Aging, Functional Learning, and Inhibition.

BACKGROUND/STUDY CONTEXT: The study compared the learning performance of younger and older adults in situations differing in the number of cues that could be relied on for predicting the value of a criterion. Two hypotheses were tested: one based on the assumption that the greater the inhibition effort needed in the task, the greater the difference between younger and older participants, and the other based on the fact that the context in which inhibition occurs plays a role, and consequently that the level of difficulty of the four learning conditions can be better predicted from the number of possible sets of valid cues. METHODS: A total of 240 adults (18-90 years old) had to learn to predict the amount of drink delivered by a drink dispenser on the basis of four cues (the height of four vertical bars). The participants were randomly distributed between four experimental conditions, one valid cue, two valid cues, three valid cues, and all valid cues. The measures that were calculated for each participant under each condition included the squared mean differences between judgment and criterion as an index of performance, and cue utilizations as a test of both the learning of the strength of direct linear relationships and of inhibition. RESULTS: The results validated the hypothesis that the level of difficulty of the four learning conditions can be better predicted from the number of possible sets of valid cues. In all conditions and in each age group, cue utilizations were direct in the first block with no feedback. Older adults discounted the nonpertinent cues as well as younger adults, whereas participants aged over 76 only succeeded under the least demanding conditions. The presence of nonpertinent cues affected the learning of direct cues, even among the younger participants. CONCLUSION: This study shows that older adults' ability to detect (and use) valid cues in an environment that contains both valid and invalid cues is relatively well preserved. It also shows that the mere presence of invalid cues can affect the learning of direct cues, which constitutes a new result in functional learning. Future research conducted in cognitive aging should examine the role of invalid cues in functional learning.

To what extent does the existence of functional relations in a learning setting change the pattern of differences between younger and older adults' performances?

UNLABELLED: BACKGROUND/STUDY CONTEXT: The study directly compared the learning performance of younger and older participants in two situations, one in which they had the possibility of detecting functional relations in the learning setting, and one in which they did not. Functional relations were defined as functional correspondences that could be established between abstract properties extracted from the sets of stimulus items and an abstract property extracted from the set of response items. METHODS: A total of 112 adults (18-90 years old) had to learn to predict the values of a numerical variable (the criterion) on the basis of two words (a plant and an animal) as cues. Five plants and five animals were graded according to size. The plant × animal design was orthogonal. The values of the criterion were obtained using an additive, linear scheme under the functional relations condition, and using random associations under the zero relations condition. RESULTS: The hypothesis was well supported by the data. In the absence of functional relations, the difference between younger and older participants' performances was shown to be practically as great as it could be in the experimental situation that was chosen. When functional relations were present, age differences were significantly reduced, to the extent that the performance of the older participants was almost as good as that achieved by the younger group. CONCLUSION: The existence of functional relations in a learning setting considerably changes the pattern of differences between younger and older adults' performance. In both the absence and the presence of functional relations, older and younger participants spontaneously approached the learning task in a functional spirit, and conceived a priori the cues and the criterion as directly related. Future studies should examine the way in which participants approach learning tasks, and the characteristics of the tasks that determine participants' spontaneous learning attitudes.

End-of-life preferences: a theory-driven inventory.

The study aimed at making a theory-driven inventory of end-of-life preferences. Participants were asked about a variety of preferences representing all eight motivational states described in Apter's Metamotivational Theory (AMT; Apter, 2001). Data from a convenience sample of 965 community participants and a convenience sample of 81 persons suffering from a terminal illness were examined using exploratory and confirmatory factor analysis. Ten factors were evidenced; they were easily interpretable in the AMT framework. In decreasing order of importance, people would, at the time of their death, like to have an understanding doctor, to be at peace with themselves, to remain autonomous, to keep a sense of humor, to remain able to oppose any decision taken without their consent, to remain an object of love, to remain a reference for others, to have resolved conflicts with others, to leave their businesses in good order, and to find themselves at peace with God.

The learning of linear and nonlinear functions in younger and older adults.

The performance of 192 adults in a functional learning task containing four types of cue-criterion relations-direct, inverse, U-shaped, and inverse-U-shaped-was compared. The ability of these adults at extrapolating learning to situations containing more extreme values than the ones in which it took place was also examined. Older participants (65-90-year-olds) were able to learn the nonlinear functions practically as well as younger participants (18-25- and 40-50-year-olds); they were also able to extrapolate well beyond the range of learned responses. When extrapolating, however, they frequently used a more limited range of responses than the younger participants.

Functional learning among children, adolescents, and young adults.

This study examined age-related differences in functional learning performance manifested among children, adolescents, and young adults placed in a two-cue ecology involving cues with direct relation and inverse relations with the criterion. On each trial, participants were instructed to consider the values taken by two cues, predict from these two values the value of a criterion, and finally examine the corresponding feedback value (i.e., the correct value of the criterion for this situation). The authors' hypotheses were that: (a) very few children under 11 years of age would be able to learn how to use the inverse relation cue for predicting the criterion, although they would be able to correctly use the direct relation cue; (b) most adolescents and young adults over 17 years of age would be able to learn how to use the inverse relation cue and combine it with the direct relation cue; and (c) adolescents between 11 and 17 years of age would show various levels of achievement. In general, these predictions were confirmed. Not until 11 years was a substantial proportion of participants (23%) able to reject the direct relation hypothesis and select the inverse relation hypothesis during learning.

Avoidance of anticipated regret: the ordering of prostate-specific antigen tests.

OBJECTIVE: When making decisions, people are known to try to minimize the regret that would be provoked by unwanted consequences of these decisions. The authors explored the strength and determinants of such anticipated regret in a study of physicians' decisions to order prostate-specific antigen (PSA) tests. METHODS: 32 US and 33 French primary care physicians indicated the likelihood they would order a PSA for 32 hypothetical men presenting for routine physical exams. They then indicated how much regret they would feel if they found advanced prostate cancer in 12 other patients for whom they had chosen not to order PSAs several years before. The latter patients differed according to age (55, 65, or 75 years), a prior request or not for PSA testing, and no or some irregularity of the prostate on the earlier rectal exam. RESULTS: ANOVA found that regret was higher when the patient had requested a PSA, the prostate was irregular, and the patient was younger. Shape had less effect when the patient had requested a PSA. US physicians had more regret than the French, patient request had a greater impact on the Americans, and increasing patient age reduced regret more among the French. In a 1-way correlation, the regret score was associated with the likelihood of ordering PSAs for both the French (r = 0.64, P < 0.005) and the Americans (r = 0.42, P< 0.02). In a regression analysis too, the regret score was the most important predictor of the likelihood of ordering a PSA (beta = 0.37, P < 0.0001). CONCLUSIONS: Regret over failing to diagnose aggressive prostate cancer is associated with a policy of ordering PSAs. This regret appears to be culturally sensitive.

Aging and probabilistic learning in single- and multiple-cue tasks.

The objective of the study was to examine some of the conditions under which elderly people are able to learn probabilistic inverse relationships and when this type of learning is no longer possible. Two kind of tasks were used: (a) two single-cue learning tasks with either direct or inverse relationships (the Single-Cue Probability Learning paradigm), and (b) three two-cue learning tasks, one with two direct relationships, one with a combination of direct and inverse relationships, and one with two inverse relationships (the Multiple-Cue Probability Learning paradigm). Four groups of participants were included in the study: young adults (18- to 25-year-olds), adults (40- to 50-year-olds), elderly people (65- to 74-year-olds), and very elderly people (75- to 90-year-olds). It was shown that (a) older adults are able to reject the direct relationship "default" hypothesis and select the inverse relationship hypothesis when outcome feedback contradicting the default hypothesis is given, and provided that the learning setting be a very simple one, involving only one cue; (b) some older adults are able to select the inverse relationship hypothesis provided that the learning setting be a simple one,involving only two inverse relationship cues; and (c) very few older adults are able to select the inverse relationship hypothesis when the learning setting is a complex one, involving two cues with both direct and inverse relationships with the criterion. These results led to the revision of the "gradual decrease of cognitive flexibility in older adults" hypothesis proposed by Chasseigne, Mullet, and Stewart (Acta Psychologicgrave;a, 103, 229-238, 1997).

Why do primary care physicians in the United States and France order prostate-specific antigen tests for asymptomatic patients?

PURPOSE: To understand why many primary care physicians in the United States and France order prostate-specific antigen (PSA) tests routinely for their asymptomatic male patients despite "evidence-based" recommendations. METHODS: Thirty-two U.S. general internists and family practitioners and 33 French generalists judged, for 32 hypothetical male patients seen for routine preventive care, the probability that the patients had asymptomatic prostate cancer and the likelihood that they would order PSA tests. They were also asked about beliefs, attitudes, and knowledge related to prostate cancer. RESULTS: The significant predictors of ordering more PSA tests in the scenarios were physicians' higher ratings of regret if untested patients were found to have advanced cancer, their greater discomfort if they suspected that patients had illnesses but could not know for sure, and their perceptions of official recommendations as favoring routine testing. IMPLICATIONS: Nonrational factors can impede physicians' adoption of "evidence-based" recommendations.

Does choosing a treatment depend on making a diagnosis? US and French physicians' decision making about acute otitis media.

BACKGROUND: The classic sequential processing model of clinical decision making-in which the treatment choice follows and depends on the diagnostic judgment-may in some cases be replaced by a processing model in which the treatment choice depends on an independent assessment of the diagnostic and other cues. The aim of this study was to determine which processing model would better describe physicians' treatment choices in a simulated clinical task. METHODS: Seventy-five US and French primary care physicians were presented twice, in a different order, with the same set of 46 scenarios of 15-month-old children suspected of having acute otitis media (AOM). They rated in one set the probability of AOM and in the other set whether they would treat the child with antibiotics (and how confident they felt in their decision). Linear regression analyses revealed the individuals' 2 judgment policies. Hierarchical discriminant analysis was used to analyze the variance explained in the treatment choice by, 1st, the diagnostic judgment, 2nd, the cues specific to treatment, and 3rd, the cues specific to diagnosis. RESULTS: Even when choosing treatment, the participants placed greatest weight on diagnostic cues, especially the ear findings. Only 28% used the cues that reflected parental issues. For 36%, the diagnostic cues had an effect on the treatment choice independent of the effect (if any) of the diagnostic judgment. CONCLUSION: In deciding how to treat AOM, the majority of the participating US and French primary care physicians followed the classic sequential processing model, but a substantial minority used instead an independent processing model.

Aging and rule learning: the case of the multiplicative law.

This work examined the effect of age on the ability to learn multiplicative combination rules. Participants learned the multiplicative relationship between daily tobacco intake, daily alcohol intake, and risk of esophageal cancer. The hypothesis was that younger adults would learn to implement a multiplicative combination rule and older adults would not, despite feedback. Among the younger adults, complete rule learning took place. Before receiving feedback, they used an underadditive rule, a result consistent with previous studies. After only a limited amount of feedback, they learned to use a multiplicative rule. Even after receiving feedback, however, the older adults still showed difficulties in using the multiplicative rule. These results strengthen the proposition by Chasseigne, Mullet, and Stewart (1997) that the differences between younger and older adults in function learning are related mainly to flexibility of functioning.

Learning the relationship between smoking, drinking alcohol and the risk of esophageal cancer.

This study examined the effect of outcome feedback on learning the multiplicative relationship between daily intakes of tobacco and alcohol, and the risk of esophageal cancer. In the first of two experiments, 65 French adults judged the risk of esophageal cancer associated with combinations of five levels of intake of tobacco and five of wine. They made these judgments both before and after learning sessions in which they were shown the actual risk for each vignette. In the second experiment, 35 French adults underwent the same testing and learning, and were re-tested twice 1 month later. The study hypotheses were supported. First, prior to the learning sessions, the participants used a subadditive rule to combine the perceived risk of esophageal cancer from smoking and drinking. Second, they learned after only one training session to change to the multiplicative rule that is consistent with epidemiological data. Third, this learning persisted for 1 month. This methodology may prove useful in correcting people's underestimation of their health risks.

Aging and intuitive physics.

The present study was aimed at comparing the judgment capacities manifested by young adults, middle-aged adults, and elderly people in an everyday life setting implying the consideration of direct as well as inverse relationships between the cues and the criterion. The chosen situation was borrowed from elementary physics and concerned the relationships between mass, volume and density. In forming their estimations of mass, all elderly people were able to use volume and density information. In addition, most of them were able to combine these pieces of information in a correct, multiplicative way. In forming their estimations of volume, all elderly people were able to use mass and density information but a majority of them used the density information in a direct way. By contrast, most young and middle-aged adults correctly used the density information in an inverse way. The findings strengthen and extend the case made by Chasseigne et al. [Acta Psychologica 97 (1997) 235] as regards the trouble elderly people face in using inverse relationships in a judgment situation. The difficulty elderly people face is not confined to learning settings. It may also be observed in ecological, non-learning environments, where the relationships considered do not entirely depend on the experimenter's choice.

Do parents and physicians differ in making decisions about acute otitis media?

OBJECTIVES: We wanted to discover how parents differ from physicians in making decisions about how to treat a child who may have acute otitis media (AOM). STUDY DESIGN: We used questionnaires that required participants to judge the probability of AOM or choose treatment for 2 sets of 46 paper scenarios of hypothetical children aged 15 months who might have AOM, and they subsequently rated the importance of individual cues and described their attitudes and opinions related to health care and AOM. POPULATION: Convenience samples of 19 US family physicians, 35 French generalists, 21 French pediatricians, 52 US parents, and 86 French parents were included. OUTCOMES MEASURED: The primary outcomes were the judgment policies-the weights placed on each of the scenario cues when making decisions-that were derived for each individual and each group by multiple linear regression. RESULTS: The mean judged probabilities of AOM were nearly the same for all groups: 50% for the US physicians, 51% for the US parents, 52.5% for the French physicians, and 52% for the French parents. The percentages of cases treated with antibiotics did not differ: 53% for US physicians, 45% for US parents, 53% for French physicians, and 51% for French parents. All groups gave greatest weight to the physical examination cues for decisions about both diagnosis and treatment. The parents paid little attention to the cues that reflected parental concerns. CONCLUSIONS: US and French parents were very similar to physicians in their judgments and treatment choices regarding AOM. They appear to be able to adopt the physician's point of view and to be selective in the use of antibiotics.