The Role of Autobiographical Resilience Memories in Emotion Regulation: An Account of Age Differences in Mnemonic and Positive Reappraisal.

A lifetime of resilience through emotionally challenging experiences may benefit older adults, lending to emotion regulation mastery with time. Yet the influence of autobiographical experiences on momentary reappraisal, the reinterpretation of negative stimuli as more positive, has never been empirically tested. This online study examined the extent to which associating life memories of resilience with novel negative scenarios enhanced reappraisal efficacy and reduced difficulty to reappraise. Younger and older adults reappraised negative images by associating reappraisals to freely selected autobiographical resilience memories, cued autobiographical resilience memories, or by finding situational silver linings without mnemonic association (control). Changes in image emotional intensity ratings revealed no difference across reappraisal conditions for younger adults, while older adults most effectively down-regulated emotional intensity using the control reappraisal strategy. Older adults found autobiographical memories more helpful for mood regulation and less difficult to implement, and identified greater similarities between novel negative scenarios and their memories than younger adults. Surprisingly, greater similarity between resilience memories and negative images was associated with lower reappraisal efficacy for both age groups. Findings demonstrate the age-equivalent benefits of utilizing reappraisals associated with past narratives of resilience and suggest a sacrifice of immediate hedonic benefit for disproportionately greater subjective benefits with age.

Older and younger adult definitions of emotion terms: a mixed-method content analysis.

OBJECTIVES: Conceptualizations of emotions might evolve over the course of adult development as motivations shift, but there are gaps in knowledge regarding these changes. This mixed-methods study tested theoretical predictions pertaining to age group differences in conceptualizations of emotions. METHOD: University students (N = 210, M age = 20.1 years) and community-dwelling older adults (N = 90, M age = 72.5 years) participated in three survey studies (2016-2018) conducted in person, online, or via mail and provided written narrative definitions for 11 emotion words. Responses were coded for valence, arousal, time frame, reference to self, reference to social contacts, and nature of response (i.e. example or definition). Code frequencies were compared for younger and older adults via odds ratio and logistic regression analyses. RESULTS: Younger and older adults used many of the same words in definitions of emotion terms. Older participants more often referenced situational examples in their definitions than younger participants. As expected, older adults used more low arousal language, referenced the 'self,' and included other persons more in their emotion descriptions than younger persons. Unexpectedly, younger participants used more positive language in descriptions of some positive emotions. CONCLUSIONS: Descriptions of emotion terms might serve a self-regulatory function, such as to facilitate low arousal emotion experiences for older adults or to illustrate important values, such as the greater importance of other persons to emotion experiences for older than younger adults.

HDQLIFE and neuro-QoL physical function measures: Responsiveness in persons with huntington's disease.

BACKGROUND: Huntington's disease (HD) is a neurological disorder that causes severe motor symptoms that adversely impact health-related quality of life. Patient-reported physical function outcome measures in HD have shown cross-sectional evidence of validity, but responsiveness has not yet been assessed. OBJECTIVES: This study evaluates the responsiveness of the Huntington Disease Health-Related Quality of Life (HDQLIFE) and the Quality of Life in Neurological Disorders (Neuro-QoL) physical function measures in persons with HD. METHODS: A total of 347 participants completed baseline and at least 1 follow-up (12-month and 24-month) measure (HDQLIFE Chorea, HDQLIFE Swallowing Difficulties, HDQLIFE Speech Difficulties, Neuro-QoL Upper Extremity Function, and/or Neuro-QoL Lower Extremity Function). Of the participants that completed the baseline assessment, 338 (90.9%) completed the 12-month assessment, and 293 (78.8%) completed the 24-month assessment. Standardized response means and general linear models evaluated whether the physical function measures were responsive to self-reported and clinician-rated change over time. RESULTS: Small to moderate effect sizes for the standardized response means supported 12-month and 24-month responsiveness of the HDQLIFE and Neuro-QoL measures for those with either self-reported or clinician-rated declines in function. General linear models supported 12-month and 24-month responsiveness for all HRQOL measures relative to self-reported declines in health, but generally only 24-month responsiveness was supported relative to clinician-rated declines in function. CONCLUSIONS: Longitudinal analyses indicate that the HDQLIFE and the Neuro-QoL physical function measures are sensitive to change over time in individuals with HD. Thus, these scales exhibit evidence of responsiveness and may be useful outcome measures in future clinical trials. © 2019 International Parkinson and Movement Disorder Society.

Psychometric properties and responsiveness of Neuro-QoL Cognitive Function in persons with Huntington disease (HD).

PURPOSE: Individuals with Huntington disease (HD) experience progressive cognitive decline that may appear years before motor manifestations of the disease. These declines have a profound effect on health-related quality of life (HRQOL) over the disease course, and thus it is important that self-report measures of cognitive function are validated for use in longitudinal studies. METHODS: 359 individuals with premanifest or manifest HD completed baseline and at least one follow-up (12- and 24-month) assessment. Neuro-QoL™ Cognitive Function was administered at each time-point. Participants completed a self-reported global rating of cognitive change, as well as performance-based cognitive changes (using the Symbol Digit Modalities Test). Standardized response means (SRMs) and general linear models evaluated whether Neuro-QoL™ Cognitive Function was responsive to change over time with respect to self-reported and performance-based anchors. Test-retest reliability and known-group validity were also examined. RESULTS: Responsiveness was supported by effect sizes that were small in magnitude, but in the expected direction relative to self-reported and performance-based change. General linear models generally supported 12- and 24-month responsiveness relative to self-reported cognitive change and 12-month responsiveness relative to performance-based change. Test-retest reliability was excellent, and the measure exhibited known-group validity. CONCLUSION: Longitudinal analyses generally indicate that the Neuro-QoL™ Cognitive Function measure is sensitive to change over time in individuals with HD. Neuro-QoL Cognitive Function changes reflect self-reported cognitive change at 12 and 24 months and performance-based change at 12 months. This measure may be useful in clinical trials or longitudinal observation studies.

Responsiveness to change over time and test-retest reliability of the PROMIS and Neuro-QoL mental health measures in persons with Huntington disease (HD).

BACKGROUND: The majority of persons with Huntington disease (HD) experience mental health symptoms. Patient-reported outcome (PRO) measures are capable of capturing unobservable behaviors and feelings relating to mental health. The current study aimed to test the reliability and responsiveness to self-reported and clinician-rated change over time of Neuro-QoL and PROMIS mental health PROs over the course of a 24-month period. METHODS: At baseline, 12-months, and 24-months, 362 participants with premanifest or manifest HD completed the Neuro-QoL Depression computer adaptive test (CAT), PROMIS Depression short form (SF), Neuro-QoL Anxiety CAT, PROMIS Anxiety SF, PROMIS Anger CAT and SF, Neuro-QoL Emotional/Behavioral Dyscontrol CAT and SF, Neuro-QoL Positive Affect and Well-Being CAT and SF, and Neuro-QoL Stigma CAT and SF. Participants completed several clinician-administered measures at each time point, as well as several global ratings of change at 12- and 24-months. Reliability (test-retest reliability and measurement error) and responsiveness (using standardized response means and general linear models) were assessed. RESULTS: Test-retest reliability and measurement error were excellent for all PROs (all ICC ≥ .90 for test-retest reliability and all SEM percentages ≤ 6.82%). In addition, 12- and 24-month responsiveness were generally supported for the Neuro-QoL and PROMIS mental health PROs; findings relative to clinician-rated anchors of change (e.g., SRMs for the group with declines ranged from .38 to .91 for 24-month change and .09 to .45, with the majority above .25 for 12-month change) were generally more robust than those relative to self-reported anchors of change (e.g., SRMs for the group with declines ranged from .02 to .75, with the majority above .39 for 24-month change and .09 to .45, with the majority above .16 for 12-month change). CONCLUSIONS: The Neuro-QoL and PROMIS mental health PROs demonstrated strong psychometric reliability, as well as responsiveness to self-reported and clinician-rated change over time in people with HD.

Screening for reading disability in university students with phonological processing and working memory tasks.

Many students in higher education have undiagnosed reading disabilities (RDs), but there are few measures to screen for RD in this population. The aim of this study was to determine the ability of tasks that are sensitive to RDs-such as measures of phonemic awareness and working memory-to differentiate university students previously diagnosed with RDs from controls. Participants were university students with an RD (n = 26), a clinical control group diagnosed with attention-deficit/hyperactivity disorder (n = 24), and neurotypical controls (n = 44). Participants completed brief phonological processing and working memory tasks. The RD group scored significantly lower on all tasks than both control groups. The phonological processing tasks alone-without the working memory task-discriminated participants with RDs from controls with excellent sensitivity and specificity. A brief battery of phonemic tasks could be an effective screening instrument for persons with RDs on university campuses.

Emotion habituation is accelerated in chronic mild traumatic brain injury.

Primary Objective: Risk for mental health disturbances (e.g., depression and anxiety), is elevated following a mild traumatic brain injury (mTBI), even in the chronic stages of injury. In our previous work, we found individuals with chronic mTBI have decreased emotion habituation. The objective of the current study was to test whether reduced habituation is a mechanism underlying increased risk for mental health disturbances following mTBI. Research Design: We used a cross-sectional assessment of emotion habituation in a sample of young adults at least 1 year after an mTBI. Methods and Procedures: We repeatedly showed mTBI and control participants the same set of highly arousing, negative images and positive images. Participants rated each image for arousal and valence. Main Outcomes and Results: Unexpectedly, we found individuals with mTBI habituated faster to emotional images than controls. However, enhanced habituation was not linkd with emotional outcomes. Participants with mTBI did not differ from controls for reactivity, but blunted reactivity in all participants was associated with higher depressive symptoms. Conclusions: Although there are subtle differences in emotion responses in chronic mTBI, the differences were not associated with mental health disturbances. Nevertheless, this difference in emotional processing may increase risk for untested mental health issues.

Older and younger adults differently judge the similarity between negative affect terms.

OBJECTIVES: Theoretical models of aging suggest changes across the adult lifespan in the capacity to differentiate emotions. Greater emotion differentiation is associated with advantages in terms of emotion regulation and emotion resiliency. This study utilized a novel method that directly measures judgments of affect differentiation and does not confound affective experience with knowledge about affect terms. Theoretical predictions that older adults would distinguish more between affect terms than younger persons were tested. METHOD: Older (n = 27; aged 60-92) and younger (n = 56; aged 18-32) adults rated the difference versus similarity of 16 affect terms from the Kessler and Staudinger ( 2009 ) scales; each of the 16 items was paired with every other item for a total of 120 ratings. Participants provided self-reports of trait emotions, alexithymia, and depressive symptoms. RESULTS: Older adults significantly differentiated more between low arousal and high arousal negative affect (NA) items than younger persons. Depressive symptoms were associated with similarity ratings across and within valence and arousal. CONCLUSION: Findings offer partial support for theoretical predictions that older adults differentiate more between affect terms than younger persons. To the extent that differentiating between negative affects can aid in emotion regulation, older adults may have an advantage over younger persons. Future research should investigate mechanisms that underlie age group differences in emotion differentiation.

Relationships Among Apathy, Health-Related Quality of Life, and Function in Huntington's Disease.

Up to 90% of individuals with Huntington's disease (HD)-a progressive, inherited neurodegenerative disorder-experience apathy. Apathy is particularly debilitating because it is marked by a reduction in goal-directed behaviors, including self-care, social interactions, and mobility. The objective of this study was to examine relationships between variables of apathy, functional status, physical function, cognitive function, behavioral status/emotional function, and health-related quality of life. Clinician-rated measures of physical, cognitive, and behavioral function, including one clinician-rated item on apathy, and self-reported measures of physical function, health-related quality of life, and emotional, cognitive, and social function were collected in a single session from 487 persons with the HD mutation (prodromal, N=193; early-stage manifest, N=186; late-stage manifest, N=108). Multiple linear regression models were used to examine which outcomes best predicted clinician-rated apathy after controlling for disease stage. Greater apathy related to less independence, increased motor impairment, and more clinician-rated behavioral problems (i.e., anger, irritability, depression). Similarly, poorer self-reported health-related quality of life; greater chorea; greater upper- and lower-extremity dysfunction; greater speech and swallowing dysfunction; worse anxiety, depression, and behavioral dyscontrol; worse cognitive function; and less satisfaction with social roles related to greater apathy. In conclusion, apathy related to physical, cognitive, and behavioral dysfunction across disease stages. Future work should explore whether clinical interventions targeting different functional domains may have the potential to reduce apathy in this patient population.

Evaluating cognition in individuals with Huntington disease: Neuro-QoL cognitive functioning measures.

PURPOSE: Cognitive functioning impacts health-related quality of life (HRQOL) for individuals with Huntington disease (HD). The Neuro-QoL includes two patient-reported outcome (PRO) measures of cognition-Executive Function (EF) and General Concerns (GC). These measures have not previously been validated for use in HD. The purpose of this analysis is to evaluate the reliability and validity of the Neuro-QoL Cognitive Function measures for use in HD. METHODS: Five hundred ten individuals with prodromal or manifest HD completed the Neuro-QoL Cognition measures, two other PRO measures of HRQOL (WHODAS 2.0 and EQ5D), and a depression measure (PROMIS Depression). Measures of functioning The Total Functional Capacity and behavior (Problem Behaviors Assessment) were completed by clinician interview. Objective measures of cognition were obtained using clinician-administered Symbol Digit Modalities Test and the Stroop Test (Word, Color, and Interference). Self-rated, clinician-rated, and objective composite scores were developed. We examined the Neuro-QoL measures for reliability, convergent validity, discriminant validity, and known-groups validity. RESULTS: Excellent reliabilities (Cronbach's alphas ≥ 0.94) were found. Convergent validity was supported, with strong relationships between self-reported measures of cognition. Discriminant validity was supported by less robust correlations between self-reported cognition and other constructs. Prodromal participants reported fewer cognitive problems than manifest groups, and early-stage HD participants reported fewer problems than late-stage HD participants. CONCLUSIONS: The Neuro-QoL Cognition measures provide reliable and valid assessments of self-reported cognitive functioning for individuals with HD. Findings support the utility of these measures for assessing self-reported cognition.

Perceptions of emotion and age among younger, midlife, and older adults.

OBJECTIVES: Older adults report greater emotional well-being than younger persons, yet negative stereotypes about aging are pervasive. Little is known about age group perceptions of emotion in adulthood, particularly for familiar persons. Thus, this project determined perceptions of general affect in familiar younger and older adults. METHOD: In two studies, participants (Study 1, younger adult n = 123, older adult n = 43; Study 2, younger adult n = 34, midlife adult n = 41, older adult n = 16) provided self-report data about their affect in general, as well as reported on the affect of a familiar younger person (aged 18--34) and a familiar older person (aged 65 or older). Emotion scales assessed high- and low-arousal positive and negative affect. RESULTS: Results suggest a less favorable perception of emotion experiences of older adults compared to younger adults. Specifically, participants of all age groups rated older adults as having lower positive emotions and higher negative emotions than is found in self-report data. CONCLUSION: Perceptions of emotion in older adulthood reflect stereotypes of negative functioning. Older adult participants were not immune to holding negative views about older adults. Negative perceptions about emotion experiences in later life may be detrimental to the physical and mental health of older adults.

Patient-reported outcomes in Huntington's disease: Quality of life in neurological disorders (Neuro-QoL) and Huntington's disease health-related quality of life (HDQLIFE) physical function measures.

BACKGROUND: There is a need for patient-reported outcome measures that capture the impact that motor impairments have on health-related quality of life in individuals with Huntington's disease. OBJECTIVES: The objectives of this study were to establish the reliability and validity of new physical functioning patient-reported outcome measures in Huntington's disease. METHODS: A total of 510 individuals with Huntington's disease completed 2 Quality of Life in Neurological Disorders (Lower Extremity Function and Upper Extremity Function) and 3 Huntington's Disease Health-Related Quality of Life (Chorea, Speech Difficulties, and Swallowing Difficulties) measures. Clinician-rated and generic self-report measures were also administered. RESULTS: Reliabilities for the new patient reported physical functioning measures were excellent (all Cronbach's α > .92). Convergent, discriminant validity and known group validity was supported. CONCLUSIONS: The results provide psychometric support for new patient-reported physical functioning measures and the fact that these measures can be used as clinically meaningful endpoints in Huntington's disease research and clinical practice. © 2017 International Parkinson and Movement Disorder Society.

Judgment and classification of emotion terms by older and younger adults.

OBJECTIVES: Theoretical models of adult development suggest changes in emotion systems with age. This study determined how younger and older adults judged and classified 70 emotion terms that varied in valence and arousal, and that have been used in previous studies of adult aging and emotion. The terms were from the Positive and Negative Affect Schedule - Expanded (PANAS-X) and the (KS) affect scales. METHOD: Older (n = 32) and younger adults (n = 111) engaged in a card sort task which determined how the 70 emotion terms were classified (i.e. grouped) in relation to one another. Activation and valence ratings of emotion terms were collected. RESULTS: There were 17 age group differences in item ratings for activation and 19 for valence. Older adults tended to rate emotion terms and scales as more positive and activating than younger persons. Card sort data indicated similarity in conceptualizations of emotion terms across groups with exceptions for serene, sad, and lonely. CONCLUSIONS: Research that utilizes self-report emotion data from older and younger persons should consider how perceptions of emotion terms may vary systematically with age. The constructs of sadness, loneliness, and serene may be age-variant and necessitate age-based adjustments in assessment and intervention. Further, older adults may perceive some emotion terms to be more activating and positive than younger persons.

Emotion Regulation and Memory: Differential Associations in Younger and Midlife/Older Adults.

BACKGROUND/STUDY CONTEXT: Older adults may devote more cognitive resources to the processing and regulation of emotion stimuli than younger adults, but no studies have determined associations between episodic memory performance and naturalistic emotion recovery in a mixed-age sample. The current study ascertained if episodic memory scores were associated with emotion recovery in younger and midlife/older adults and if these associations were moderated by age. METHODS: Participants watched a montage of film clips about interpersonal loss. Self-reported negative and positive emotions were assessed prior to the video, immediately after, and again 10 min after the video. Executive functions, processing speed, and episodic memory were assessed. RESULTS: Participants with better episodic memory recovered more quickly from the mood induction than participants with lower scores. Age moderated the association between joviality recovery and memory. Specifically, there was a significantly stronger, positive association between joviality recovery and memory in midlife/older adults relative to younger adults. CONCLUSIONS: Stronger memory may facilitate emotion recovery, and this may be particularly true for older adults. Older adults with memory impairment may be at risk for emotion dysregulation.

Discrimination and Cognition in Midlife Black Women: The Roles of Social Support and Spirituality.

OBJECTIVES: Black women are at high risk for discrimination and cognitive impairment in late life. It is not known if discrimination is a risk factor for cognitive decline in Black women and if so, what factors are protective against the adverse cognitive effects of discrimination. Using the biopsychosocial model of gendered racism, we determined if discrimination is associated with poorer cognition in midlife Black women and if social support and/or spirituality would protect against the deleterious effects of discrimination on cognition. METHODS: Participants were midlife Black women (N = 669) from the Study of Women's Health Across the Nation. Discrimination was measured by the Everyday Discrimination scale. Cognitive outcomes included episodic memory, processing speed, and working memory. Total social support, emotional support, instrumental support, and spirituality were assessed as protective factors. RESULTS: Contrary to expectations, structural equation modeling indicated that discrimination was associated with better immediate recall. For women with more emotional support, greater discrimination was associated with better immediate recall than for women with lower emotional support. Spirituality was not a significant moderator in the association between discrimination and cognition. DISCUSSION: Discrimination had unexpected positive associations with learning and attention-based cognitive skills for midlife Black women. Discrimination might enhance vigilance, which could be facilitated by higher levels of emotional support. There is an opportunity for clinical and public health interventions for cognitive health and discrimination focused on Black women to better incorporate emotional support as a coping resource.

A survey of the perceptions and practices of faculty in clinical neuropsychology doctoral training programs: is heterogeneity the norm?

Objective: Doctoral education is a cornerstone in the training of clinical neuropsychologists. However, we know little about perceptions, practices, and needs of the faculty who oversee doctoral training in clinical neuropsychology (CN). Method: Seventy-one faculty from 45 doctoral programs providing CN training completed at least part of a survey assessing characteristics of their programs, current training practices and views, and challenges to CN doctoral training. Results: Over half of CN faculty reported having zero or only one CN colleague. CN faculty reported that the goals of CN doctoral training are research training, clinical training, and acquisition of knowledge and skills reflected in the Houston Conference Guidelines (HCG). CN faculty reported that doctoral trainees obtain more clinical hours than faculty would like and endorsed alternative clinical metrics, including competency-based ratings. CN faculty are divided about the benefits of a required two-year postdoctoral CN fellowship. Conclusions: The HCG states that specialization in CN begins at the doctoral level. CN faculty in doctoral programs are fully immersed in the early development and education of future CN researchers and practitioners. Tensions between clinical and research training in CN at the doctoral level-and student overemphasis on accruing clinical hours-might place CN at risk for failing to make research innovations necessary for our field to evolve and thrive. More CN doctoral faculty are needed to serve as mentors to students, especially for students from backgrounds that have been historically excluded and marginalized. A greater voice from CN doctoral faculty in CN governance is needed.

Attentional biases and memory for emotional stimuli in men and male rhesus monkeys.

We examined attentional biases for social and non-social emotional stimuli in young adult men and compared the results to those of male rhesus monkeys (Macaca mulatta) previously tested in a similar dot-probe task (King et al. in Psychoneuroendocrinology 37(3):396-409, 2012). Recognition memory for these stimuli was also analyzed in each species, using a recognition memory task in humans and a delayed non-matching-to-sample task in monkeys. We found that both humans and monkeys displayed a similar pattern of attentional biases toward threatening facial expressions of conspecifics. The bias was significant in monkeys and of marginal significance in humans. In addition, humans, but not monkeys, exhibited an attentional bias away from negative non-social images. Attentional biases for social and non-social threat differed significantly, with both species showing a pattern of vigilance toward negative social images and avoidance of negative non-social images. Positive stimuli did not elicit significant attentional biases for either species. In humans, emotional content facilitated the recognition of non-social images, but no effect of emotion was found for the recognition of social images. Recognition accuracy was not affected by emotion in monkeys, but response times were faster for negative relative to positive images. Altogether, these results suggest shared mechanisms of social attention in humans and monkeys, with both species showing a pattern of selective attention toward threatening faces of conspecifics. These data are consistent with the view that selective vigilance to social threat is the result of evolutionary constraints. Yet, selective attention to threat was weaker in humans than in monkeys, suggesting that regulatory mechanisms enable non-anxious humans to reduce sensitivity to social threat in this paradigm, likely through enhanced prefrontal control and reduced amygdala activation. In addition, the findings emphasize important differences in attentional biases to social versus non-social threat in both species. Differences in the impact of emotional stimuli on recognition memory between monkeys and humans will require further study, as methodological differences in the recognition tasks may have affected the results.

Loneliness and risk for cardiovascular disease in the United States and Japan: The effects of nationality, collectivism, and gender.

RATIONALE: Loneliness is a global concern associated with adverse effects on cardiovascular disease (CVD) that may differ by nationality, collectivism, and gender. OBJECTIVE: This study examined whether associations between loneliness and CVD indicators (e.g., metabolic dysregulation [MetD], inflammation, sleep dysfunction) would vary by nationality, collectivism, and gender. We predicted that loneliness would be associated with poorer CVD values in (1) Japan than the United States (U.S.), (2) in individuals higher rather than lower in collectivism, and (3) our exploratory hypotheses about gender were that loneliness would interact with gender to be associated with differential CVD indicators in the U.S. versus Japan. METHODS: Participants (aged 36 to 78) from the MIDUS Refresher Biomarker (n = 644) and the MIDJA 2 Biomarker studies (n = 293) completed questionnaires, bloodwork, and a physical exam. U.S. participants were from multiple cities, and Japanese participants were from Tokyo. Loneliness was measured via responses to the question, "How often in the past week did you feel lonely?" Logistic regression and path analyses using structural equation modeling determined individual differences in loneliness, whether loneliness predicted CVD indicators, and whether nationality, collectivism, and gender moderated these associations. RESULTS: Loneliness was prevalent in the U.S. (25.39%) and Japan (20.82%). Unexpectedly, Japanese adults reported less collectivism than U.S. adults. We found significant interactions of (1) nationality and gender on MetD and inflammation, (2) gender and loneliness on sleep dysfunction, and (3) nationality and loneliness on MetD. Loneliness was associated with greater MetD in the U.S. but not in Japan. CONCLUSIONS: Cultural influences on loneliness contradicted expectations and suggested caution when equating nationality with cultural values. Our Japanese sample was from Tokyo, which may have lower collectivism than rural Japanese regions. We recommend future studies consider geographic location when examining associations between loneliness, collectivism, and CVD.

Culturally responsive psychological assessment with racially and ethnically diverse older adults.

The older adult population in the United States (U.S.) is becoming more racially and ethnically diverse, whereas most practicing neuropsychologists are white. Psychologists hold social privilege of which they may not be aware and work in health care systems that benefit the racial majority. System-level change is necessary to create a more equitable and accessible health care system for racially and ethnically diverse older adults. It is vital for the field of psychology to understand how oppression, power, and privilege impact the accessibility, reliability, and effectiveness of psychological assessment. The aim of this article is to address how historical medical injustices, poor education quality, barriers to communication, biases, and intersectionality influence psychological evaluations. Via a selective literature review, we illustrate how these issues apply to working with racially and ethnically diverse older adults. We discuss the historical context of the multicultural approach to assessment; system- and interpersonal-level manifestations of oppression; and age-cohort-related considerations. A clinical vignette illustrates how oppression, power, and privilege can manifest in the context of an evaluation. We issue a commentary and call to action, charging psychologists to implement individual- and system-level change. We provide recommendations for culturally responsive psychological assessments. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Emotional complexity and emotional well-being in older adults: risks of high neuroticism.

Older and midlife adults tend to report greater emotional complexity and greater emotional well-being than younger adults but there is variability in these factors across the lifespan. This study determined how the personality trait of neuroticism at baseline predicts emotional complexity and emotional well-being 10 years later; a goal was to determine if neuroticism is a stronger predictor of these emotion outcomes with increasing age in adulthood. Data were obtained from two waves of the MIDUS projects (N = 1503; aged 34-84). Greater neuroticism predicted less emotional complexity as indicated by associations between positive and negative affect, particularly for older participants. Neuroticism predicted lower emotional well-being and this association was stronger for older and midlife than for younger adults. Overall, high neuroticism may be a greater liability for poor emotion outcomes for older and perhaps for midlife adults than for younger persons. Clinical and theoretical implications of this conclusion are discussed.