Processing speed and executive functioning in relation to off-topic verbosity among young adults and older adults.

PURPOSE: Off-topic verbosity (OTV) is a tendency towards excessive, off-topic speech and has been linked with age-related deficits in executive functioning, particularly inhibition. However, there are numerous disagreements within the literature on what constitutes OTV, and there is a further lack of investigation into alternative cognitive explanations for the link between inhibition and OTV. The purpose of this study was to investigate the speech characteristics of OTV in young and older adults as well as to examine whether variations in OTV are better explained by diminished executive functioning or processing speed, as measured by the D-KEFS Stroop test. METHODS: Young adults (n = 65; age 18-28) and older adults (n = 85; age 60-98) completed the D-KEFS Color-Word Interference Test and provided verbal samples of autobiographical episodic and procedural speech. These speech samples were rated on three facets of OTV: tangentiality, egocentrism and quantity of speech. RESULTS: Procedural autobiographical speech was found to best measure age cohort variations in OTV, and higher OTV was associated with poorer Stroop test performance in older adults but not in young adults. In fact, young adults only displayed associations between poorer Stroop performance and a reduction in speech quantity. Finally, processing speed deficits were more associated with increased OTV in older adults than executive functioning. CONCLUSION: These results provide support for links between age-related cognitive decline and OTV, but the results suggest that processing speed may be more implicated than executive functioning.

End-of-life treatment preferences and advanced care planning among older adults.

End-of-life treatment preferences (EOLTPs) refer to the amount of medical intervention an individual would wish to receive in a life-threatening scenario. This study aimed to investigate relationships between older adults' EOLTPs and advance care planning (ACP). Using archival data from two interview surveys of community-dwelling older adults (study 1 n = 331, study 2 n = 338; age 60-102), results found that a desire for less end-of-life medical intervention was associated with greater EOL discussion with physicians. This relationship was explained by greater death preparation and younger age. Older adults may use ACP to limit unwanted medical interventions.

Development of the Virtual Kitchen Protocol for Prospective Memory: a virtual reality-based measure of everyday prospective memory abilities.

INTRODUCTION: Prospective memory is the ability to remember to accomplish a task at a specified point in the future. While this cognitive ability has a large impact on daily functioning, it is rarely assessed during neuropsychological evaluations. Furthermore, existing clinical prospective memory measures are few in number and have significant limitations, including applicability to everyday functioning and appropriate norming for older adulthood. There are also many gaps in the literature on prospective memory, such as how environmental factors affect performance across the lifespan. METHOD: In the current study, we develop and establish a new virtual reality-based measure of prospective memory, the Virtual Kitchen Protocol for Prospective Memory. Young adults (ages 18-29; n = 56), healthy older adults (ages 60-90; n = 94), and clinical older adults (ages 62-90; n = 30) were compared on their performances on both the developed virtual reality prospective memory test and a parallel paper-and-pencil prospective memory test to investigate the impact of test environment across participant group. RESULTS: The Virtual Kitchen Protocol for Prospective Memory was found to adequately differentiate between young adult, healthy older adult, and clinical older adult populations - suggesting baseline ability for prospective memory assessment in clinical settings with older adults and potential for future improvement of neuropsychological evaluations. Additionally, the developed virtual prospective memory task appeared to mimic environmental factors in everyday life but did not replicate the benefit previously measured in healthy older adults' prospective memory ability in naturalistic settings. CONCLUSIONS: Overall, the current study built upon extant knowledge of prospective memory in both normal and abnormal aging, suggesting future directions in replicating familiar home environments. Findings provided additional evidence toward future validation of virtual reality assessment tools in clinical neuropsychological evaluations of cognitive abilities, such as prospective memory, with both healthy and clinical older adult populations.

Inhibition mediates the relationship between age cohort and virtual reality-based prospective memory.

INTRODUCTION: Prospective memory has received relatively little attention from a clinical perspective, yet it is an important part of daily functioning. Executive functions have been linked with prospective memory abilities, and age differences are found in both executive functions and prospective memory. The purpose of this study was to investigate whether age cohort differences in prospective memory abilities are mediated by executive functions, specifically inhibition. METHOD: Participants (N = 108) consisted of young adults (n= 53) and older adults (n= 55) without any neurocognitive impairment. Participants completed a clinical interview and a battery of neuropsychological tests that included the Mini-Mental Status Exam-2 Standard Version (MMSE-2-SV), the Wisconsin Card Sorting Test-64 (WCST-64), the Delis-Kaplan Executive Functioning System Color-Word Interference Test (D-KEFS CWIT), and the Virtual Kitchen Protocol (VKP). RESULTS: Young adults had higher prospective memory scores than older adults. Inhibition (i.e., D-KEFS CWIT) mediated the relationship between age cohort and prospective memory, while cognitive flexibility did not mediate the relationship. CONCLUSIONS: Older adults may have diminished inhibition abilities that may negatively affect their ability to complete prospective memory tasks.

Performance on a virtual environment shopping task and adaptive functioning among older adults.

Neuropsychologists are often asked to evaluate patients' functional capacities, yet traditional neuropsychological tests have limited correspondence with real-world outcomes. The Virtual Environment Grocery Store (VEGS) is a virtual environment that simulates shopping tasks. The purpose of this study was to investigate the relationship between older adults' performance on the VEGS in relation to their self-reported adaptive functioning as well as performance on a performance-based adaptive functioning measure. Older adults (n = 98; age 65-90, M = 75.82, SD = 6.27) were administered the VEGS, the Instrumental Activities of Daily Living Scale (IADLS), and the Texas Functional Living Scale (TFLS). Neither premorbid functioning nor the VEGS variables were associated with self-rated adaptive functioning. However, all three VEGS variables were associated with performance-based adaptive functioning (i.e., the TFLS). Performance on the VEGS measure of correct items in the shopping cart explained 13.9% of the variance in performance on the performance-based adaptive functioning task. Whether the participant picked up the VEGS prescription explained 12.6% of the variance in performance on the performance-based adaptive functioning task. Performance on VEGS long delay free recall explained 35.1% of the variance in performance on the performance-based adaptive functioning task. These results suggest that the VEGS demonstrates value in predicting older adults' functional capacities.

Peer observation of teaching: A feasible and effective method of physician faculty development.

Physician faculty learn teaching skills informally while fighting competing professional obligations. One underutilized proven technique to improve teaching skills is peer observation with feedback. We aimed to understand benefits and challenges of a physician faculty development program based on peer observation of teaching and to develop best practice recommendations for future program development. The authors developed a peer observation-based physician faculty development program from 2015 to 2017. Two interviewers conducted and analyzed qualitative interviews with 13 faculty participants and four non-participants using content analysis to identify themes and subthemes in NVivo©. Participant-identified program benefits included conveyed institutional support for teaching, the opportunity for peer observation with direct and timely feedback, the opportunity for community building, and overall program feasibility. Program challenges included competing scheduling demands, variability in feedback quality, and difficulty maintaining engagement for the program duration. Potential areas for improvement included participation incentives, external faculty involvement, assistance with program logistics and administration, and improvement in the consistency of the feedback experience. While peer observation is a valued approach to physician faculty development of teaching skills, competing demands on physicians may still limit program effectiveness. Program sustainability depends on optimizing feedback quality, boosting motivation for participation, and providing administrative support.

Loneliness and Off-Topic Verbosity Among Young Adults and Older Adults.

OBJECTIVES: Off-topic verbosity (OTV) refers to prolonged speech that derails from the initial conversational topic by including more loosely associated speech and becoming increasingly more unfocused and distant from the initial topic. Previous research has suggested that, among older adults, loneliness may be associated with greater OTV. The purpose of this study was to investigate the nature of the relationship between loneliness and OTV among young adults (n = 62) and older adults (n = 80). METHODS: Participants completed a measure of loneliness and provided speech samples, which were transcribed and rated for OTV. RESULTS: Results indicated some relationship between loneliness and tangentiality of speech, particularly among older adults. DISCUSSION: Overall, loneliness may be associated with greater OTV in older adults, which could further explain the connection between increased loneliness and worse health outcomes in older adulthood.

Comparison of Traditional and Virtual Reality-Based Episodic Memory Performance in Clinical and Non-Clinical Cohorts.

The California Verbal Learning Test, Second Edition (CVLT-II) and the Virtual Environment Grocery Store (VEGS) use list learning and recognition tasks to assess episodic memory. This study aims to: (1) Replicate prior construct validity results among a new sample of young adults and healthy older adults; (2) Extend this work to a clinical sample of older adults with a neurocognitive diagnosis; (3) Compare CVLT-II and VEGS performance among these groups; and (4) Validate the independence of CVLT and VEGS episodic memory performance measures from executive functioning performance measures. Typically developing young adults (n = 53) and older adults (n = 85), as well as older adults with a neurocognitive diagnosis (n = 18), were administered the CVLT-II, VEGS, and D-KEFS CWIT. Results found that (1) the relationship of the VEGS and CVLT-II measures was highly correlated on all variables, (2) compared to the CVLT-II, participants (particularly older adults) recalled fewer items on the VEGS, and (3) the CVLT-II and VEGS were generally independent of D-KEFS CWIT. It appeared that the VEGS may be more difficult than the CVLT-II, possibly reflecting the word length effect. Performance may have also been impacted by the presence of everyday distractors in the virtual environment.

Correlates of Disclosure of Virginity Status Among U.S. College Students.

Disclosure of virginity status (DVS) refers to the extent to which an individual reveals that they identify as a virgin or not to different individuals in their lives. The purpose of this study was to investigate how generalized self-disclosure, virginity beliefs, and religiosity, as well as interactions with gender and virginity status, relate to DVS to family, peers, and religious communities. Southern U.S. college students (N = 690) took an online sexuality questionnaire. Generalized self-disclosure did not relate to DVS, suggesting that DVS represents a unique form of self-disclosure. Gender by virginity status interactions suggested that societal double standards of gender and virginity status (i.e., non-virgin women and virgin men being stigmatized for their virginity identifications) may be most relevant to one's decision to disclose to family, and somewhat relevant to one's decision to disclose to religious communities. Individuals high in religiosity overall tended to disclose their virginity status when they identified as a virgin, but not as a non-virgin. Virgins concealed their virginity status from religious communities when they stigmatized their own virginity but disclosed to family and peers when they viewed virginity as a gift. Overall, the results suggest that, although religiosity and virginity beliefs indeed play a role in DVS toward certain targets, one's gender and virginity status appear to be most important. Increased education on the double standard regarding gender and virginity status may help reduce stigma and improve sexual well-being.

Correlates of end-of-life treatment preferences among young adults and older adults.

The purpose of this study was to investigate correlates of end-of-life treatment preferences. Young adults (n = 117) and older adults (n = 305) completed an interview survey. Compared to older adults, young adults endorsed a desire for more medical intervention in end-of-life scenarios. After controlling for age cohort and education, a desire for more medical intervention in end-of-life scenarios was associated with higher religiosity, greater death anxiety, and more positive attitudes toward aging but not with physical or mental health. End-of-life treatment preferences may be more closely related to attitudes, beliefs, and practices than health status.

Compassion fatigue, emotional labor, and emotional display among hospice nurses.

The purpose of this study was to investigate relationships between compassion fatigue, emotional labor, and emotional display among hospice nurses (N = 90; 94.4% women). The hospice nurses indicated the emotional labor they utilize is primarily suppressing both positive and negative affect. Compassion fatigue was positively associated with expressing negative emotions, faking negative emotions, negative display rule perceptions, and surface acting, and negatively associated with suppressing negative emotions. Interventions and policies that foster greater authenticity and support emotional regulation may help reduce compassion fatigue among hospice nurses.

Clinging to power, clinging to life: Rightwing authoritarianism, social dominance orientation, and attitudes toward life extension.

The purpose of this study was to investigate the relationship between political ideology and attitudes toward life extension among college students (N = 484). Older age and male gender were associated with more positive attitudes toward life extension, while religious commitment was not. Authoritarian aggression/submission and social dominance orientation were associated with more positive attitudes toward life extension. The results suggest older people, men, and individuals higher in authoritarian traits and social dominance orientation may be more likely to use life-extending biomedical technology.

The development of an individual differences end-of-life treatment preferences scale.

The purpose of this study was to create an individual differences measure of end-of-life treatment preferences (EOLTPs). Young adults (n = 427) and older adults (n = 333) completed a survey. Results found that hope of recovery was an important factor in whether individuals preferred a given medical intervention. A single factor explained the majority of the variance in EOLTPs, and EOLTPs were distinct from more general attitudes about medical care. Older adults preferred less end-of-life medical intervention compared to younger adults. Overall, the results of the study support the use of an individual differences approach to measuring EOLTPs.

Attitude toward death, not religious commitment mediates the relationship between political ideology and attitudes toward life extension.

Previous research has linked political ideology - right-wing authoritarianism and social dominance orientation - with more positive attitudes toward life extension. The purpose of this study was to investigate death attitudes and religious commitment as mediators of the relationship between political ideology and attitudes toward life extension. College students (N = 406) completed an online survey. One death attitude - neutral acceptance - and not religious commitment mediated the relationship between political ideology and attitudes toward life extension. Individuals with more intolerant political ideology may see death as aberrant and thus be more likely to embrace life extension technology.

Communicating About Time-Limited Trials.

Time-limited trials (TLTs) are used in the management of critical care patients undergoing potentially nonbeneficial interventions to improve prognostication and build trust and consensus between family and intensivists. When these trials are not well defined and executed, discordant views of the patient's prognosis, conflict, and continuation of nonbeneficial care can arise. The mnemonic TIME (truth about uncertainty in prognosis, interval of time, measurement of improvement, and end or extend) can help facilitate clear communication surrounding TLTs. This framework allows physicians and families to deal more effectively with the inherent uncertainty and required flexibility needed in caring for complex critical care patients. This can lead to patient-centered decision-making that improves patient-physician relationships and goal-concordant care and also potentially reduces nonbeneficial treatments at the end of life.

Health Professionals Palliative Care Education for Older Adults: Overcoming Ageism, Racism, and Gender Bias.

Purpose of review: Most aging Americans lack access to specialist palliative care aimed at those experiencing serious illness and/or high symptom burden at end of life. The curricula used by training programs for all healthcare professions should focus on helping learners develop the primary palliative care skills and competencies necessary to provide compassionate bias-free care for adults with serious illness. We believe there is much opportunity to improve this landscape via the incorporation of palliative care competencies throughout generalist healthcare professional programs. Recent findings: Several recent publications highlight multiple issues with recruitment and retention of diverse students and faculty into healthcare professional training programs. There are also concerns that the curricula are reinforcing age, race, and gender biases. Due to these biases, healthcare professionals graduate from their training programs with socialized stereotypes unquestioned when caring for older adult minority patients and caregivers. Summary: Important lessons must be incorporated to assure that bias against age, race, and gender are discovered and openly addressed in healthcare professional's education programs. This review highlights these three types of bias and their interrelationships with the aim of revealing hidden truths in the education of healthcare professionals. Ultimately, we offer targeted recommendations of focus for programs to address implicit bias within their curricula.

Who wants to live forever? Age cohort differences in attitudes toward life extension.

INTRODUCTION: Biomedical technology holds the promise of extending human life spans; however, little research has explored attitudes toward life extension. METHODS: This survey asked young adults (n = 593), younger-old adults (n = 272), and older-old adults (n = 46) whether they would take a hypothetical life extension treatment as well as the youngest and oldest age at which they would wish to live forever. RESULTS: Age cohorts did not vary in their willingness to use life extension; however, in all three age cohorts, a plurality indicated that they would not use it. Men indicated a higher level of willingness to use the life extension treatment than women. Younger-old and older-old adults indicated that they would prefer to live permanently at an older age than younger adults. DISCUSSION: If a life extension treatment were to become available that effectively stopped aging, young adults may be likely to use such a treatment to avoid reaching the ages at which older cohorts say they would prefer to live forever.

A Virtual Kitchen Protocol to Measure Everyday Memory Functioning for Meal Preparation.

In this study, we developed the Virtual Kitchen Protocol (VKP), a virtual reality-based measure of everyday memory functioning for meal preparation tasks. We investigated the construct validity of the VKP by comparing the performance of young adults (n = 41) and older adults without (n = 52) and with (n = 7) a neurocognitive diagnosis, as well as by examining correlations with standardized measures of verbal and visual memory. The results show that young adults had higher recall than older adults and that the VKP was sensitive to neurocognitive impairment among older adults. The VKP demonstrated moderate to high correlations with other memory tests. These results support the construct validity of the VKP and suggest that it holds promise as a virtual reality-based measure of memory for meal preparation tasks.