Wendy Loken Thornton

Age Differences in Everyday Problem-Solving and Decision-Making Effectiveness: A Meta-Analytic Review

The authors report a meta-analysis of age differences in everyday problem-solving/decision-making effectiveness (EPSE). Effect sizes were calculated to reflect 3 age group comparisons: old versus young, young versus middle-aged, and middle-aged versus old. Findings from the meta-analysis of 28 separate studies with an aggregate of 4,482 participants do not support theories of preserved EPSE in late adulthood. Although significant age differences of moderate magnitude persisted across methodological and theoretical domains, rating criteria (experimenter vs. participant) emerged as a significant moderator of the effect magnitude and direction. In addition, EPSE in older adults was bolstered when problem content was interpersonal and when samples were highly educated. Finally, the current results support the conceptual integration of findings from the everyday problem-solving and everyday decision-making literatures.

Theory of Mind Through the Ages: Older and Middle-Aged Adults Exhibit More Errors Than Do Younger Adults on a Continuous False Belief Task

Theory of mind (ToM), or the ability to understand mental states, is a fundamental aspect of social cognition. Previous research has documented marked advances in ToM in preschoolers, and declines in ToM in older-aged adults. In the present study, younger (n = 37), middle-aged (n = 20), and older (n = 37) adults completed a continuous false belief task measuring ToM. Middle-aged and older adults exhibited more false belief bias than did younger adults, irrespective of language ability, executive function, processing speed, and memory. The authors conclude that ToM declines from younger to older adulthood, independent of age-related changes to domain-general cognitive functioning.

Differential impact of age on verbal memory and executive functioning in chronic kidney disease

We compared aspects of verbal memory and executive functioning in 51 community-dwelling persons with chronic kidney disease (CKD) and 55 healthy controls matched on age and education. Depressive symptoms were assessed with the Centre for Epidemiological Studies-Depression Scale (CES-D), and illness variables included glomerular filtration rate (GFR) and hemoglobin. Findings indicate that persons with CKD exhibited poorer performance on measures of memory (CVLT-II) and executive functioning (DKEFS Trailmaking Test B and Color-Word Interference Tests) in comparison with healthy controls. Furthermore, performance decrements were magnified in older CKD participants on measures of verbal memory and inhibition. Nearly half of CKD participants aged 61 and older exhibited significant impairments in verbal memory and inhibition in comparison to matched controls. Cognitive performance in CKD was not associated with measures of illness severity. The differences observed were not accounted for by depressive symptoms, which were only weakly associated with cognitive performance, and negatively associated with age. Findings highlight the need for further exploration of the etiologies and functional consequences of the neuropsychological presentation of CKD.

Predicting medication adherence and employment status following kidney transplant: The relative utility of traditional and everyday cognitive approaches.

OBJECTIVE The authors investigated the utility of both traditional and everyday cognitive measures in predicting medication adherence and employment status among kidney transplant recipients. In addition, the role of noncognitive predictors was examined. METHOD Cognitive measures of processing speed, memory, everyday problem solving, executive functioning, and questionnaires assessing mood, medication adherence, and employment status were individually administered to 108 kidney transplant recipients. Because the eligibility criteria differed for the two analyses, there were 103 participants in the medication adherence analyses and 94 participants in the employment analyses. Stepwise hierarchical regression and sequential binomial logistic regression analyses were conducted for continuous and dichotomous outcome measures, respectively. RESULTS Findings indicate that both poorer performance on the everyday problem-solving test and a higher number of depressive symptoms were predictive of poorer self-reported medication adherence (R(2) = .19, p < .01). Furthermore, being on antidepressant medication, having a higher number of depressive symptoms, and poorer performance on traditional neuropsychological measures were predictive of fewer hours worked (Nagelkerkes R(2) = .29, ps <.05). CONCLUSIONS This study highlights the differential associations between neurocognitive and psychosocial status, and medication adherence and employment status following kidney transplantation. The findings suggest that the relative importance of traditional and everyday measures is dependent upon the outcome examined.

Neuropsychological mediators of the links among age, chronic illness, and everyday problem solving.

Reductions in everyday problem solving (EPS) are often reported in older age, although the underlying mechanisms remain unclear. The authors examined the role of 2 variables predicted to mediate (neuropsychological abilities and health status) or moderate (health status) the relationship between age and EPS performance. Toward these ends, they compared EPS and neuropsychological performance in 50 functionally independent adults with chronic kidney disease (CKD) and 64 control participants matched on age and education. Both older age and CKD were associated with worse performance on measures of EPS and memory/executive abilities. Neuropsychological abilities were positively associated with EPS performance. In both the full sample and control participants only, memory/executive functioning mediated the association between presence of chronic illness and EPS. Furthermore, memory/executive functioning partially mediated the link between age and EPS. Findings indicate that relations among age, health status, and EPS are not straightforward. Although performance on neuropsychological measures appeared to underlie EPS declines in chronic illness, increasing age remained independently associated with reduced EPS. The authors discuss implications for models of adult developmental changes in everyday cognition.

Aging and the role of working memory resources in visuospatial attention

ABSTRACT Visuospatial attention has been shown to be robust to the effects of increasing age. Nonetheless, models linking individual differences in working memory capacity to attentional performance suggest that older adults may experience disruptions in visuospatial attention under conditions of resource load. Two experiments were conducted to investigate the effects of age and concurrent working memory load on two tasks that have been proposed to require posterior attentional processes. The findings suggest that loading working memory resources selectively disrupts performance on a nonintegrated Stroop task, whereas cue utilization remains intact. In addition, imposing a working memory load delays the deployment of visuospatial attention in both experiments. Regarding the effects of age, findings suggest that older adults can effectively perform both attentional tasks despite working memory load. Age differences did emerge in the time course of cue utilization. Findings point to the resilience of visuospatial attention in aging, even under conditions of significant cognitive load. We discuss these results and their implications for models postulating a role for working memory capacity in attentional behaviors.

Explaining individual differences in cognitive processes underlying hindsight bias.

After learning an event’s outcome, people’s recollection of their former prediction of that event typically shifts toward the actual outcome. Erdfelder and Buchner (Journal of Experimental Psychology: Learning, Memory, and Cognition, 24, 387–414, 1998) developed a multinomial processing tree (MPT) model to identify the underlying processes contributing to this hindsight bias (HB) phenomenon. More recent applications of this model have revealed that, in comparison to younger adults, older adults are more susceptible to two underlying HB processes: recollection bias and reconstruction bias. However, the impact of cognitive functioning on these processes remains unclear. In this article, we extend the MPT model for HB by incorporating individual variation in cognitive functioning into the estimation of the model’s core parameters in older and younger adults. In older adults, our findings revealed that (1) better episodic memory was associated with higher recollection ability in the absence of outcome knowledge, (2) better episodic memory and inhibitory control and higher working memory capacity were associated with higher recollection ability in the presence of outcome knowledge, and (3) better inhibitory control was associated with less reconstruction bias. Although the pattern of effects was similar in younger adults, the cognitive covariates did not significantly predict the underlying HB processes in this age group. In sum, we present a novel approach to modeling individual variability in MPT models. We applied this approach to the HB paradigm to identify the cognitive mechanisms contributing to the underlying HB processes. Our results show that working memory capacity and inhibitory control, respectively, drive individual differences in recollection bias and reconstruction bias, particularly in older adults.

Age-related effects of blood pressure on everyday cognitive function in community-dwelling women

ABSTRACT Objectives: Blood pressure is an indicator of vascular health that has been associated with cognition and quality of life in older age. Few studies have examined blood pressure across everyday cognitive tasks, which may have superior predictive functional utility than traditional cognitive measures. We explored blood pressure as a predictor of everyday problem solving (EPS) performance in middle-aged and older women. Method: Community-dwelling women (age: 51–91) with low-normal blood pressure to mild hypertension underwent traditional and everyday cognitive testing. EPS was determined by the number of safe/effective solutions generated for real-world scenarios. Results: Analyses revealed that lower systolic blood pressure and pulse pressure were associated with worse EPS ability after controlling for age, education, and traditional cognitive abilities. Discussion: These results support that blood pressure may be an important predictor of everyday cognitive abilities in older age. Potential implications for real-world functioning are discussed.

Age differences in everyday problem solving The role of problem context

Reductions in everyday problem solving (EPS) are often reported in older age, although it has been suggested that problem context may modify this effect. We evaluated the impact of two aspects of problem context: age appropriateness (age-neutral vs. older-age content) and problem type (interpersonal vs. practical) on EPS performance in 175 adults aged 18–87. Older adults generated fewer solutions to ill-structured EPS vignettes than younger and middle-aged adults. Middle-aged adults demonstrated an advantage on practical problems. While all age groups demonstrated a relative performance advantage for interpersonal content on older age problems, older adults showed the least relative benefit in this condition. Thus older adults do not exhibit relative performance gains on EPS problems designed to be most salient and relevant to this age group.

An observational study of health literacy and medication adherence in adult kidney transplant recipients

Background There is a high prevalence of non-adherence to immunosuppressants in kidney transplant recipients. Although limited health literacy is common in kidney recipients and is linked to adverse outcomes in other medical populations, its effect on medication adherence in kidney transplant recipients remains poorly understood. The objective was to investigate the effect of lower health literacy on immunosuppressant adherence. Methods Kidney recipients who were at least 6 months post-transplant and outpatients of Vancouver General Hospital in B.C., Canada were recruited through invitation letters. A total of 96 recipients completed the Health Literacy Questionnaire, which provides a multifactorial profile of self-reported health literacy and the Transplant Effects Questionnaire-Adherence subscale measuring self-reported immunosuppressant adherence. Hierarchical linear regression was used to analyze the association between health literacy and adherence after controlling for identified risk factors of non-adherence. Results Our sample was on average 53 years old, 56% male and 9 years post-transplant. Kidney recipients reported low levels of health literacy on scales measuring active health management and critical appraisal of information and 75% reported non-perfect adherence. Worse adherence was associated with poorer overall health literacy (ΔR2 = 0.08, P = 0.004) and lower scores on six of nine of the health literacy factors. Conclusions Poorer health literacy is associated with lower immunosuppressant adherence in adult kidney transplant recipients suggesting the importance of considering a recipients level of health literacy in research and clinical contexts. Medication adherence interventions can target the six factors of health literacy identified as being risk factors for lower medication adherence.