Exposure to Memory-Relevant versus Memory-Irrelevant Aging Stereotypes Differentially Affects Memory Self-Perceptions and Memory Test Scores of Young, Middle, and Older Age Adults.

This study examined the combined influence of assimilation and contrast effects on the memory self-efficacy and objective memory of young (ages 18-25, n = 114), middle-age (ages 26-59, n = 48), and older (ages 60-98, n = 59) adults. We reminded participants that they matched positive, not negative, memory-relevant or memory-irrelevant stereotypes of aging either before (experimental conditions) or after (control condition) they completed a memory self-efficacy questionnaire and took a memory test. Participants exposed to memory-relevant aging stereotypes prior to other measures reported higher memory self-efficacy than those exposed to memory-irrelevant stereotypes; this effect did not depend on age group. In contrast, the effect of stereotype exposure on memory performance differed with age. Young and older, but not middle-aged, adults showed differences in their memory scores depending on whether they were exposed to memory-relevant, memory-irrelevant or no aging stereotypes. In general, exposure to stereotypes (particularly those relevant to memory) had a negative influence on memory that contrasted with its positive effect on memory self-efficacy. Together, these results indicate that exposure to aging stereotypes can have opposing effects on the memory self-efficacy and objective test performance of adults of various ages and that the relevance of the stereotypes to the cognitive domain being assessed matters.

Category norms with a cross-sectional sample of adults in the United States: Consideration of cohort, age, and historical effects on semantic categories.

This paper describes normative data for newly collected exemplar responses to 70 semantic categories described in previous norming studies (Battig & Montague, Journal of Experimental Psychology, 80(3, pt.2): 1-46, 1969; Van Overschelde, Rawson, & Dunlosky, Journal of Memory and Language, 50(3): 289-335, 2004; Yoon et al., Psychology and Aging, 19(3), 379-393, 2004). These categories were presented to 246 young (18-39 years), middle (40-59 years), and older (60 years and older) English-speaking adults living in the United States who were asked to generate as many category exemplars as possible for each of the 70 categories. In order to understand differences in normative responses, we analyzed these responses a) between age groups within the current sample and b) in comparison to three previously published sets of norms. Experimental studies using such norms typically assume invariance of normative likelihoods across age and historical time. We replicate previous findings such that exemplar frequency correlations suggest moderate stability in generated category members between age groups and cohorts for many, but not all, categories. Further, analyses of rank-order correlations highlight that the traditional measure of typicality may not capture all aspects of typicality, namely that for some categories there is high consistency in the frequency of exemplars across age groups and/or norms, but the ordering of those exemplars differs significantly. We include a cluster analysis to aid in grouping categories based on relative stability across time, cohort, and age groups. These results emphasize the importance of maintaining and updating age-differentiated category norms.

Behaviors and Strategies Supporting Everyday Memory in Older Adults.

BACKGROUND: Little is known about the means by which older adults achieve memory-demanding goals in everyday life or alternatively about why they fail to do so. OBJECTIVES: We conducted qualitative interviews to evaluate what older people do to support everyday memory functioning. A principal focus was on understanding the ways in which individuals use internal memory strategies and external memory aids. METHODS: We interviewed 25 community-dwelling older adults (mean age 70 years) in a semi-structured interview. The transcribed results were coded by extracting segments of the interviews and classifying the responses into emergent categories. All coded interview segments were reviewed by category. Memos were created and relevant themes identified. RESULTS: The older adults reported everyday memory failures (such as forgetting names), often without nominating explicit methods for avoiding these problems. They also reported using a number of external memory aids such as calendars and lists. Our interviews indicated this use was typically a part of complex routines and habits of living that often seemed vulnerable to errors. For instance, people would report filling medication organizers or completing to-do lists without mentioning plans for how to effectively use these aids later. Furthermore, they often reported reliance on spontaneous encoding and retrieval - for example, stating that they would routinely remember to perform important actions in the future. CONCLUSIONS: Older adults' reported everyday memory failures were linked to suboptimal use of external memory aids and to a reliance on incidental learning and remembering. There is potential value for interventions that improve procedures for managing everyday life goals that rely on memory.

Are there Sex Differences in Confidence and Metacognitive Monitoring Accuracy for Everyday, Academic, and Psychometrically Measured Spatial Ability?

The current study evaluated sex differences in (1) self-perceptions of everyday and academic spatial ability, and (2) metacognitive monitoring accuracy for measures of spatial visualization and spatial orientation. Undergraduate students completed the Paper Folding Test, Spatial Relations Test, and the Revised Purdue Spatial Visualization Test while making confidence judgments (CJs) for each trial. They also made global estimates of performance and rated their ability to perform several everyday and academic spatial scenarios. Across multiple spatial measures, female students displayed lower confidence in their item-level monitoring and global assessments of performance than did male students, even when no actual differences in spatial performance occurred. Women were also less confident in their self-assessments of their visualspatial ability for scientific domains than were men. However, the absolute and relative accuracy of CJs did not differ as a function of sex suggesting that women can monitor their spatial performance as well as men.

Does the Cognitive Reflection Test actually capture heuristic versus analytic reasoning styles in older adults?

Background/Study Context: This study evaluated adult age differences in the original three-item Cognitive Reflection Test (CRT; Frederick, 2005, The Journal of Economic Perspectives, 19, 25-42) and an expanded seven-item version of that test (Toplak et al., 2013, Thinking and Reasoning, 20, 147-168). The CRT is a numerical problem-solving test thought to capture a disposition towards either rapid, intuition-based problem solving (Type I reasoning) or a more thoughtful, analytical problem-solving approach (Type II reasoning). Test items are designed to induce heuristically guided errors that can be avoided if using an appropriate numerical representation of the test problems. METHODS: We evaluated differences between young adults and old adults in CRT performance and correlates of CRT performance. Older adults (ages 60 to 80) were paid volunteers who participated in experiments assessing age differences in self-regulated learning. Young adults (ages 17 to 35) were students participating for pay as part of a project assessing measures of critical thinking skills or as a young comparison group in the self-regulated learning study. RESULTS: There were age differences in the number of CRT correct responses in two independent samples. Results with the original three-item CRT found older adults to have a greater relative proportion of errors based on providing the intuitive lure. However, younger adults actually had a greater proportion of intuitive errors on the long version of the CRT, relative to older adults. Item analysis indicated a much lower internal consistency of CRT items for older adults. CONCLUSION: These outcomes do not offer full support for the argument that older adults are higher in the use of a "Type I" cognitive style. The evidence was also consistent with an alternative hypothesis that age differences were due to lower levels of numeracy in the older samples. Alternative process-oriented evaluations of how older adults solve CRT items will probably be needed to determine conditions under which older adults manifest an increase in the Type I dispositional tendency to opt for superficial, heuristically guided problem representations in numerical problem-solving tasks.

Cognitive Predictors of Everyday Problem Solving across the Lifespan.

BACKGROUND: An important aspect of successful aging is maintaining the ability to solve everyday problems encountered in daily life. The limited evidence today suggests that everyday problem solving ability increases from young adulthood to middle age, but decreases in older age. OBJECTIVES: The present study examined age differences in the relative contributions of fluid and crystallized abilities to solving problems on the Everyday Problems Test (EPT). We hypothesized that due to diminishing fluid resources available with advanced age, crystallized knowledge would become increasingly important in predicting everyday problem solving with greater age. METHOD: Two hundred and twenty-one healthy adults from the Dallas Lifespan Brain Study, aged 24-93 years, completed a cognitive battery that included measures of fluid ability (i.e., processing speed, working memory, inductive reasoning) and crystallized ability (i.e., multiple measures of vocabulary). These measures were used to predict performance on EPT. RESULTS: Everyday problem solving showed an increase in performance from young to early middle age, with performance beginning to decrease at about age of 50 years. As hypothesized, fluid ability was the primary predictor of performance on everyday problem solving for young adults, but with increasing age, crystallized ability became the dominant predictor. CONCLUSION: This study provides evidence that everyday problem solving ability differs with age, and, more importantly, that the processes underlying it differ with age as well. The findings indicate that older adults increasingly rely on knowledge to support everyday problem solving, whereas young adults rely almost exclusively on fluid intelligence.

The cortisol awakening response and cognition across the adult lifespan.

Although the hippocampus is thought to play a central role in the regulation of the cortisol awakening response (CAR), results from past studies examining the relationship between the CAR and hippocampal-mediated memory and cognition have been mixed. Inconsistent findings may be due to the use of cortisol samples collected on only 1-2days since reduced sampling can permit unstable situational factors to bias results. We used cortisol assessments from 10 consecutive days to test the relationship of the CAR to episodic memory, working memory, and processing speed in a sample of healthy young, middle-aged, and older adults (age range: 23-79years; N=56). We tested if the relationship between the CAR and cognition would depend upon age and also tested if other cortisol measures, specifically waking cortisol, diurnal cortisol output (i.e., area under the curve) and diurnal cortisol slope (linear and quadratic), would be related to cognition. We found that a more positive CAR slope was related to better episodic memory and that this relationship did not depend upon age. The CAR was not significantly related to working memory. The relationship of the CAR to processing speed was not significant when using a CAR measure that corrected for non-compliant cortisol sampling. We also found that higher waking cortisol was significantly related to better working memory, but not episodic memory or processing speed. Neither diurnal cortisol output nor diurnal linear cortisol slope was significantly related to cognitive functioning. Future work should investigate the mechanisms underpinning the relationship of the cortisol awakening process to cognitive functioning.

The Importance of Leisure Activities in the Relationship between Physical Health and Well-Being in a Life Span Sample.

BACKGROUND: Previous studies have examined the relationships between physical health and leisure activities and between leisure activities and well-being, but, to our knowledge, none has examined these relationships simultaneously. OBJECTIVE: This study investigated the relationships between leisure activities, health and well-being considering the role of age, and whether leisure activities mediate the relationship between physical health and well-being. METHODS: Utilizing a cross-sectional database of 259 adults (ages 18-81 years) who completed several questionnaires, linear regression models and mediation models were tested. RESULTS: Regression analyses indicated that physical health was related to leisure activities and leisure activities were related to well-being. When physical health was measured by subjective ratings, age had a stronger relationship with leisure activities. However, when physical health was indicated by health restrictions, physical health had a stronger relationship with leisure activities than did age. Leisure activities were a partial mediator of the relationship between physical health and well-being. CONCLUSION: The results demonstrated that the reduction in leisure activities with age has more to do with physical health limitations than with older age itself. In addition, regardless of age, the benefits of physical health for well-being are due in part to the level of leisure activity participation. These results highlight the importance of leisure activities for successful aging throughout the adult life span. Interventions designed to improve well-being through increasing leisure activity participation should take physical health into consideration, particularly for older adults.

Correlates and moderators of change in subjective memory and memory performance: findings from the health and retirement study.

Aging researchers have long been interested in understanding individuals' subjective perceptions of their own memory functioning. Previous research has shown that subjective memory ratings are partly based on memory performance but also reflect the influence of other factors, such as depressive symptoms. The aim of the present study was to examine (1) longitudinal associations between trajectories of subjective memory and memory performance, (2) variables that predict levels of and changes in subjective memory and memory performance, and (3) variables that moderate associations between these constructs. We applied a latent growth curve model to four occasions of data from 15,824 participants of the Health and Retirement Study (HRS; mean age at baseline=64.27 years, SD=9.90; 58% women). Results revealed that latent changes in subjective memory were correlated with latent changes in memory performance (φ=0.49), indicating that participants who reported steeper declines of subjective memory indeed showed steeper declines of memory performance over time. Three major patterns of associations emerged with respect to predictors of subjective memory and subjective memory change. First, the level of memory performance showed stronger associations with age, gender, and education, whereas subjective memory was more strongly associated with subjective age and personality traits. For example, women performed better than men on the episodic memory test, but there were no gender differences in subjective memory. Also, older age was associated with steeper declines of memory performance but with less decline of subjective memory. Second, personality traits that predicted subjective memory intercepts did not predict subjective memory slopes. Third, the strength of associations between levels and slopes of subjective memory and memory performance varied as a function of gender, education, depressive symptoms, and personality traits. Conscientiousness moderated the relationship of the level of subjective memory to the level of memory performance, consistent with the hypothesis that persons high in conscientiousness more accurately monitor memory successes and failures. The results reinforce the importance of depressive symptoms as a predictor of subjective memory but also indicate that a broader perspective on the reasons why memory complaints have modest correlations with memory itself is needed.

Does strategy training reduce age-related deficits in working memory?

BACKGROUND: Older adults typically perform worse on measures of working memory (WM) than do young adults; however, age-related differences in WM performance might be reduced if older adults use effective encoding strategies. OBJECTIVE: The purpose of the current experiment was to evaluate WM performance after training individuals to use effective encoding strategies. METHODS: Participants in the training group (older adults: n = 39; young adults: n = 41) were taught about various verbal encoding strategies and their differential effectiveness and were trained to use interactive imagery and sentence generation on a list-learning task. Participants in the control group (older: n = 37; young: n = 38) completed an equally engaging filler task. All participants completed a pre- and post-training reading span task, which included self-reported strategy use, as well as two transfer tasks that differed in the affordance to use the trained strategies - a paired-associate recall task and the self-ordered pointing task. RESULTS: Both young and older adults were able to use the target strategies on the WM task and showed gains in WM performance after training. The age-related WM deficit was not greatly affected, however, and the training gains did not transfer to the other cognitive tasks. In fact, participants attempted to adapt the trained strategies for a paired-associate recall task, but the increased strategy use did not benefit their performance. CONCLUSIONS: Strategy training can boost WM performance, and its benefits appear to arise from strategy-specific effects and not from domain-general gains in cognitive ability.

Recalled aspects of original encoding strategies influence episodic feelings of knowing.

We tested the hypothesis that the feeling of knowing (FOK) after a failed recall attempt is influenced by recalling aspects of the original encoding strategy. Individuals were instructed to use interactive imagery to encode unrelated word pairs. We manipulated item concreteness (abstract vs. concrete) and item repetitions at study (one vs. three). Participants orally described the mediator produced immediately after studying each item, if any. After a delay, they were given cued recall, made FOK ratings, and attempted to recall their original mediator. Concreteness and item repetition enhanced strategy recall, which had a large effect on FOKs. Controlling on strategy recall reduced the predictive validity of FOKs for recognition memory, indicating that access to the original aspects of encoding influenced FOK accuracy. Confidence judgments (CJs) for correctly recognized items covaried with FOKs, but FOKs did not fully track the strategy recall associations with CJs, suggesting emergent effects of strategy cues that were elicited by recognition tests but not accessed at the time of the FOK judgment. In summary, cue-generated access to aspects of the original encoding strategy strongly influenced episodic FOKs, although other influences were also implicated.

Accuracy and speed feedback: global and local effects on strategy use.

UNLABELLED: BACKGROUND/STUDY CONTEXT: Skill acquisition often involves a shift from an effortful algorithm-based strategy to more fluent memory-based performance. Older adults' slower strategy transitions can be ascribed to both slowed learning and metacognitive factors. Experimenters often provide feedback on response accuracy; this emphasis may either inadvertently reinforce older adults' conservatism or might highlight that retrieval is generally quite accurate. Response time (RT) feedback can lead to more rapid shift to retrieval (Hertzog, Touron, & Hines, 2007, Psychology and Aging, 22, 607-624). METHODS: This study parametrically varied trial-by-trial feedback to examine whether strategy shifts in the noun-pair task in younger (M = 19) and older (M = 67) adults were influenced by type of performance feedback: none, trial accuracy, trial RT, or both accuracy and RT. RESULTS: Older adults who received accuracy feedback retrieved more often, particularly on difficult rearranged trials, and participants who receive speed feedback performed the scanning strategy more quickly. Age differences were also obtained in local (trial-level) reactivity to task performance, but these were not affected by feedback. CONCLUSIONS: Accuracy and speed feedback had distinct global (general) influences on task strategies and performance. In particular, it appears that the standard practice of providing trial-by-trial accuracy feedback might facilitate older adults' use of retrieval strategies in skill acquisition tasks.

Computerized assessment of age differences in memory beliefs.

Beliefs about memory play a role in older adults' concerns about aging and can influence their performance on memory tasks. Visual analog scales can capture beliefs about how aging affects memory in general (the General Beliefs About Memory Instrument [GBMI]) and one's own memory (the Personal Beliefs About Memory Instrument [PBMI]). Data were combined across four cross-sectional studies of adults who had completed the two measures, contrasting traditional paper-and-pencil versions of the questionnaires with newer computerized versions that use a computer mouse for visual analog scaling. This scaling method is easy to use and automates scoring of graphic rating scale responses. Adults of all ages produced GBMI responses reflecting their belief that memory declines with advancing age. Older adults' PBMI responses indicated that they perceived their memory ability more negatively than those of young adults and middle-aged adults. Adults of all ages were able to use the computerized questionnaires without difficulty, making these measures suitable for use in adult developmental research.

Instructing Use of an Effective Strategy Improves Recognition Memory in Healthy Adults.

OBJECTIVES: Age-related memory decrements correlate with metacognitive declines, including knowledge and deployment of effective mnemonic encoding strategies. However, whether imparting such strategy suffices for mitigating memory differences is unclear. METHOD: In a longitudinal study of 276 healthy adults aged 18-79 years, we tested associative and working memory, and assessed beliefs regarding mnemonic strategies. Testing was repeated every 2 years, 5 times. Starting with the third occasion, we instructed participants to use an effective mnemonic strategy (sentence generation). Using continuous-time dynamic modeling, we assessed changes in the item and associative recognition, intervention effects, and their relations with age, sex, meta-memory beliefs, working memory, and metabolic health. RESULTS: Younger age, better working memory, and stronger belief in effective mnemonic strategies predicted better recognition, whereas instructional intervention attenuated associative memory deficits, with some persistence over time. DISCUSSION: The present findings show merely imparting effective strategies holds promise for mitigating age-related associative memory deficits.

Longitudinal changes in gray matter correspond to changes in cognition across the lifespan: implications for theories of cognition.

The present study examines the association between gray matter volume and cognition. Studies that have examined this issue have focused primarily on older adults, whereas the present study examines the issue across the entire adult lifespan. A total of 463 adults, ages 20-88 at first assessment, were followed longitudinally across three assessments over 8-10years. Significant individual differences in a general cognition measure comprised of measures of speed of processing, working memory, and episodic memory were observed, as well as in measures of cortical and subcortical gray matter. Parallel process latent growth curve modeling showed a reliable relationship between decreases in cortical matter and cognitive decline across the entire adult lifespan, which persisted after controlling for age effects. Implications of these findings in relation to progression toward dementia, risk assessment, cognitive intervention, and environmental factors are discussed, as well as implications for theories of cognitive aging.

Immediate judgments of learning are insensitive to implicit interference effects at retrieval.

We conducted three experiments to determine whether metamemory predictions at encoding, immediate judgments of learning (IJOLs) are sensitive to implicit interference effects that will occur at retrieval. Implicit interference was manipulated by varying the association set size of the cue (Experiments 1 and 2) or the target (Experiment 3). The typical finding is that memory is worse for large-set-size cues and targets, but only when the target is studied alone and later prompted with a related cue (extralist). When the pairs are studied together (intralist), recall is the same regardless of set size; set size effects are eliminated. Metamemory predictions at retrieval, such as delayed JOLs (DJOLs) and feeling-of-knowing (FOK) judgments accurately reflect implicit interference effects (e.g., Eakin & Hertzog, 2006. In all three experiments, we found that DJOLs and FOKs accurately predicted set size effects on retrieval but that IJOLs did not. The findings provide further evidence that metamemory predictions are inferred from information other than direct access to the state of the memory trace, as well as indicate that inferences are based on different sources depending on when in the memory process predictions are made.

Age differences in the effects of experimenter-instructed versus self-generated strategy use.

UNLABELLED: Background/Study Context: Interactive imagery is superior to rote repetition as an encoding strategy for paired associate (PA) recall. Younger and older individuals often rate these strategies as equally effective before they gain experience using each strategy. The present study investigated how experimenter-supervised and participant-chosen strategy experience affected younger and older adults' knowledge about the effectiveness of these two strategies. METHODS: Ninety-nine younger (M = 19.0 years, SD = 1.4) and 90 older adults (M = 70.4 years, SD = 5.2) participated in the experiment. In learning a first PA list participants were either instructed to use imagery or repetition to study specific items (supervised) or could choose their own strategies (unsupervised). All participants were unsupervised on a second PA list to evaluate whether strategy experience affected strategy knowledge, strategy use, and PA recall. RESULTS: Both instruction groups learned about the superiority of imagery use through task experience, downgrading repetition ratings and upgrading imagery ratings on the second list. However, older adults showed less knowledge updating than did younger adults. Previously supervised younger adults increased their imagery use, improving PA recall; older adults maintained a higher level of repetition use. CONCLUSION: Older adults update knowledge of the differential effectiveness of the rote and imagery strategies, but to a lesser degree than younger adults. Older adults manifest an inertial tendency to continue using the repetition strategy even though they have learned that it is inferior to interactive imagery.

The role of metacognitive uncertainty in the delayed retrieval shift of older adults.

Strategic choice behavior of older adults in many skill acquisition tasks can be characterized as a delayed and/or incomplete shift to a more efficient retrieval-based strategy, even when older adults possess the requisite knowledge to use it successfully. The noun-pair lookup task (NPLT) requires verification of whether a centrally presented word pair matches one of a set of pairs displayed at the top of the screen. Because the pairings do not change, verification can be made from memory as the associations are learned. This study examines the role of metacognitive uncertainty in explaining older adults' delayed retrieval shift in the NPLT. Older and younger adults participated in a NPLT with previously learned items and new items. For each trial, the look-up table was shown only if the scanning strategy was selected. Some participants were given a precue informing whether the item had been previously learned. Retrieval strategy choice was low for older adults but precueing increased its frequency. Older adults' retrieval choices had minimal costs on NPLT accuracy, suggesting that the delayed retrieval shift can be exacerbated by metacognitive uncertainty that was reduced by precueing. The role of metacognitive uncertainty in older adults' retrieval avoidance was supported by a robust item-level regression effect of retrospective confidence judgments during prelearning tests and later NPLT retrieval strategy choices for older adults.

Are age differences in recognition-based retrieval monitoring an epiphenomenon of age differences in memory?

Older adults often demonstrate a monitoring deficit by producing more high-confidence memory errors on recognition memory tests. To eliminate lower memory performance by older adults (OA) as a candidate explanation, we studied how distinctive encoding enhances the retrieval-monitoring accuracy in older adults and younger adults (YA) under different delays (2-day delay for OA, 7-day delay for YA). Individuals viewed items consisting of four randomly selected exemplars (e.g., SALMON, BASS, PERCH, and SHARK) from a taxonomic category (e.g., FISH), one being designated as the to-be-remembered target. Participants were randomly assigned to two encoding conditions: Shared (generate a shared feature of all exemplars, e.g., GILLS) or Distinctive (generate a distinctive feature of the designated target). We collected retrospective confidence judgments (RCJs) after a five-alternative forced-choice (5AFC) recognition test, with the lures being either previously presented (old) exemplars or new category exemplars. Recall and recognition memory were better with distinctive encoding, with shared feature generation producing more high-confidence false alarms (HCFAs). Distinctive encoding dramatically reduced HCFAs and improved RCJ resolution. Comparison of OA with 2-day delay YA revealed age differences in HCFA consistent with previous studies. As important, age differences in memory for OA and 7-day delay YA were minimized, eliminating age deficits in HCFAs. Matching OAs to a subset of 7-day delay YAs on recognition memory produced additional evidence favoring the null hypothesis of age-equivalence in HCFAs. The results therefore indicated that age differences in recognition-based retrieval monitoring in a forced-choice recognition test are an epiphenomenon of age differences in memory. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Metacognitive training at home: does it improve older adults' learning?

BACKGROUND: Previous research has described the success of an intervention aimed at improving older adults' ability to regulate their learning. This metacognitive approach involves teaching older adults to allocate their study time more efficiently by testing themselves and restudying items that are less well learned. OBJECTIVE: Although this type of memory intervention has shown promise, training older adults to test themselves in the laboratory can be very time-intensive. Thus, the purpose of the present study is to transport the self-testing training method from the laboratory to home use. METHODS: A standard intervention design was used that included a pretraining session, multiple training sessions, and a posttraining session. Participants were randomly assigned to either the training group (n = 29) or the waiting list control group (n = 27). Moreover, we screened participants for whether they used the self-testing strategy during their pretraining test session. RESULTS: Compared to the performance of the control group, the training group displayed significant gains, which demonstrates that older adults can benefit from training themselves to use these skills at home. Moreover, the results of the present study indicate that this metacognitive approach can effectively improve older adults' learning, even in those who spontaneously self-test prior to training. CONCLUSIONS: Training metacognitive skills, such as self-testing and efficient study allocation, can improve the ability to learn new information in healthy older adults. More importantly, older adult clients can be supplied with an at-home training manual, which will ease the burden on practitioners.