Spiritual and Religious Implications of Aging with HIV: A Conceptual and Methodological Review

ABSTRACT

Spirituality and religious practices can buffer people from stressful life circumstances and promote positive biopsychosocial outcomes. The beneficial effects of spirituality and religious practices have been documented in aging and HIV. Unfortunately, little is known about spirituality and religious practices in older adults with HIV. As the number of older adults with HIV increases, with an estimated 91,000 adults over 50 being diagnosed with this disease in the United States, spirituality and religious practices may help HIV-positive people to age successfully. Crisis competence and spiritual trajectories are ways of conceptualizing spiritual development when confronting aging with a life-changing event such as a being diagnosed with HIV. Methodological issues in studying spirituality in adults aging with HIV are identified including defining spirituality and religiosity, heterogeneity of the population, timing of diagnosis, mode of transmission, sexual orientation, religious and cultural stigma, and hardiness. Implications for possible interventions are also posited.     

The Neuropsychology of HIV/AIDS in Older Adults

Highly active antiretroviral therapy is allowing increasing numbers of adults to age with HIV. The neuropsychological effects of aging with HIV are reviewed through three types of studies. First, the separate effects of HIV and aging on cognition are examined in studies that compare younger adults with HIV with neurologically normal older adults. Second, studies examine the impact of aging within samples of adults with HIV only. Third, providing the most critical evidence, are studies that assess cognition in younger and older adults with HIV relative to younger and older adults without HIV. In general research findings are inconclusive. Large individual differences among older adults with HIV as well as co-factors (APOE4 and detectable viral load) may account for inconsistent findings in the literature. A subgroup of older adults with HIV may be at greater risk for cognitive impairment, especially in attention functioning.     

Aging and performance on an everyday-based visual search task

Research on aging and visual search often requires older people to search computer screens for target letters or numbers. The aim of this experiment was to investigate age-related differences using an everyday-based visual search task in a large participant sample (n=261) aged 20-88 years. Our results show that: (1) old-old adults have more difficulty with triple conjunction searches with one highly distinctive feature compared to young-old and younger adults; (2) age-related declines in conjunction searches emerge in middle age then progress throughout older age; (3) age-related declines are evident in feature searches on target absent trials, as older people seem to exhaustively and serially search the whole display to determine a target's absence. Together, these findings suggest that declines emerge in middle age then progress throughout older age in feature integration, guided search, perceptual grouping and/or spreading suppression processes. Discussed are implications for enhancing everyday functioning throughout adulthood.     

Aging, inhibition, and social inappropriateness

This study explores the hypothesis that age-related declines in inhibitory ability are associated with increases in socially inappropriate behavior. Consistent with this hypothesis, older participants were less likely than younger participants to differentiate between public and private settings when inquiring about potentially embarrassing issues, according to their peers. Additionally, this indiscriminate public inquiry was associated with decreased closeness with participants' peers, particularly for older adults. Finally, this age-related increase in social inappropriateness was mediated by inhibitory deficits associated with aging. These results suggest that age-related deficits in inhibitory ability may cause people to become socially inappropriate against their will.     

老年人整体运动知觉衰退的视觉机制——基于知觉模板模型

整体运动知觉存在年龄相关的衰退,然其老化的视觉机制仍不清楚。本研究分别招募34名青年人和老年人为研究对象,采用随机点阵范式,首次以动态速度为外部噪声考察了这一问题。结果发现,老年组整体运动一致性阈值显著高于青年组,且中等速度下的差异较小,证明整体运动知觉存在老化效应,且老化程度受到速度的影响。对两组数据进行知觉模板拟合发现,以青年组为基准,老年组表征内部加法噪声和排除外部噪声能力的 A_a 和 A_f 均大于1,且 A_a >> A_f ,提示老年人整体运动知觉的衰退可能源于其内部加法噪声的增强和排除外部噪声能力的减弱,其中内部加法噪声的增强更为显著。     

Perceived Control Over Aging-Related Declines: Adaptive Beliefs and Behaviors

ABSTRACT— The belief that people are in control of desired outcomes, including those associated with aging, is a hallmark of American culture. Nevertheless, older adults are less likely than the young to believe there are things that can be done to control aging-related declines in areas such as memory. Within age groups, individual differences in control beliefs are related to cognitive performance, health, and well-being. Mechanisms linking perceived control and positive outcomes include adaptive behaviors such as strategy use and physical activity. There is some evidence that control beliefs can be modified in later life, as illustrated in an intervention for fear of falling. Further work is needed to examine the antecedents of perceived control in later life and the implications of control beliefs in other aging-related domains.     

Arthritic pain, aging, and psychomotor decline in people with HIV

Arthritic pain and subsequent immobility are common in people with Human Immunodeficiency Virus (HIV) and in persons of older ages. It is hypothesized that such pain may contribute to psychomotor impairment commonly observed with HIV and aging. Empirical evaluation of this hypothesis among older persons with HIV and consideration of treatment should be undertaken.     

Not your parents' test scores: cohort reduces psychometric aging effects

Increases over birth cohorts in psychometric abilities may impact effects of aging. Data from 2 cohorts of the Long Beach Longitudinal Study, matched on age but tested 16 years apart, were modeled over ages 55-87 to test the hypothesis that the more fluid abilities of reasoning, list and text recall, and space would show larger cohort differences than vocabulary. This hypothesis was confirmed. At age 74, average performance estimates for people from the more recently born cohort were equivalent to those of people from the older cohort when they were up to 15 years younger. This finding suggests that older adults may perform like much younger ones from the previous generation on fluid measures, indicating higher levels of abilities than expected. This result could have major implications for the expected productivity of an aging workforce as well as for the quality of life of future generations. However, cohort improvements did not mitigate age declines.     

Changing Attitudes Toward Older Adults Through a Simulated Aging Exercise: Implications for Family Therapy

Past research suggests that many young people hold negative attitudes toward the elderly. Simulated aging is one method to reduce aging that had been successfully applied with those individuals working in the helping professions. However, it has not yet been applied to ordinary young adults. The current study examined whether a simulated aging activity would cause more positive attitudes toward the aged, an increased desire to help, and higher satisfaction with life. Seventy-eight college students participated; half were randomly assigned to complete three tasks with sensory deficits designed to simulate aging (i.e., wearing non-magnified glasses covered with petroleum jelly, wearing foam earplugs, and wearing cloth gloves), and half served as the control. Three questionnaires were completed that measured attitudes toward older adults, prosocial desires, and satisfaction with life. Results showed that young adults who experienced simulated aging had more favorable attitudes toward older adults than did individuals in the control condition. These results suggest that simulated aging activities may be an effective method to reduce ageism. This has potential implications for multigenerational family therapy, such as to assist younger people to understand what their grandparents may be experiencing.     

Age differences in veridical and false recall are not inevitable: The role of frontal lobe function

The relationship of neuropsychological measures of frontal lobe function to age differences in false recall was assessed using the Deese/Roediger-McDermott associative false memory paradigm (Deese, 1959; Roediger & McDermott, 1995). As other studies have found, older adults were less likely to correctly recall studied items and more likely to falsely recall highly related but nonpresented items than were younger adults. When older adults were divided based on a composite measure of frontal lobe functioning, this age difference was found only for low frontal lobe functioning individuals. High frontal lobe functioning older adults and young adults had equivalent levels of false recall, as well as equivalent levels of veridical recall. These results suggest that age differences in memory may be due to declines in frontal lobe function. More important, our findings indicate that declines in veridical recall and increases in false recall are not an inevitable consequence of aging.     

Beliefs about age-related changes in physical functioning across the adult life span and their relationship with physical activity levels of older adults

Physical activity declines across the adult life span despite the well-established links between physical activity and health-related, psychological, cognitive, and social benefits. We contrasted the beliefs young and older adults hold about how aging affects both physical abilities and physical activity and determined whether older adults’ beliefs about physical aging relate to their engagement in physical activity. Using visual rating scales, 56 young and 49 community-dwelling older adults indicated the extent to which a typical woman or typical man aged 20–90 possesses six different physical abilities and engages in three different types of physical activity. Stereotypes of physical aging were ability- and activity-specific, and older adults endorsed more positive views than their younger peers. Stereotypical beliefs predicted older adults’ engagement in moderate-intensity activity. This study offers intriguing avenues for future research and suggests that better understanding physical aging stereotypes may contribute toward designing interventions that promote lifelong physical activity.     

Everyday Problem Solving and Emotion: An Adult Developmental Perspective

ABSTRACT— Despite cognitive declines that occur with aging, older adults solve emotionally salient and interpersonal problems in more effective ways than young adults do. I review evidence suggesting that older adults (a) tailor their strategies to the contextual features of the problem and (b) effectively use a combination of instrumental and emotion-regulation strategies. I identify factors of problem-solving contexts that affect what types of problem-solving strategies will be effective. Finally, I discuss how this identification of factors affects what we know about developmental differences in everyday problem-solving competence.     

The effects of HIV disease and older age on laboratory-based,naturalistic, and self-perceived symptoms of prospective memory: does retrieval cue type and delay interval matter?

There is a rising prevalence of older HIV+ adults who are at risk of deficits in higher order neurocognitive functions and associated problems in everyday functioning. The current study applied multiprocess theory to examine the effects of HIV and aging on measures of laboratory-based, naturalistic, and self-perceived symptoms of prospective memory (PM). Participants included 125 Younger (48 with HIV, age = 32 ± 4.6 years) and 189 Older (112 with HIV, age = 56 ± 4.9 years) adults. Controlling for global neurocognitive functioning, mood, and other demographics, older age and HIV had independent effects on long-delay time-based PM in the laboratory, whereas on a naturalistic PM task older HIV? adults performed better than older HIV+ adults and younger persons. In line with the naturalistic findings, older age, but not HIV, was associated with a relative sparing of self-perceived PM failures in daily life across longer delay self-cued intervals. Findings suggest that, even in relatively younger aging cohorts, the effects of HIV and older age on PM can vary across PM delay intervals by the strategic demands of the retrieval cue type, are expressed differently in the laboratory and in daily life, and are independent of other higher order neurocognitive functions (e.g., retrospective memory).     

A review of metacognition in aging with HIV

Declines in metacognitive ability occur more with aging and HIV such that some people aging with HIV may be even less able to report accurately on the status of their cognitive functioning. This is problematic because clinicians and allied health professionals rely on clients' self-reports of cognition to help judge if they are developing cognitive impairments. Such self-reports of cognition may be moderated by mood disturbance, histories of alcoholism or drug abuse, or even limited educational achievement. In this review, implications of this phenomenon and suggestions for researching this topic and assessing at-risk clients are posited.     

Working memory predicts subsequent episodic memory decline during healthy cognitive aging: evidence from a cross-lagged panel design

Aging adults experience declines in working memory and episodic memory, however, it is unclear how these declines operate over time. Decreased working memory may be associated with early changes in episodic memory, by reducing older adults’ ability to meaningfully integrate new information into pre-existing schemas and recall information without the assistance of cues. Given the increased prevalence of Alzheimer’s disease, and concerns based on subjective memory changes, it is important to understand how these processes interact over time. To assess the relationship between working memory and episodic memory during healthy cognitive aging, we performed neuropsychological assessments at multiple time points in a sample of 310 community-dwelling older adults. Using a cross-lagged panel design, we demonstrated that the lagged associations between working memory and later episodic free recall were 50% larger than the lagged associations between episodic recall and later working memory, suggesting working memory may be a useful metric of future episodic memory decline.     

Effects of emotional arousal on memory binding in normal aging and Alzheimer's disease

Previous research suggests that associative memory declines in normal aging and is severely affected by Alzheimer's disease (AD); however, it is unclear whether and how this deficit can be minimized. The present study investigated whether emotional arousal improves associative memory in healthy younger and older adults and patients with probable AD. We examined the effect of arousal on memory for item-location associations. Arousal improved memory for item location similarly across the three groups, whereas valence had no effect in any groups. Overall, our results suggest that arousal has beneficial effects on associative memory in healthy older adults and patients with AD, as previously observed in younger adults.     

Aging and Language Production

Experimental research and older adults' reports of their own experience suggest that the ability to produce the spoken forms of familiar words declines with aging. Older adults experience more word-finding failures, such as tip-of-the-tongue states, than young adults do, and this and other speech production failures appear to stem from difficulties in retrieving the sounds of words. Recent evidence has identified a parallel age-related decline in retrieving the spelling of familiar words. Models of cognitive aging must explain why these aspects of language production decline with aging whereas semantic processes are well maintained. We describe a model wherein aging weakens connections among linguistic representations, thereby reducing the transmission of excitation from one representation to another. The structure of the representational systems for word phonology and orthography makes them vulnerable to transmission deficits, impairing retrieval.     

Further considerations regarding inhibitory processes, working memory, and cognitive aging

The present study explored the relationship between inhibitory processing (as indexed by identity negative priming in a letter-naming task), working memory, discourse processing, and cognitive aging effects. Consistent with several other recent reports, this study found evidence of intact inhibitory processing, as measured by negative priming, in older adults as well as younger adults. This intact negative priming occurred in conjunction with diminished working memory span and impaired memory in the discourse processing task in the same sample of older adults, further arguing against the likelihood that declines in these areas are caused by impairments in the inhibitory processes measured by negative priming. The implications of these results for theories of cognitive aging and possible reasons for inconsistent findings regarding negative priming effects among the elderly are discussed.     

Attachment,Social Support,Resilience and Posttraumatic Stress Disorder Symptoms in Chinese Adults Living with HIV/AIDS

The present study aimed to examine the effects of attachment, social support and resilience on posttraumatic stress disorder (PTSD) symptoms in people living with HIV/AIDS. One hundred fifty-two HIV+ adults in China were investigated. The results suggested that attachment anxiety had a significant direct effect on PTSD symptoms and impacted PTSD symptoms indirectly though associations with social support and resilience. Attachment avoidance could also be considered a distal risk factor of PTSD symptoms via the mediation of social support and resilience. The findings highlight the importance of identifying trauma and PTSD symptoms in people affected by HIV/AIDS and suggest that people with attachment anxiety and low social support resources might be at high risk for PTSD.     

情景记忆成功年老化的神经机制

随着年龄的增长,大部分老年人的情景记忆会出现衰退,但也会有一部分老年人的情景记忆表现出成功的年老化,即记忆成绩较好或随增龄的衰退程度较小。脑保持理论、神经去分化理论、认知储备理论以及神经补偿理论分别从不同角度解释了情景记忆成功年老化的神经机制。基于选择性优化与补偿模型对现有理论进行整合,发现情景记忆成功年老化可能与个体的认知储备水平直接相关：高认知储备的老年人能够对情景记忆相关的脑区和脑网络进行优化且具备更强的神经补偿能力,因而其脑功能(比如,神经表征和神经加工通路的特异性)可能会保持地更好。未来研究需要更多地采用纵向设计来考察各理论之间的关系及其影响因素,从而更好地解释记忆成功年老化的神经机制并为提升老年人的脑与认知健康提供支持。