Age Differences in Gaze Following: Older Adults Follow Gaze More than Younger Adults When free-viewing Scenes.

Previous research investigated age differences in gaze following with an attentional cueing paradigm where participants view a face with averted gaze, and then respond to a target appearing in a location congruent or incongruent with the gaze cue. However, this paradigm is far removed from the way we use gaze cues in everyday settings. Here we recorded the eye movements of younger and older adults while they freely viewed naturalistic scenes where a person looked at an object or location. Older adults were more likely to fixate and made more fixations to the gazed-at location, compared to younger adults. Our findings suggest that, contrary to what was observed in the traditional gaze-cueing paradigm, in a non-constrained task that uses contextualized stimuli older adults follow gaze as much as or even more than younger adults.

Confronting the Complexities of "Co-Production" in Participatory Health Research: A Critical, Reflexive Approach to Power Dynamics in a Collaborative Project on Parkinson's Dance.

The literature on participatory health research describes various ways of overcoming obstacles to the co-production of knowledge by redressing power imbalances. In this article, we propose an approach to understanding and analyzing co-production which conceptualizes power, not as an obstacle but as an intrinsic, productive force in bringing "co-production" into being. In the approach, "co-production" is understood and analyzed as a tensional, complex, unstable entity that emerges in power-imbued negotiations of meanings throughout the research process. Focusing on a participatory project on Parkinson's dance, our purpose is to illustrate how the approach can generate knowledge about the complexities of "co-production." We also demonstrate how the approach can provide a foundation for a relational ethics that confronts the complexities head-on. In conclusion, we discuss the insights gained into the possibilities and challenges of co-production and the value of the approach as a foundation for relational ethics.

The Experiences of Persons Living with Dementia Planning for a Dementia Research Meeting. Lessons Learned From the National Research Summit on Care, Services, and Supports for Persons With Dementia and Their Caregivers.

OBJECTIVE: A stakeholder group for persons living with dementia (PLWD) was convened to support the work of a major US dementia research meeting. The objectives of this examination are to present the steps used to implement the Group and guidance for both PLWD and researchers for partnering on research conference planning and participation. METHODS: PLWD met monthly to provide input into the agenda for the 2017 Research Summit on Dementia Care and some Group members also presented at the Summit. Following the Summit, the Group reviewed their contributions and completed an evaluation of the Group process, identifying best practices to support future efforts. RESULTS: Group members were initially unsure about participating due to concerns about ability to contribute and concerns about disease progression. Members reported that participation was a positive experience, however, identifying Group-led governance and attention to Group work process as important contributors. In addition to giving input to the Summit and having the opportunity to interact with researchers, sharing personal experiences with each other was part of the value of the Group to members. Careful Group selection and attention to governance were among the Best Practices members. CONCLUSION: Despite initial uncertainty among members about participating as a Stakeholder Group to inform a national research meeting, members developed a successful process for governance, convening, and providing input to a major national research meeting. Group's self-evaluation yielded specific strategies likely to be useful in formation and implementation of future partnerships between researchers and persons living with dementia.

Contributions of Persons Living With Dementia to Scientific Research Meetings. Results From the National Research Summit on Care, Services, and Supports for Persons With Dementia and Their Caregivers.

OBJECTIVE: Inclusion of patients in research activities has increased in the United States but no guidelines for inclusion of individuals with cognitive impairment exist. The experiences from the Persons Living with Dementia (PLWD) Stakeholder Group that formed to support the first National Research Summit on Care, Services, and Supports for Persons with Dementia and Their Caregivers provided a test of feasibility of this type of participation for a major research meeting and an opportunity to understand specific contributions of the Group. METHODS: The PLWD Stakeholder Group was formed by Summit co-chairs as one of six stakeholder groups charged with providing input into the Summit agenda and meeting recommendations. Members were recruited through clinician/researchers with personal knowledge of potential members. Following the Summit, Group members convened to review Group contributions to the Summit agenda, list of speakers, and Summit research recommendations. RESULTS: The PLWD Group influenced the content of the Summit agenda and some Group members were invited to contribute through Summit presentations. The Group influenced Summit outcomes: of the 58 research recommendations that emerged, 30 express ideas contributed by the PLWD. CONCLUSIONS: The Stakeholder Group for PLWD proved feasible to implement and impacted the agenda and output of a major national research meeting on dementia.

Visual attention, biological motion perception, and healthy ageing.

Biological motion perception is the ability of the visual system to perceive complex human movement patterns. The previous studies have shown a direct link between attentional abilities and performance on biological motion tasks, both of which have been shown to deteriorate with age. However, it is not known whether there is a direct link between age-related deficits in biological motion processing and attention. Here, we investigated whether age-related changes in biological motion perception are mediated by impaired attentional abilities. To assess basic biological motion performance, we asked 42 younger (M = 21 years) and 39 older adults (M = 69 years) to indicate the facing direction of point-light actions. Performance did not differ between age groups. We assessed visual spatial and selective attentional abilities, using a range of tasks: conjunctive visual search, spatial cueing, and the Stroop task. Across all tasks, older adults were significantly slower to respond and exhibited larger interference/cueing effects, compared to younger adults. To assess attentional demands in relation with biological motion perception, participants performed a biological motion search task for which they had to indicate the presence of a target point-light walker among a varied number of distracters. Older adults were slower, and generally worse than younger adults at discriminating the walkers. Correlations showed that there was no significant relationship between performance in attention tasks and biological motion processing, which indicates that age-related changes in biological motion perception are unlikely to be driven by general attentional decline.

Minding the Gap Between the Policy and Practice of Patient-Centeredness: Cocreating a Model for Tensional Dialogue in the "Active Patient Support" Program.

Several studies identify obstacles to patient-centered care that can be eradicated by bridging the gap between policy goals and practice. In this article, "patient-centeredness" is theorized as an unstable entity riddled with intrinsic, ineradicable tensions. The purpose of the article is to propose a reflexive approach to the tensions as the most appropriate strategy for narrowing the gap between policy and practice. The reflexive approach is illustrated in an account of an action research project on a Danish, patient-centered initiative, "Active Patient Support." The account focuses on the development of a dialogic communication model through collaborative, reflexive analyses of the tensions in the enactment of "patient-centeredness" in dialogue between health care practitioners and citizens-in particular, the tension between empowerment and self-discipline. Finally, the conceptual expansion of one of the dimensions of patient-centeredness, "health-practitioner-as-person," is discussed as a platform for reflexivity, and the limitations of reflexivity are addressed.

Gaze detection and gaze cuing in Alzheimer's disease.

People with Alzheimer's disease (AD) show problems with social processing in tasks which require the understanding of others' mental states. However traditional social processing tasks are cognitively complex, which may influence the effects of AD. Less is known about how AD influences more basic aspects of social perception, such as the ability to decode eye gaze direction or follow the gaze of another. The current research assessed whether those with AD showed difficulty in both explicitly decoding subtle manipulations of gaze direction (Study 1), and reflexively following another's eye gaze (Study 2). Those with AD were more impaired than a matched control group when making explicit discrimination distinctions between direct and averted gaze. In contrast people with Alzheimer's disease performed comparably to a control group when following gaze. This pattern indicates that more automatic aspects of social perception such as gaze following are unaffected by AD. In contrast, more controlled processes such as deciding whether someone is looking towards you are impaired in AD. This has implications for socially engaging with other people and interpreting their focus of interest.

Effect of Different Types of Physical Activity on Activities of Daily Living in Older Adults: Systematic Review and Meta-Analysis.

Physical activity is associated with greater independence in old age. However, little is known about the effect of physical activity level and activity type on activities of daily living (ADL). This review systematically analyzed the effects of physical activity level and activity type on ADL in older adults (mean age, 60+). Electronic search methods (up to March 2015) identified 47 relevant, randomized controlled trials. Random effects meta-analyses revealed significant, beneficial effects of physical activity on ADL physical performance (SMD = 0.72, 95% CI [0.45, 1.00]; p < .01), with the largest effects found for moderate physical activity levels, and for activity types with high levels of mental (e.g., memory, attention), physical (e.g., coordination, balance) and social (e.g., social interaction) demands. Inconsistent effects were observed on self-reported ADL measures. Interventions that include moderate physical activity levels with high mental, physical, and social demands may produce the greatest benefits on ADL physical performance.

Mental and perceptual feedback in the development of creative flow.

Sketching is considered by artists and designers to be a vital tool in the creative process. However, research shows that externalisation during the creative process (i.e., sketching) is not necessary to create effectively. This study examines whether sketching may play a more important role in the subjective experience of creativity by facilitating the deeply focused, optimal state of consciousness termed 'flow' (being 'in the zone'). The study additionally explored whether sketching affects flow by easing cognitive load or by providing a clearer sense of self-feedback. Participants carried out the creative mental synthesis task (combining sets of simple shapes into creative drawings), experimentally simulating the visual creative process. Ideas were generated either mentally before committing to a final drawing, or with external perceptual support through sketching, and cognitive load was varied by using either three- or five-shape sets. The sketching condition resulted in greater experience of flow and lower perceived task difficulty. However, cognitive load did not affect flow and there was no interaction between load and sketching conditions. These findings are the first to empirically demonstrate that sketching increases flow experience, and that this is not dependent on an associated reduction in overall working memory load.

Cross-national comparisons of attitudes towards suicide and suicidal persons in university students from 12 countries.

This paper reports the results of a comparative investigation of attitudes to suicide and suicidal persons in 5,572 university students from 12 countries. Participants filled out two scales measuring attitudes towards suicide and suicidal persons, a measure of psychological distress together with the questions about suicidal behavior. Results showed that the highest suicide acceptance scores were observed in Austrian, UK, Japanese and Saudi Arabian samples and the lowest scores were noted in Tunisian, Turkish, Iranian and Palestinian samples. While the highest social acceptance scores for a suicidal friend were noted in Turkish, US, Italian and Tunisian samples, the lowest scores were seen in Japanese, Saudi Arabian, Palestinian and Jordanian samples. Compared to participants with a suicidal past, those who were never suicidal displayed more internal barriers against suicidal behavior. Men were more accepting of suicide than women but women were more willing to help an imagined suicidal peer. Participants with accepting attitudes towards suicide but rejecting attitudes towards suicidal persons reported more suicidal behavior and psychological distress, and were more often from high suicide rate countries and samples than their counterparts. They are considered to be caught in a fatal trap in which most predominant feelings of suicidality such as hopelessness or helplessness are likely to occur. We conclude that in some societies such as Japan and Saudi Arabia it might be difficult for suicidal individuals to activate and make use of social support systems.

Physical disease and resilient outcomes: a systematic review of resilience definitions and study methods.

BACKGROUND: Findings from physical disease resilience research may be used to develop approaches to reduce the burden of disease. However, there is no consensus on the definition and measurement of resilience in the context of physical disease. OBJECTIVE: The aim was to summarize the range of definitions of physical disease resilience and the approaches taken to study it in studies examining physical disease and its relationship to resilient outcomes. METHODS: Electronic databases were searched from inception to March 2013 for studies in which physical disease was assessed for its association with resilient outcomes. Article screening, data extraction, and quality assessment were carried out independently by 2 reviewers, with disagreements being resolved by a third reviewer. The results were combined using a narrative technique. RESULTS: Of 2280 articles, 12 met the inclusion criteria. Of these studies, 1 was of high quality, 9 were of moderate quality, and 2 were low quality. The common findings were that resilience involves maintaining healthy levels of functioning following adversity and that it is a dynamic process not a personality trait. Studies either assessed resilience based on observed outcomes or via resilience measurement scales. They either considered physical disease as an adversity leading to resilience or as a variable modifying the relationship between adversity and resilience. CONCLUSION: This work begins building consensus as to the approach to take when defining and measuring physical disease resilience. Resilience should be considered as a dynamic process that varies across the life-course and across different domains, therefore the choice of a resilience measure should reflect this.

The role of emotion regulation on social participation following stroke.

UNLABELLED: Following stroke, individuals often experience reduced social participation, regardless of physical limitations. Impairments may also occur in a range of cognitive and emotional functions. Successful emotion regulation, which has been identified as important in psychological adaptation to chronic illness, is associated with better perceived psychological well-being and social functioning. However, there is little evidence about the effect of stroke on emotion regulation difficulties, and associated impact on important outcomes in recovery from stroke. OBJECTIVES: The objectives were (1) to determine whether people who have had a stroke reported greater difficulties in emotion regulation than controls and (2) to establish whether emotion regulation difficulties relate to social participation. METHODS: 75 stroke and 40 healthy participants completed measures of emotion regulation (DERS), social participation (Modified Functional Limitation Profile [mFLP], WHOQoL-Bref) and activity limitations (mFLP). Stroke participants were seen at the acute stage (63 days post-stroke) for Study 1 and 18 months post-stroke for Study 2. RESULTS: In Study 1, acute-stage stroke patients had significant impairments on impulse control, awareness of emotions, and strategies for emotion regulation. There was also evidence that emotion regulation difficulties (impulse control, awareness and clarity about emotions) were associated with social participation in the stroke sample, even after controlling for potential confounders. In Study 2, there was evidence that, in the chronic-stage post-stroke, difficulties with strategy and acceptance of emotions were associated with social participation restrictions. Whilst emotion regulation as a whole in the acute phase predicted social participation in the chronic phase of stroke, no one domain of emotion regulation was a significant predictor of social participation >1 year later. DISCUSSION: These results indicate that multiple aspects of emotion regulation are impaired following stroke, with implications for social participation and recovery. PRACTITIONER POINTS: This research highlights the following important clinical implications: Following a stroke, emotion regulation can be immediately and persistently affected, with post-stroke individuals experiencing greater difficulties with their emotion regulation than control participants. Emotion regulation can significantly predict important stroke outcomes including social participation and quality of life, over and above physical limitations and other post-stroke confounders. This study highlights the potential for developing a behaviour change intervention to address emotion regulation difficulties and thus ensuring individuals maximize their potential rehabilitation outcome. Cautions of the study for consideration: Emotion regulation was a self-report measure, and proxy measures would have been desirable. We are unable to establish if the post-stroke individuals differed from the controls on their emotion regulation prior to stroke.

Flow, affect and visual creativity.

Flow (being in the zone) is purported to have positive consequences in terms of affect and performance; however, there is no empirical evidence about these links in visual creativity. Positive affect often--but inconsistently--facilitates creativity, and both may be linked to experiencing flow. This study aimed to determine relationships between these variables within visual creativity. Participants performed the creative mental synthesis task to simulate the creative process. Affect change (pre- vs. post-task) and flow were measured via questionnaires. The creativity of synthesis drawings was rated objectively and subjectively by judges. Findings empirically demonstrate that flow is related to affect improvement during visual creativity. Affect change was linked to productivity and self-rated creativity, but no other objective or subjective performance measures. Flow was unrelated to all external performance measures but was highly correlated with self-rated creativity; flow may therefore motivate perseverance towards eventual excellence rather than provide direct cognitive enhancement.

Mood effects on memory and executive control in a real-life situation.

In the laboratory, studies have shown an inconsistent pattern of whether, and how, mood may affect cognitive functions indicating both mood-related enhancement as well as decline. Surprisingly, little is known about whether there are similar effects in everyday life. Hence, the present study aimed to investigate possible mood effects on memory and executive control in a real-life situation. Mood effects were examined in the context of winning in a sports competition. Sixty-one male handball players were tested with an extensive cognitive test battery (comprising memory and executive control) both after winning a match and after training as neutral baseline. Mood differed significantly between the two testing situations, while physiological arousal and motivation were comparable. Results showed lowered performance after the win compared with training in selected cognitive measures. Specifically, short-term and episodic memory performance was poorer following a win, whereas executive control performance was unaffected by condition. Differences in memory disappeared when emotional states after the match were entered as covariates into the initial analyses. Thus, findings suggest mood-related impairments in memory, but not in executive control processes after a positive real-life event.

A dynamic mathematical model of red blood cell clinical demand to assess the impact of prolonged blood shortages and transfusion restriction policies.

BACKGROUND: Estimating change in clinical demand for red blood cells (RBCs) from a disaster, as well as triaging introduced in response, is essential to plan effectively for a major blood shortage. We aimed to develop a RBC demand model to assess the impact of restriction policies on RBC use and patient outcomes. STUDY DESIGN AND METHODS: A compartmental dynamic model was developed in which patients require RBCs acutely (within 1 hr), urgently (24 hr), semiurgently (1-7 days), or nonurgently; outcomes included death or remaining at or transitioning to more or less urgent categories. A mathematical model was developed with transitions governed by differential equations and calibrated to a baseline scenario of adequate blood supply (using population-based hospital data sets, registries, and RBC issues). Distribution into urgency categories was based on a prospective study of 5132 randomly selected RBC units. Scenarios when the blood supply is limited compared to baseline were investigated. Transition rates between urgency categories under these scenarios were established by clinician survey. RESULTS: In the baseline 21-day scenario, patients requiring the most RBCs were other surgery (2162, 22%), medical anemia (1916, 12%), malignant hematology (1092, 16%), and gastrointestinal hemorrhage (1115, 8%). A policy of withholding RBCs for all nonurgent indications results in an estimated reduction of only 1007 (11.2%) RBC units and, if extended to semiurgent, a reduction of 2567 (28.5%) RBC units. CONCLUSIONS: Based on this model, restrictions that withhold transfusion from nonurgent patients have minimal impact on RBC demand and may not be sufficient to address changed demand and/or decreased supply during a prolonged disaster.

Importance effects on age differences in performance in event-based prospective memory.

BACKGROUND: Most laboratory-based studies on prospective memory show a decline with increasing age. Theoretical explanations for age differences focus on the allocation of attentional resources to support prospective remembering. The recruitment of prospective memory target monitoring seems to be influenced by perceived task importance. OBJECTIVE: In the present study, we investigated the influence of task importance on the magnitude of age differences in event-based prospective memory. METHODS: Healthy younger (n = 25) and older (n = 25) adults were instructed a priori to prioritize either the ongoing or the prospective memory task before performing an event-based prospective memory task. RESULTS: We found an interaction between age and task importance: instructed higher importance of the ongoing task compared to the prospective memory task component produced significant age-related declines in prospective remembering. By contrast, if older adults treated the prospective memory task component as more important than the ongoing task, they achieved equivalent levels of prospective memory performance as their younger counterparts, but did so at a cost to ongoing task performance. CONCLUSIONS: The present data indicate that task importance is one of the factors determining the presence or absence of age deficits in prospective remembering. Findings are discussed in the context of limited processing resources in old age and theoretical frameworks of event-based prospective memory. © 2013 S. Karger AG, Basel.

Theory of mind and switching predict prospective memory performance in adolescents.

Research indicates ongoing development of prospective memory as well as theory of mind and executive functions across late childhood and adolescence. However, so far the interplay of these processes has not been investigated. Therefore, the purpose of the current study was to investigate whether theory of mind and executive control processes (specifically updating, switching, and inhibition) predict prospective memory development across adolescence. In total, 42 adolescents and 41 young adults participated in this study. Young adults outperformed adolescents on tasks of prospective memory, theory of mind, and executive functions. Switching and theory of mind predicted prospective memory performance in adolescents.

Links between emotion perception and social participation restriction following stroke.

OBJECTIVES: Stroke can cause impairment in emotion perception, but the social consequences of these problems have not been explored to date. In a group of patients with stroke, this study investigated whether difficulties in emotion perception related to social participation and quality-of-life. It also assessed whether these relationships remained significant when controlling for activity limitations. METHOD: Individuals 1 year post-stroke (n = 28) and control participants (n = 40) were assessed on emotion perception across different modalities. Activity limitations, social participation, and multiple domains of quality-of-life were assessed in patients. RESULTS: Participants with stroke were impaired on emotion perception compared to controls. Emotion perception problems in stroke were significantly correlated with social participation and psychological aspects of QoL, but not with activity limitations. CONCLUSIONS: The strong relationships of emotion perception with social participation and psychological aspects of QoL following stroke may have implications for post-stroke outcomes.

Exploring own-age biases in deception detection.

The present study explored own-age biases in deception detection, investigating whether individuals were more likely to trust those in their own-age group. Younger and older participants were asked to detect deceit from videos of younger and older speakers, rating their confidence in each decision. Older participants showed an own-age bias: they were more likely to think that deceptive speakers of their own age, relative to younger speakers, were telling the truth. Older participants were also more confident in their judgements of own-age, relative to other-age, speakers. There were no own-age biases for younger participants. In a subsequent (apparently unrelated) task, participants were asked to rate the trustworthiness of the speakers. Both age groups of participants trusted younger speakers who had previously told the truth more compared to those who had lied. This effect was not found for older speakers. These findings are considered in relation to the in-group/out-group model of social cognition and common stereotypical beliefs held about younger and older adults.