Social anxiety in older adults: phenomenology, prevalence, and measurement

Although phobias represent the most common anxiety disorders among the elderly, little is known about their social nature. The present study provides information about the prevalence, measurement, and phenomenology of social anxiety in older adults (n = 283) and compares results to those of younger adults (n = 318). Analyses revealed that social anxiety is less prevalent in old age than it is within younger cohorts and is associated with different symptomatology. The psychopathological profile of those who reach clinical levels of social anxiety is however similar, irrespective of age. Results regarding the psychometric properties of the SPAI when used for the elderly were promising, but the questionnaire appears to be difficult for some older adults to complete. Results are discussed in terms of explanations for age differences in social anxiety, initial psychometrics of the SPAI in an older adult sample, and suggestions for future research.     

Space Fortress game training and executive control in older adults: A pilot intervention

ABSTRACT

We investigated the feasibility of using the Space Fortress (SF) game, a complex video game originally developed to study complex skill acquisition in young adults, to improve executive control processes in cognitively healthy older adults. The study protocol consisted of 36 one-hour game play sessions over 3 months with cognitive evaluations before and after, and a follow-up evaluation at 6 months. Sixty participants were randomized to one of three conditions: Emphasis Change (EC) – elders were instructed to concentrate on playing the entire game but place particular emphasis on a specific aspect of game play in each particular game; Active Control (AC) – game play with standard instructions; Passive Control (PC) – evaluation sessions without game play. Primary outcome measures were obtained from five tasks, presumably tapping executive control processes. A total of 54 older adults completed the study protocol. One measure of executive control, WAIS-III letter–number sequencing, showed improvement in performance from pre- to post-evaluations in the EC condition, but not in the other two conditions. These initial findings are modest but encouraging. Future SF interventions need to carefully consider increasing the duration and or the intensity of the intervention by providing at-home game training, reducing the motor demands of the game, and selecting appropriate outcome measures.     

The hypercorrection effect in younger and older adults

ABSTRACT

The hypercorrection effect, which refers to the finding that errors committed with high confidence are more likely to be corrected than are low confidence errors, has been replicated many times, and with both young adults and children. In the present study, we contrasted older with younger adults. Participants answered general-information questions, made confidence ratings about their answers, were given corrective feedback, and then were retested on questions that they had gotten wrong. While younger adults showed the hypercorrection effect, older adults, despite higher overall accuracy on the general-information questions and excellent basic metacognitive ability, showed a diminished hypercorrection effect. Indeed, the correspondence between their confidence in their errors and the probability of correction was not significantly greater than zero, showing, for the first time, that a particular participant population is selectively impaired on this error correction task. These results potentially offer leverage both on the mechanisms underlying the hypercorrection effect and on reasons for older adults’ memory impairments, as well as on memory functions that are spared.     

Bias in older adults’ driving self-assessments: The role of personality

A convenience sample of 50 older drivers (M_age = 73.14, SD = 4.85) completed the Myers-Briggs Type Indicator® (MBTI®) Step III™ instrument and rated their own driving abilities (compared to all other drivers, same age drivers, and their own driving 20 years prior) and their ability to perform 68 specific driving-related behaviors. Each subject’s driving performance was also evaluated in a comprehensive on-road assessment conducted by a certified driving rehabilitation specialist, who rated the same 68 driving behaviors as well as driving performance. Drivers identified by the MBTI Step III instrument as Extraverted, Sensing, and (above median) Confident rated their driving significantly more favorably than Introverts, Intuitives, and below median Confidence drivers. Step III Sufficiency scales were associated with on-road performance: drivers with scores indicating low Confidence, low Stamina, or critical high levels of Compensatory Strain received significantly lower evaluations. Drivers with a Sensing preference or critical Strain score rated their driving significantly more favorably than evaluators did. These findings present preliminary evidence for the utility of personality assessments in identifying self-serving bias in driving self-evaluations, essential for safe self-regulation of driving.     

Individually tailored internet-based cognitive behaviour therapy for older adults with anxiety and depression: a randomised controlled trial

Mixed anxiety and depression is common among older adults. The aim of the study was to compare the effects of an eight-week-long tailored internet-supported cognitive behaviour therapy (ICBT) programme and to compare against the provision of weekly general support. A second aim was to investigate if pre-treatment cognitive flexibility and self-reported cognitive problems would predict outcome. We included 66 older adults (aged over 60 years) with mixed anxiety/depression following media recruitment and randomised them into treatment and control groups. We also included a one-year follow-up. As a measure of executive function, we used the Wisconsin Card Sorting Test (perseverative errors) and the Cognitive Failures Questionnaire during the pre-treatment phase. Results showed a moderate between-group effect on the main outcome measure, the Beck Anxiety Inventory (BAI) (d= .50), favouring the treatment group. Nearly half (45.5%) of that group were classified as responders. One person (3%) in the treatment group deteriorated. There were significant correlations between perseverative errors and outcome (on the BAI r = ?.45), but not among self-reported cognitive function. We conclude that guided, tailored ICBT may be effective for some older adults and that the role of cognitive function needs to be investigated further.     

The influence of face age on identification from a video line-up: A comparison between older and younger adults

A group of young-adult (aged 18–35 years) and older-adult witnesses (aged 61–83 years) viewed films of two similar staged thefts, one that depicted a young culprit and the other an older culprit. After a short delay of 40–60 minutes participants were presented with two separate video line-ups, one for each target. In one line-up the target was present (TP) and the other the target was absent (TA). Older adults performed more poorly in target present and absent line-ups, and showed no own-age bias, however young adults showed an own age advantage for the TA line-ups.     

Time monitoring and executive functioning in children and adults

This study examined time-based prospective memory performance in relation to individual and developmental differences in executive functioning. School-age children and young adults completed six experimental tasks that tapped three basic components of executive functioning: inhibition, updating, and mental shifting. Monitoring performance was examined in a time-based prospective memory task in which participants indicated the passing of time every 5min while watching a movie. Separate analyses of the executive functioning data yielded a two-factor solution for both age groups, with the updating and inhibition tasks constituting a common factor and the shifting tasks constituting a separate factor. Both children and adults showed accelerating monitoring functions with low rates of clock checking during the early phase of each 5-min interval. However, compared with adults, children needed more clock checks for obtaining the same level of response accuracy. Executive functioning had selective effects on time-based prospective memory performance. In both children and adults, monitoring performance was related to the inhibition and updating components, but not to the shifting component, of executive functioning. We conclude that difficulties in temporary maintenance and updating of working memory contents may create discontinuities in sense of time, leading to an increased reliance on external cues for time keeping.     

Competitive Memory Training for treating depression and rumination in depressed older adults: a randomized controlled trial

Although rumination is an important mediator of depressive symptoms, there is insufficient proof that an intervention that specifically targets rumination ameliorates the clinical condition of, depressed patients. This study investigates whether a time-limited cognitive behavioral intervention (Competitive Memory Training, or COMET for depressive rumination) is an effective treatment for depression and rumination. This intervention was tested in older adult depressed outpatients. A total of 93 patients (aged ≥65 years with major depression and suffering from rumination) were treated in small groups according to the COMET protocol in addition to their regular treatment. Patients were randomized to two treatment conditions: 7 weeks of COMET + treatment-as-usual (TAU) versus TAU only. COMET + TAU showed a significant improvement in depression and rumination compared with TAU alone. This study shows that the transdiagnostic COMET protocol for depressive rumination might also be successful in treating depression and rumination in older adults.     

Contextual Design for driving: Developing a trip-planning tool for older adults

Independent living depends on mobility, and mobility depends on driving, particularly for people 65 years and older. The longer older adults can safely drive, the longer they can independently run errands, shop, exercise, and maintain social networks. Age-related decline of perceptual, motor, and cognitive abilities can undermine the mobility and driving safety of older drivers. Data from driving simulators, on-road tests, surveys, and crash reports describe the driving safety and mobility challenges of older adults, but these methods offer a limited view of these challenges and fail to indicate design solutions. Contextual Design—a combination of Contextual Inquiry interviews, model building, and affinity diagrams—offers a complementary approach to uncover challenges that older adult drivers’ experience. For two weeks, 39 drivers age 65 and above, had their vehicles instrumented to collect driving and video data. Applying Contextual Design to these data showed that older drivers in urban and rural settings faced different mobility challenges and adopted various strategies to mitigate risk: older drivers often involved their spouse or passenger in the driving task, avoided certain driving maneuvers such as left turns, avoided unfamiliar or poorly lit roads at night, and planned trips to avoid risky driving situations. Ridesharing and trip planning emerged as important strategies to improve the safety and mobility of older drivers. Ridesharing could serve as a potential solution to prolong mobility; however, factors such as wait time, scheduling conflicts, costs, and trust were concerns for older drivers. A paper prototype was developed to validate the driving challenges faced by older drivers, and guide the development of a customized web-based trip-planning tool. The trip-planning tool could help older drivers make safer route choices by offering routes with fewer driving challenges, thereby enhancing their driving safety, mobility, and independence.     

Endogenous estradiol is associated with verbal memory in nondemented older men

This study examined the relationship between endogenous hormones and cognitive function in nondemented, ethnically-diverse community-dwelling older men enrolled in the Einstein Aging Study (EAS). All eligible participants (185 men, mean age=81 years) received neuropsychological assessment (Free and Cued Selective Reminding Test (FCSRT), Logical Memory (LM), Trail Making Test B (TMTB), block design (BD)) and provided blood samples for hormonal assays (total estradiol, total testosterone, calculated free testosterone index). Linear regression analysis adjusted for age, education, body mass index, and cardiovascular comorbidities indicated that men with high levels of total estradiol demonstrated better FCSRT verbal memory performance (β=0.17, p<0.02) compared to men with lower levels of total estradiol. The results remained unchanged when the model was further adjusted for ethnicity. We did not detect an association between testosterone and cognitive performance. These findings indicate that high levels of total estradiol in older men are associated with better performance on a cue-based, controlled learning test of verbal memory that is a sensitive predictor of dementia.     

Space Fortress game training and executive control in older adults: a pilot intervention

We investigated the feasibility of using the Space Fortress (SF) game, a complex video game originally developed to study complex skill acquisition in young adults, to improve executive control processes in cognitively healthy older adults. The study protocol consisted of 36 one-hour game play sessions over 3 months with cognitive evaluations before and after, and a follow-up evaluation at 6 months. Sixty participants were randomized to one of three conditions: Emphasis Change (EC)--elders were instructed to concentrate on playing the entire game but place particular emphasis on a specific aspect of game play in each particular game; Active Control (AC)--game play with standard instructions; Passive Control (PC)--evaluation sessions without game play. Primary outcome measures were obtained from five tasks, presumably tapping executive control processes. A total of 54 older adults completed the study protocol. One measure of executive control, WAIS-III letter-number sequencing, showed improvement in performance from pre- to post-evaluations in the EC condition, but not in the other two conditions. These initial findings are modest but encouraging. Future SF interventions need to carefully consider increasing the duration and or the intensity of the intervention by providing at-home game training, reducing the motor demands of the game, and selecting appropriate outcome measures.     

The moderating role of executive functioning in older adults' responses to a reminder of mortality

In previous research, older adults responded to mortality salience (MS) with increased tolerance, whereas younger persons responded with increased punitiveness. One possible explanation for this is that many older adults adapt to challenges of later life, such as the prospect of mortality, by becoming more flexible. Recent studies suggest that positively oriented adaptation is more likely for older adults with high levels of executive functioning. Thus, we hypothesized that the better an older adult's executive functioning, the more likely MS would result in increased tolerance. Older and younger adults were randomly assigned to MS or control conditions, and then evaluated moral transgressors. As in previous research, younger adults were more punitive after reminders of mortality; executive functioning did not affect their responses. Among older adults, high functioning individuals responded to MS with increased tolerance rather than intolerance, whereas those low in functioning became more punitive.     

The effect of parental modeling of anxious behaviors and cognitions in school-aged children: An experimental pilot study

The current study tested: (1) the impact of parental modeling of anxious behaviors and cognitions on child anxiety level, anxious cognitions, desired avoidance, and objective performance using an experimental paradigm; and (2) whether the impact of parental modeling of anxious behaviors and cognitions differed by parent gender. Twenty-five parents (a random selection of 12 male and 13 female parents) participated with one of their children (ages 8-12 years; 56.0% male; 76.0% Caucasian). All children experienced two test conditions: an anxious condition in which their parent was trained to act anxiously before a planned spelling test and a non-anxious condition in which their parent was trained to act in a relaxed and confident manner before a planned spelling test. Results showed that, regardless of parent gender, children endorsed higher anxiety levels, anxious cognitions, and desired avoidance of the spelling test in the anxious relative to the non-anxious condition. Parental modeling of anxiety did not affect child spelling performance. Significant interaction effects indicated that fathers had a stronger impact on child anxiety level and cognitions than did mothers. Results highlight the importance of parental modeling and the potential role of both mothers and fathers in prevention and treatment for child anxiety.     

Modified CBT using visualization for Autism Spectrum Disorder (ASD), anxiety and avoidance behavior – a quasi‐experimental open pilot study

In recent studies it has been suggested that Cognitive Behavior Therapy (CBT) is beneficial to people with Autism Spectrum Disorder (ASD) but that the method needs to be modified in relation to their cognitive profile. The aim of this study is to measure the effect of modified CBT, that is, using visualized language throughout the entire session for clients with ASD and anxiety and avoidance behavior. The modification of CBT in this study consists of focusing on CBT protocols for anxiety disorders and depression, while visualizing and systematizing “the invisible” in the conversation, in order for the clients to understand the social, cognitive and emotional context of self and others and how they should interact to avoid misunderstandings. ASD clients may need help to detect the invisible code of social interaction and communication. The level of anxiety and the frequency of target behavior were measured. Four assessments were made, two at the pre‐assessment, and one in mid‐therapy and end of therapy respectively. Generally, results suggest no improvement during pre‐treatment period but a significant improvement during treatment. The values of the clients' psychological, social and occupational ability to function improved on the Global Function Rating scale. The preliminary conclusion of this pilot study indicates that the use of visualized language throughout the CBT therapy sessions is a promising modification of current CBT protocols for individuals with ASD. After manualization, larger studies with randomized controlled study designs can replicate or challenge these results.     

The fight against prejudice in older adults: perspective taking effectiveness

Inhibition of prejudice appears to be more problematic for older adults, hence the need to develop programs to reduce intergroup bias at later stages in life. Perspective taking was analyzed in this study, as one of various cognitive strategies that have been shown to reduce such bias. Data on a sample of 63 Spanish participants with a mean age of 64.1 years was gathered after an intervention based on mental imagery, aimed at reducing explicit prejudice. A wide array of variables was measured (personality traits, values, empathy, and attribution) which may moderate effectiveness in perspective taking. Despite no main effect was found, effects due to interaction of perspective taking found in OLS regression analysis revealed that perspective taking based intervention was effective for some older adults, particularly those who had low scores on agreeableness, empathy, and universalism, and high scores on conformity. The conclusions suggest that perspective taking might be successfully applied to some profiles of older people albeit it is not as strong and transferable strategy as it used to be thought.     

Computerized cognitive training during physical inactivity improves executive functioning in older adults

The hippocampus is closely tied to spatial navigation, a central component in cognitive functioning, and critically involved in age-associated cognitive decline and dementia. This study evaluated a novel, cognitive computerized spatial navigation training (CSNT) program targeting the hippocampus, with expectation of mitigating possible cognitive decline with bed rest (BR). During a 14-day BR study with 16 healthy, older men (mean age = 60 ± 3, range = 55–65 years), half received CSNT for 12 days in 50-min sessions and half were controls (watching documentaries). This design uniquely controlled diet, sleep, and other personal and environmental activities. Although there were no cognitive declines in controls post-BR, CSNT participants demonstrated significant increases in executive/attention ability and processing speed, and continued spatial navigation testing showed improvement to 400 days post-BR. This intervention may prove useful to mitigate cognitive declines known to occur in long periods of immobilization and could have broader implications in protecting against age-related cognitive decline.     

Experiences of older adults interacting with a shared autonomous vehicle and recommendations for future implementation

IntroductionA recognised potential benefit of autonomous vehicles is increased mobility for older adults. However, this group is more apprehensive about adoption, which may hinder uptake. Shared autonomous vehicles (SAVs) represent a use case that may be especially relevant for older people due to emerging applications in retirement villages and similar precincts. However, little research has examined the SAV-related concerns of older adults and strategies to address them. This study used an exploratory approach involving SAV exposure to identify strategies that may increase older people’s receptiveness to SAVs.MethodOlder adults living in retirement villages (n = 63) were interviewed while interacting with an SAV to examine their needs, expectations, and concerns regarding SAVs. The interview data were coded and thematically analysed.ResultsParticipants recommended the following approaches to ensuring SAVs are useful and acceptable to older adults: providing physical accessibility for those with mobility impairments, comfortable and practical internal layouts, and operating SAVs on convenient routes at useful speeds. Strategies such as exposing older adults to SAVs in operation to encourage uptake and initially ensuring a human assistant is present were suggested methods of increasing receptivity.DiscussionThe findings suggest older passengers are likely to share many of the same reactions to SAVs as the broader population, but with a stronger focus on issues relating to accessibility and the physical layout of the vehicles. The solutions to these issues suggested by the study participants may be useful for those designing SAVs for use in older people’s settings and beyond.     

Dispositional mindfulness and the wandering mind: Implications for attentional control in older adults

Age-related cognitive decline brings decreases in functional status. Dispositional mindfulness, the tendency towards present-moment attention, is hypothesized to correspond with enhanced attention, whereas mind-wandering may be detrimental to cognition. The relationships among mindfulness, task-related and task-unrelated thought, and attentional control performance on Go/No-Go and Continuous Performance tasks were examined in older adults. Dispositional mindfulness was negatively associated with task-unrelated thought and was positively associated with reactive control, but not proactive control or Go/No-Go performance. Although mind-wandering was not directly associated with performance, task-unrelated thought mediated the mindfulness-proactive control relation. Fewer task-unrelated thoughts were associated with lower proactive control. Interestingly, this effect was moderated by working memory such that it was present for those with low-average, but not high, working memory. This study highlights the importance of dispositional mindfulness and mind-wandering propensity in accounting for individual differences in attentional control in older adults, providing important targets for future cognitive remediation interventions.     

Dual-task effects of simulated lane navigation and story recall in older adults with and without memory impairment

ABSTRACT

While driving is a complex task, it becomes relatively automatic over time although unfamiliar situations require increased cognitive effort. Much research has examined driving risk in cognitively impaired elders and found little effect. This study assessed whether mildly memory impaired elders made disproportionate errors in driving or story recall, under simultaneous simulated driving and story recall. Forty-six healthy (61% women; mean age = 76.4) and 15 memory impaired (66% women, mean age = 79.4) elders participated. Cognitive status was determined by neuropsychological performance. Results showed that during dual-task conditions, participants stayed in lane more, and recalled stories more poorly, than when they did the tasks separately. Follow-up analysis revealed that verbatim recall, in particular, was reduced while driving for healthy participants. While memory impaired participants performed more poorly than healthy controls on both tasks, cognitive status was not associated with greater dual-task costs when driving and story recall were combined.