Social and Neighborhood Context Moderates the Associations Between Processing Speed and Driving Mobility: A 10-year Analysis of the ACTIVE Study.

Objectives: Processing speed is essential to functional independence in later life, such as driving a vehicle. Few studies have examined processing speed and driving mobility in the context of racial differences and social determinants of health (SDoH). This study characterized the longitudinal association between processing speed and driving mobility, and how it varied by race and SDoH. Methods: Using data from the control arm of the Advanced Cognitive Training in Vital Elderly study (n = 581, 24.5% Black), multilevel models examined longitudinal associations between processing speed and driving mobility outcomes (driving space, exposure, and difficulty). Race and SDoH moderations were explored. Results: Decline in processing speed measures was associated with increased self-reported driving difficulty, but only for older adults with below-average to average scores for neighborhood and built environments and social community context SDoH domains. Discussion: Findings emphasize the influence of physical and social environmental characteristics on processing speed and driving mobility.

Feasibility of a pilot dyadic randomized controlled trial testing the effects of three behavioral interventions on older adults' cognitive, physical and everyday function.

Introduction: Maintaining functional abilities is critical for optimizing older adults' well-being and independence. This randomized controlled trial (RCT) pilot examined the feasibility of testing the effects of three commercially available interventions on function-related outcomes in older adults. Methods: Pairs of community-dwelling older adults (N=55, Mage=71.4) were randomized to a 10-week intervention (cognitive-COG, physical-EX, combined exergame-EXCOG, or control-CON). Cognitive, physical, and everyday function were assessed at baseline, immediately post-intervention, and 6-months post-intervention. Feasibility was evaluated using recruitment, enrollment, training adherence, and retention metrics. Variability and patterns of change in functional outcomes were examined descriptively. Results: A total of 208 individuals were screened, with 26% subsequently randomized. Across training arms, 95% of training sessions were completed and 89% of participants were retained at immediate post-test. Variability in functional outcomes and patterns of change differed across study arms. Discussion: Results support a fully powered RCT, with several modifications to the pilot study design, to investigate short- and long-term training impacts.

Does Cognitive Training Reduce Falls across Ten Years?: Data from the ACTIVE Trial.

The purpose of this study was to examine the effect of cognitive training on the risk of experiencing a fall across 10 years. The study used data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized controlled trial. Older adults aged 65-94 were randomly assigned to speed of processing, memory, or reasoning training or to a no-contact control group (n = 2802). The experience of a fall in the prior two months was assessed at baseline and at 1, 2, 3, 5, and 10 years posttest. Cox proportional hazards explored group differences in the total sample, as well as group differences for participants classified as low risk (n = 2360) and high risk (n = 442) for future falls. The data were censored at the first reported fall postbaseline. After baseline, 983 (35.08%) participants across the full sample reported a fall. There were no significant effects of the training in the full sample or in the low-risk sample of participants. However, the participants at greater risk for future falls in the speed of processing training group were 31% less likely (HR = 0.69; 95% CI = 0.48, 0.998, p = 0.049) to experience a subsequent fall across ten years compared to the control group. Reasoning and memory training did not reduce a future fall in the high-risk sample. The speed of processing training reduced the risk of future falls across ten years in the high-risk participants. Future work should examine moderators and mediators of training in at-risk samples.

Indicators of Crash Risk in Older Adults: A Longitudinal Analysis From the ACTIVE Study.

Objective: This study aims to examine indicators of crash risk longitudinally in older adults (n = 486). Method: This study applied secondary data analyses of the 10 years of follow-up for the ACTIVE study combined with state-recorded crash records from five of the six participating sites. Cox proportional hazards models were first used to examine the effect of each variable of interest at baseline after controlling for miles driven and then to assess the three cognitive composites as predictors of time to at-fault crash in covariate-adjusted models. Results: Older age, male sex, and site location were each predictive of higher crash risk. Additionally, worse scores on the speed of processing cognitive composite were associated with higher crash risk. Discussion: Results support previous findings that both age and male sex are associated with higher crash risk. Our significant finding of site location could be attributed to the population density of our testing sites and transportation availability.

Does the association between objective and subjective memory vary by age among healthy older adults?

Subjective memory is commonly used as an indicator of older adults' objective memory in clinical screening; however, the correspondence between subjective and objective memory across different ages is unclear. The current study examined age-varying associations between subjective and objective memory in a cross-sectional sample of healthy older adults from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study (N = 2,496). Time varying effects modeling (TVEM) models the association between variables as a function of time-varying metrics including age without imposing linear assumptions. TVEM was used to examine relationship magnitude fluctuations between subjective and objective memory across ages 65 to 85. Better subjective memory was weakly associated with better objective memory, even after controlling for gender, depressive symptoms, and education. The association was stable across all ages. There is a stable weak correspondence between subjective and objective memory in older adulthood across age, supporting the use of linear age as an appropriate time metric for examinations of objective and subjective memory among healthy older adults. Future work should examine the correspondence between subjective and objective memory in a larger age range. Longitudinal designs can also provide insights on whether the accuracy of subjective memory ratings change within a person over time.

The Preventing Alzheimer's with Cognitive Training (PACT) randomized clinical trial.

BACKGROUND: To address the rising prevalence of Alzheimer's disease and related dementias, effective interventions that can be widely disseminated are warranted. The Preventing Alzheimer's with Cognitive Training study (PACT) investigates a commercially available computerized cognitive training program targeting improved Useful Field of View Training (UFOVT) performance. The primary goal is to test the effectiveness of UFOVT to reduce incidence of clinically defined mild cognitive impairment (MCI) or dementia with a secondary objective to examine if effects are moderated by plasma ß-amyloid level or apolipoprotein E e4 (APOE e4) allele status. METHODS/DESIGN: This multisite study utilizes a randomized, controlled experimental design with blinded assessors and investigators. Individuals who are 65 years of age and older are recruited from the community. Eligible participants who demonstrate intact cognitive status (Montreal Cognitive Assessment score > 25) are randomized and asked to complete 45 sessions of either a commercially available computerized-cognitive training program (UFOVT) or computerized games across 2.5 years. After three years, participants are screened for cognitive decline. For those demonstrating decline or who are part of a random subsample, a comprehensive neuropsychological assessment is completed. Those who perform below a pre-specified level are asked to complete a clinical evaluation, including an MRI, to ascertain clinical diagnosis of normal cognition, MCI, or dementia. Participants are asked to provide blood samples for analyses of Alzheimer's disease related biomarkers. DISCUSSION: The PACT study addresses the rapidly increasing prevalence of dementia. Computerized cognitive training may provide a non-pharmaceutical option for reducing incidence of MCI or dementia to improve public health. REGISTRATION: The PACT study is registered at http://Clinicaltrials.govNCT03848312.

Longitudinal associations of pain and cognitive decline in community-dwelling older adults.

Pain is inversely associated with cognitive function in older adults, but the effects of pain on cognitive decline are not fully clear. This study examined the associations of baseline pain, pain persistence, and incident pain with changes in cognition across 10 years in a sample of healthy community-dwelling older adults (n = 688; Mage = 74, SD = 6.05) from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial. While ACTIVE was a four-arm single-blind cognitive training randomized controlled trial, the present study includes only participants from the no-contact control group. Pain was examined using the Medical Outcomes Survey SF-36-Item (MOS SF-36) and cognitive tests examined simple processing speed, complex processing speed, divided and selective attention, memory, reasoning, and cognitive status. Multilevel models tested the associations of baseline pain, incident pain, and pain persistence on cognitive function and cognitive decline, adjusted for baseline age, time (years after follow-up), race, gender, education, marital status, and depressive symptoms at baseline and over time. Thirty-one percent reported pain at baseline which was related to worse baseline memory and accelerated decline in processing speed. Forty-two percent of older adults reported incident pain had accelerated decline in complex processing speed, divided attention, memory, reasoning, and cognitive status. On average, older adults reported a mean of two waves of pain persistence related to accelerated decline in memory. In sum, pain is common in community-dwelling older adults and is related to accelerated cognitive decline, especially when the incident. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Age- and Time-Varying Associations Between Subjective Health and Episodic Memory in Older Adults.

OBJECTIVES: There are positive correlations between subjective health reports and episodic memory performance in older adults. However, previous studies have not evaluated the scope of such complex relationships, nor the potentially nonlinear magnitude of these correlations across age and time. We employed multiple subjective heath indices to evaluate the scope and nonlinearity of such relationships with memory performance. METHODS: We utilized a cross-sectional (N = 2,783 at baseline) and longitudinal sample (N = 311) of healthy older adults aged 65 and older from the Advanced Cognitive Training for Independent and Vital Elderly study. We used time-varying effects modeling (TVEM) to assess potential differences in relationship magnitudes between memory and 3 subjective health subscales (general health, role physical function, and physical function, from the Short Form Health Survey) across 5 years. RESULTS: Episodic memory positively predicted all subjective health measures cross-sectionally and longitudinally in our sample. TVEM revealed the relationships between all subjective health measures and episodic memory were stable across age. While role physical function and physical function maintained stable relationships with episodic memory across time, general health became increasingly coupled with memory 5 years following baseline. DISCUSSION: Together, our findings highlight stable and varying relationships between episodic memory and multiple subjective health indicators across metrics of time in older adults. Clinical Trials Registration Number: NCT00298558.

Feasibility and Enjoyment of Exercise Video Games in Older Adults.

Introduction: Several interventions have been developed to enhance social connectedness among older adults. However, little research has demonstrated their performance in a social distancing environment. Exergames are not only beneficial to older adults' physical and cognitive health, but they also allow players to interact with each other at a distance, which can reduce loneliness and increase social connection. The aim of this pilot study was to investigate older adults' perceptions of two commercially available exergames. Methods: Twenty healthy community-dwelling older adults (M age = 73.30, SD = 5.95, range = 65-84 years, 80% women) were recruited in this pilot study between July 2019 and February 2020. They were asked to play two exergames for 10 min each on the Xbox One with Kinect console: Just Dance and Kinect Sports Rivals. After gameplay, they provided both quantitative and qualitative feedback on these games. Results: Participants reported an average rating for exergame enjoyment. Greater enjoyment was significantly related with younger age and greater extraversion but not gender. Participants were highly motivated to do well on the games but reported lower scores for likelihood of playing these games in the future. Greater likelihood of future play was associated with younger age but not gender or extraversion. "Not aerobic or strengthen enough; not enough exertion," and "slower movements, repetition, clear purpose of doing the exercise" were some factors that would influence their decision to buy and play these games. Discussion: The preliminary results of this pilot study suggest that exergames may help address social isolation and loneliness-particularly during times of social distancing. Before applying exergames as a social isolation or loneliness intervention for older adults, study replication in larger representative studies and future work that examines important design issues related to older adults' experiences with these games is needed.

Examining Rural and Racial Disparities in the Relationship Between Loneliness and Social Technology Use Among Older Adults.

Loneliness, the subjective negative experience derived from a lack of meaningful companionship, is associated with heightened vulnerability to adverse health outcomes among older adults. Social technology affords an opportunity to cultivate social connectedness and mitigate loneliness. However, research examining potential inequalities in loneliness is limited. This study investigates racial and rural-urban differences in the relationship between social technology use and loneliness in adults aged 50 and older using data from the 2016 wave of the Health and Retirement Study (N = 4,315). Social technology use was operationalized as the self-reported frequency of communication through Skype, Facebook, or other social media with family and friends. Loneliness was assessed using the UCLA Loneliness scale, and rural-urban differences were based on Beale rural-urban continuum codes. Examinations of race focused on differences between Black/African-American and White/Caucasian groups. A path model analysis was performed to assess whether race and rurality moderated the relationship between social technology use and loneliness, adjusting for living arrangements, age, general computer usage. Social engagement and frequency of social contact with family and friends were included as mediators. The primary study results demonstrated that the association between social technology use and loneliness differed by rurality, but not race. Rural older adults who use social technology less frequently experience greater loneliness than urban older adults. This relationship between social technology and loneliness was mediated by social engagement and frequency of social contact. Furthermore, racial and rural-urban differences in social technology use demonstrated that social technology use is less prevalent among rural older adults than urban and suburban-dwelling older adults; no such racial differences were observed. However, Black older adults report greater levels of perceived social negativity in their relationships compared to White older adults. Interventions seeking to address loneliness using social technology should consider rural and racial disparities.

Use of multilevel modeling to examine variability of distracted driving behavior in naturalistic driving studies.

Current methods of analyzing data from naturalistic driving studies provide important insights into real-world safety-related driving behaviors, but are limited in the depth of information they currently offer. Driving measures are frequently collapsed to summary levels across the study period, excluding more fine-grained differences such as changes that occur from trip to trip. By retaining trip-specific data, it is possible to quantify how much a driver differs from trip to trip (within-person variability) in addition to how he or she differs from other drivers (between-person variability). To the authors' knowledge, the current study is the first to use multilevel modeling to quantify variability in distracted driving behavior in a naturalistic dataset of older drivers. The current study demonstrates the utility of examining within-person variability in a naturalistic driving dataset of 68 older drivers across two weeks. First, multilevel models were conducted for three distracted driving behaviors to distinguish within-person variability from between-person variability in these behaviors. A high percentage of variation in distracted driving behaviors was attributable to within-person differences, indicating that drivers' behaviors varied more across their own driving trips than from other drivers (ICCs = .93). Then, to demonstrate the utility of personal characteristics in predicting daily driving behavior, a hypothetical model is presented using simulated daily sleep duration from the previous night to predict distracted driving behavior the following day. The current study demonstrates substantial variability in driving behaviors within an older adult sample and the promise of individual characteristics to provide better prediction of driving behaviors relevant to safety, which can be applied in investigations of current naturalistic driving datasets and in designing future studies.

Correlates of Life Satisfaction Among Middle-Aged and Older Black Adults.

BACKGROUND: This study examines satisfaction across life domains (condition of the home, city of residence, daily life/leisure, family life, current financial situation, total household income, health, and life as a whole) among Black adults. The study also explores the association between satisfaction in each life domain and sociodemographic, personality, and mental/physical health measures. METHODS: A community-dwelling sample of Black adults (n = 93, age range = 55-80) residing in the Tampa, FL area, completed a life satisfaction scale and measures of sociodemographic factors, personality, and mental/physical health between October 2014 and June 2016. RESULTS: Better life satisfaction was observed in the oldest-old (80+) compared with the middle-aged (55-64; p < .05). Less education, less financial strain, lower depressive symptoms, and better self-rated physical health were associated with higher satisfaction although the pattern of results varied by domain. CONCLUSIONS: Our findings suggest that the evaluation of life satisfaction domains may be a useful approach for identifying specific individual needs, which may inform age-friendly community initiatives.

Cognitive Training Attenuates Decline in Physical Function Across 10 Years.

OBJECTIVES: Poor physical function is associated with negative health and cognitive outcomes. Although nine studies demonstrated that cognitive training reduces age-related declines in physical function, only one study has examined the effects beyond immediate posttest changes. The first aim of this study was to assess the impact of three cognitive training programs on physical function measures across 10 years and the second aim was to examine whether baseline cognitive self-efficacy or depressive symptoms moderated training effects. METHOD: Using data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized controlled trial, older adults in a no-contact control condition (n = 698) were compared to those receiving processing speed (n = 702), memory (n = 703), or reasoning (n = 694) training. Intention-to-treat (ITT) and dosage analyses were conducted for grip strength and Turn 360. Participants were followed up to 10 years posttest. RESULTS: There were no significant ITT effects of processing speed, memory, or reasoning training assignment to any physical function outcome (p > .05). Dosage models indicated that there were small age-related attenuation effects in Turn 360 decline with more processing speed training (b = -.011, p < .001), memory training (b = -.011, p < .001), and reasoning training (b = -.012, p < .001). There was no significant transfer to grip strength. These training gains were greater for those with more baseline depressive symptoms who received more processing speed training (b = -.001, p < .001). DISCUSSION: This is the first study to demonstrate the effects of cognitive training to complex physical function across 10 years.

A systematic review and meta-analysis of older driver interventions.

The purpose of this systematic review and meta-analysis was to summarize and quantify the effects of different driving interventions among older adults on outcomes of crashes, on-road driving performance, self-reported outcomes of errors and crashes, and driving simulator performance. Randomized controlled trials examining the effects of a driving intervention among older adults ≥ 50 years of age were included. Thirty-one studies were identified using a systematic literature review, and 26 were included in meta-analyses. The following types of driving interventions were identified: physical retraining/exercise (e.g., flexibility and coordination training); visual-perceptual training (e.g., improving figure-ground discrimination); cognitive training (e.g., Useful Field of View cognitive training); education (e.g., classroom driver refresher course); context-specific training (i.e., on-road training in car, driving simulator training); combined intervention approaches (e.g., education and context-specific training combined). Effect sizes were calculated for each driving intervention type relative to control groups using random-effects. Physical retraining/exercise, visual-perceptual training, and combined intervention approaches demonstrated medium to large effects on on-road driving performance, ds = 0.564-1.061, ps < .050. Cognitive training approaches reduced at-fault crashes by almost 30 %, OR = 0.729, 95 % CI [0.553, 0.962], p = .026. Education and context-specific approaches were not efficacious to improve driving safety outcomes, ps> .050. In summary, skill-specific interventions (physical retraining/exercise, visual-perceptual training, cognitive training) and combined intervention approaches improved on-road driving performance and reduced at-fault crashes. Optimizing interventions that target age-related functional declines and combined intervention approaches is recommended.

Older Black Adults' Satisfaction and Anxiety Levels After Completing Alternative Versus Traditional Cognitive Batteries.

OBJECTIVE: The objective of this study was to examine satisfaction, test anxiety, and performance using computer-based cognitive batteries versus a paper-and-pencil neuropsychological battery among older Blacks. METHOD: Self-identified Black adults (n = 87, age range: 55-86; mean education = 14) completed two computer-based tests (CogState and Joggle) and a paper-and-pencil neuropsychological battery. After each battery, participants reported their testing anxiety and satisfaction using the batteries. Descriptive, correlational, and regression analyses compared satisfaction, anxiety, and performance across the batteries. RESULTS: Majority of the participants reported more satisfaction with the computer-based (Joggle: 66%; CogState: 77%) than the neuropsychological (52%) battery. Participants also reported less testing anxiety after completing the computer-based batteries than the neuropsychological battery, F(2, 172) = 22.96, p < .001. Older adults' familiarity and comfort level with the computer were not associated with their performance on the computer-based tests (p > .05). Although testing anxiety was not associated with performance across the batteries, age and education quality were uniquely associated with performance on the CogState and neuropsychological batteries. CONCLUSIONS: Computer-based cognitive batteries appear to be less intimidating than the commonly used paper-and-pencil neuropsychological tests for Black adults. Thus, these cognitive batteries may be useful tools for monitoring older Blacks' cognitive status.

A viewpoint on change point modeling for cognitive aging research: Moving from description to intervention and practice.

Chronological age is a commonly-used time metric, but there may be more relevant time measures in older adulthood. This paper reviews change point modeling, a type of analysis increasingly common in cognitive aging research but with limited application in applied research. Here, we propose a new application of such models for cognitive training studies. Change point models have the potential to assess intervention outcomes such as compression of morbidity or reduced decline after an event (e.g., reduced cognitive decline after a dementia diagnosis) as well as changes in outcome trajectories across different intervention dosages (e.g., initial vs. booster training). Through change point modeling, we can better understand how interventions impact cognitive aging trajectories.

The impact of behavioral interventions on cognitive function in healthy older adults: A systematic review.

Behavioral interventions to improve cognitive function in older adults are widespread and can vary from theater classes to cognitive training programs. However, the effectiveness in maintaining different cognitive domains varies greatly both across and within intervention types. To date, no systematic reviews have synthesized findings across more than a few types of interventions (e.g., cognitive vs. exercise). This systematic review examined 11 types of behavioral interventions and the respective transfer to 19 cognitive domains, as well as transfer to everyday function. Study inclusion criteria were: peer-reviewed articles in English, samples of healthy adults aged 65 and older, and randomized controlled trials of behavioral interventions with reported cognitive outcomes. The 2017 search yielded 75 eligible articles comprising cognitive training, exercise training, combination interventions, cognitively-stimulating activities, and action video games. In general, process- (n = 26) and strategy-based (n = 16) cognitive training improved the trained domains but had weak transfer to non-trained domains. Aerobic training (n = 13) most consistently improved executive function, and strength/resistance (n = 8) and aerobic/resistance combination training (n = 6) most consistently improved cognitive inhibition and visual working memory. Combination interventions (n = 15 nonfactorial, n = 3 factorial) showed promise in improving verbal delayed recall and executive function. Few studies examined cognitively-stimulating activities or action video games, leaving inconclusive results about their effect on cognitive function. Few studies examined everyday function (n = 9), however, process- and strategy-based training demonstrated notable long-term transfer. Recommendations for future research and practice are highlighted.

The Effects of Useful Field of View Training on Brain Activity and Connectivity.

OBJECTIVES: Useful Field of View training (UFOVt) is an adaptive computerized cognitive intervention that improves visual attention and transfers to maintained health and everyday functioning in older adults. Although its efficacy is well established, the neural mechanisms underlying this intervention are unknown. This pilot study used functional MRI (fMRI) to explore neural changes following UFOVt. METHOD: Task-driven and resting-state fMRI were used to examine changes in brain activity and connectivity in healthy older adults randomized to 10 hr of UFOVt (n = 13), 10 hr of cognitively stimulating activities (CSA; n = 11), or a no-contact control (NC; n = 10). RESULTS: UFOVt resulted in reduced task-driven activity in the majority of regions of interest (ROIs) associated with task performance, CSA resulted in reduced activity in one ROI, and there were no changes within the NC group. Relative to NC, UFOVt reduced activity in ROIs involved in effortful information processing. There were no other significant between-group task-based differences. Resting-state functional connectivity between ROIs involved in executive function and visual attention was strengthened following UFOVt compared with CSA and NC. DISCUSSION: UFOVt enhances connections needed for visual attention. Together with prior work, this study provides evidence that improvement of the brain's visual attention efficiency is one mechanism underlying UFOVt.

Older Adult Lifespace Varies by Driving Status and Residential Population Density.

Individual- and environmental-level factors may explain differential trajectories in lifespace mobility in older adults. The current study tested whether driving status was associated with lifespace, whether lifespace change varied by driving status, and whether residential context moderated the relationship between driving status and lifespace. Participants were older adults ages 65 to 94 (mean = 73.6 + 5.9) enrolled in the Advanced Cognitive Training for Independent and Vital Elderly Study (N = 2,792). Lifespace and driving status were assessed at baseline and first, second, third, and fifth annual follow-up visits. Residential population density was measured as the population density for participants' enrollment site counties. Two sites were categorized as low density (< 600 per square mile) and four sites were categorized as high density (> 1,200 per square mile). Multilevel longitudinal models tested relationships between driving status, residential population density, and lifespace over five years. After controlling for potential confounders, results indicated that non-drivers had smaller mean lifespace than drivers across five years. Rates of lifespace declines did not differ between drivers and non-drivers. Non-drivers at baseline residing in low population density areas had smaller lifespace than non-drivers in high population density areas and all drivers regardless of population density. The findings suggest that residential context plays a role in older adults' travel behaviors and choices. Further research is needed to understand what residential characteristics support or hinder lifespace maintenance for older adult non-drivers, such as availability and usability of transportation and walkability.

Age-Varying Relationships Between Physical Function and Cognition in Older Adulthood.

OBJECTIVES: There are positive relationships between physical and cognitive function in older adulthood; however, the strength of these relationships are inconsistent across studies. Although novel statistical tools provide flexibility to explore age-related differences in relationship magnitude, such methods have not been implemented in gerontological research. This study applied such methods to examine variations in relationship magnitude between physical function and cognition in healthy older adults (N = 2,783). METHOD: Time-varying effects modeling (TVEM) is an extension of regression that models changes in relationships as a function of time-varying metrics like age. TVEM was used to examine if physical function (Turn 360, grip strength) predicted cognitive performance (memory, processing speed/attention, and reasoning) similarly across adults aged 65-90. RESULTS: All associations between Turn 360 and all cognitive domains were significant and positive; however, speed of processing had significant magnitude variation across age such that the young-old and the old-old demonstrated the strongest relationships. Associations between grip strength and all cognitive domains significantly strengthened with increased age. DISCUSSION: Results suggest that depending on the sample age, there may be inconsistencies in the relationships between physical and cognitive performance. Future research should explore these relationships longitudinally to better elucidate discrepant findings.