Evidence that implementation intentions reduce self-harm in the community.

OBJECTIVES: Implementation intentions are 'IF-THEN' plans that encourage goal-intended behaviour. This study was designed to test whether an intervention encouraging the formation of implementation intentions can reduce self-harm in the community. DESIGN: A randomized controlled design was used. METHODS: At pre-intervention, outcome variables (self-harm in both specified and unspecified critical situations and suicidality) and potential moderators of implementation intentions (goal intention, mental imagery, and exposure to self-harm) were measured using self-report questionnaires. The participants (N = 469, aged 18-66 years, 86.4% female, 6.8% male and 6.7% other) were then randomized to either an experimental (implementation intention) or control task. At three-months post-intervention, self-report questionnaires were used again to measure the outcome variables. RESULTS: There were no overall differences between the conditions at post-intervention. However, goal intention and mental imagery, but not exposure to self-harm, moderated the effects of condition on self-harm in specified critical situations. At high (mean + 1SD) levels of both goal intention and mental imagery, the experimental condition reported self-harming less frequently in the situations specified in their implementation intentions. CONCLUSIONS: Implementation intentions therefore represent a useful intervention for reducing self-harm in specified critical situations for people in the community who wish to avoid self-harm and those who frequently experience self-harm and suicide related mental imagery.

Autistic traits are associated with enhanced working memory capacity for abstract visual stimuli.

We tested whether the association between autistic traits and enhanced performance in visual-perceptual tasks extends to visual working memory capacity. We predicted that any positive effect of autistic traits on visual working memory performance would be greatest during domain-specific tasks, in which visual resources must be relied upon. We used a visual 'matrix' task, involving recall of black-and-white chequered patterns which increased in size, to establish participants' capacity (span). We assessed 144 young adults' (M = 22.0 years, SD = 2.5) performance on abstract, 'low semantic' versus 'high semantic' task versions. The latter offered multimodal coding due to the availability of long-term memory resources that could supplement visual working memory. Participants also completed measures of autistic traits and trait anxiety. Autistic traits, especially Attention to Detail, Attention Switching, and Communication, positively predicted visual working memory capacity, specifically in the low semantic task, which relies on visual working memory resources. Autistic traits are therefore associated with enhanced processing and recall of visual information. The benefit is removed, however, when multimodal coding may be incorporated, emphasising the visual nature of the benefit. Strengths in focused attention to detail therefore appear to benefit domain-specific visual working memory task performance.

Improving older adults' vaccination uptake: Are existing measures of vaccine hesitancy valid and reliable for older people?

We sought to establish whether two recently developed measures, the 5C scale and the Vaccination Attitudes Examination (VAX) were reliable and valid for use with older adults. A total of 372 UK-dwelling participants (65-92 years, M = 70.5 years, SD = 4.6) completed a cross-sectional survey measuring health and socio-demographic characteristics in relation to vaccine uptake for influenza, pneumococcal and shingles. The 5C and VAX scales were administered to test their reliability, validity and dimensionality. Both scales showed good internal reliability and convergent, discriminant and concurrent validity. Their factor structures were also confirmed, supporting their use with older adult populations.

Changes in attitudes to vaccination as a result of the COVID-19 pandemic: A longitudinal study of older adults in the UK.

BACKGROUND: The rapid development of COVID-19 vaccines has brought an unprecedented focus on public attitudes to vaccines, with intention to accept a COVID-19 vaccine fluctuating during the pandemic. However, it is unclear how the pandemic may influence attitudes and behaviour in relation to vaccines in general. The aim of the current study is to examine older adults' changes in vaccination attitudes and behaviour over the first year of the pandemic. METHODS: In February-March 2020 (before the first COVID-19 national lockdown in the UK), 372 older adults (aged 65+) provided sociodemographic information, self-reported influenza vaccine uptake, and completed two measures of vaccination attitudes: the 5C scale and the Vaccination Attitudes Examination Scale. One-year later, following rollout of COVID-19 vaccines to older adults, participants provided information on their COVID-19 and influenza vaccine uptake in the previous 12 months, and completed the 5C and VAX scales again. Paired samples t-tests were used to examine changes in vaccination attitudes over time. RESULTS: Almost all participants (98.7%) had received at least one dose of a COVID-19 vaccine, and a significant increase in influenza uptake was identified (83.6% in 2020 to 91.6% in 2021). Complacency, mistrust of vaccine benefit, concerns about commercial profiteering, and constraints to vaccination had significantly decreased between Time 1 and Time 2, and collective responsibility had significant increased. However, calculation and worries about unforeseen future effects had increased, indicating that participants now perceived higher risks related to vaccination and were taking a more deliberative information-seeking approach. CONCLUSION: The results show significant changes in vaccination attitudes across the pandemic. These changes suggest that while older adults became less complacent about the importance of vaccines, concerns about potential risks associated with vaccination increased. It will be important for public health communication to address these concerns for all vaccines offered to this group.

Adult Aging Moderates the Relationship Between Trait Cognitive Anxiety and Subjective Everyday Cognitive Difficulties.

The present aim was to determine, across the adult lifespan, the extent to which different dimensions of trait anxiety might affect subjective cognitive difficulties in everyday life. Following Attentional Control Theory (ACT; Eysenck et al., 2007), we predicted that trait anxiety would have a greater effect on attention and verbal abilities than on visual abilities. We also expected trait cognitive anxiety to exhibit more robust relationships with cognition than trait somatic anxiety. Importantly, we predicted that effects of anxiety would be greater in older adults, in line with the Strength and Vulnerability Integration model (SAVI; Charles, 2010). The sample comprised 286 United Kingdom-based adults aged 18-93 years. Participants completed self-report measures of trait cognitive and somatic anxiety (the State-Trait Inventory for Cognitive and Somatic Anxiety; STICSA, Ree et al., 2008) and everyday cognitive difficulties (the Multiple Abilities Self-Report Questionnaire; MASQ, Seidenberg et al., 1994). Moderated regression models were constructed, including trait cognitive or somatic anxiety as a predictor of cognitive difficulties, and age as the moderator variable. Covariates included depression, stress (the Depression Anxiety Stress Scales-short form; DASS-21, Lovibond and Lovibond, 1995), gender, current mental health treatment status, and physical health status. When cognitive anxiety was the predictor variable, somatic anxiety was also included as a covariate, and vice-versa. Trait cognitive anxiety and age interacted to predict all MASQ subscales other than visual-perceptual ability. Difficulties with attention, verbal memory, and language abilities were significantly greater at higher levels of anxiety for all age groups, with the effect greatest in older adults. Difficulties with visual-spatial memory were significantly greater at higher levels of anxiety in middle-aged and older adults only. Higher trait somatic anxiety predicted difficulties with verbal memory and language ability independently of age, and interacted with age to predict language difficulties. Interestingly, age also significantly predicted less subjective difficulty with attention, independently of anxiety level. The results show that trait cognitive and somatic anxiety are both related to subjective, everyday cognitive difficulties. However, effects of trait cognitive anxiety are more robust across cognitive domains and tend to increase, or first appear, over the course of the adult lifespan.

A systematic review of the impacts of intergenerational engagement on older adults' cognitive, social, and health outcomes.

BACKGROUND: Intergenerational engagement could benefit health and wellbeing within an ageing population. This systematic review evaluated the impacts of intergenerational engagement on cognitive, social, and health outcomes in healthy older adults and older adults with mild cognitive impairment. RESEARCH DESIGN AND METHODS: Comprehensive literature searches were undertaken, with records filtered according to pre-registered criteria. Study quality was formally assessed, and a narrative synthesis of the findings produced. RESULTS: Forty-four studies were reviewed. Regarding quantitative evidence, 4 out of 8 studies found significant intergenerational engagement effects on cognitive outcomes, 15 of 24 on social outcomes, and 21 of 31 on health-related outcomes. Qualitative evidence was also important for understanding perceived impacts and experiences of intergenerational programmes. Only 11 studies fully met criteria for high quality research, of which the majority focused on social outcomes. DISCUSSION AND IMPLICATIONS: There are a range of potential benefits of intergenerational engagement, most notably regarding anxiety, generativity, cross-age attitudes, and physical activity. However, heterogeneity in programme context, sample design, dosage, and duration indicate that more research is required to enable wider implementation and generalisability. Scientific rigour in both quantitative and qualitative research should also be employed as far as possible, to provide the highest quality evidence.

Older adults' vaccine hesitancy: Psychosocial factors associated with influenza, pneumococcal, and shingles vaccine uptake.

Influenza, pneumococcal disease, and shingles (herpes zoster) are more prevalent in older people. These illnesses are preventable via vaccination, but uptake is low and decreasing. Little research has focused on understanding the psychosocial reasons behind older adults' hesitancy towards different vaccines. A cross-sectional survey with 372 UK-based adults aged 65-92 years (M = 70.5) assessed awareness and uptake of the influenza, pneumococcal, and shingles vaccines. Participants provided health and socio-demographic data and completed two scales measuring the psychosocial factors associated with vaccination behaviour. Self-reported daily functioning, cognitive difficulties, and social support were also assessed. Participants were additionally given the opportunity to provide free text responses outlining up to three main reasons for their vaccination decisions. We found that considerably more participants had received the influenza vaccine in the last 12 months (83.6%), relative to having ever received the pneumococcal (60.2%) and shingles vaccines (58.9%). Participants were more aware of their eligibility for the influenza vaccine, and were more likely to have been offered it. Multivariate logistic regression analyses showed that a lower sense of collective responsibility independently predicted lack of uptake of all three vaccines. Greater calculation of disease and vaccination risk, and preference for natural immunity, also predicted not getting the influenza vaccine. For both the pneumococcal and shingles vaccines, concerns about profiteering further predicted lack of uptake. Analysis of the qualitative responses highlighted that participants vaccinated to protect their own health and that of others. Our findings suggest that interventions targeted towards older adults would benefit from being vaccine-specific and that they should emphasise disease risks and vaccine benefits for the individual, as well as the benefits of vaccination for the wider community. These findings can help inform intervention development aimed at increasing vaccination uptake in future.

Strategic prioritisation enhances young and older adults' visual feature binding in working memory.

Visual working memory for features and bindings is susceptible to age-related decline. Two experiments were used to examine whether older adults are able to strategically prioritise more valuable information in working memory and whether this could reduce age-related impairments. Younger (18-33 years) and older (60-90 years) adults were presented with coloured shapes and, following a brief delay, asked to recall the feature that had accompanied the probe item. In Experiment 1, participants were either asked to prioritise a more valuable object in the array (serial position 1, 2, or 3) or to treat them all equally. Older adults exhibited worse overall memory performance but were as able as younger adults to prioritise objects. In both groups, this ability was particularly apparent at the middle serial position. Experiment 2 then explored whether younger and older adults' prioritisation is affected by presentation time. Replicating Experiment 1, older adults were able to prioritise the more valuable object in working memory, showing equivalent benefits and costs as younger adults. However, processing speed, as indexed by presentation time, was shown not to limit strategic prioritisation in either age group. Taken together, these findings demonstrate that, although older adults have poorer visual working memory overall, the ability to strategically direct attention to more valuable items in working memory is preserved across ageing.

Impacts of trait anxiety on visual working memory, as a function of task demand and situational stress.

Higher trait anxiety can impair cognitive functioning via attention, but relatively little is known about the impacts on visual working memory. These were investigated using previously validated visual feature binding tasks. In Study 1, participants' memory for visual features (shapes) and feature bindings (coloured shapes) was assessed. Stimulus presentation was simultaneous or sequential, varying attentional demand, and participants were grouped according to trait cognitive anxiety (low, moderate, high). No reliable effect of trait anxiety, either cognitive or somatic, was found on memory accuracy, but moderate trait cognitive anxiety was associated with faster correct response times (i.e. increased efficiency) when stimuli were sequentially presented. In Study 2, the role of situational stress was explored during a simultaneously presented task. Higher trait cognitive and somatic anxiety were both associated with poorer efficiency during both shape and binding memory tasks. Trait somatic anxiety also predicted poorer binding effectiveness (i.e. accuracy), in those reporting higher state cognitive anxiety. Situational stress predicted binding effectiveness, but never interacted with trait anxiety, and was therefore not necessary to observe these trait anxiety-visual working memory relationships. Trait cognitive and somatic anxiety, and situational stress, therefore each influence visual working memory performance.

Towards intervention development to increase the uptake of COVID-19 vaccination among those at high risk: Outlining evidence-based and theoretically informed future intervention content.

OBJECTIVES: Development of a vaccine against COVID-19 will be key to controlling the pandemic. We need to understand the barriers and facilitators to receiving a future COVID-19 vaccine so that we can provide recommendations for the design of interventions aimed at maximizing public acceptance. DESIGN: Cross-sectional UK survey with older adults and patients with chronic respiratory disease. METHODS: During the UK's early April 2020 'lockdown' period, 527 participants (311 older adults, mean age = 70.4 years; 216 chronic respiratory participants, mean age = 43.8 years) completed an online questionnaire assessing willingness to receive a COVID-19 vaccine, perceptions of COVID-19, and intention to receive influenza and pneumococcal vaccinations. A free text response (n = 502) examined barriers and facilitators to uptake. The Behaviour Change Wheel informed the analysis of these responses, which were coded to the Theoretical Domains Framework (TDF). Behaviour change techniques (BCTs) were identified. RESULTS: Eighty-six per cent of respondents want to receive a COVID-19 vaccine. This was positively correlated with the perception that COVID-19 will persist over time, and negatively associated with perceiving the media to have over-exaggerated the risk. The majority of barriers and facilitators were mapped onto the 'beliefs about consequences' TDF domain, with themes relating to personal health, health consequences to others, concerns of vaccine safety, and severity of COVID-19. CONCLUSIONS: Willingness to receive a COVID-19 vaccination is currently high among high-risk individuals. Mass media interventions aimed at maximizing vaccine uptake should utilize the BCTs of information about health, emotional, social and environmental consequences, and salience of consequences.

Multimodal coding and strategic approach in young and older adults' visual working memory performance.

Visual working memory (WM) was investigated in young (18-35 yrs) and older (63-88 yrs) adults by assessing use of visual and verbal processing, and strategic approach. Experiment 1 comprised a visual interference paradigm, to investigate visual rehearsal during an abstract visual WM task. Results suggested both groups used a visual strategy, but older adults struggled more when visual interference was administered first, perhaps due to difficulty developing non-visual strategies. In Experiment 2, a more meaningful task version was additionally administered, offering greater opportunity for multimodal coding. Despite the marked effect of age, both groups benefited from semantic availability to the same extent. Young adults reported a verbal strategy more than older adults, who reported less verbal labeling and more visual refreshing, and a less efficient approach overall. The results highlight age-related limitations in visual WM capacity and strategy use, but show potential for compensation, and a role for task practice.

Simulation for emergency nurses (SIREN): A quasi-experimental study.

BACKGROUND: Within nursing education, simulation has been recognised as an effective learning strategy. Embedding simulation within clinical units has the potential to enhance patient safety and improve clinical outcomes. However it is important to evaluate the effectiveness of this educational technique to support the actual value and effectiveness. OBJECTIVE: This study aimed to implement and evaluate an innovative simulation experience for registered nurses. METHODS: A high-fidelity simulation focusing on nursing assessment was conducted with 50 Registered Nurses in an Emergency Department (ED) at a large tertiary referral hospital. Two questionnaires were completed pre and post simulation to assess anxiety related to participating in the simulation, and self-efficacy in patient assessment. Participant satisfaction and self-confidence in learning was assessed post simulation. Additionally a documentation audit from the patient's electronic chart was completed to review documentation entries before and after participation in the simulation. RESULTS: Anxiety scores decreased significantly from pre (M = 38.56, SD = 9.87) to post (M = 33.54, SD = 8.99), t(49) = 4.273, p < 0.001. There was a statistically significant increase in self-efficacy scores from pre (M = 195.16, SD = 28.09) to post (M = 214.12, SD =25.77), t(49) = 5.072, p < 0.001. ED nurses were highly satisfied with their simulation training and they were in agreement with the statements about self-confidence in learning. There was a statistically significant increase in two components of the documentation scores; initial clinical handover increased from pre (M = 7.88, SD = 1.76) to post (M = 8.79, SD =1.22), t(41) = 3.41, p < 0.001 and indicators of urgent illness increased from pre (M = 7.33, SD = 1.95) to post (M = 8.10, SD = 1.45), t(41) =2.27, p = 0.028. CONCLUSIONS: This study has demonstrated that a high fidelity simulation decreased participants' anxiety, increased self-efficiency in patient assessment, and improved documentation in patient records. Additionally ED nurses were highly satisfied with the simulation training.