Prospective associations of technostress at work, burnout symptoms, hair cortisol, and chronic low-grade inflammation.

BACKGROUND: Working conditions in the age of digitalization harbor risks for chronic stress and burnout. However, real-world investigations into biological effects of technostress, that is stress in the context of digital technology use, are sparse. This study prospectively assessed associations between technostress, general work stress, burnout symptoms, hair cortisol, and chronic low-grade inflammation. METHODS: Hospital employees (N = 238, 182 females, Mage = 28.5 years) participated in a prospective cohort study with two follow-ups six months apart (T2, T3). Participants answered standardized questionnaires on general job strain (job demand-control ratio), technostressors (work interruptions, multitasking, information overload), burnout symptoms (exhaustion, mental distance), and relevant confounders. Moreover, they provided capillary blood samples for C-reactive protein (CRP) and hair strands for hair cortisol concentration (HCC) analysis. Structural equation modelling was performed. RESULTS: The factorial structure of survey measures was confirmed. Burnout symptoms (MT2 = 2.17, MT3 = 2.33) and HCC (MT2 = 4.79, MT3 = 9.56; pg/mg) increased over time, CRP did not (MT2 = 1.15, MT3 = 1.21; mg/L). Adjusted path models showed that technostress was negatively associated with HCC (ß = -0.16, p =.003), but not with burnout and CRP. General work stress in contrast, was not significantly associated with burnout, HCC or CRP. Furthermore, there were reciprocal effects of CRP on HCC (ß = 0.28, p =.001) and of HCC on CRP (ß = -0.10, p ≤.001). Associations were robust in additional analyses including further confounders. CONCLUSION: This is the first study on prospective effects of technostress on employees' endocrine and inflammatory systems. Results suggest differential effects of technostress on the hypothalamic-pituitary-adrenocortical axis activity. Given its key role for long-term health, the findings have important implications for occupational health and safety in digitalized work environments.

The brain-derived neurotrophic factor Val66met polymorphism is associated with better attention and working memory performance and resilience to mild chronic stress.

The val66met polymorphism of the brain-derived neurotrophic factor (BDNF) gene has been identified as a potential moderator for the relationship between chronic stress and executive functioning. However, whether the presence of the met allele increases cognitive vulnerability or resilience to stress has yet to be determined. Given the established effects of autonomic activity and psychological arousal on executive functioning, in the present study, 56 healthy university students completed self-report measures of chronic stress, positive arousal (vigour) and negative arousal (anxiety) and measured heart-rate variability to quantify autonomic activity. Participants then completed a cognitive test battery that measured attention, decision-making, visual learning and working memory. Regression analyses demonstrated that Val/met participants performed better on attention and working memory tasks than Val/val participants, but no differences were seen in decision-making and visual learning. Further, Val/met participants were protected from stress-related differences in attention seen in Val/val participants. Val66met was not associated with physiological or psychological arousal. This study demonstrates that val66met plays an important but selective role in cognitive performance.

A Systematic Review and Revised Meta-analysis of the Effort-Reward Imbalance Model of Workplace Stress and Hypothalamic-Pituitary-Adrenal Axis Measures of Stress.

OBJECTIVE: Despite considerable research in the past 20 years into associations between the effort-reward imbalance (ERI) model and various health outcomes, the mechanisms responsible for the association remain unclear. Our meta-analysis assessed the associations of ERI and overcommitment (OC) in the workplace with measures from the hypothalamic-pituitary-adrenal (HPA) axis. METHODS: Electronic databases were searched with the phrase "effort * reward * imbalance," which yielded 319 studies leading to 56 full-text studies being screened. Thirty-two studies within 14 articles met the inclusion criteria and were meta-analyzed using mixed- and random-effects models. RESULTS: Greater ERI was associated with increased HPA axis activity (r = 0.05, p = .02, k = 14, n = 2461). The cortisol waking concentrations (r = 0.11, p = .02, k = 6, n = 493) were the only subgroup associated with ERI. Meta-regression revealed that studies that contained more men had stronger ERI to HPA marker associations. When all HPA markers were considered collectively, OC was not associated with greater HPA axis activity (r = 0.01, p = .70, k = 10, n = 1684), with only cortisol (pm) associated with OC (r = -0.24, p = .02, k = 2, n = 95). CONCLUSIONS: ERI and OC were associated with HPA responsivity. Although the cortisol waking concentrations and not the CAR were associated with ERI, this may be due to heterogeneity in the experience of stress between studies. Future studies should consider the concurrent assessment of burnout to better assist the interpretation of ERI with HPA responsivity.

Mild Traumatic Brain Injury and Functional Outcome in Older Adults: Pain Interference But Not Cognition Mediates the Relationship Between Traumatic Injury and Functional Difficulties.

OBJECTIVE: To examine functional status of older people 3 months after mild traumatic brain injury (mTBI) and identify whether pain interference or cognition mediates any relationship found between injury status and functional outcomes. SETTING: Patients admitted to a Melbourne-based emergency department. PARTICIPANTS: Older adults 65 years and older: 40 with mTBI, 66 with orthopedic injury without mTBI (TC), and 47 healthy controls (CC) without injury. DESIGN: Observational cohort study. MAIN MEASURES: Functional outcome was measured using the World Health Organization Disability Assessment Schedule (WHODAS 2.0) and single- and dual-task conditions of the Timed-Up-and-Go task. Pain interference and cognitive performance at 3 months post-injury were examined as mediators of the relationship between injury status (injured vs noninjured) and functional outcome. RESULTS: Patients with mTBI and/or orthopedic injury reported greater difficulties in overall functioning, including community participation, compared with noninjured older people (CC group). Both trauma groups walked slower than the CC group on the mobility task, but all groups were similar on the dual-task condition. Pain interference mediated the relationship between injury status and overall functioning [ b = 0.284; 95% CI = 0.057, 0.536), community participation ( b = 0.259; 95% CI = 0.051, 0.485), and mobility ( b = 0.116; 95% CI = 0.019, 0.247). However, cognition did not mediate the relationship between injury status and functional outcomes. CONCLUSIONS: Three months after mild traumatic injury (with and without mTBI), patients 65 years and older had greater functional difficulties compared with noninjured peers. Pain interference, but not cognition, partially explained the impact of traumatic injury on functional outcomes. This highlights the importance of reducing pain interference for older patients after injury (including mTBI) to support better functional recovery.

Quality of life and psychological health after mild traumatic brain injury in older people: Three- and six-month follow up.

OBJECTIVES: Examine quality of life (QoL) and psychological health after mild traumatic brain injury (mTBI) in older people (65+ years) at 3- and 6-month follow-up and explore which injury factors predicted QoL. METHODS: mTBI patients were compared to trauma comparison (TC) and community comparison (CC) groups. QoL and psychological health were measured at both timepoints. After accounting for 3-month psychological health, injury severity, neuroimaging, and 3-month neuropsychological performance were assessed as predictors of 6-month QoL. RESULTS: Overall 3-month QoL was lower for mTBI (Cohen's d = 0.938) and TC (Cohen's d = 0.485) groups compared to CCs, but by 6 months only mTBI patients continued to report poorer overall QoL (Cohen's d = 0.577) and physical QoL (Cohen's d = 0.656). Despite group differences, QoL for most (~92%) was within normative limits. 3-month psychological health predicted QoL 6-months postinjury (ß = -.377, 95% CI -.614, -.140) but other proposed risk factors (GCS <15, neuroimaging, 3-month neuropsychological performance) did not uniquely predict QoL. CONCLUSIONS: Older adults following mTBI reported lower QoL up to 6-months postinjury compared to non-injured peers, indicating that mTBI patients were particularly susceptible to ongoing differences in QoL 6-months postinjury.

Observed Strategies on Naturalistic Associative Memory Tasks in Healthy Older Adults and Amnestic Mild Cognitive Impairment.

BACKGROUND: Understanding the strategies people with amnestic mild cognitive impairment (aMCI) spontaneously use can inform targeted memory training. METHOD: Strategy use was observed for 99 people with aMCI and 100 healthy older adults (HOA) on two memory tasks. RESULTS: No differences were found between aMCI and HOA in the amount or types of strategies used, but strategy use varied with task. Association was more effective for one task, whereas on the other task, use of written notes or multiple strategies were detrimental to performance and related to poorer performance than active (spaced) retrieval, for aMCI. CONCLUSION: Our findings suggest the importance of identifying ineffective habits, in addition to instruction in more beneficial approaches.

Subjective Cognitive Decline: Level of Risk for Future Dementia and Mild Cognitive Impairment, a Meta-Analysis of Longitudinal Studies.

Subjective Cognitive Decline (SCD) in older adults has been identified as a risk factor for dementia, although the literature is inconsistent, and it is unclear which factors moderate progression from SCD to dementia. Through separate meta-analyses, we aimed to determine if SCD increased the risk of developing dementia or mild cognitive impairment (MCI). Furthermore, we examined several possible moderators. Longitudinal studies of participants with SCD at baseline, with data regarding incident dementia or MCI, were extracted from MEDLINE and PsycINFO. Articles were excluded if SCD occurred solely in the context of dementia, MCI, or as part of a specific disease. Pooled estimates were calculated using a random-effects model, with moderator analyses examining whether risk varied according to SCD definition, demographics, genetics, recruitment source, and follow-up duration. Risk of study bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. 46 studies with more than 74,000 unique participants were included. SCD was associated with increased risk of developing dementia (HR = 1.90, 95% CI 1.52-2.36; OR = 2.48, 95% CI 1.97-3.14) and MCI (HR = 1.73, 95% CI 1.18-2.52; OR = 1.83, 95% CI 1.56-2.16). None of the potential moderating factors examined influenced the HR or OR of developing dementia. In contrast, including worry in the definition of SCD, younger age, and recruitment source impacted the OR of developing MCI, with clinic samples demonstrating highest risk. SCD thus represents an at-risk phase, ideal for early intervention, with further research required to identify effective interventions for risk reduction, and cognitive-behavioural interventions for cognitive management. PROSPERO, protocol number: CRD42016037993.

Systematic Review and Meta-analysis of Outcome after Mild Traumatic Brain Injury in Older People.

OBJECTIVE: Older age is often identified as a risk factor for poor outcome from traumatic brain injury (TBI). However, this relates predominantly to mortality following moderate-severe TBI. It remains unclear whether increasing age exerts risk on the expected recovery from mild TBI (mTBI). In this systematic review of mTBI in older age (60+ years), a focus was to identify outcome through several domains - cognition, psychological health, and life participation. METHODS: Fourteen studies were identified for review, using PRISMA guidelines. Narrative synthesis is provided for all outcomes, from acute to long-term time points, and a meta-analysis was conducted for data investigating life participation. RESULTS: By 3-month follow-up, preliminary findings indicate that older adults continue to experience selective cognitive difficulties, but given the data it is possible these difficulties are due to generalised trauma or preexisting cognitive impairment. In contrast, there is stronger evidence across time points that older adults do not experience elevated levels of psychological distress following injury and endorse fewer psychological symptoms than younger adults. Meta-analysis, based on the Glasgow Outcome Scale at 6 months+ post-injury, indicates that a large proportion (67%; 95% CI 0.569, 0.761) of older adults can achieve good functional recovery, similar to younger adults. Nevertheless, individual studies using alternative life participation measures suggest more mixed rates of recovery. CONCLUSIONS: Although our initial review suggests some optimism in recovery from mTBI in older age, there is an urgent need for more investigations in this under-researched but growing demographic. This is critical for ensuring adequate health service provision, if needed.

Memory Strategy Training Can Enhance Psychoeducation Outcomes for Dementia Family Caregivers: A Randomized Controlled Trial.

This study investigated caregiver outcomes when a psychoeducation program for older people with dementia and caregivers is modified to extend practice in memory strategies. Moderation effects of increased memory strategy use were also explored. Fifty-six care dyads participated in the multicenter, randomized controlled trial comparing psychoeducation (active control) with psychoeducation and memory strategy practice (intervention). Primary outcome was memory strategy use; secondary outcome was caregiver emotional reactivity (burden, depression, and anxiety). Results showed memory strategy use significantly increased following psychoeducation for both groups. However, psychoeducation combined with memory strategy practice resulted in a significant reduction in depression for caregivers reporting at least mild baseline symptoms. Greater use of memory strategies moderated the relationship between burden and depression following intervention. Psychoeducation programs that incorporate practical memory strategy training may offer more substantial outcomes.

Assessing the association of university stress and physiological reactivity with decision-making among students.

Compared with age-matched employees, university students report higher levels of chronic stress and this may affect their decision-making. The impact of chronic stress and physiological reactivity upon cognitive function is receiving more attention, but few studies have empirically assessed the associations of these variables concurrently. Our aim was to investigate if chronic student stress, as assessed by effort-reward imbalance (ERI) and overcommitment, and physiological reactivity, were related to decision-making. As measures of physiological reactivity, we collected salivary alpha-amylase (sAA) and continuously recorded heart rate variability (HRV) data from male students (n = 79) at pretest and immediately after some computerized decision-making tasks (simple and choice- reaction times). Our findings suggest that students who are higher in overcommitment and who are more physiologically reactive (sAA and HRV indices) at the pretest stage may be more "at-risk" of poor decision-making than others. If others can replicate our findings in more diverse samples, this will contribute to an evidence base for interventions targeted at reducing overcommitment, ERI, and dysregulated autonomic reactivity to improve decision-making.

A Systematic Review and Meta-analysis of the Effort-Reward Imbalance Model of Workplace Stress and Hypothalamic-Pituitary-Adrenal Axis Measures of Stress.

OBJECTIVE: The association between effort-reward imbalance (ERI) and various health outcomes has been well documented over the past 20 years, but the mechanisms responsible for this association remain unclear. The present meta-analysis assessed the associations of ERI and overcommitment (OC) in the workplace with hypothalamic-pituitary-adrenal (HPA) axis measures. METHODS: Electronic databases were searched with the phrase "effort*reward*imbalance," which yielded 319 studies leading to 56 full-text studies being screened. Thirty-two studies within 14 articles met inclusion criteria and were meta-analyzed using mixed and random effects models. RESULTS: Greater ERI was associated with increased HPA axis activity (r = .09, p < .001, k = 14, N = 2541). The cortisol awakening response (r = .14, p < .001, k = 9, N = 584) and cortisol waking concentrations (r = .12, p = .01, k = 6, N = 493) were the only HPA measures associated with ERI. OC was also associated with greater HPA axis activity (r = .06, p < .01, k = 10, N = 1918). Cortisol (PM) (r = .13, p = .02, k = 3, N = 295) was the only HPA measure associated with OC. CONCLUSIONS: ERI and OC were similarly related with HPA responsivity. However, because OC moderated the relationship between ERI and HPA axis markers, the importance of OC should not be overlooked. Because OC is likely more malleable than ERI to intervention, this may be a promising avenue for future research.

The salivary alpha amylase awakening response is related to over-commitment.

We assessed the relationship between physiological and psychological measures of workplace stress as measured by the effort-reward imbalance (ERI) model, with a seldom studied sample of owner-operator dairy farmers. Dairy farmers (N = 74) self-reported ERI, over-commitment (OC), dedication, and health then provided awakening saliva samples that were used to calculate the salivary alpha amylase awakening response (sAA-AR), cortisol awakening response (CAR), and salivary immunoglobulin A (sIgA) level. ERI, OC, and dedication levels were not related with sIgA or the CAR, but more over-committed farmers had a less pronounced sAA-AR. OC was more associated than ERI with the physiological indicators of stress, potentially due to the owner-operator sample used in this investigation. The suitability of sAA as a viable physiological measure of autonomic nervous system activity has been debated, but our findings promote its inclusion in future occupational stress research.

An objective and cross-sectional examination of sun-safe behaviours in New South Wales primary schools.

BACKGROUND: Previous evaluations have supported the link between sun protection policies and improved sun protection behaviours. However these evaluations have relied on self-reported data. METHODS: A cross-sectional design as part of an ongoing 18-month cluster-controlled trial in primary schools (n = 20) was used. Researchers conducted direct observations to record students' hat use and teachers' use of sun protective measures during recess and lunch. Researchers also recorded the volume of sunscreen consumed in each school. RESULTS: Only 60% of primary school children wear a sun-safe hat during their breaks when observed using objective measures. Weak correlations were observed between the wearing of a sun-safe hat and a school's socio-economic status (r = 0.26). All other independent variables measured had only very weak correlations (r < 0.19) with sun-safe hat wearing behaviour of students. Sunscreen consumption by school students during the school day is negligible. CONCLUSIONS: A large percentage of NSW primary schools in this study wear sun-safe hats during the school day but this is well below what has been reported in previous national surveys. Given the finite resources of schools and the correlation, though small, with SES status for these behaviours, it behoves researchers to investigate low-cost solutions to these problems. Further qualitative data will also be needed to inform the enablers and barriers for sun-safe behaviour interventions to be adopted in NSW primary schools.

Rationale and study protocol to evaluate the SunSmart policy intervention: a cluster randomised controlled trial of a primary school-based health promotion program.

BACKGROUND: Previous evaluations of the SunSmart Program have supported the link between a written sun protection policy and improved sun protection behaviours in New South Wales (NSW) primary schools. However these evaluations have relied on self-reported data and research suggests that direct observations are required to better represent schools' usual sun protective practices. METHODS/DESIGN: Data will be collected in the summer months of 2014, 2015, and 2016 as part of an 18-month cluster-controlled trial in NSW primary schools (n = 20). Researchers will conduct three direct observations to record students' hat use and teachers' use of sun protective measures during recess and lunch periods in each school. Researchers will also record the volume of sunscreen that the Year 6 classes in each school utilise over the term. At the conclusion of baseline data collection, five schools will be randomised into an intervention group that will work with researchers to develop a policy-driven intervention to improve sun safety behaviour in NSW primary schools. DISCUSSION: An initial review of relevant Australian and New Zealand literature suggests that provision of policy support is likely to improve school sun protection practices; however there is no suggested model for this support. This will be the first objective analysis of sun safe behaviours leading to a policy-driven intervention conducted in Australian primary schools since the 1990s, and will inform the future direction of sun safety in our schools. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Register ACTRN12614000926639 Registered 28(th) August 2014.

Greater severity of depressive symptoms is associated with changes to perceived sweating, preferred ambient temperature, and warmth-seeking behavior.

The thermosensory system is relevant to both the conceptualization and treatment of depression. There is evidence that depression is associated with changes in thermoregulatory functioning, and that thermosensory pathways can be recruited to influence affect and reduce depressive symptoms. In this study, we investigated the relationship between severity of depressive symptoms and changes to measures of subjective experiences associated with thermoregulatory processes as well as the relationship between severity of depressive symptoms and affective responses to warm stimuli, specifically frequency of warmth-seeking behavior. Participants (N = 529) completed measures of depressive symptoms, subjective experiences associated with thermoregulatory processes (i.e., perceived sweating and preferred ambient temperature) and frequency of warmth-seeking behavior (e.g., long hot baths, saunas, etc.). We demonstrate that, controlling for age and gender, greater severity of depressive symptoms is associated with greater perceived sweating and lower preferred ambient temperature. Furthermore, we demonstrate that greater severity of depressive symptoms is associated with more frequent warmth-seeking behavior, and that something other than thermal preference (i.e., stated preference for warmer temperature) is driving this behavior. These data highlight the importance of incorporating the thermoregulatory system in our conceptualization of the pathophysiology of depression and support the potential to recruit thermosensory pathways to target depressive symptoms.

Gender and Workplace Stress Affect the Association Between Concussion History and Depression Symptoms in Professional Jockeys.

OBJECTIVE: Professional jockeys experience high rates of concussion, workplace stress, and poor mental health. The present cross-sectional study, for the first time, concurrently assessed the potential interplay between concussion history and workplace stress with current depression symptoms. METHOD: Seventy-two professional flat-track jockeys (male = 49, female = 23) were grouped based on self-reported concussion history (CG; n = 56) and those who did not report a concussion history (NCG; total n = 16). Analyses featured both between (CG vs NCG) and within group (CG only) assessment on self-reported measures of workplace stress and depression symptoms (affect, daily functioning). RESULTS: Jockeys in the CG had more symptoms of negative affect than the NCG. This association, however, was nonsignificant after covarying for age, gender, and workplace stress. Higher workplace stress (p = .005) and gender (p = .001) were associated with poorer daily functioning after controlling for concussion history (CG vs. NCG) and age. Gender moderated the association between concussion group and poorer daily functioning (ß = -18.739, t (71) = -2.924, p = .005), with the difference between CG and NCG significant for females, but not males (ß = 33.648, t (71) = 3.420, p = .001). CONCLUSIONS: The findings provide preliminary evidence that previously concussed females may be more likely to report poorer daily functioning than males with a history of concussion, and that workplace stress may reduce the association between a history of concussion and depression symptoms. Prospective studies are required to validate and extend these findings.

Association between dietary factors, symptoms, and psychological factors in adults with dyspepsia: A cross-sectional study.

BACKGROUND: Evidence-based dietary management approaches for symptoms of dyspepsia are lacking. This study aimed to compare dietary factors, symptoms, quality of life (QOL) and salivary cortisol in dyspepsia participants and healthy controls. METHODS: A cross-sectional survey was completed by adults with dyspepsia (n = 121) meeting Rome IV criteria and healthy controls (n = 52). Outcome measures included self-reported questionnaires about dietary habits, triggers, restrictions, dietary management approaches, nutritional intake, psychological variables, QOL, gastrointestinal symptoms, and optional cortisol awakening response (CAR) via saliva samples. Data were analyzed using Chi-square or Mann-Whitney U. Cortisol awakening response data was analyzed using moderated regression controlling for age, gender and distress. KEY RESULTS: Fermentable carbohydrates (FODMAPs) (55%) were the most reported trigger in adults with dyspepsia. The dyspepsia group (88%) followed special diets more than controls (47%; p < 0.001), with a low FODMAP diet being most common (69%). The dyspepsia group consumed less fiber (p = 0.014), calcium (p = 0.015), and total FODMAPs (p < 0.001) than controls. There was a greater prevalence of comorbid anxiety (41%) and depression (31%) in dyspepsia compared to controls (15% and 12%, respectively, p < 0.001 and p = 0.006). The dyspepsia group had poorer QOL and greater gastrointestinal symptom severity than controls (p < 0.001). There was a negative association between anxiety and CAR (p = 0.001) in dyspepsia but not in controls. CONCLUSIONS & INFERENCES: Adults with dyspepsia follow special diets more than controls and perceive FODMAPs as a key dietary trigger. These findings highlight the importance of monitoring nutritional adequacy and QOL, and emphasize mechanisms of depleted stress response in dyspepsia, warranting further exploration.

Clinical and Blood Biomarker Trajectories after Concussion: New Insights from a Longitudinal Pilot Study of Professional Flat-Track Jockeys.

There is a recognized need for objective tools for detecting and tracking clinical and neuropathological recovery after sports-related concussion (SRC). Although computerized neurocognitive testing has been shown to be sensitive to cognitive deficits after SRC, and some blood biomarkers have shown promise as indicators of axonal and glial damage, the potential utility of these measures in isolation and combination for assisting SRC diagnosis and tracking recovery is not well understood. To provide new insights, we conducted a prospective study of 64 male and female professional flat-track jockeys (49 non-SRC, 15 SRC), with each jockey undergoing symptom evaluation, cognitive testing using the CogSport battery, and serum biomarker quantification of glial fibrillary acidic protein (GFAP), tau, and neurofilament light (NfL) using a Simoa HD-X Analyzer. Measures were performed at baseline (i.e., pre-injury), and 2 and 7 days and 1 and 12 months after SRC. Symptoms were most pronounced at 2 days and had largely resolved by either 7 days or 1 month. CogSport testing at 2 days revealed cognitive impairments relative to both non-concussed peers and their own pre-injury baselines, with SRC classification utility found at 2 days, and to a slightly lesser extent, at 7 days. Relatively prolonged changes in serum NfL were observed, with elevated levels and classification utility persisting beyond the resolution of SRC symptoms and cognitive deficits. Finally, SRC classification performance throughout the 1st month after SRC was optimized through the combination of cognitive testing and serum biomarkers. Considered together, these findings provide further evidence for a role of computerized cognitive testing and fluid biomarkers of neuropathology as objective measures to assist in the identification of SRC and the monitoring of clinical and neuropathological recovery.

Assessing prospective memory in older age: the relationship between self-report and performance on clinic-based and naturalistic tasks.

This investigation assessed the relationship between subjective self-reports and objective measures of prospective memory with forty-eight healthy, community-dwelling older-adults (> 65 years). The Prospective and Retrospective Memory Questionnaire provided the self-report data, the Cambridge Prospective Memory Test was used as a clinic-based test, and the Telephone Task (telephoning the examiner at irregular, pre-scheduled times across one week) was used as a naturalistic measure. The self-reported difficulties were negatively associated with performance on the naturalistic task, r (41) = -0.341, p = <0.05, but not the clinic-based task. Performance tasks (clinic-based and naturalistic) were moderately associated, r (41) = 0.312, p = <0.05. Tests of retrospective memory (delayed recall) and executive function (attention set-shifting) did not individually predict performance on any of the prospective memory measures. Incorporating naturalistic probes of prospective memory performance into a clinical assessment may allow insight into the experience of prospective memory challenges in older-age clients.