Cognition-oriented treatments for older adults: A systematic review of the influence of depression and self-efficacy individual differences factors.

The increasing prevalence of cognitive decline, mild cognitive impairment (MCI), and dementia with the aging population has led to scrutiny of the efficacy of cognition-oriented treatments (COTs) aiming to maintain functioning, and delay or prevent further cognitive decline. However, little is known regarding the role of individual differences patient-variables (such as depression, self-efficacy, and motivation) in moderating the efficacy of COTs. This systematic review aimed to identify and analyze COT trials which investigated the relationship between differences in these patient-variables and intervention outcomes for older adults across healthy, MCI, and dementia populations. Of the 4854 studies extracted from the systematic search, 14 were included for analysis. While results were mixed across interventions and populations, on balance, greater depression severity predicted poorer cognitive functioning, and improvement in depressive symptom severity may account for at least part of the cognitive benefits seen at post-intervention. These findings were strongest for studies of MCI populations, with there being limited evidence of a relationship for healthy older adults or those with dementia. Overall, this review demonstrates the need for further investigation into the role of individual differences and clinical variables - particularly depression symptom severity - in attenuating COT outcomes through larger sample, high-quality randomized controlled trials.

Retirees' perceptions of goal setting: A qualitative study.

OBJECTIVE: To investigate the language and meanings that retirees give to goals, including their perceptions of the benefits and limitations of pursuing goals in retirement. METHODS: In-depth interviews and mini-group discussions were conducted with 60 community-dwelling Australian retirees aged 57 to 88 years. Data were transcribed and analysed thematically. RESULTS: Responses to the term 'goal' varied by age in relation to the meaning and relevance of the term to retirement planning, largely shaped by the perceived formality and flexibility of goal setting which linked to acceptance or fear of failure when goals were not achieved with three profiles emerging: the Acceptors, the Ambivalent and the Rejectors. Language was highly influential in forming perceptions. CONCLUSION: Retirees' perceptions about the meaning and usefulness of goals varied greatly, with the language used a key factor in the perceived relevance of goal setting.

Meta-Analysis of the Effects of Computerized Cognitive Training on Executive Functions: a Cross-Disciplinary Taxonomy for Classifying Outcome Cognitive Factors.

The growing prevalence of neurodegenerative disorders associated with aging and cognitive decline has generated increasing cross-disciplinary interest in non-pharmacological interventions, such as computerized cognitive training (CCT), which may prevent or slow cognitive decline. However, inconsistent findings across meta-analytic reviews in the field suggest a lack of cross-disciplinary consensus and on-going debate regarding the benefits of CCT. We posit that a contributing factor is the lack of a theoretically-based taxonomy of constructs and representative tasks typically used. An integration of the Cattell-Horn-Carroll (CHC) taxonomy of broad and narrow cognitive factors and the Miyake unity-diversity theory of executive functions (EF) is proposed (CHC-M) as an attempt to clarify this issue through representing and integrating the disciplines contributing to CCT research. The present study assessed the utility of this taxonomy by reanalyzing the Lampit et al. (2014) meta-analysis of CCT in healthy older adults using the CHC-M framework. Results suggest that: 1) substantively different statistical effects are observed when CHC-M is applied to the Lampit et al. meta-analytic review, leading to importantly different interpretations of the data; 2) typically-used classification practices conflate Executive Function (EF) tasks with fluid reasoning (Gf) and retrieval fluency (Gr), and Attention with sensory perception; and 3) there is theoretical and practical advantage in differentiating attention and working-memory tasks into the narrow shifting, inhibition, and updating EF domains. Implications for clinical practice, particularly for our understanding of EF are discussed.

The Structure of the FACT-Cog v3 in Cancer Patients, Students, and Older Adults.

CONTEXT: The Functional Assessment of Cancer Therapy-Cognitive (FACT-Cog) version 3 questionnaire is designed to assess perceived cognitive function and impact on quality of life in cancer patients. OBJECTIVES: We examined the factor structure of the FACT-Cog version 3 in samples of cancer patients, older adults, and students. METHODS: Data from three populations were sourced. Cancer patient data (N = 158) came from two studies, one evaluating a web-based cognitive training program, and the other evaluating symptoms in patients receiving chemotherapy. The older adult sample (N = 477) was commercial brain training users in the general population. The student sample (N = 154) came from a study examining the relation between cognitive test performance and perceived cognitive function. RESULTS: The patient sample conformed to the traditional four-factor structure (impairments, abilities, noticeability, and quality of life), with some support for separating the broad impairment/ability factors into specific cognitive domains. The older adult sample was best described using both impairments/abilities and specific cognitive domains. The student sample suggested two impairment/ability factors but separation of concentration/acuity and memory/verbal impairment items. CONCLUSION: The FACT-Cog can be used in populations other than cancer patients, with modifications to the scoring system. Even when used with cancer patients, it is worth considering scoring specific cognitive domains separately.

Carer Characteristics and Health, Wellbeing and Employment Outcomes of Older Australian Baby Boomers.

Supporting caregivers and enabling continued workforce participation are central strategies in Australia's response to an ageing population, however these strategies have potential disadvantages for carers, particularly women, including reduced workforce participation and retirement income, and poorer health status. This paper explores the nexus between paid work and caregiving for Australia's baby boomer cohort as this group faces unprecedented pressures to manage paid work alongside caring longer and more intensively for family members, including grandchildren. A sample of 1261 men and women aged 60 to 64 completed the 2011-12 Life Histories and Health survey, a sub-study of the New South Wales 45 and Up Study. The survey collected data on sociodemographic, psychosocial, life history and health-related variables including caregiving and employment status. Around a third (32.5%) of the sample (52.2% female) were involved in some type of caregiving at the time. Compared to non-carers, carers reported lower workforce participation (45.8% versus 54.7% for non-carers) as well as poorer health, more mobility difficulties, lower quality of life and lower self-rated SES. Carers who also cared for grandchildren were more likely to be in part-time or no paid work compared to other carers. Working carers tended to be more highly educated, have fewer mobility difficulties, better self-rated health and higher SES than non-working carers. Male carers were more likely than female carers to be in full-time or no paid work. Results indicate that reduced workforce participation and health status of caregivers varies by gender and type of caregiving. Policy reforms are recommended to mitigate these adverse consequences on those providing care, their families, employers and the community.

Multimorbidity, health and aging in Canada and Australia: a tale of two countries.

BACKGROUND: Multimorbidity has been recognized as a major public health issue, negatively affecting health-related quality of life, including physical, functional, mental, emotional, and social domains, as well as increasing health care utilization. This exploratory study examines selected health outcomes associated with multimorbidity across older age groups/cohorts and gender, comparing Canada and Australia. METHODS: Data were drawn from the 2008/09 Canadian Community Health Survey and the 2009 Australian HILDA survey. Seven major chronic conditions were identical across the two data sets, and were combined into an additive measure of multimorbidity. OLS and logistic regression models were performed within age group (45-54, 55-64, 65-74, 75+) and gender to estimate associations between multimorbidity and several health-related outcomes, including: loneliness, life satisfaction, perceived health, mobility restriction, and hospital stays, adjusting for marital status, education and foreign born status. RESULTS: Overall, country-level differences were identified for perceptions of loneliness, life satisfaction, and perceived health. Australians tended to experience a greater risk of loneliness and lower self-rated health in the face of multimorbidity than Canadians, especially among older men. Canadians tended to experience lower life satisfaction associated with multimorbidity than Australians. No country-level differences were identified for associations between multimorbidity and hospital stays or mobility limitations. CONCLUSIONS: The associations between multimorbidity and health are similar between the two countries but are variable depending on population, age group/cohort, and gender. The strongest country-level associations are for indicators of health-related quality of life, rather than health care or mobility limitation outcomes.

Pathways to Well-Being in Later Life: Socioeconomic and Health Determinants Across the Life Course of Australian Baby Boomers.

In many countries like Australia and the United States, baby boomers are referred to as the 'lucky cohort', yet there has been little research on the origins and extent of inequalities within this cohort. This study uses path analysis to investigate direct and indirect effects of childhood and adult socioeconomic status and health on two subjective well-being measures: quality of life and life satisfaction. Retrospective life course data were obtained for 1,261 people aged 60 to 64 in the 2011-12 Life Histories and Health survey, a sub-study of the Australian 45 and Up Study. Supporting an accumulation model, the number of negative childhood and adult exposures were inversely related to both types of well-being. Consistent with a critical period model, childhood exposures had small but significant effects on subjective well-being and were relatively more important for quality of life than for life satisfaction. However, these childhood effects were largely indirect and significantly mediated by more proximal adult exposures, providing support for a pathway model. A key implication of this research is that the critical period for later life well-being is significant in adulthood rather than childhood, suggesting that there may be key opportunities for improving individuals' later life well-being far beyond the early, formative years. This research highlights the importance of understanding how earlier life exposures impact experiences in later life, and investing in health and socioeconomic opportunities to reduce inequalities across all stages of life.

Adapting data collection methods in the Australian Life Histories and Health Survey: a retrospective life course study.

OBJECTIVE: Ideally, life course data are collected prospectively through an ongoing longitudinal study. We report adaptive multimethod fieldwork procedures that gathered life history data by mail survey and telephone interview, comparable with the face-to-face methods employed in the English Longitudinal Study on Ageing (ELSA). DESIGN: The Australian Life Histories and Health (LHH) Survey was a substudy of the Australian 45 and Up Study, with data collection methods modified from the ELSA Study. A self-complete questionnaire and life history calendar were completed by the participants, followed by a computer-assisted telephone interview recording key life events. RESULTS: The LHH survey developed and tested procedures and instruments that gathered rich life history data within an ongoing Australian longitudinal survey on ageing. Data collection proved to be economical. The use of a self-complete questionnaire in conjunction with a life history calendar and coordinated computer-assisted telephone interview was successful in collecting retrospective life course information, in terms of being thorough, practical and efficient. This study has a diverse collection of data covering the life course, starting with early life experiences and continuing with socioeconomic and health exposures and outcomes during adult life. CONCLUSIONS: Mail and telephone methodology can accurately and economically add a life history dimension to an ongoing longitudinal survey. The method is particularly valuable for surveying widely dispersed populations. The results will facilitate understanding of the social determinants of health by gathering data on earlier life exposures as well as comparative data across geographical and societal contexts.

The moderating effect of individual differences in error-management training: who learns from mistakes?

OBJECTIVE: We investigated the effectiveness of error-encouragement training and the influence of ability and personality attribute-treatment interactions using a dynamic decision-making task. BACKGROUND: Error-encouragement training is said to be more effective than error-avoidance training because active exploration and error encouragement promote better learning and transfer. Past research, which is limited by confounded experimental designs involving simple tasks with little consideration of individual differences, provides evidence for the value of active exploration but less so for error encouragement METHOD: We randomly allocated 164 participants to receive error-encouragement, error-avoidance, or no error-related instructions in training on ATC-lab, a dynamic computer simulated air traffic control task. Active exploration and task information were controlled, and ability and personality were assessed. RESULTS: Error encouragement yielded better transfer performance than did error avoidance but was no better than the control training. Higher- rather than lower-ability trainees benefited from training with an error orientation (positive or negative), suggesting that learning from errors in training requires greater cognitive resources. Trainees higher in openness to experience and agreeableness performed more poorly with error-avoidance training than with error-encouragement and control training. CONCLUSION: Error-avoidance training had a detrimental effect especially for those less open to experience, lower in agreeableness, and of lower ability. The significant benefits of error-encouragement training reported in previous research were probably attributable to confounding factors, such as active exploration and differential task information. APPLICATION: Although errors and active exploration can be useful learning tools in training, trainers should be mindful that focusing on errors, whether positively or negatively, may not suit everyone.

A mental model of factors associated with subjective life expectancy.

The objective was to develop and test a framework based on a biopsychosocial model that can be used to identify factors associated with subjective (self-estimated) life expectancy (SLE). SLE predicts important work and retirement decisions so a better understanding of the factors that contribute to an individual's thoughts about their likely age at death is essential for late-career and financial planning and for developing interventions aimed at addressing inappropriate estimates. This is a sub-study of the Australian 45 and Up Study cohort. Survey data were collected at two time points (3 years apart) from 2579 participants aged over 55 years. Correlations and regression analyses tested the relationship of SLE with biomedical/genetic factors (age, health diagnoses, parental longevity), socioeconomic factors (income, education) health behaviors (exercise, smoking, alcohol use, diet), and psychosocial factors (optimism, distress, social connectedness). Variables within each set of factors except the socioeconomic set were significantly related to SLE. Healthy lifestyle behaviors significantly moderated the effect of parental longevity. The findings indicate that individuals construct an understanding of their personal life expectancy based on similar factors that predict actual life expectancy, but not all mortality risk factors appear to be weighted realistically. The findings imply that, at least to some extent, SLE is not a stable construct and might be amenable to intervention.