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.     

Aging and mental health in the decade ahead: what psychologists need to know

Until relatively recently, most psychologists have had limited professional involvement with older adults. With the baby boomers starting to turn 65 years old in 2011, sheer numbers of older adults will continue to increase. About 1 in 5 older adults has a mental disorder, such as dementia. Their needs for mental and behavioral health services are not now adequately met, and the decade ahead will require an approximate doubling of the current level of psychologists' time with older adults. Public policy in the coming decade will face tensions between cost containment and facilitation of integrated models of care. Most older adults who access mental health services do so in primary care settings, where interdisciplinary, collaborative models of care have been found to be quite effective. To meet the needs of the aging population, psychologists need to increase awareness of competencies for geropsychology practice and knowledge regarding dementia diagnosis, screening, and services. Opportunities for psychological practice are anticipated to grow in primary care, dementia and family caregiving services, decision-making-capacity evaluation, and end-of-life care. Aging is an aspect of diversity that can be integrated into psychology education across levels of training. Policy advocacy for geropsychology clinical services, education, and research remains critical. Psychologists have much to offer an aging society.     

Mental Health Concerns of Older Adults Living in Long-Term Care Facilities: An Area of Expansion for MFTs

As baby boomers reach retirement age, the number of older adults living in long-term care will inevitably increase. Living in long-term care often brings psychological, relational, and emotional challenges for older adults, their families, and professional care-providers. Despite these trends and associated challenges, there appears to be an underrepresentation of attention addressing the mental health care of older adults and their families in marriage and family therapy (MFT) literature. Emphasis needs to be turned to assessing the quality and effectiveness of mental health resources for older adults in residential facilities, and to filling the gap where needed services are unavailable. The current review summarizes research addressing residential care for older adults, detailing a) mental health challenges faced by residents, families, and professional care-providers, b) effective mental health treatment options, and c) how MFTs are uniquely suited to working in long-term care settings.     

An exploratory investigation of the personality correlates of aging using the Hand Test.

The Hand Test was administered to 27 older adults of both sexes (Mage = 66.56) to investigate possible changes in personality concomitant with normal aging. To control partially for such factors as cultural influences and intelligence differences a matched-pair design was used in which the test protocols of the older adults were matched with those of their children of the same sex (Mage = 36.44). Though the Hand Test has not been independently validated on older adults, results were consistent with past findings using projective techniques inasmuch as depletion and constriction of personality were noted. Criticisms of research on the clinical assessment of the elderly were discussed.     

Anxiety Disorders in Late Life: Considerations for Assessment and Cognitive-Behavioral Treatment

Anxiety disorders are among the most frequently diagnosed mental disorders in late life. As older adults comprise a growing segment of the population, evidence-based treatments for anxiety disorders in late life have come into sharper focus. Cognitive-behavioral therapy (CBT) for anxiety disorders in late life has received less empirical attention and widespread dissemination relative to other age groups. Increasing older adults’ access to timely assessment and effective treatment can help reduce the personal and societal costs of anxiety disorders. The purpose of this review paper is to discuss important considerations for the assessment of anxiety disorders in older adults and offer adaptations to CBT treatment for this population. As part of assessment considerations, we discuss how physical health conditions, cognitive impairment, and functional limitations can impact anxiety disorder diagnoses with older adults. We also outline validated self-report measures of anxiety disorder symptoms for older adults and highlight the importance of assessing older adults’ suitability for CBT. Several recommendations for adapting CBT protocols for older adults with anxiety disorders are described, such as extending psychoeducation, altered treatment pacing, use of content aids, and medical contraindications for interoceptive exposure. A case study is included that illustrates helpful assessment and treatment adaptions for an older woman with panic disorder. We highlight the pressing need to increase research and dissemination of CBT for anxiety disorders for older adults to meet the needs of an increasing segment of the population worldwide.     

Guided Internet-Based CBT for Common Mental Disorders

The Internet has become a part of most people’s lives in many parts of the world. Since the late 1990s there has been an intensive research activity in which psychological treatments, such as cognitive behavior therapy (CBT), have been found to be effective when delivered via the Internet. Most research studies indicate that the effects are larger when some form of guidance is provided from a therapist, and unguided treatments tend to lead to more dropout and smaller effects. Guided Internet treatments often consists of book length text materials, but can also include other components such as audio files and video clips. Homework assignment is often included and feedback is given for completed homework. Guided Internet-based CBT (iCBT) has been found to work for problems such as depression, panic-, social anxiety-, and generalized anxiety disorders. There are many research trials in which participants have been recruited via media, and there has been less research conducted in representative clinical settings. Most research has been conducted on adults and in university settings with nationwide recruitment. There is a need for treatments and studies on older adults, children and adolescents. In conclusion, dissemination of the research findings on guided iCBT to regular clinical settings is warranted.     

Translating Research for Professional Development and Effective Clinical Practice With Older Adults

This paper offers a commentary on the articles in the special series on cognitive behavior therapy with older adults (Carmin, 2012-this issue), noting the commonalities found across discussions of diagnostic interviewing and cognitive-behavioral assessment and treatment for late-life insomnia, depression and suicide risk, PTSD, and OCD. These case studies demonstrate best practices in the application of cognitive-behavioral strategies for assessment and intervention with a diverse range of older adults. Clinicians can improve the effectiveness of their work with aging clients by expanding their skills in assessment and managing interprofessional relationships in integrated health-care settings. Reflected by the papers in this series, ongoing professional development and research attention are both essential as clinicians from the mental health disciplines increase provision of CBT with older adults. Treatments for specific disorders and problems will also benefit from the growing literature on successful aging, and the application of positive psychology in our future collaborations with older adults and their care partners.     

Pragmatic Screening of Anxiety,Depression, Suicidal Ideation,and Substance Misuse in Older Adults

Older adults’ mental health needs are often unmet across care settings (e.g., primary or residential care) for a variety of reasons, such as mental health stigma and mental health care professionals’ lack of awareness of age-related changes in mental disorders. Screening, when coupled with access to evidence-based interventions, is effective at identifying and reducing anxiety, depression, suicidal ideation, and substance misuse in older adults across care settings. Unfortunately, due to lack of training many mental health care professionals may be unsure about what or how to screen, as well as which screening measures are available for use with older adults. Following professional guidelines recommended for older adults, we provide an overview of screening measures for anxiety, depression, suicidal ideation, and substance misuse that are evidence-based and meet pragmatic criteria identified by stakeholder research. Specific pragmatic criteria include screening measures developed with older adults (unless unavailable) as well as brief in length (items ≤30), time for administration (≤15 minutes), scoring (<5 minutes), and interpretation (<5 minutes). Other pragmatic criteria include screening measures readily available on the internet at no cost and usable across diverse settings (e.g., community, primary care, and/or residential care). For each measure, we also review relevant psychometric properties (e.g., reliability, cut-scores, sensitivity, specificity, and construct validity). Lastly, we discuss strategies to facilitate screening with older adults and direct mental health care providers to internet resources that can be used to learn more about assessment with older adults.     

Cognitively impaired older adults exhibit comparable difficulties on naturalistic and laboratory prospective memory tasks

Prospective memory, or remembering future intentions, is critical for independent living for all ages, but especially older adults. Previous laboratory research has found that cognitively impaired older adults may have particular difficulties with prospective memory, but previous studies have not examined whether these difficulties occur in everyday life. In normal ageing, a dissociation between settings has been observed, with older adults selectively impaired in laboratory (but not naturalistic) contexts. Consequently, in the present study 15 cognitively impaired older adults were compared to demographically matched controls on laboratory and naturalistic measures of prospective memory. The results indicated that the cognitively impaired group performed more poorly on both measures, with the magnitude of the deficit comparable across setting. These results indicate that for older adults who present with cognitive impairment prospective memory deficits observed in laboratory settings may be a valid indicator of difficulties experienced executing delayed intentions in everyday life. Copyright © 2008 John Wiley & Sons, Ltd.     

Clinical Geropsychology: Implications for Practice in Medical Settings

Older adults are a rapidly growing segment of the population, who have high rates of chronic illness and who utilize health care resources heavily. Psychologists must become better prepared to work with older patients in geriatric settings, including geriatric assessment units, memory disorders clinics, and nursing homes. In addition, all psychologists will increasingly encounter older patients in environments such as primary care clinics, rehabilitation settings, and disease management programs focusing on problems that are prevalent in older patients (e.g., cancer, diabetes). Suggestions are offered for adaptation of usual clinical practice to address the special needs of older patients and their families, and recommendations made for advancing and expanding the practice of clinical geropsychology.     

Relationship of cognitive strategy use to prospective memory performance in a diverse sample of nondemented older adults with varying degrees of cognitive complaints and impairment

Although older adults typically have better performance on prospective memory (PM) tasks carried out in naturalistic settings, a paucity of research directly assesses older adults’ use of compensatory strategies on such tasks. The current study investigates external memory strategy use during performance of a clinical PM test that features both short-term (in laboratory) and long-term (out of laboratory) subtasks (i.e., the Royal Prince Alfred Prospective Memory Test – RPA-ProMem. Nondemented, community-dwelling older adults (n = 214; mean age = 80.5; 68.2% female; 39.7% non-white) with mild cognitive impairment, subjective cognitive decline, and healthy controls completed the RPA-ProMem while external strategy use was permitted and recorded. Overall, participants utilized external strategies 41% of the time on the RPA-ProMem. Increased utilization of external memory strategies was significantly associated with better PM performance. Additionally, better performance on executive functioning tasks was associated with increased use of external memory strategies. Results are discussed in relation to how memory strategy use can be enhanced to improve everyday memory ability in older adults at risk for dementia.     

Depression Screening in Medically Ill Homecare Elderly

PURPOSE: This article provides data on a depression screening model (HOME) in acute home health care designed to detect clinical depression among medically ill homebound older patients. The model was developed to address the lack of mental health services in home health care settings and to specifically improve geriatric depression screening as part of routine care. Authors report on the concordance of homecare and research interview ratings of depression in older homecare patients. DESIGN AND METHODS: Using a prospective cohort design, data were collected from 289 elderly patients, aged 65 and older, from a large home health care agency to examine depression, cognitive functioning, medical comorbidity, functional status, and social isolation. Research interviews used the depression module of the structured clinical interview for DSM (SCID). RESULTS: The overall prevalence of major depression was 5.7 percent according to both homecare and research raters. The prevalence of subthreshold depressive disorder was 16.4 percent as reported by research raters. Observed agreement was 73 percent and kappa agreement was 0.42, indicating a fair to moderate agreement. We identified patient characteristics that may influence the accuracy of homecare worker estimates of depressive symptoms. IMPLICATIONS: Findings suggest that depression continues to be underdetected in medically ill homebound elderly patients. Ongoing training in depression screening methods, patient follow-up interviews, and appropriate referral would improve care of depressed elderly homecare patients.     

Leaving Home: An Examination of Late‐Life Relocation Among Older Adults

This article describes older adults' experiences of a late‐life residential relocation from a home to a long‐term health care setting. Findings from 14 participants who engaged in a focus group and/or an individual interview supported 8 major themes. Thematic experiences were related to precipitating factors prior to the move, risks and protective factors in relocation, and aspects of positive aging. Implications for clinical practice with older adults who undergo late‐life transitions are described.     

Contextual Adult Life Span Theory for Adapting Psychotherapy with Older Adults

Our aging population is growing in size and diversity. To integrate different views on aging and make explicit the role of culture as a contextual factor, we modified Knight’s (Psychotherapy with older adults, 2004) Contextual, Cohort-based, Maturity, Specific Challenge (CCMSC) model of psychotherapy with older adults into the Contextual Adult Lifespan Theory for Adapting Psychotherapy (CALTAP). This article describes various components of the CALTAP, which serves as a meta-theoretical framework in guiding an integrated psychotherapy approach for the aging population. The interaction between environmental factors like cohort differences and socio-cultural contexts and individual factors such as maturation and age-related specific challenges not only shapes the experience and presentation of older adults in clinical settings, but also highlights special considerations in adapting psychotherapy for older adults.     

Does the use of dolls facilitate children's memory of visits to the doctor?

Age differences in children's recall of salient experiences have frequently been documented, but these findings have routinely been based on studies in which verbal interviews have been employed. Because verbal interview protocols may underestimate the memory of young children, the purpose of this research was to compare the effectiveness of such an interview with two alternative protocols that involved the use of a doll. Using these contrasting protocols, 3-and 5-year-old children were asked to remember the details of a routine physical examination. Neither doll protocol facilitated 3-year-olds' recall of the features of the check-up. In contrast, 5-year-olds who were asked to demonstrate with a doll what happened in their examination showed enhanced recall. The inclusion of a doll had no effect on older or younger children's provision of elaborative detail about their visits to the doctor. Various measures of individual differences (e. g. temperament, language skill) predicted some aspects of the children's recall and elaboration. The findings are discussed in terms of the cognitive skills necessary for effective use of dolls in the assessment process, and are related to problems associated with interviewing young children who are involved in legal proceedings.     

The Assertive Interaction Coding System

Conceptual and theoretical issues concerning the assessment of assertive behavior are discussed. A summary of a variety of instruments utilized in experimental and clinical settings is offered that reflects these issues. This review is followed by the presentation of a new assessment device developed by the authors—the Assertive Interaction Coding System. Research evidence as to its reliability and validity in experimental and clinical settings is presented. Implications for its use in clinical and research protocols are addressed.     

A Conceptual Framework for Assessing the Spiritual Functioning and Fulfillment of Older Adults in Long-Term Care Settings

ABSTRACT

The 1971 White House Conference on Aging asserted that all persons are spiritual, and that the spiritual well-being of older adults is a significant area of concern for both researchers and practitioners. Many attempts have been made to define and describe spirituality, using instruments designed to measure religious functioning and behavior. While these have been helpful to researchers, they have been of little practical use.

This paper presents a conceptual framework for the operationalization of the variable, “spirituality.” Using this framework, the authors chose three qualitative research questions related to spiritual values which were asked of both older adults and service providers. The results were factor analyzed and an instrument was developed which enables the practitioner to assess the type of spiritual functioning and fulfillment desired by older adults in long-term care settings.     

Measuring episodic memory: A novel approach with an indefinite number of alternative forms

Both clinical practice and clinical research settings can require successive administrations of a memory test, particularly when following the trajectory of suspected memory decline in older adults. However, relatively few verbal episodic memory tests have alternative forms. We set out to create a broad‐based memory test to allow for the use of an essentially unlimited number of alternative forms. Four tasks for inclusion in such a test were developed. These tasks varied the requirement for recall as opposed to recognition, the need to form an association between unrelated words, and the need to discriminate the most recent list from earlier lists, all of which proved useful. A total of 115 participants completed the battery of tests and were used to show that the test could differentiate between older and younger adults; a sub‐sample of 73 participants completed alternative forms of the tests to determine test–retest reliability and the amount of learning to learn. Copyright © 2009 John Wiley & Sons, Ltd.     

Aging, subjective experience, and cognitive control: dramatic false remembering by older adults

Recent research suggests that older adults are more susceptible to interference effects than are young adults; however, that research has failed to equate differences in original learning. In 4 experiments, the authors show that older adults are more susceptible to interference effects produced by a misleading prime. Even when original learning was equated, older adults were 10 times as likely to falsely remember misleading information and were much less likely to increase their accuracy by opting not to answer under conditions of free responding. The results are well described by a multinomial model that postulates multiple modes of cognitive control. According to that model, older adults are likely to be captured by misleading information, a form of goal neglect or deficit in inhibitory functions.     

The applied value of collaborative memory research in aging: Behavioral and neural considerations

Our aim in this paper is to bring attention to the applied value of collaborative memory research in aging. At this time, much collaborative memory research focuses on the negative effects of collaboration in younger adults, and is primarily basic in nature. Here, we highlight the positive effects of collaboration that have received less attention, with a particular emphasis on the applied value of these effects in older adults. We first review studies to show that recalling in a group improves later individual recall and reduces memory errors in older adults. We then outline a four-step approach towards bridging laboratory and applied collaborative memory research, which involves: (1) complementing traditional paradigms with more ecologically valid paradigms, (2) evaluating these paradigms in applied settings, (3) adapting these paradigms for use with cognitively intact and cognitively impaired populations, and (4) modifying these paradigms to examine the neural systems that operate during collaborative recall.