The influence of expertise and task factors on age differences in pilot communication.

The influence of expertise and task factors on age differences in a simulated pilot-Air Traffic Control (ATC) communication task was examined. Young, middle-aged, and older pilots and nonpilots listened to ATC messages that described a route through an airspace, during which they referred to a chart of this airspace. Participants read back each message and then answered a probe question about the route. It was found that pilots read back messages more accurately than nonpilots, and younger participants were more accurate than older participants. Age differences were not reduced for pilots. Pilots and younger participants also answered probes more accurately, suggesting that they were better able to interpret the ATC messages in terms of the chart in order to create a situation model of the flight. The findings suggest that expertise benefits occur for adults of all ages. High levels of flying experience among older pilots (as compared with younger pilots) helped to buffer age-related declines in cognitive resources, thus providing evidence for the mediating effects of experience on age differences.

Effects of aging, message repetition, and note-taking on memory for health information.

This study investigated whether repetition improves older adults' memory for health service appointment messages delivered by automated telephone systems. Whereas imposed repetition reduces age differences in memory (Morrow, Leirer, Carver, Tanke, & McNally, 1999), the present study examined the effect of optional repetition. Both older and younger participants in Experiment 1 chose to repeat messages. More repetition, higher cognitive ability (working memory and processing speed), and younger age were associated with better memory for appointment information. The effect of age was eliminated when cognitive ability, but not repetition, was controlled. Thus, older adults used optional repetition in automated systems, but this strategy did not eliminate age differences in memory. In Experiment 2, older as well as younger adults took accurate notes and also repeated messages. Both note-taking and message repetition improved memory for the messages but did not reduce age differences. These findings suggest that older as well as younger adults use presentation strategies in automated messaging systems. Older adults may not take full advantage of these strategies, perhaps because of age-related declines in self-initiated or metacognitive processes.

Icons improve older and younger adults' comprehension of medication information.

We examined whether timeline icons improved older and younger adults' comprehension of medication information. In Experiment 1, comprehension of instructions with the icon (icon/text format) and without the icon (text-only format) was assessed by questions about information that was (a) implicit in the text but depicted explicitly by the icon (total dose in a 24 hour period), (b) stated and depicted in the icon/text condition (medication dose and times), and (c) stated but not depicted by the icon (e.g., side effects). In a separate task, participants also recalled medication instructions (with or without the icon) after a study period. We found that questions about dose and time information were answered more quickly and accurately when the icon was present in the instructions. Notably, icon benefits were greater for information that was implicit rather than stated in the text. This finding suggests that icons can improve older and younger adults' comprehension by reducing the need to draw some inferences. The icon also reduced effective study time (study time per item recalled). In Experiment 2, icon benefits did not occur for a less integrated version of the timeline icon that, like the text, required participants to integrate dose and time information in order to identify the total daily dose. The integrated version of the icon again improved comprehension, as in Experiment 1, as well as drawing inferences from memory. These findings show that integrated timeline icons improved comprehension primarily by aiding the integration of dose and time information. These findings are discussed in terms of a situation model approach to comprehension.

The influence of list format and category headers on age differences in understanding medication instructions.

We examined whether instructions are better understood and remembered when they contain organizational cues. Our previous research found that older and younger adults organize medication information in similar ways, suggesting that they have a schema for taking medication. In the present study, list formats (vs. paragraphs) emphasized the order of information and category headers emphasized the grouping of information specified by this schema. Experiment 1 examined whether list and header cues improve comprehension (answer time and accuracy) and recall for adults varying in age and working memory capacity (measured by a sentence span task). List instructions were better understood and recalled than paragraphs, and reduced age differences in answer time and span differences in accuracy. Headers reduced paragraph comprehension for participants with lower levels of working memory capacity, presumably because they were not salient cues in the paragraphs. Experiment 2 investigated if headers were more effective when more saliently placed in paragraphs and lists, and if list and header cues helped readers draw inferences from the instructions. List formats again reduced age differences in comprehension, especially reducing the time needed to draw inferences about the medication. While headers did not impair comprehension, these cues did impair recall. The present study suggests that list-organized instructions provide an environmental support that improves both older and younger adult comprehension and recall of medication information.

The role of reader age and focus of attention in creating situation models from narratives.

We examined adult age differences in the mental representation of situations and how readers update this representation during narrative comprehension. Older and younger adults memorized a building layout and then read narratives about a protagonist's actions in this building. The narratives contained critical sentences that described the protagonist moving from one room (the "source room") into another (the "goal room"), through an unmentioned path room. Each critical sentence was followed by a target sentence referring to an object in one of these rooms. Half of the target sentences explicitly mentioned the room containing this object and half did not. Reading time increased when the target object was more distant from the protagonist and when the room containing the object was not mentioned, suggesting that readers tracked the protagonist's location in the layout and allocated resources in order to maintain coherence in the situation model. Older adults' reading times differentially slowed with distance, and older readers who more accurately understood the narrative differentially slowed when the location of the target object was not mentioned. Finally, the more accurate readers (older and younger) slowed primarily when updating was most difficult (i.e., both when the room containing the object was not mentioned and for more distant objects). While these findings reveal qualitative similarity in how older and younger readers update spatially organized situation models, they also suggest that older readers must sometimes allocate more resources to this updating process in order to maintain comprehension.

Medication instruction design: younger and older adult schemas for taking medication.

We examined whether older and younger adults share a schema for taking medication and whether instructions are better recalled when they are organized to match this schema. Experiment 1 examined age difference in schema organization. Participants sorted medication items (e.g., purpose, dose, possible side effects) according to similarity and then ordered the items to create a preferred instruction set. Cluster analysis of the sort and order data showed that younger and older adults share a schema for taking medication. Secondary regression analyses found that verbal ability (i.e., vocabulary scores) predicted individual differences in schema organization. In Experiment 2 participants recalled instructions that were either compatible with this schema in terms of grouping and order of items or were presented in nonpreferred orders. Younger participants remembered more information than did older participants, but both age groups better remembered and preferred the more schema-compatible instructions. Secondary analyses showed that recall was also positively related to verbal ability. Along with our earlier research, this study suggests that older and younger adults possess a schema for taking medication and that instructions that are compatible with this schema provide an environmental support that improves memory for medication information.

Using icons to convey medication schedule information.

We examined older adult comprehension and memory for medication schedules conveyed by different types of visual icons as well as text. Three icons were compared: a timeline, a pair of 12 h clocks (one for AM and one for PM hours) and a 24 h clock. In Experiment 1, older and younger participants paraphrased and then recalled schedules that were conveyed by the three icons or by text. Text and timeline schedules were paraphrased more accurately than either clock icon. Paraphrase errors suggested that subjects had trouble integrating schedule information across the two 12 h clocks. Analysis of paraphrase times showed that the text schedule was paraphrased most quickly, followed by the timeline, the 24 h clock and the 12 h clock. No differences were found for the accuracy of recalling the icon and text schedules. Experiment 2 examined free and cued recall after limited study time by older adults. Because text superiority in Experiment 1 may have reflected greater familiarity with text than with icons, recall was examined across four trials in Experiment 2. Text was recalled most accurately, followed by the timeline, the 24 h clock and the 12 h clock. Study-test trials did not influence recall. Text schedules may have been generally more effective than the icons because of their greater familiarity. The timeline may have been the most effective icon because it was more compact and familiar than the clock icons used in the study. The findings suggest that including such icons in medication instructions requires training.

The effects of information load and speech rate on younger and older aircraft pilots' ability to execute simulated air-traffic controller instructions.

In this applied study of memory for orally presented information, 15 younger and 15 older pilots heard recorded air-traffic controller (ATC) messages in the context of six simulated flights. The ATC messages varied in length (3 vs 4 items), speech rate (235 vs 365 wpm), and type of command (course commands consisting of headings and altitudes vs radio/transponder commands consisting of radio frequencies and transponder codes). Older pilots made more execution errors on average and the age difference was greater for the radio/transponder commands, which contained more unique digits than the course commands. Although longer message lengths and faster speech rates led to higher error rates, the increases were not more marked in the older group. Backward digit span was correlated with communication performance, but the older group's lower level of accuracy was not explainable in terms of differences in digit span.

Time of day and naturalistic prospective memory.

Fatigue and circadian rhythms have been proposed as explanations of time-of-day effects on retrospective memory. Both explanations predict poor morning performance, a midday performance peak, and then declining performance and poorest recall in the evening. Whereas this pattern has been found in research on retrospective memory using ordered serial recall, in the single relevant study on prospective memory, performance was found to be highest in early morning, followed by a midday decline with no additional declines. Using post hoc analyses, we investigated older adults' prospective memory throughout the day. Data were taken from two studies we had conducted previously and one recently completed experiment. In each of the three experiments, we examined simulated medication and appointment adherence over a 13-day period and found prospective memory to be better in the morning than at midday. In two experiments, we found no further decline after midday, and in the third experiment, performance actually increased in the evening compared with midday. These post hoc analyses provide preliminary evidence that factors different from or at least in addition to fatigue and circadian rhythms produce time-of-day effects on prospective memory, indicating the need for more programmatic research in the future. One explanation for these findings is that attentional capacity devoted to prospective-memory tasks varies inversely as a function of activity level during different times of the day.

Automated telephone reminders for improving ambulatory care services.

In conclusion, automated telephone reminders offer a single inexpensive approach to many different problems associated with ambulatory care. Depending on the exact application, their effectiveness is equal to or better than other more expensive and time-consuming approaches for reducing costs and improving the quality of patient care. In some cases, such as medication reminders, it may be the only feasible approach to effective care.

Aging, expertise, and narrative processing.

In a study of how aviation expertise influences age differences in narrative processing, young and older pilots and nonpilots read and recalled aviation and general narratives. They chose referents for sentences referring to a protagonist or minor character mentioned 1 sentence (recent character) or 3 sentences (distant character) before this target sentence. All groups chose referents less accurately for sentences about distant and minor characters than about recent and protagonist characters, perhaps because these referents were less likely to be in working memory. Young readers and pilots were more accurate for distant and minor character target sentences in aviation narratives, and recalled aviation narratives more accurately. Expertise did not reduce age differences. Expertise differences may reflect decreased demands on working memory capacity, and age declines may reflect reduced capacity.

Elders' nonadherence: its assessment and medication reminding by voice mail.

This study investigates four questions related to the problem of medication nonadherence among elders. First, does memory failure play a significant role in nonadherence? Second, can memory-related nonadherence be predicted by simple tests of cognitive performance? Third, can the new portable bar code scanner technology be used to unobtrusively monitor nonadherence? Most importantly, can inexpensive telephone voice mail technology be used to improve medication adherence? The results show that: elders have substantial levels of forgetting; nonadherence decreases with higher cognitive test scores; portable bar code scanners are useful for monitoring adherence; and voice mail reduces tardiness and complete forgetting.

Marijuana carry-over effects on aircraft pilot performance.

This study finds evidence for 24-h carry-over effects of a moderate social dose of marijuana on a piloting task. In separate sessions, nine currently active pilots smoked one cigarette containing 20 mg of delta 9 THC and one Placebo cigarette. Using an aircraft simulator, pilots flew just before smoking, and 0.25, 4, 8, 24, and 48 h after smoking. Marijuana impaired performance at 0.25, 4, 8, and 24 h after smoking. While seven of the nine pilots showed some degree of impairment at 24 h after smoking, only one reported any awareness of the drug's effects. The results support our preliminary study and suggest that very complex human/machine performance can be impaired as long as 24 h after smoking a moderate social dose of marijuana, and that the user may be unaware of the drug's influence.

Mental models in narrative comprehension.

Readers of stories construct mental models of the situation and characters described. They infer causal connections relating characters' actions to their goals. They also focus attention on characters' movements, thereby activating nearby parts of the mental model. This activation is revealed in readers' faster answering of questions about such parts, with less facilitation the greater their distance from the focus. Recently visited as well as imagined locations are also activated for several seconds. These patterns of temporary activation facilitate comprehension.

Memory skills elders want to improve.

While many research studies have investigated memory training for elders, none have asked which specific memory skills elders would like to improve. This study investigates two related questions. First, which memory skills elders would like to improve? Second, is there a common set of these memory skills? Elders completed a three-part questionnaire. First, it asked for subject demographics. Second, it asked for the first, second, third, and then all other memory skills they would most like to improve. Finally, it asked elders to rate the importance of 10 specific memory skills. The results indicate that elders share a common set of memory skills they wish to improve. They are: (a) people's names, (b) important dates, (c) location of household objects, (d) recent and past events, (e) meetings and appointments, (f) information and facts, (g) general improvement, and (h) medication. One conclusion from these findings is that at least some memory training research should focus on these specific memory skills.

Marijuana, aging, and task difficulty effects on pilot performance.

This study provides evidence that diverse factors can cumulatively contribute to human/machine performance decrements. In separate sessions, young and old pilots smoked one of three cigarettes containing either 0 mg, 10 mg, or 20 mg of the active ingredient, delta 9 THC. They flew a calm and a turbulent flight in a light aircraft simulator at 1, 4, 8, 24, and 48 hour (h) delay after smoking. Effects were found at 1 and 4 h after smoking in the turbulent flight conditions when 20 mg cigarettes were smoked. Drug dose level, age, weather conditions (i.e., task difficulty), and delay period all affected pilot performance. Most important, these variables produced cumulative performance decrements.

Increasing influenza vaccination adherence through voice mail.

The number of influenza and influenza-related deaths is alarmingly high, yet mean vaccination adherence rates among the high-risk elderly population remain at only 20%. The present study investigates the use of an inexpensive voice-mail system, TeleMinder, as a method of increasing influenza vaccination adherence among a subpopulation of elders identified as low adherers. The first group of older people received no intervention. Group 2 received a voice-mail message informing them of the cost, time, date, and location of an influenza vaccination clinic. Group 3 was exposed to posted and verbal announcements alone. Group 4 both received voice mail and was exposed to posted and verbal announcements. Vaccination adherence levels for groups 1 through 4 were 1.5%, 11.8%, 7.4%, and 37.5%, respectively. Voice mail significantly increased vaccination adherence either alone or in combination with posted and verbal announcements. These findings suggest that voice mail provides an inexpensive means of increasing influenza vaccination rates.

Elders' nonadherence, its assessment, and computer assisted instruction for medication recall training.

This study investigates three questions related to the problem of medication nonadherence among elders. First, does recall failure play a significant role in nonadherence? Recent research suggests that it may not. Second, can the new portable bar code scanner technology be used to study nonadherence? Other forms of monitoring are obtrusive or inaccurate. Finally, can inexpensive computer assisted instructions (CAI) be used to teach mnemonic techniques specifically designed to improve medication schedule recall? Current research on memory training teaches nonspecific mnemonics and uses the expensive classroom approach. Results of the present study suggest that physically active and cognitively alert elders do have significant nonadherence (control group = 32.0%) problems related to forgetting and that CAI courseware can significantly reduce (medication recall training group = 10.0%) this form of nonadherence. Portable bar code technology proved easy to use by elderly patients and provided detailed information about the type of forgetting underlying nonadherence. Most significant recall failure was in the complete forgetting to take medication rather than delays in medicating or overmedicating.

Diminished virucidal activity of kethoxal against vesicular stomatitis virus pretreated with guanidinating reagent and proteases.

The reactivity of vesicular stomatitis virus (VSV) with kethoxal can be appreciably altered by treatment with 1-guanyl-3, 5-dimethyl pyrazole nitrate (GDMP) and proteolytic enzymes. Pretreatment of purified VSV with GDMP or proteolytic enzymes markedly reduced the effectiveness of kethoxal as a virucide. The rate of neutralizability of GDMP- and trypsin-treated viruses by specific antiserum differed from that of controls.