Perceptions of task difficulty predict cognitive effort for older adults.

This study examined age differences in effort devoted to completing cognitively demanding tasks. Fifty-two younger adults ages 18-30 years (Mage = 21.19) and 57 older adults ages 61-93 years (Mage = 76.56) completed a series of memory tests. Following each test, participants rated the test's difficulty and had their blood pressure measured. Effort was indexed by systolic blood pressure response (SBP-R) with greater increases in SBP-R reflecting more effort. Multilevel modeling was used to examine age differences in the intraindividual association between trial-level subjective task difficulty and trial-level effort. Results showed that increases in task difficulty were significantly related to decreases in SBP-R for the older but not younger adults, suggesting the older adults disengaged from the tests they perceived as highly difficult. Findings support Selective Engagement Theory (Hess, 2014), which suggests the perceived cognitive costs of completing difficult tasks may reduce older adults' motivation to engage in the tasks.

A Coordinated Data Analysis of Four Studies Exploring Age Differences in Social Interactions and Loneliness During a Global Pandemic.

OBJECTIVES: Examining loneliness and social isolation during population-wide historical events may shed light on important theoretical questions about age differences, including whether these differences hold across different regions and the time course of the unfolding event. We used a systematic, preregistered approach of coordinated data analysis (CDA) of 4 studies (total N = 1,307; total observations = 18,492) that varied in design (intensive repeated-measures and cross-sectional), region, timing, and timescale during the first year of the coronavirus disease 2019 pandemic. METHODS: We harmonized our data sets to a common period within 2020-2021 and created a common set of variables. We used a combination of ordinary least squares regression and multilevel modeling to address the extent to which there was within- and between-person variation in the associations between social isolation and loneliness, and whether these associations varied as a function of age. RESULTS: Within- and between-person effects of social interactions were negatively associated with loneliness in 1 study; in follow-up sensitivity analyses, these patterns held across early and later pandemic periods. Across all data sets, there was no evidence of age differences in the within-person or between-person associations of social interactions and loneliness. DISCUSSION: Applying the CDA methodological framework allowed us to detect common and divergent patterns of social interactions and loneliness across samples, ages, regions, periods, and study designs.

Applying the Project ECHO Model to Support Implementation and Sustainment of Cognitive Behavioral Therapy for Psychosis.

INTRODUCTION: Project Extension for Community Healthcare Outcomes (ECHO) is a teleconsultation model that leverages technology to sustain specialized interventions in underresourced settings. We present the application of the ECHO model to longitudinal training and consultation for community behavioral health providers learning to deliver cognitive behavioral therapy for psychosis, an evidence-based psychotherapy for individuals with psychotic disorders that has poorly penetrated the US mental health system. METHODS: We analyzed within-group change over practitioners' 6-month ECHO participation cycle using the Expanded Outcomes Framework. We evaluated outcomes associated with participation, satisfaction, knowledge acquisition, performance, patient symptom severity, and functional impairment. RESULTS: In the first 3 years, the cognitive behavioral therapy for psychosis ECHO Clinics supported 150 providers from 12 community agencies. Forty percent did not complete the 6-month ECHO calendar, most commonly due to separation from their agency. Participants reported high degrees of satisfaction. Declarative and procedural knowledge increased over the 6-month period. Of the 24 providers who received a fidelity review, 87.5% met or exceeded the competency benchmark within the 6-month period. Clinical outcomes reflected reductions in hallucinations, negative symptoms, depression, mania, and functional impairment, but no reductions were detected in delusions, disorganized speech, or abnormal psychomotor behavior. DISCUSSION: ECHO Clinics offer a mode of providing continuous access to expert instruction, peer-to-peer consultation, and case-based learning that other workforce training models lack. Our evaluation suggests that the ECHO model supports continuous professional development for practitioners, most of whom had indicated inadequate preparation for their role. We observed improved learner and select patient outcomes.

A Precautionary Tale: Individual Decision Making in the Time of COVID-19.

Precaution taking is an important part of managing COVID-19 and has been since the start of the pandemic. Guided by the Health Belief Model, two studies conducted during the beginning of the COVID-19 pandemic aimed to identify possible individual difference predictors of precautionary actions. Study 1 was an online, cross-sectional study using 763 adults aged 20-79 years old. Study 2, a 30-day daily diary study, examined daily precautions in 261 persons over the age of 55 years old. Study 1 and Study 2 indicated that COVID-19 knowledge predicted precautionary behaviors. Multilevel models from Study 2 indicated that daily increases in in-person interactions and leaving home were associated with decreases in precautions, but increases in disruption to routine were associated with increases in precautions. In both studies, including concurrent and lagged models in Study 2, significant interactions between information seeking and perceived risk suggested higher information seeking was related to higher precautions for those who consider themselves low risk. Findings highlight the burden of daily precautions and potentially modifiable factors of engagement in precautions.

Experiencing and Forecasting COVID-19 Daily Stress on Mental Health Reactivity Across Age and Race.

OBJECTIVES: This study systematically evaluates age and race differences in mental health symptoms as they unfold microlongitudinally during the coronavirus disease 2019 (COVID-19) pandemic with a focus on within-person reactivity to forecasting and experiencing COVID-19 stress. METHOD: A daily diary approach was used to examine predictors of daily anxiety and depressive symptoms among 526 adults (White [54%] and Black American [46%]) aged 21-79. A total of 3,605 online diaries were collected for 21 consecutive days between October and November, 2020. In addition to mental health symptoms, participants reported forecasted (next 24 h) stress as well as experienced (past 24 h) stress related to COVID-19. RESULTS: Patterns of reactivity to forecasted and experienced COVID-19 stress depended on age and race. White older adults displayed greater reactivity to COVID-19-related stress than White younger adults, but the effects of COVID-19-related stress were consistently detrimental for the daily anxiety of Black Americans, regardless of age. For Black Americans, age was less negatively associated with depressive symptoms than for White Americans. Increases in experienced COVID-19 stress were also more strongly associated with increases in depressive symptoms for Black Americans relative to White participants. DISCUSSION: This study moves beyond cross-sectional, descriptive work within the context of the COVID-19 pandemic and emphasizes the dynamic nature of within-person reactivity patterns that differ by age and race. Although White older adults experienced an increase in daily anxiety when forecasting COVID-19 stress, the co-occurring pandemic of systemic racism may be more powerful than age-related vulnerabilities for Black adults.

Erratum to: AAA Research Methodology I: Overcoming Linguistic and Cultural Barriers in Aging Research Among Asians: Presenter Discussion.

[This corrects the article DOI: 10.1093/geroni/igaa057.3519.].

Age Differences in Risk and Resilience Factors in COVID-19-Related Stress.

OBJECTIVES: Older adults are at higher risk for death and infirmity from COVID-19 than younger and middle-aged adults. The current study examines COVID-19-specific anxiety and proactive coping as potential risk and resilience factors that may be differentially important for younger and older adults in understanding stress experienced due to the COVID-19 pandemic. METHODS: Five hundred and fifteen adults aged 20-79 years in the United States reported on their anxiety about developing COVID-19, proactive coping, and stress related to COVID-19 in an online survey. RESULTS: Although there were no age differences in stress levels, anxiety about developing COVID-19 was associated with more COVID-19 stress for older adults relative to younger adults, but proactive coping was associated with less COVID-19 stress for older adults relative to younger adults. DISCUSSION: Our results suggest that anxiety might function as a risk factor, whereas proactive coping may function as a resilience factor for older adults' COVID-19 stress. We encourage future context-dependent investigations into mental health among older adults during this pandemic and beyond.

Initial Evidence for the Efficacy of an Everyday Memory and Metacognitive Intervention.

BACKGROUND AND OBJECTIVES: The objective of this paper is to demonstrate the efficacy of an Everyday Memory and Metacognitive Intervention (EMMI) designed to improve everyday functioning of older adults. The EMMI emphasizes self-regulation as a behavioral approach to take priority over habitual behaviors that often impede everyday functioning. RESEARCH DESIGN AND METHODS: This study used a quasi-experimental design (intervention vs waitlist control) to test whether the EMMI improved several aspects of everyday cognition. Thirty-three EMMI participants (M age = 70.24) were compared to 20 control participants (M age = 71.70 years). The 2 groups were compared on everyday memory failures and successes, measures of well-being, subjective memory, and a prospective memory task. RESULTS: Participants who received the EMMI reported more memory successes and fewer memory failures over a 10-day measurement period postintervention. In addition, EMMI participants reported significantly higher life satisfaction and better subjective memory at posttest than the control group. Critically, the EMMI participants performed better on a laboratory contact prospective memory task. DISCUSSION AND IMPLICATIONS: The results from this study suggest that the EMMI is a promising approach that has potential to improve everyday memory functioning and perhaps help extend functional independence. Future studies will include randomized controlled trials as well as electronic measurement of memory incidents.

Mental Health Challenges of United States Healthcare Professionals During COVID-19.

As COVID-19 continues to impact global society, healthcare professionals (HCPs) are at risk for a number of negative well-being outcomes due to their role as care providers. The objective of this study was to better understand the current psychological impact of COVID-19 on HCPs in the United States This study used an online survey tool to collect demographic data and measures of well-being of adults age 18 and older living in the United States between March 20, 2020 and May 14, 2020. Measures included anxiety and stress related to COVID-19, depressive symptoms, current general anxiety, health questions, tiredness, control beliefs, proactive coping, and past and future appraisals of COVID-related stress. The sample included 90 HCPs and 90 age-matched controls (M age = 34.72 years, SD = 9.84, range = 23 - 67) from 35 states of the United States. A multivariate analysis of variance was performed, using education as a covariate, to identify group differences in the mental and physical health measures. HCPs reported higher levels of depressive symptoms, past and future appraisal of COVID-related stress, concern about their health, tiredness, current general anxiety, and constraint, in addition to lower levels of proactive coping compared to those who were not HCPs (p < 0.001, η2 = 0.28). Within the context of this pandemic, HCPs were at increased risk for a number of negative well-being outcomes. Potential targets, such as adaptive coping training, for intervention are discussed.

State Anxiety Is Related to Cortisol Response During Cognitive Testing for Older Adults.

Cognitive testing situations can be stressful for both younger and older adults, but threats of cognitive evaluation may be particularly salient among anxious older individuals as they tend to be more concerned than younger adults about their cognitive abilities and age-related cognitive decline. We examined age-related differences in the effect of anxiety on cortisol responses during cognitive testing in a sample of 27 younger (M = 19.8) and 29 older (M = 71.2) adults. Older adults with higher anxiety also had higher during-task cortisol (suggesting higher reactivity to testing) than older adults with lower anxiety and young adults. There was no effect of anxiety on cortisol for younger adults. Simultaneously examining subjective (state anxiety) and physiological (cortisol response) indicators of threat during cognitive testing appears to be especially important for older adults with higher state anxiety. The results are important for understanding cortisol reactivity, particularly in older adults. Researchers who administer cognitive tests to older adults and clinicians who work with older adults with cognitive concerns and/or anxiety may want to consider how they present their material.

Fostering Self-Management of Everyday Memory in Older Adults: A New Intervention Approach.

Traditional memory strategy training interventions improve older adults' performance on tests of episodic memory, but have limited transfer to episodic memory tasks, let alone to everyday memory. We argue that an alternative approach is needed to assist older adults to compensate for age-related cognitive declines and to maintain functional capacity in their own natural ecologies. We outline a set of principles regarding how interventions can successfully train older adults to increase successful goal pursuit to reduce risks of everyday memory failures. We argue that training individuals to use metacognitive self-regulatory strategies to proactively manage formulation and pursuit of daily goals can compensate for age-related cognitive changes and increase the likelihood of goal attainment. We then describe an intervention approach that instantiates these principles in a multi-modal intervention that is unique in its three-phase approach: (1) individualized assessment of an individual's current approaches to self-regulation; (2) training memory strategies, self-management skills, and new habits of mind in a group training context; and (3) a behavioral shaping period in which individuals receive coaching and feedback on their efforts to use trained procedures to improve everyday cognition. A recently completed study conducted an initial test of the intervention, with highly encouraging results. We advocate further efforts to replicate, extend, and fine-tune this type of intervention. The ultimate goal is to be able to deliver the intervention in a way that increases its potential reach, including to subpopulations of older adults at risk for everyday cognitive impairments.

Implementing illness management and recovery within assertive community treatment teams: A qualitative study.

OBJECTIVE: The study purpose was to assess the feasibility, advantages/disadvantages, and factors that hinder or facilitate the implementation of illness management and recovery (IMR) within assertive community treatment (ACT) teams. METHOD: A qualitative study was conducted with 11 ACT teams that implemented IMR. We conducted semistructured individual interviews with 17 persons enrolled in services and 55 ACT staff in individual and focus groups. Questions were designed to assess perceptions of IMR implementation, effects of IMR, staff training considerations, and recommendations. Data were analyzed using an inductive, consensus-building, thematic analysis, which included multiple research staff reviewing interview transcripts and field notes, developing and refining a codebook, constructing data summaries, and thematic synthesis. RESULTS: The analysis revealed six major themes: (a) a generally positive fit exists between the two models and population served, (b) both people with serious mental illness and staff benefited from ACT + IMR, (c) ACT teams encountered significant implementation barriers, (d) relationships and engagement with participants facilitated implementation, (e) taking a flexible approach to IMR and ACT improved implementation, and (f) programs should focus on greater integration of IMR within ACT teams. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: While there can be barriers to implementing IMR within ACT teams, there is generally a positive fit, it is feasible to implement, and it offers meaningful benefits. ACT teams should improve their recovery orientation by more widespread implementation of IMR. Future research on ACT + IMR should include mixed-methods approaches, implementation methodologies to identify barriers and facilitators, and idiographic measures that capture the individualized recovery goals of people with serious mental illness. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Women's Self-Perceived Similarity to Their Mother and Associations with Patterns of Alcohol Misuse over 20 Years.

AIMS: This study examined transgenerational transmission of risk for female alcohol misuse. Women's perceived similarity to their mother/father in adulthood was examined in terms of its influence on the expected association between perceived maternal alcohol use and female offsprings' trajectories of alcohol misuse. We hypothesized that a daughter's self-perceived similarity to her mother, in instances where her mother was perceived to be a frequent- or problem-drinker, would be associated with an increase in the daughter's count of negative consequences from alcohol use and potential symptoms of alcohol dependence across adulthood. SHORT SUMMARY: Women's perceived similarity to their mother/father was examined as a factor influencing associations between perceived parental alcohol use during childhood and patterns of alcohol misuse in adulthood. Women's self-perceived similarity to their frequent- or problem-drinking mothers increased the risk of negative consequences from drinking over time as well as potential symptoms of alcohol dependence over time. METHODS: Analyses utilized data from a survey of women (N = 911) who were followed over a 20-year period, beginning in 1981. Women, ages 21 or older and living in households in the contiguous USA, were eligible, and women who consumed four or more alcoholic drinks per week were oversampled. Model estimates were weighted to adjust for the oversampling of heavier drinking women and to reflect national demographics. Latent growth mixture models estimated regression parameters that captured variation in participants' alcohol misuse over time. RESULTS: Women who reported that their mother was a frequent- or problem-drinker and who perceived themselves to be similar to their mother, in general, showed increases in alcohol misuse. The same pattern of results was not shown for fathers. CONCLUSIONS: Results support that interventions seeking to reduce female alcohol misuse should address the role of perceived similarity to heavy-drinking female role models or 'female-drinker' prototypes to reduce problem-drinking behavior among female drinkers.