processing under a lifespan perspective, including older adulthood. Children 5–7 and 9–10 years of age, as well as young and older adults were instructed to assign faces into two categories. The categories were constructed to allow either a holistic categorization according to the overall face similarities or an analytical categorization by focusing on single facial features. The results show an increase in holistic face processing from childhood to young adulthood and a decrease towards older adulthood. Features used for categorization changed from internal to external features with age. Thus, crucial changes of face processing occur beyond young adulthood.     

Decision-making and feedback sensitivity: A comparison between older and younger adults

This study investigated decision-making and feedback sensitivity in healthy older adults with a new task: the Pictures Decision Task. The study was conducted on 27 older (aged 64–88) and 26 younger adults (aged 25–57) matched for years of education. Results showed that older adults did not show the Jumping to Conclusions bias and that older adults had difficulty learning from feedback only when the context was ambiguous and not when they were given aids or interpretative information that decreased ambiguity. The Pictures Decision Task, with respect to the Iowa Gambling Task and the Wisconsin Card Sorting Test, allowed us to assess decision-making and feedback sensitivity under highly ambiguous conditions and therefore to add new insight into the reasoning process of older people.     

Performance in auditory and visual emotional stroop tasks: a comparison of older and younger adults

Research has shown age-related declines in the cognitive ability to inhibit irrelevant information. Thirty-six younger adults (mean age = 22 years) and 36 older adults (mean age = 74 years) performed 2 versions of an emotional Stroop task. In one, they made lexical decisions to emotion words spoken in 1 of several tones of voice. Latencies were longer for test words spoken in an incongruent tone of voice, but only for older adults. In another, words were displayed on a computer screen in a colored font, and participants quickly named the font color. Latencies were longer for test words high on arousal, but only for older adults. Results are discussed in terms of inhibitory cognitive processes, attention, and theories of emotional development.     

Preferred perceptual tempo for sound sequences: comparison of adults, children, and infants

Previous motor and perceptual tasks have found optimal processing for sound sequences of a rate of around 600 msec. IOI (Interonset Interval). This zone of optimal processing (the rate at which discrimination is optimal) slows with age and is also found with infants. The current work investigated whether listeners "prefer" sequences at the rate for which they demonstrate optimal processing. In the present study, three experiments were done. Exp. 1 measured tempo preferences in adults who listened to pairs of isochronous sound sequences varying in tempo (from 100- to 1500-msec. IOI) and were required to indicate which they preferred. As expected, highest preferences were expressed for the intermediate tempi, supporting the hypothesis of a zone of preferred tempi comparable to the zone of optimal processing. Moreover, this preference for intermediate tempi was not affected by the temporal context (absence of differences between a fast, a slow, and a wide set of tempi). In Exp. 2, the same procedure was applied to 6- and 10-yr.-olds. Children in both groups had systematic preferences for the fastest tempi within a set, and the older children generally preferred slower sequences. Exp. 3 used a preference paradigm for sound sequences with 4-mo.-old infants, comparing sequences of 100- vs 300-msec. IOI, 300- vs 900-msec. IOI, and 100- vs 900-msec. IOI. No systematic tempo preferences were observed. We conclude that tempo discrimination and tempo preference may have some commonality (perhaps related to a zone of optimal processing), especially in adults, but that they also involve quite distinct processes which undergo different developmental sequences. Whereas adults prefer what they process the best, children prefer what is fastest (and therefore more attention-getting), and we have not been able to detect preferences in infants.     

Body image of children and adolescents with chronic illness: A meta-analytic comparison with healthy peers

This meta-analysis integrates results from 330 studies on differences between body image of children and adolescents with and without chronic physical illness. Young people with a chronic illness had a less positive body image than their healthy peers although the average size of differences was small (g = ?.30 standard deviation units). A comparison of diseases showed that young people with obesity (g = ?.79), cystic fibrosis (g = ?.50), scoliosis (g = ?.41), asthma (g = ?.37), growth hormone deficits (g = ?.35), spina bifida (g = ?.23), cancer (g = ?.20), and diabetes (g = ?.17) evaluated their body less positively than their healthy peers. Furthermore, levels of body dissatisfaction varied by age at onset of the disease, method for assessing body image, ethnicity, year of publication, and comparison group. Recommendations are stated for reducing effects of chronic illness on the body image of people with chronic illness.     

Perceived racism and mental health among Black American adults: a meta-analytic review

The literature indicates that perceived racism tends to be associated with adverse psychological and physiological outcomes; however, findings in this area are not yet conclusive. In this meta-analysis, we systematically reviewed 66 studies (total sample size of 18,140 across studies), published between January 1996 and April 2011, on the associations between racism and mental health among Black Americans. Using a random-effects model, we found a positive association between perceived racism and psychological distress (r = .20). We found a moderation effect for psychological outcomes, with anxiety, depression, and other psychiatric symptoms having a significantly stronger association than quality of life indicators. We did not detect moderation effects for type of racism scale, measurement precision, sample type, or type of publication. Implications for research and practice are discussed.     

Orienting task effects on memory for presentation modality in children, young adults, and older adults.

Children (7 to 10 years), young adults (17 to 24 years), and older adults (55 to 77 years) were asked to learn three lists of words that were of mixed modality (half the words were visual, and half the words were auditory). With one list the subjects were asked a semantic orienting question; with another, a nonsemantic orienting question; and with a third, no orienting question. Half the subjects in each age group were also asked to remember the presentation modality of each word. Older adults remembered less information about modality than children and young adults did, and the variation in the type of orienting question--or the lack of one--affected modality identification. However, there was no Orienting Task x Age interaction for modality identification. The results of this study suggest that encoding modality information does not take place automatically--in any age group--but that explanations focusing on encoding strategies and effort are not likely to account for older adults' difficulties in remembering presentation modality.     

Sleep patterns and aging: comparison of older adults with and without insomnia complaints

The nature of geriatric insomnia was studied by comparing older adults with (n = 42) and without (n = 30) insomnia complaints on measures of sleep, mood, life-style, health, and sleep-requirement expectations. Elderly persons with insomnia complaints reported longer sleep latency and more frequent and longer awakenings and used sleeping aids more often than those without insomnia complaints. Nocturnal sleep time was not a reliable discriminator. Poor sleepers showed greater discrepancies between their current sleep patterns and sleep-requirement expectations than did good sleepers. Elderly insomniacs acknowledged greater symptomatology of depression and anxiety than did good sleepers. Daytime napping and physical exercise were equivalent in both groups. Medical disorders, pain conditions, and drug usage (other than sleep aids) did not distinguish the two groups. Clinical implications for the treatment of geriatric insomnia are discussed.     

Neuromodulation as a cognitive enhancement strategy in healthy older adults: promises and pitfalls

Increases in life expectancy have been followed by an upsurge of age-associated cognitive decline. Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) have risen as promising approaches to prevent or delay such cognitive decline. However, consensus has not yet been reached about their efficacy in improving cognitive functioning in healthy older adults. Here we review the effects of TMS and tDCS on cognitive abilities in healthy older adults. Despite considerable variability in the targeted cognitive domains, design features and outcomes, the results generally show an enhancement or uniform benefit across studies. Most studies employed tDCS, suggesting that this technique is particularly well-suited for cognitive enhancement. Further work is required to determine the viability of these techniques as tools for long-term cognitive improvement. Importantly, the combination of TMS/tDCS with other cognitive enhancement strategies may be a promising strategy to alleviate the cognitive decline associated with the healthy aging process.