Applying the Health Belief Model to Quantify and Investigate Expectations for Computerized Cognitive Training.

Despite the demonstrated benefits of computerized cognitive training for older adults, little is known about the determinants of training behavior. We developed and tested scales to quantify expectations about such training, examine whether expectations predicted training adherence, and explore if training expectations changed from pre- to post-training. Participants (N=219) were healthy older adults aged 55-96 years (M=75.36, SD=9.39), enrolled in four studies investigating Dakim, Insight, or Posit Science Brain Fitness computerized cognitive training programs. Instruments were adapted from existing health behavior scales: Self Efficacy for Cognitive Training, Outcome Expectations for Cognitive Training, Perceived Susceptibility to Cognitive Decline, Dementia or Alzheimer's Disease, and Perceived Severity of Cognitive Decline, Dementia or Alzheimer's Disease. Participants completed scales at baseline (N=219) and post-training (n=173). Eight composites were derived from factor analyses. Adherence rates were high (M=81%), but none of the composites predicted training adherence. There was an overall significant effect of time, Wilks' λ=.843, F(8, 114)=2.65, p=.010, partial η 2 =.157, a significant overall effect of training group, Wilks' λ=.770, F(16, 228)=1.99, p=.015, partial η 2 =.123, and an overall significant group x time interaction, Wilks' λ=.728, F(16, 226)=2.44, p=.002, partial η 2 =.147. Significant effects of time were found for expected psychological outcomes and self-efficacy. Post-training, participants more strongly agreed that training was enjoyable and increased their sense of accomplishment. Changes in self-efficacy for cognitive training varied by program, improvingfor Dakim- and declining for the more challenging Brain Fitness- and InSight participants. These newly devised scales may be useful for examining cognitive training behaviors. However, more work is needed to understand factors that influence older adults' enrollment in and adherence to cognitive training.

Handgrip Weakness and Asymmetry Independently Predict the Development of New Activity Limitations: Results from Analyses of Longitudinal Data from the US Health and Retirement Study.

OBJECTIVES: Examining strength asymmetries in assessments of muscle function may improve screenings for limitations in independent living tasks such as instrumental activities of daily living (IADL). We sought to determine the associations between handgrip strength (HGS) asymmetry and future IADL limitations in aging Americans. DESIGN: Longitudinal panel. SETTING AND PARTICIPANTS: Secondary analyses of data from participants aged at least 50 years from the 2006-2016 waves of the Health and Retirement Study. The analytic sample included 18,235 Americans who identified hand dominance and had measures of HGS for both hands in a single wave. METHODS: Hand dominance was self-reported, and a handgrip dynamometer measured HGS on each hand. The highest HGS values on each hand were used to calculate the HGS asymmetry ratio: (nondominant HGS/dominant HGS). Individuals with HGS asymmetry ratio <0.80 or >1.20 had HGS asymmetry. Persons with HGS asymmetry ratio <0.80 had dominant HGS asymmetry, whereas participants with HGS asymmetry ratio >1.20 had nondominant HGS asymmetry. Persons with HGS asymmetry ratio <1.0 also had their ratio inversed to make all HGS asymmetry ratios ≥1.0. IADL were self-reported. Covariate-adjusted generalized estimating equations were used for the analyses. RESULTS: Participants with HGS asymmetry had 1.12 [95% confidence interval (CI): 1.03-1.20] greater odds for future IADL limitations. Each HGS asymmetry dominance group also had greater odds for future IADL limitations: 1.09 (CI: 1.01-1.18) for individuals with dominant HGS asymmetry and 1.29 (CI: 1.09-1.52) for persons with nondominant HGS asymmetry. Every 0.10 increase in inverted HGS asymmetry ratio was associated with 1.30 (CI: 1.07-1.57) greater odds for future IADL limitations. CONCLUSIONS AND IMPLICATIONS: Assessing HGS asymmetry, as another potential biomarker of impaired muscle function, may provide novel insights for predicting IADL limitations. Future research should continue examining how strength asymmetries, and other aspects of muscle function beyond maximal strength, factor into the disabling cascade.

The Impact of Three Cognitive Training Interventions on Older Adults' Physical Functioning Across 5 Years.

OBJECTIVE: Physical functioning is closely associated with cognition. The current study assessed the impact of three cognitive training programs on objective measures of physical functioning across 5 years. METHOD: Older adults randomized to a processing speed ( n = 702), reasoning ( n = 694), or memory ( n = 703) training intervention were compared with those randomized to a no-contact control condition ( n = 698). Intention-to-treat (ITT) and treatment-received/dosage (time-varying number of training sessions) analyses were conducted. RESULTS: There were no transfer effects in the ITT analyses. Treatment-received models demonstrated that training sessions (i.e., higher dosage) across all intervention arms transferred to better maintained Digit Symbol Copy and Turn 360 performance relative to the control group. More reasoning training transferred to better grip strength. DISCUSSION: This is the first study to demonstrate differential longitudinal cognitive training transfer effects to three performance-based physical functioning measures. Future research should investigate mechanisms of far-transfer effects.

Use, maintenance and dose effects of cognitive speed of processing training in Parkinson's disease.

INTRODUCTION: Recent research indicated that cognitive speed of processing training (SPT) improved Useful Field of View (UFOV) among individuals with Parkinson's disease (PD). The effects of SPT in PD have not been further examined. The objectives of the current study were to investigate use, maintenance and dose effects of SPT among individuals with PD. METHODS: Participants who were randomized to SPT or a delayed control group completed the UFOV at a six-month follow-up visit. Use of SPT was monitored across the six-month study period. Regression explored factors affecting SPT use. Mixed effect models were conducted to examine the durability of training gains among those randomized to SPT (n = 44), and training dose effects among the entire sample (n = 87). RESULTS: The majority of participants chose to continue to use SPT (52%). Those randomized to SPT maintained improvements in UFOV performance. A significant dose effect of SPT was evident such that more hours of training were associated with greater UFOV performance improvements. The cognitive benefits derived from SPT in PD may be maintained for up to three months. CONCLUSION: Future research should determine how long gains endure and explore if such training gains transfer.

Engaging Graduate-Level Distance Learners in Research: A Collaborative Investigation of Rural Aging.

Online educational programs pose challenges to nonresidential graduate students for whom research is a key professional development experience. In this article, the authors share their pedagogical approach to engaging graduate-level online distance learners in research. Five students enrolled in an online master's degree program participated in a directed research course designed to facilitate a semester-long, collaborative, hands-on research experience in gerontology. As such, students recruited participants and conducted phone interviews for a multisite study examining aging in place in rural areas. Several strategies were used to facilitate student engagement and learning, including: regular meetings with faculty mentors, creation of a research team across institutions, interactive training, and technological tools to aid in communication. The authors discuss the process of implementing the project, challenges that arose, strategies for dealing with these issues, and a pedagogical framework that could be used to guide future endeavors of this type.

The Transfer of Cognitive Speed of Processing Training to Older Adults' Driving Mobility Across 5 Years.

OBJECTIVES: Multilevel models assessed the effects of cognitive speed of processing training (SPT) on older adults' self-reported driving using intention-to-treat (ITT, randomization to training or control conditions) and dosage (treatment-received via number of training sessions) analyses across 5 years. METHOD: Participants randomized to SPT (n = 598) were compared with those randomized to either the no-contact control (n = 598) or memory training, which served as an active control (n = 610). Driving mobility (frequency, exposure, and space) was assessed over time. RESULTS: No significant effects were found within the ITT analyses. However, number of SPT sessions did affect driving mobility outcomes. In the full sample (N = 1,806), higher SPT doses were associated with maintained driving frequency as compared with both control groups, but no effects were found for driving exposure or space. Subsample analyses (n = 315) revealed that persons at-risk for mobility declines (i.e., poor initial processing speed) who received additional booster SPT sessions reported greater maintenance of both driving frequency and exposure over time as compared with the no-contact and active control groups. DISCUSSION: These results and prior research indicate that cognitive SPT transfers to prolonged driving mobility among older adults. Future research should investigate the mechanisms behind transfer effects to real-world activities, such as driving.

Influence of Social and Health Indicators on Pain Interference With Everyday Activities Among Older Black and White Cancer Patients.

Objective: This prospective study aimed to determine the influence social and health factors have on pain interference with everyday activities among older patients receiving outpatient treatment services from a comprehensive cancer center. Method: Participants were surveyed on questions assessing pain interference, and social (communication), health (pain severity, comorbidities), behavioral (self-efficacy, affect), and demographic characteristics. Multivariate analyses were specified to examine determinants of pain interference, with items loading on separate cluster composites: physical interference and psychosocial interference. Results: Pain severity was a significant indicator for physical interference. Similarly, pain severity, education, self-efficacy, negative affect, and communication were predictors of psychosocial interference. Discussion: Factors defining the daily lived experiences of older adults are important in providing baseline information on functional status. This emphasizes the need to rigorously examine the association between pain, and clinical and psychosocial indicators, but more importantly indicators that contribute to the patient's ability to perform normal everyday activities.

The Influence of Pain Severity and Interference on Satisfaction with Pain Management among Middle-Aged and Older Adults.

Background. Health outcomes are often contingent on how effective the individual is able to manage existent illness-related symptoms. This is all the more relevant among chronic pain patients. Objective. This study aimed to identify indicators of pain treatment satisfaction among middle-aged and older adults (N = 150) receiving outpatient treatment from a comprehensive cancer center. Methods. Patients were surveyed on questions assessing pain treatment satisfaction, pain severity, and additional social characteristics. Results. Descriptive data showed that middle-aged adults reported more pain locations, greater pain severity, and less satisfaction with pain treatment. A multivariate model was specified, showing older adults being more satisfied with their pain treatment. For the middle-aged adults, treatment satisfaction was generally lower with greater pain severity. This counters that for the older adults, where treatment satisfaction remained consistent despite increased levels of pain severity. Conclusion. These findings address an important issue regarding how pain is experienced across the life course. This suggests that general assumptions cannot be made about the health outcomes of older adults. Beyond the descriptive definitions of pain, there remains the need to develop models that account for determinants that may account for the pain experience among a diverse adult population.

Gender and Racial Disparities in Life-Space Constriction Among Older Adults.

PURPOSE OF THE STUDY: "Life-space" is the spatial area through which a person experiences and interacts with the world. Life-space constriction, the shrinking of the spatial area that a person traverses, is associated with negative health outcomes in later life. Racial and gender disparities in mobility as indicated by life-space constriction are thought to contribute to broader disparities in health and functioning among older adults. DESIGN AND METHODS: Data come from the 5-year follow-up of the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Study (N = 2,765; mean age = 73.6; 75.8% women; 73.7% White). Life-space constriction was defined as "not traveling beyond one's town." A series of logistic regression and Cox proportional hazard models were used to estimate risk for incident life-space constriction by race and gender. RESULTS: Blacks and women had greater likelihood of life-space constriction at baseline. Women were more likely to experience incident life-space constriction at follow-up relative to men (Hazard ratio [HR]: 1.89, 95% Confidence interval [CI]: 1.26-2.83). Blacks were associated with lower risk of life-space constriction over time (HR: 0.67, 95% CI: 0.45-0.99) relative to Whites. IMPLICATIONS: Disparities in life-space constriction by gender and race exist in later life. Understanding the processes underlying these mobility restrictions is important to developing intervention programs to enhance health and functioning for older adults.

Cognitive speed of processing training in older adults with visual impairments.

PURPOSE: To examine whether older adults with vision impairment differentially benefit from cognitive speed of processing training (SPT) relative to healthy older adults. METHODS: Secondary data analyses were conducted from a randomised trial on the effects of SPT among older adults. The effects of vision impairment as indicated by (1) near visual acuity, (2) contrast sensitivity, (3) self-reported cataracts and (4) self-reported other eye conditions (e.g., glaucoma, macular degeneration, diabetic retinopathy, optic neuritis, and retinopathy) among participants randomised to either SPT or a social- and computer-contact control group was assessed. The primary outcome was Useful Field of View Test (UFOV) performance. RESULTS: Mixed repeated-measures ancovas demonstrated that those randomized to SPT experienced greater baseline to post-test improvements in UFOV performance relative to controls (p's < 0.001), regardless of impairments in near visual acuity, contrast sensitivity or presence of cataracts. Those with other eye conditions significantly benefitted from training (p = 0.044), but to a lesser degree than those without such conditions. Covariates included age and baseline measures of balance and depressive symptoms, which were significantly correlated with baseline UFOV performance. CONCLUSIONS: Among a community-based sample of older adults with and without visual impairment and eye disease, the SPT intervention was effective in enhancing participants' UFOV performance. The analyses presented here indicate the potential for SPT to enhance UFOV performance among a community-based sample of older adults with visual impairment and potentially for some with self-reported eye disease; further research to explore this area is warranted, particularly to determine the effects of eye diseases on SPT benefits.

Experience and knowledge of pain management in patients receiving outpatient cancer treatment: what do older adults really know about their cancer pain?

OBJECTIVE: An individual's ability to effectively manage their cancer pain is influenced by knowledge and perceptions regarding the pain experience. While significance of the physician's knowledge of cancer pain management has been reported, much less is known how a patient's knowledge may influence their ability to optimally manage their pain. The purpose of this study is to determine the influence health and social factors have on the knowledge and experience of cancer pain among older adults. DESIGN: A prospective cross-sectional study of older Black and White patients presenting for outpatient cancer treatment. METHODS: Participants were surveyed on questions assessing pain severity, knowledge and experience of pain, self-efficacy for pain treatment, satisfaction with pain treatment, and additional social, health, and demographic characteristics. A series of hierarchical regression models were specified to examine predictors of cancer pain knowledge and experience. RESULTS: Education, race, and trust were significant predictors of pain knowledge, whereas self-efficacy for pain, pain interference, and pain severity were indicators of the experience of cancer pain. CONCLUSIONS: Knowledge and experience of (cancer) pain are contingent upon a myriad of social and clinical factors that are not exclusive but rather coexisting determinants of health. Understanding older adults' knowledge of pain may begin to diminish the imparities in the diagnosis and treatment of pain among this growing diverse population of older adults. It may similarly allow for programs to be tailored to fit the specific needs of the patient in the treatment and management of their cancer pain.

Satisfaction with pain treatment in older cancer patients: Identifying variants of discrimination, trust, communication, and self-efficacy.

How satisfied a patient is with their medical treatment may influence compliance and adherence to medical regimens. While a number of studies have examined patient satisfaction among younger populations, few have determined the impact social factors have on satisfaction with pain treatment among older adults. This study aimed to determine the influence discrimination, trust, communication, and other health characteristics have on satisfaction with pain treatment among older adults receiving outpatient services from a comprehensive cancer center. Participants were surveyed on questions assessing pain symptomatology, and identified social (discrimination, trust, and communication), physical (comorbidities, pain interference), behavioral (self-efficacy), and demographic characteristics. Analyses were calculated to determine the total and indirect effects of trust, communication, and self-efficacy as mediators on the perceived discrimination-patient satisfaction with pain treatment relationship. Data showed a significant relationship of communication and discrimination on patient satisfaction. However, none of the mediating effects were significant. It must be recognized that patient satisfaction is contingent upon a myriad of social factors that are not exclusive, but rather coexisting determinants of health. Particularly among the elderly, perceived discrimination and incidences of poor communication may be significant influences on health and the lived day-to-day experiences of this adult population.

Longitudinal differences in cognitive functioning among older adults with and without heart failure.

OBJECTIVE: Secondary data analyses were conducted to examine cognitive function and longitudinal cognitive decline among older adults with and without heart failure (HF). METHOD: Data from the Advanced Cognitive Training for Independent and Vital Elderly study were used to compare baseline (N = 2,790) and longitudinal (n = 692) changes in memory, reasoning, and speed of processing performance among participants (M age = 73.61, SD = 5.89) who self-reported HF at baseline, developed HF over time, or never reported HF. RESULTS: At baseline, there were differences in memory and speed of processing with participants who never reported HF performing better than those who reported developing HF over time, and those who reported HF at baseline performing the worst (ps < .05). Longitudinally, participants with self-reported HF at baseline showed declines in reasoning over time. DISCUSSION: The results indicate that cognitive difficulties in memory and speed may occur prior to a HF diagnosis, while those with HF may experience steeper declines in reasoning as measured by word series test.

Randomized trial of cognitive speed of processing training in Parkinson disease.

OBJECTIVE: To examine the efficacy of cognitive speed of processing training (SOPT) among individuals with Parkinson disease (PD). Moderators of SOPT were also examined. METHODS: Eighty-seven adults, 40 years of age or older, with a diagnosis of idiopathic PD in Hoehn & Yahr stages 1-3 and on a stable medication regimen were randomized to either 20 hours of self-administered SOPT (using InSight software) or a no-contact control condition. Participants were assessed at baseline and after 3 months of training (or an equivalent delay). The primary outcome measure was useful field of view test (UFOV) performance, and secondary outcomes included cognitive self-perceptions and depressive symptoms. RESULTS: Results indicated that participants randomized to SOPT experienced significantly greater improvements on UFOV performance relative to controls, Wilks λ = 0.938, F 1,72 = 4.79, p = 0.032, partial η(2) = 0.062. Findings indicated no significant effect of training on secondary outcomes, Wilks λ = 0.987, F2,70 < 1, p = 0.637, partial η(2) = 0.013. CONCLUSIONS: Patients with mild to moderate stage PD can self-administer SOPT and improve their cognitive speed of processing, as indexed by UFOV (a robust predictor of driving performance in aging and PD). Further research should establish if persons with PD experience longitudinal benefits of such training and if improvements translate to benefits in functional activities such as driving. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that SOPT improves UFOV performance among persons in the mild to moderate stages of PD.

Self-rated driving habits among older adults with clinically-defined mild cognitive impairment, clinically-defined dementia, and normal cognition.

Older adults with clinically-defined dementia may report reducing their driving more than cognitively normal controls. However, it is unclear how these groups compare to individuals with clinically-defined mild cognitive impairment (MCI) in terms of driving behaviors. The current study investigated self-reported driving habits among adults age 60 and older with clinical MCI (n=41), clinical mild dementia (n=40), and normal cognition (n=43). Participants reported their driving status, driving frequency (days per week), and how often they avoided accessing the community, making left turns, driving at night, driving in unfamiliar areas, driving on high-traffic roads, and driving in bad weather. After adjusting for education, a MANCOVA revealed that participants with MCI and dementia avoided unfamiliar areas and high-traffic roads significantly more than normal participants. Participants with dementia also avoided left turns and accessing the community more than those with normal cognition and MCI (p<0.05 for all). The other driving variables did not significantly differ between groups. Thus, older adults with clinically-defined MCI, as well as those with dementia, avoided some complex driving situations more than cognitively intact adults. However, all diagnostic groups had similar rates of driving cessation and frequency. Future research should examine the safety implications of such findings.

Mediators of the association between driving cessation and mortality among older adults.

OBJECTIVE: The present study examined health and physical performance as mediators of the association between driving cessation and mortality among older residents of small and large cities. METHOD: Participants (N = 2,793) were from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study. Participants' driving status and health were measured at baseline, and mortality rates were observed across the subsequent 5 years. RESULTS: Overall, mortality risk was 1.68 times higher for nondrivers versus drivers; this relationship was significantly mediated by physical performance and social, physical, and general health. For large-city residents, mediation effects for all mediators were significant and complete. For small-city residents, only physical and general health were significant mediators, and these effects were partial. DISCUSSION: Health difficulties that accompany or follow driving cessation may explain the association between driving cessation and mortality, particularly for residents of large cities, where alternative transportation options may be more numerous.

The effects of cognitive speed of processing training among older adults with psychometrically- defined mild cognitive impairment.

Despite the growing interest in cognitive training programs as a potential non-pharmacological approach to slowing cognitive decline in mild cognitive impairment (MCI), there has been little research on the differential effectiveness of training among subtypes of MCI (i.e., amnestic, single non-amnestic, and multi-domain). The current study examined the longitudinal effects of cognitive speed of processing training (SOPT) among older adults with psychometricallydefined MCI from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial. Mixed model ANOVAs examined the effectiveness of SOPT in participants with MCI relative to controls and also compared training effectiveness in MCI subgroups to appropriate controls. A mixed effects model compared SOPT training effects longitudinally across five years relative to controls. A second mixed effects model compared the durability of training gains between the MCI subtypes across 5 years. All subtypes of MCI showed immediate improvement post-training relative to controls, with the single non-amnestic subtype showing the most benefit. Additionally, all subtypes showed similar trajectories across five years. There were no significant changes in performance across time, indicating initial training gains were maintained. These results provide support for the effectiveness and potential durability of SOPT among persons with MCI regardless of subtype. Future research should investigate if SOPT transfers to improvements in the everyday functioning of those with MCI.

Patterns of level and change in self-reported driving behaviors among older adults: who self-regulates?

OBJECTIVES: The present study investigated patterns of self-reported driving habits among healthy older adults over 5 years, as well as characteristics that distinguished subgroups with different patterns. METHODS: Participants were drivers from the control group of the Advanced Cognitive Training for Independent and Vital Elderly study at the baseline assessment (N = 597). The outcome was a composite of driving frequency, driving space, and perceived driving difficulty. Growth mixture models identified classes of participants with different baseline scores and change trajectories, and classes were compared in terms of baseline sensory, physical, and cognitive functioning. RESULTS: A 3-class model was indicated, consisting of 2 classes with intercept differences and stability over time, "above-average stable" (39%) and "average stable" drivers (44%), and 1 class with a lower intercept and negative slope, "decreasers" (17%). Relative to stable drivers, decreasers exhibited significantly more depressive symptoms and poorer self-rated health, balance, everyday functioning, and speed of processing after controlling for age and education (p < .05). DISCUSSION: The majority of older drivers maintained their driving over time at different levels, whereas a subgroup of individuals with poorer baseline functioning self-regulated by reducing their driving. Future studies should determine how such patterns affect driving safety.

Cognitive Speed of Processing Training Can Promote Community Mobility among Older Adults: A Brief Review.

Background. Community mobility is crucial for maintaining independent functioning and quality of life for older adults. Purpose. The present paper describes the relationship of cognition, particularly speed of processing as measured by the Useful Field of View Test, to mobility as indicated by driving behaviors, life space, and falls among healthy older adults. Research examining the impact of cognitive speed of processing training (SOPT) on older adults' community mobility (i.e., driving behaviors) is also summarized. Key Issues. Even slight cognitive declines can place older adults at risk for mobility limitations. However, cognitive interventions like SOPT can mitigate declines in driving mobility. Implications. The potential of SOPT to sustain community mobility among older adults is discussed.

Changes in mobility among older adults with psychometrically defined mild cognitive impairment.

Studies have found that adults with possible mild cognitive impairment (MCI) exhibit decrements in everyday functioning (e.g., Wadley, V. G., Crowe, M., Marsiske, M., Cook, S. E., Unverzagt, F. W., Rosenberg, A. L., et al. (2007). Changes in everyday function among individuals with psychometrically defined mild cognitive impairment. Journal of the American Geriatrics Society, 55, 1192-1198). However, it is not known whether driving mobility and life space mobility are reduced in such individuals. The current study examined 5-year trajectories of mobility change in older adults (N = 2,355) with psychometrically defined MCI from the Advanced Cognitive Training for Independent and Vital Elderly trial. Mixed effect models evaluated group differences for the following mobility outcomes: driving space, life space, driving frequency, and driving difficulty. Relative to cognitively normal participants, participants with possible MCI showed reduced baseline mobility for all outcomes as well as faster rates of decline for driving frequency and difficulty. These results suggest that mobility declines could be features of MCI, and changes in mobility may be particularly important for researchers and clinicians to monitor in this population.