Fear of COVID-19 is associated with trust, subjective numeracy, and differentially with loneliness in older versus younger adults.

Introduction: The emotional impacts of the COVID-19 pandemic and resulting public health emergency are only beginning to be understood. Methods: We assessed the contributions of emotional and cognitive factors and age-related comorbidities to greater COVID-19 fear in a community dwelling sample of 142 younger (Mage = 19.63, SDage = 2.59) and 157 older (Mage = 72.01, SDage = 7.06) adults, between July 2020 and July 2021. We hypothesized that individuals with increased loneliness, depression, and/or decreased subjective numeracy (SN) and interpersonal trust would experience more COVID-19 fear. We also predicted that females and older adults would experience more COVID-19 fear given that age-related comorbidities are associated with increased illness severity. Results: Results showed that the extent of loneliness in older adults was more strongly related to fear of COVID-19 than it was in younger adults (ß = 0.197, p = 0.016), and poorer SN was associated with increased COVID-19 fear in both age groups (ß = -0.138, p = 0.016). Further, higher interpersonal mistrust was associated with increased COVID-19 fear (ß = 0.136, p = 0.039), as was identifying as female (ß = 0.137, p = 0.013). Discussion: Given that self-described poor numeracy was a marker for greater COVID-19 fear, investigators and policy makers might consider mitigation opportunities addressing data literacy requirements imposed by the media. Further, outreach to mitigate loneliness, particularly of the elderly, might effectively lessen the negative psychological impact of this ongoing public health crisis.

Traumatic brain injury in precariously housed persons: Incidence and risks.

BACKGROUND: Homeless and precarious housed persons are particularly prone to traumatic brain injuries (TBIs), but existent incidence rates are hampered by poor case acquisition. We rigorously documented TBIs in precariously housed persons transitioning in and out of homelessness. METHODS: Between December 2016 and May 2018, 326 precariously housed participants enrolled in a longitudinal study in Vancouver, Canada were assessed monthly for TBI occurrences after education on sequelae. Over one participant-year, 2433 TBI screenings were acquired for 326 person-years and variables associated with odds of incident TBI were evaluated. FINDINGS: One hundred participants acquired 175 TBIs, yielding an observed incidence proportion of 30·7% and event proportion of 53·7%. Of the injured, 61% reported one TBI and 39% reported multiple injuries. Acute intoxication was present for more than half of the TBI events assessed. Additionally, 9·7% of TBI events occurred in the context of a drug overdose. Common injury mechanisms were falls (45·1%), assaults (25·1%), and hitting one's head on an object (13·1%). In this community-based but non-randomly recruited sample, exploratory analyses identified factors associated with odds of an incident TBI over one year of follow-up, including: schizophrenia disorders (odds ratio (OR) = 0·43, 95% confidence interval (CI) 0·19, 0·94), role functioning (OR = 0·69, 95% CI 0·52, 0·91), opioid dependence (OR = 2·17, 95% CI 1·27, 3·72) and those reporting past TBIs (OR = 1·99, 95% CI 1·13, 3·52). INTERPRETATION: Given the ubiquity of TBIs revealed in this precariously housed sample, we identify an underappreciated and urgent healthcare priority. Several factors modified the odds of incident TBI, which can facilitate investigations into targeted prevention efforts. FUNDING: Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, William and Ada Isabelle Steel Research Fund, Simon Fraser University Vice-President Research Undergraduate Student Research Award and Simon Fraser University Psychology Department Research Grant.

La nécessité des approches interdisciplinaires et collaboratives pour évaluer l'impact de la COVID-19 sur les personnes âgées et le vieillissement: déclaration conjointe de l'ACG / CAG et de la RCV / CJA.

La pandémie de la COVID-19 et l'état d'urgence publique qui en a découlé ont eu des répercussions significatives sur les personnes âgées au Canada et à travers le monde. Il est impératif que le domaine de la gérontologie réponde efficacement à cette situation. Dans la présente déclaration, les membres du conseil d'administration de l'Association canadienne de gérontologie/Canadian Association on Gerontology (ACG/CAG) et ceux du comité de rédaction de La Revue canadienne du vieillissement/Canadian Journal on Aging (RCV/CJA) reconnaissent la contribution des membres de l'ACG/CAG et des lecteurs de la RCV/CJA. Les auteurs exposent les voies complexes par lesquelles la COVID-19 affecte les personnes âgées, allant du niveau individuel au niveau populationnel. Ils préconisent une approche impliquant des équipes collaboratives pluridisciplinaires, regroupant divers champs de compétences, et différentes perspectives et méthodes d'évaluation de l'impact de la COVID-19.

Interdisciplinary and Collaborative Approaches Needed to Determine Impact of COVID-19 on Older Adults and Aging: CAG/ACG and CJA/RCV Joint Statement.

The COVID-19 pandemic and subsequent state of public emergency have significantly affected older adults in Canada and worldwide. It is imperative that the gerontological response be efficient and effective. In this statement, the board members of the Canadian Association on Gerontology/L'Association canadienne de gérontologie (CAG/ACG) and the Canadian Journal on Aging/La revue canadienne du vieillissement (CJA/RCV) acknowledge the contributions of CAG/ACG members and CJA/RCV readers. We also profile the complex ways that COVID-19 is affecting older adults, from individual to population levels, and advocate for the adoption of multidisciplinary collaborative teams to bring together different perspectives, areas of expertise, and methods of evaluation in the COVID-19 response.

False-belief reasoning from 3 to 92 years of age.

False-belief reasoning, defined as the ability to reason about another person's beliefs and appreciate that beliefs can differ from reality, is an important aspect of perspective taking. We tested 266 individuals, at various ages ranging from 3 to 92 years, on a continuous measure of false-belief reasoning (the Sandbox task). All age groups had difficulty suppressing their own knowledge when estimating what a naïve person knew. After controlling for task-specific memory, our results showed similar false-belief reasoning abilities across the preschool years and from older childhood to younger adulthood, followed by a small reduction in this ability from younger to older adulthood. These results highlight the relative similarity in false-belief reasoning abilities at different developmental periods across the lifespan.

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 recipient's 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.

Inhibitory control underlies individual differences in older adults' hindsight bias.

Outcome knowledge influences recall of earlier predictions of the event in question. Researchers have hypothesized that age-related declines in inhibitory control may underlie older adults' increased susceptibility to the two underlying bias processes that contribute to this hindsight bias (HB) phenomenon, recollection bias and reconstruction bias. Indeed, Coolin et al. (2015) found that older adults with lower inhibitory control were less likely to recall their earlier predictions in the presence of outcome knowledge (lower recollection ability) and were more likely to be biased by outcome knowledge when reconstructing their forgotten predictions (higher reconstruction bias) than those with higher inhibitory control. In the present study, we assess intraindividual differences in older adults' recollection and reconstruction processes using a within-subjects manipulation of inhibition. We tested 80 older adults (Mage = 71.40, range = 65 to 87) to assess whether (a) experimentally increasing inhibition burden via outcome rehearsal during the HB task impacts the underlying HB processes, and (b) the effects of this outcome rehearsal manipulation on the underlying HB processes vary with individual differences in cognitive abilities. Our findings revealed that outcome rehearsal increased recollection bias independently of individuals' cognitive abilities. Conversely, outcome rehearsal only increased reconstruction bias in individuals with higher inhibitory control, resulting in these individuals performing similarly to individuals with lower inhibitory control. These observations support the role of inhibitory control in older adults' HB and suggest that even individuals with higher inhibition ability are susceptible to HB when processing resources are limited. (PsycINFO Database Record

Positive affect predicts everyday problem-solving ability in older adults.

OBJECTIVES: Increased symptom endorsement on the short form of the Centre for Epidemiologic Studies Depression (CES-D) Scale has been previously associated with lower everyday problem-solving (EPS) ability in older adults. However, given the multifactorial and complex nature of depressive symptoms, it remains unclear whether certain symptoms/aspects of depression account for this relationship. We examined established factor scores on the full version of the CES-D to assess their utility as predictors of EPS in an older adult cohort. METHODS: Community-dwelling older adults (n = 103; age: 51-91) were administered the CES-D along with a measure of EPS ability assessing both social and practical EPS. Regression analyses were used to determine the relationships between variables. RESULTS: Analyses revealed that increased CES-D scores predicted worse EPS ability in older adults (ß = -.17, p < .05) beyond the effects of age, gender, and education. Regression analyses examining each CES-D factor score revealed that decreased positive affect (loss of hope/enjoyment in life; ß = -.21, p < .01) remained the only significant predictor of decreased overall EPS scores beyond demographic variables, while depressed affect, interpersonal, and somatic factors were not significant predictors. Positive affect predicted both practical, as well as social EPS scores. CONCLUSIONS: Current results extend previous findings by showing that the relationship between increased depressive symptoms and decreased EPS ability in older age may be primarily driven by anhedonia as opposed to other depressive symptoms.

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 differences in hindsight bias: the role of episodic memory and inhibition.

UNLABELLED: BACKGROUND/STUDY CONTEXT: After learning an event's outcome, people's recollection of their former prediction of that event shifts towards the actual outcome. This hindsight bias (HB) phenomenon tends to be stronger in older compared with younger adults; however, it is unclear whether age-related changes in other cognitive abilities mediate this relationship. METHODS: Sixty-four younger adults (Mage = 20.1; range = 18-25) and 60 community-dwelling older adults (Mage = 72.5; range = 65-87) completed a memory design HB task. Two aspects of HB, its occurrence and magnitude, were examined. Multiple regression and mediation analyses were conducted to determine whether episodic memory and inhibition mediate age differences in the occurrence and magnitude of HB. RESULTS: Older adults exhibited a greater occurrence and magnitude of HB as compared with younger adults. The present findings revealed that episodic memory and inhibition mediated age-related increases in HB occurrence. Conversely, neither cognitive ability mediated age-related increases in HB magnitude. CONCLUSION: Older adults' susceptibility to the occurrence of HB is partly due to age-related declines in episodic memory and inhibition. Conversely, age differences in the magnitude of HB appear to be independent of episodic memory and inhibition. These findings have important implications for understanding the mechanisms by which susceptibility to HB changes across the adult life span.

Vascular health modifies theory of mind performance in older adults.

OBJECTIVES: Age reductions in theory of mind (ToM) are well documented, though underlying mechanisms are poorly understood. Research suggests that traditional cognitive abilities underlie ToM in part; however, whether age-associated health modifiers also predict ToM remains unknown. We investigated the role of pulse pressure (PP), an age-related marker of vascular risk, in modifying ToM performance. METHOD: Sixty-six community-dwelling older adults (65-92 years) completed a short story paradigm assessing ToM. Participants also completed measures assessing blood pressure and cognitive abilities empirically linked to ToM. We used hierarchical regression to test our prediction that high PP would adversely influence associations between ToM and cognition. RESULTS: Reduced ToM was associated with older age and decreased verbal memory, processing speed, and working memory; however, associations between ToM and working memory were attenuated when PP was included in the regression model. Importantly, associations between ToM, memory, and processing speed were qualified by vascular health, in that participants with elevated PP showed stronger associations between reduced ToM and lower memory/speed. DISCUSSION: This is the first study to demonstrate that vascular risk modifies the strength of associations between ToM and age-sensitive cognitive resources. Results add to current perspectives on mechanisms influencing reduced ToM in older age.

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.

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

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.

The ecological validity of everyday cognition in hospitalized patients with serious mental illness.

In 47 tertiary inpatients with schizophrenia or schizoaffective disorder, we report on the extent to which everyday cognition (EC), as represented by tasks utilizing naturalistic stimuli or commonly encountered problems, accounts for variation in daily functioning. Patients underwent interview-based measures of psychiatric symptoms, nurses' observations of functioning, and measures of EC and traditional cognition (TC). Our results indicate that EC accounts for "real-world" functioning above that of TC and psychiatric symptoms. This observation supports the utility of incorporating salient measures that rely upon common experience and accumulated knowledge structure into existent test batteries.

Cognitive outcome following kidney transplantation.

BACKGROUND: While a handful of studies have assessed cognition in kidney transplant (TX) recipients, the neuropsychological presentation of this population is not yet clear. Kidney transplantation typically leads to improvement of metabolic factors associated with chronic kidney disease (CKD). However, comorbid diseases independently linked with cognitive compromise often persist, and for this reason, cognitive difficulties may still be present following transplantation. METHODS: In this cross-sectional study, we assessed cognition in 42 kidney TX recipients, 45 outpatients with pre-dialysis CKD and 49 healthy controls using measures of verbal learning and memory and executive functioning. RESULTS: Findings indicated that TX and CKD patients demonstrated significantly worse verbal learning and memory in comparison to controls. While both CKD and TX patients exhibited significantly worse performance than controls on a response inhibition measure, only CKD patients performed significantly worse on a set-shifting task. CONCLUSIONS: Results suggest that, in comparison to controls, verbal memory and executive functioning skills are worse in both CKD and TX patients. Further research is needed to determine the etiology and extent of cognitive compromise, as well as to assess the clinical implications of these findings.

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.

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.