A survey of World Wide Web use in middle-aged and older adults.

We conducted a survey to document World Wide Web use patterns in middle-aged (ages 40-59), young-old (ages 60-74), and old-old adults (ages 75-92). We conducted this survey of 550 adults 40 years old and over in southeastern Michigan, and the overall response rate was approximately 71%. The results suggested that (a) there are distinct age and demographic differences in individuals who use the Web; (b) middle-aged and older Web users are similar in their use patterns; (c) the two primary predictors for not using the Web are lack of access to a computer and lack of knowledge about the Web; (d) old-old adults have the least interest in using the Web compared with middle-aged and young-old adults; and (e) the primary content areas in learning how to use the Web are learning how to use electronic mail and accessing health information and information about traveling for pleasure. This research may serve as a preliminary attempt to ascertain the issues that must be faced in order to increase use of the World Wide Web in middle-aged and older adults.

Medication adherence in rheumatoid arthritis patients: older is wiser.

OBJECTIVES: To create a profile of individuals nonadherent to their medications in an age-stratified sample (ages 34-84) of community-dwelling rheumatoid arthritis patients. The relative contributions of age, cognitive function, disability, emotional state, lifestyle, and beliefs about illness to nonadherence were assessed. DESIGN: A direct observation approach was used in conjunction with structural equation modeling. All participants were administered a preliminary assessment battery. Medications were then transferred to vials with microelectronic caps that recorded medication events for all medications for the next 4 weeks. PARTICIPANTS AND SETTING: A volunteer sample of 121 community-dwelling rheumatoid arthritis (RA) patients were recruited from newspaper ads, posters, and via informal physician contact from private rheumatology practices in Atlanta and Athens, Georgia. Written verification of the RA diagnosis and a disease severity rating were obtained from personal physicians before patients were enrolled in the study. Patients were tested in a private physician's office, and their medication adherence was monitored electronically for a month in their every-day work and home settings. MEASUREMENTS AND RESULTS: Structural equation modeling techniques were used to develop a model of adherence behavior. Cognitive and psychosocial measures were used to construct latent variables to predict adherence errors. The model of medication adherence explained 39% of the variance in adherence errors. The model demonstrated that older adults made the fewest adherence errors, and middle-aged adults made the most. A busy lifestyle, age, and cognitive deficits predicted nonadherence, whereas coping with arthritis-related moods predicted adherence. Illness severity, medication load, and physical function did not predict adherence errors. Omission of medication accounted for nearly all errors. CONCLUSION: Despite strong evidence for normal, age-related cognitive decline in this sample, older adults had sufficient cognitive function to manage medications. A busy lifestyle and middle age were more determinant of who was at risk of nonadherence than beliefs about medication or illness. Thus, practicing physicians should not assume that older adults have insufficient cognitive resources to manage medications and that they will be the most likely to make adherence errors. Very busy middle-aged adults seem to be at the greatest risk of managing medications improperly.

Do cognitive processes predict mental health in individuals with rheumatoid arthritis?

The purpose of the present study was to assess the hypothesis that intellectual functioning affects the mental health of individuals with rheumatoid arthritis. Structural equation modeling techniques were used to assess the relative contributions of age, education, intellectual functioning, self-efficacy, and pain to mental health. It was hypothesized that individuals with rheumatoid arthritis who had higher intellectual functioning and higher self-efficacy would report better mental health than those with lower intellectual functioning and self-efficacy. One hundred twenty-one adults aged 34 to 84 with rheumatoid arthritis completed a battery of cognitive tasks, and multiple measures of self-efficacy, pain, and mental health, twice in 1 month. The data provided a good fit to the hypothesized model. Intellectual functioning was directly related to mental health and, also, indirectly related to mental health through self-efficacy and pain. Older individuals who performed poorly on cognitive tasks reported less self-efficacy, more pain, and poorer mental health than those individuals who performed well on cognitive tasks.

Adherence to antihypertensive medications across the life span.

Although treatment for hypertension is readily available, poor control of hypertension is a major health problem frequently manifested in late life. Researchers believe that one of the major causes of uncontrolled hypertension is failure to take medication as directed. In this preliminary study, the medication-taking behaviors of 48 adults diagnosed with hypertension, ranging in age from 35 to 87, were recorded for 2 months with credit card-sized bar-code scanners. The social-cognitive model (Park, 1992) for understanding medication adherence, which proposes that medication adherence is governed by both beliefs and cognitive factors, was used as a basis for this research. Therefore, measures of health behaviors, attitudes about health and medication taking, and cognitive function were recorded, as well as blood pressure readings. The main findings were that (a) the oldest-old and groups of middle-aged adults were the most nonadherent, whereas the young-old were more likely to adhere than the other age groups; (b) high blood pressure readings predicted adherence to antihypertensive medications; and (c) medication beliefs influenced adherence in some situations.

Effect of age on event-based and time-based prospective memory.

The magnitude of age differences on event- and time-based prospective memory tasks was investigated in 2 experiments. Participants performed a working memory task and were also required to perform either an event- or time-based prospective action. Control participants performed either the working memory task only or the prospective memory task only. Results yielded age differences on both prospective tasks. The age effect was particularly marked on the time-based task. Performance of the event-based prospective task, however, had a higher cost to performance on the concurrent working memory task than the time-based task did, suggesting that event-based responding has a substantial attentional requirement. The older adults also made a significant number of time-monitoring errors when time monitoring was their sole task. This suggests that some time-based prospective memory deficits in older adults are due to a fundamental deficit in time monitoring rather than to prospective memory.

The effects of age, illustrations, and task variables on the performance of procedural assembly tasks.

Older adults may be disadvantaged in the performance of procedural assembly tasks because of age-related declines in working memory operations. It was hypothesized that adding illustrations to instructional text may lessen age-related performance differences by minimizing processing demands on working memory in the elderly. In the present study, younger and older adults constructed a series of 3-dimensional objects from 3 types of instructions (text only, illustration only, or text and illustrations). Results indicated that instructions consisting of text and illustrations reduced errors in construction for both age groups compared with the other formats. Younger adults, however, outperformed older adults under all instructional format conditions. Measures of spatial and verbal working memory and text comprehension ability accounted for substantial age-related variance across the different format conditions but did not fully account for the age differences observed.

Medication adherence behaviors in older adults: effects of external cognitive supports.

Medication adherence behaviors of 61 elderly adults were examined using a sensitive microelectronic monitoring device. To assess the effects of external cognitive supports on adherence, different subjects received (a) no intervention, (b) an organizational chart, (c) an over-the-counter medication organizer, or (d) both the chart and organizer. The young-old subjects showed a high rate of adherence (94%) and were not improved by the addition of the interventions. Old-old subjects had a lower rate of adherence (85%) than young-olds. Omission errors were the most frequent mistakes and were lower in the condition in which subjects received both chart and organizer.

Cognitive factors and the use of over-the-counter medication organizers by arthritis patients.

The present study investigated the ability of 45 arthritis patients, all using three or more prescription medications, to correctly load their medications into three types of over-the-counter medication organizers. The results indicated that use of a seven-day organizer with compartments for different times resulted in fewer errors than did an hour-by-hour wheel organizer or a seven-day organizer with only one compartment for each day. It was concluded that the seven-day organizer with compartments for different times appears to have the potential to improve compliance behaviors, but the usefulness of the other two organizers in promoting compliance is uncertain. Data analyses also indicated that age was not related to comprehension or loading accuracy of the organizers but that individuals using seven or more prescribed medications were particularly likely to make comprehension errors.

Effects of labeling techniques on memory and comprehension of prescription information in young and old adults.

We conducted a study to determine the effects of presenting prescription information in a pictorial compared to a verbal format on comprehension and memory in young and old adults. Both comprehension and memory for drug information were studied as a function of age and presentation method. Participants received prescription instructions on actual medicine bottles in one of two formats: verbal instructions only, or verbal instructions mixed with pictorial representations. Results indicated that (a) younger adults' memory for prescription information was facilitated by the mixed instructions, but that mixed instructions appeared to hamper older adults' memory for prescription information; (b) younger adults recalled more information overall relative to older adults across both presentation conditions; and (c) older adults were less able to comprehend prescription information relative to younger adults. Results suggest that well-organized verbal prescription labels are more facilitative for the elderly and that additional efforts must be undertaken to improve the clarity of labeling on prescription drugs.

Effects of contextual integration on recall of pictures by older adults.

This study investigated age-related differences in the ability to utilize integrative relationships between target and context as a memory support by directly manipulating the relationship between a target picture and context. We hypothesized that as the active integration required between target and cue increased, age differences would increase. Old and young adults were instructed to remember target pictures, each presented with a pictorial cue. The cue/target relationship was one of three types: categorically related (high integration condition), visually interacting (high integration condition), or unrelated and noninteracting (low integration condition). Cued recall of the targets was tested. The results indicated that the poorly integrated target-context relationship produced the largest age difference, supporting the integration hypothesis.

Quality of instructions on prescription drug labels: effects on memory and comprehension in young and old adults.

We examined both comprehension of and memory for information on prescription labels as a function of age, memory load, and study time across three experiments with young and old adults. We found that older adults consistently manifested poorer recall of prescription information than young adults; age effects occurred even when participants received unlimited study time; and both young and old adults had substantial difficulty comprehending drug information as it is presented from a pharmacy.

Age-related slowing in mental rotation of three-dimensional objects.

Twenty-four old (M = 70.9 years) and 24 young (M = 21.7 years) adults performed a mental rotation task in which stimuli were pairs of three-dimensional objects (toy cowboy figures). Participants were presented with one pair of figures on each trial and were required to make a "yes/no" decision as to whether the figures were in identical ("yes") or mirror image ("no") poses. A significant interactive effect of age and rotation angle on response time suggested slower rates of mental rotation for old vs. young adults, as did significant age differences in mean slope and intercept values based on individual subjects' linear equations for response time over rotation angle. Findings were consistent with those of previous studies which have reported significant age-related slowing in mental rotation.

Intracellular synthesis of Clostridium botulinum type B toxin. I. Demonstration of toxin synthesis and sedimentation studies on toxic products.

The synthesis and nature of the toxin of Clostridium botulinum type B were studied in growing cells. It was demonstrated that the toxin was synthesized in the latter stage of logarithmic growth and was released into the culture supernatant fluid during lysis of the cells. Studies were done on the sedimentation properties of intracellular toxin. Two components were demonstrated, one of low molecular weight and low specific activity and one of high molecular weight with specific activity similar to that isolated from culture lysates. The high molecular weight toxin was shown to be composed of an aggregate of small subunits, separable with either high ionic strength or sodium dodecyl sulfate.