Self-efficacy beliefs and change in cognitive performance: MacArthur Studies of Successful Aging

Better Later Than Never: Meaning in Late Life

The quest for meaning in life takes on new challenges and directions during late life. This mini-review draws on prior theory to analyze meaningfulness into six discrete dimensions (purpose, value, efficacy, self-worth, mattering, and comprehension) and covers research into how these apply and operate specifically during late life. Limited remaining time, concern with one's legacy, concerns with self-continuity and integration, variable challenges to self-worth, and prioritization of positivity emerge as key themes.

In multiple facets of subjective memory decline sex moderates memory predictions

INTRODUCTION

Two established subjective memory decline facets (SMD; complaints, concerns) are early indicators of memory decline and Alzheimer's disease. We report (1) a four-facet SMD inventory (memory complaints, concerns, compensation, self-efficacy) and (2) prediction of memory change and moderation by sex.

METHODS

The longitudinal design featured 40 years (53 to 97) of non-demented aging (n = 580) from the Victoria Longitudinal Study. Statistical analyses included confirmatory factor analyses and conditional latent growth modeling.

RESULTS

The four-facet SMD Inventory was psychometrically confirmed. Longitudinal analyses revealed significant variability in level and change for SMD and memory. Prediction analyses showed complaints and concerns predicted lower level and steeper memory decline; however, follow-up moderation analyses revealed selective predictions for females. Memory compensation predicted decline overall. Lower memory self-efficacy predicted steeper decline selectively for males.

DISCUSSION

Although traditional and novel SMD facets predicted memory decline, differential sex moderation was observed. SMD research benefits from conceptual complementarity and precision prediction.

Control beliefs are associated with preserved memory function in the face of low hippocampal volume among diverse older adults

Growing evidence supports a link between locus of control and memory in older adults. Control beliefs may directly predict larger hippocampal volume (i.e., brain maintenance). Alternatively, control beliefs may be associated with smaller hippocampal volume at any given level of memory (i.e., cognitive reserve). Multivariable regression analyses examined associations between verbal episodic memory, locus of control and hippocampal volume among 236 non-demented older adults in the community-based Washington Heights-Inwood Columbia Aging Project. Control beliefs were negatively associated with hippocampal volume when controlling for memory performance, indicating that individuals with stronger control beliefs were able to maintain memory function in the face of lower hippocampal volume. Subsequent exploratory models stratified by race/ethnicity indicated that this association was more prominent among racial/ethnic minorities (particularly Caribbean Hispanic older adults) than among non-Hispanic White older adults. Control beliefs were not associated with hippocampal volume before memory was taken into account. Results are consistent with the view that control beliefs facilitate the maintenance of memory function despite hippocampal volume loss. Results are not consistent with the view that locus of control contributes to brain maintenance. Culturally-appropriate interventions are needed to test whether strengthening control beliefs provides cognitive resistance to neuropathology.

Grandparent Caregiving, Race, and Cognitive Functioning in a Population-Based Sample of Older Adults

Objective: The aim of this study was to evaluate the association between noncustodial grandparent caregiving and cognition using the Health and Retirement Study (HRS), a population-based study of older adults. Method: Participants were White and African American grandparents aged ≥65 years. Only noncustodial grandparents who reported not living with their grandchildren over the three waves were included in our analyses. Grandparent caregiving status and cognition were assessed in 2006, 2008, and 2010. Analyses controlled for demographics, baseline health, depressive symptoms, and baseline cognition. Results: Both the number of waves of grandparent caregiving and the total number of grandparent caregiving hours across the three waves were associated with better cognitive functioning at 4-year follow-up in 2010. Associations were observed among Whites, but not among African Americans. Discussion: This study uses longitudinal data to evaluate the association between grandparent caregiving and cognitive functioning. Findings suggest that providing care may be beneficial for some grandparents.

Relationship between self-reported and objectively measured physical activity and subjective memory impairment in breast cancer survivors: role of self-efficacy, fatigue and distress

PURPOSE

Many breast cancer survivors report cancer and cancer treatment-associated cognitive change. However, very little is known about the relationship between physical activity and subjective memory impairment (SMI) in this population. The purpose of this study is to examine the relationship between physical activity and SMI and longitudinally test a model examining the role of self-efficacy, fatigue and distress as potential mediators.

METHODS

Post-treatment breast cancer survivors (N = 1477) completed measures of physical activity, self-efficacy, distress (depression, concerns about recurrence, perceived stress, anxiety), fatigue and SMI at baseline and 6-month follow-up. A subsample (n = 362) was randomly selected to wear an accelerometer. It was hypothesized that physical activity indirectly influences SMI via exercise self-efficacy, distress and fatigue. Relationships were examined using panel analysis within a covariance modeling framework.

RESULTS

The hypothesized model provided a good fit in the full sample (χ²  = 1462.5, df = 469, p = <0.001; CFI = 0.96; SRMR = 0.04) and the accelerometer subsample (χ2 = 961.8, df = 535, p = <0.001, CFI = 0.94, SRMR = 0.05) indicating increased physical activity is indirectly associated with reduction in SMI across time, via increased exercise self-efficacy and reduced distress and fatigue.

CONCLUSIONS

Higher levels of physical activity, lower levels of fatigue and distress and higher exercise self-efficacy may play an important role in understanding SMI in breast cancer survivors across time. Future research is warranted to replicate and explore these relationships further. Copyright © 2016 John Wiley & Sons, Ltd.

Increased perceived self-efficacy facilitates the extinction of fear in healthy participants

Self-efficacy has been proposed as an important element of a successful cognitive behavioral treatment (CBT). Positive changes in perceived self-efficacy have been linked to an improved adaptive emotional and behavioral responding in the context of anxiety-provoking situations. Furthermore, a positive influence of increased self-efficacy on cognitive functions has been confirmed. The present study examined the effect of verbal persuasion on perceived self-efficacy and fear extinction. Healthy participants were subjected to a standardized differential fear conditioning paradigm. After fear acquisition, half of the participants received a verbal persuasion aimed at increasing perceived self-efficacy. The extinction of fear was assessed immediately thereafter on both the implicit and explicit level. Our results suggest that an increased perceived self-efficacy was associated with enhanced extinction, evidenced on the psychophysiological level and accompanied by more pronounced decrements in conditioned negative valence. Changes in extinction were not due to a decrease in overall emotional reactivity to conditioned stimuli (CS). In addition, debriefing participants about the false positive feedback did not affect the processing of already extinguished conditioned responses during a subsequent continued extinction phase. Our results suggest that positive changes in perceived self-efficacy can be beneficial for emotional learning. Findings are discussed with respect to strategies aimed at increasing extinction learning in the course of exposure-based treatments.

Does Self-Efficacy Affect Responsiveness to Cognitive Speed of Processing Training?

OBJECTIVE

Older adults with higher self-efficacy may be more likely to benefit from some cognitive training approaches. We examined whether self-efficacy serves as a mediator or moderator of responsiveness to cognitive speed of processing training (SOPT).

METHOD

We used data from the Staying Keen in Later Life (SKILL) study (N = 128) and the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study (N = 1,400). Both studies assessed cognitive speed of processing (Useful Field of View Test-UFOV) and self-efficacy among community-dwelling older adults who were either randomized to SOPT or control conditions. We constructed regression models examining self-efficacy as a predictor of training responsiveness.

RESULTS

Analyses from both studies indicated that participants' self-efficacy scores were not predictive of training gains from SOPT, as measured by UFOV performance.

DISCUSSION

Self-efficacy does not affect older adults' ability to benefit from cognitive SOPT.

Physical activity and cognitive functioning in the oldest old: Within- and between-person cognitive activity and psychosocial mediators

OBJECTIVE

The current study examines the role of social contact intensity, cognitive activity, and depressive symptoms as within- and between-person mediators for the relationships between physical activity and cognitive functioning.

METHOD

All three types of mediators were considered simultaneously using multilevel structural equations modeling with longitudinal data. The sample consisted of 470 adults ranging from 79.37 to 97.92 years of age (M = 83.4; SD = 3.2) at the first occasion.

RESULTS

Between-person differences in cognitive activity mediated the relationship between physical activity and cognitive functioning, such that individuals who participated in more physical activities, on average, engaged in more cognitive activities and, in turn, showed better cognitive functioning. Mediation of between-person associations between physical activity and memory through social contact intensity was also significant. At the within-person level, only cognitive activity mediated the relationship between physical activity and change in cognition; however, the indirect effect was small. Depressive symptomatology was not found to significantly mediate within- or between-person effects on cognitive change.

DISCUSSION

Our findings highlight the implications of physical activity participation for the prevention of cognitive decline and the importance of meditational processes at the between-person level. Physical activity can provide older adults with an avenue to make new friendships and engage in more cognitive activities which, in turn, attenuates cognitive decline.

Indestructible plastic: the neuroscience of the new aging brain

In recent years, research on experience-dependent plasticity has provided valuable insight on adaptation to environmental input across the lifespan, and advances in understanding the minute cellular changes underlying the brain's capacity for self-reorganization have opened exciting new possibilities for treating illness and injury. Ongoing work in this line of inquiry has also come to deeply influence another field: cognitive neuroscience of the normal aging. This complex process, once considered inevitable or beyond the reach of treatment, has been transformed into an arena of intense investigation and strategic intervention. However, important questions remain about this characterization of the aging brain, and the assumptions it makes about the social, cultural, and biological space occupied by cognition in the older individual and body. The following paper will provide a critical examination of the move from basic experiments on the neurophysiology of experience-dependent plasticity to the growing market for (and public conception of) cognitive aging as a medicalized space for intervention by neuroscience-backed technologies. Entangled with changing concepts of normality, pathology, and self-preservation, we will argue that this new understanding, led by personalized cognitive training strategies, is approaching a point where interdisciplinary research is crucial to provide a holistic and nuanced understanding of the aging process. This new outlook will allow us to move forward in a space where our knowledge, like our new conception of the brain, is never static.

Low perceived control as a risk factor for episodic memory: the mediational role of anxiety and task interference

Low perceived control is considered a risk factor for poor cognitive functioning, but the mechanisms are unclear. The goal of the present study was to analyze anxiety and task interference as sequential mediators of the association between control beliefs and episodic memory. Cognitive-specific control beliefs were assessed prior to the lab session. State anxiety was assessed in the lab, followed by a word list recall task. The frequency of intrusive thoughts during the memory task was reported by the participants as a measure of task interference after the completion of the cognitive testing. The results for 152 participants from the ages of 22 to 84 years supported the predicted three-path mediation model. Lower levels of control beliefs were associated with higher state anxiety, which in turn affected episodic memory performance by increasing the likelihood of task interference, with age, sex, and verbal abilities as covariates. The implications of the results for developing interventions to improve memory performance are considered.

Mild cognitive impairment is associated with selected functional markers: integrating concurrent, longitudinal, and stability effects

OBJECTIVE

We examined functional performance on multiple indicators for two cognitive status groups: (a) not impaired controls (NIC) and (b) mild cognitive impairment (MCI). We identified functional markers associated with differences, changes, and stability in cognitive status.

METHOD

In the Victoria Longitudinal Study (VLS) we examined cognitive status group effects in (a) cross-sectional functional performance, (b) longitudinal stability, (c) longitudinal functional performance change, and (d) functional marker prediction of later cognitive status. We assembled markers from five continuous clusters of MCI-related functional factors: biological vitality, activity lifestyle, psychosocial affect, subjective health, and global cognition. We used a cross-sectional sample and a two-wave longitudinal sample, stratified by age (mid-old, old-old) and cognitive status (MCI, NIC).

RESULTS

First, cross-sectional results showed that eight markers differentiated MCI and NIC adults, with the latter performing uniformly better. The groups differed on diastolic blood pressure, body mass index, positive and negative affect, MMSE, and the lifestyle indicators of self-maintenance, travel, and novel cognitive activities. Second, Wave 1 to Wave 2 stabilities in cognitive status classification were high. Third, several markers differentiated the stable (NIC-to-NIC, MCI-to-MCI) from the unstable (NIC-to-MCI, MCI-to-NIC) cognitive status groups. Fourth, five relevant markers for identifying older adults at risk for cognitive status changes were: diastolic blood pressure, self-maintenance activities, novel cognitive activities, positive affect, and global cognitive status.

CONCLUSION

Selected risk and protective factors differentiate persons classified with MCI from those not currently cognitively impaired, both cross-sectionally and longitudinally.

Falls-related self-efficacy is independently associated with quality-adjusted life years in older women

BACKGROUND

falls-related self-efficacy is associated with falls, falls-related injury and subsequent functional decline which may lead to poor health-related quality-of-life (HRQL). To our knowledge, no previous studies have examined the independent contribution of falls-related self-efficacy to HRQL. Our primary objective was to determine whether falls-related self-efficacy is independently associated HRQL, measured by quality-adjusted life years (QALYs), in older women after accounting for known covariates.

METHOD

we conducted a secondary analysis of 135 community-dwelling older women aged 65-75 years who participated in a 12-month randomised controlled trial of resistance training. We assessed falls-related self-efficacy using the Activities-specific Balance Confidence Scale and QALYs calculated from the EuroQol EQ-5D (EQ-5D).

RESULTS

our multivariate linear regression model demonstrated that falls-related self-efficacy as assessed using the Activities-specific Balance Confidence Scale was independently associated with QALYs after accounting for age, group, education, functional co-morbidity index, general mobility, global cognition and physiological falls risk. The final model explained 52% of the variation in QALYs. The ABC Scale accounted for 5% of the total variance in the final model.

CONCLUSIONS

although falls-related self-efficacy was independently associated with QALYs after controlling for a number of known variables, there may well be other factors not investigated, such as risk taking behaviour and psychological measures, which could account for some of the association.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT00426881.

Early-stage memory loss support groups: outcomes from a randomized controlled clinical trial

OBJECTIVES

This article describes results of a randomized controlled trial comparing a time-limited early-stage memory loss (ESML) support group program conducted by a local Alzheimer's Association chapter to a wait-list (WL) control condition.

METHODS

One hundred and forty-two dyads were randomized in blocks to ESML (n = 96) or WL (n = 46). Mean age of participants was 74.9 years, and mean Mini-Mental State Examination was 23.4. The primary outcome was participant's quality of life; secondary outcomes included mood, family communication, and perceived stress.

RESULTS

On the intent-to-treat (ITT) pre-post analysis, significant differences were seen in participant quality of life (p < .001), depression (p < .01), and family communication (p < .05). Within the care partner groups, there was no significant difference between ESML and WL in the ITT analysis. A post hoc exploratory examination of changes that were associated with improved quality of life in ESML participants revealed significant reductions of depressive symptoms and behavior problems (p < .05), improved family communication (p < .05), self-efficacy (p < .01), Medical Outcomes Study short form (SF-36) role-emotional (p < .05), SF-36 social functioning (p < .05), and SF-36 mental health components (p < .01) in improvers.

DISCUSSION

These results support the efficacy of ESML support groups for individuals with dementia.

Preliminary evidence for subdimensions of geriatric frailty: the MacArthur study of successful aging

OBJECTIVES

To identify frailty subdimensions.

DESIGN

Longitudinal cohort (MacArthur Study).

SETTING

Three U.S. urban centers.

PARTICIPANTS

One thousand one hundred eighteen high-functioning subjects aged 70 to 79 in 1988.

MEASUREMENTS

Participants with three or more of five Cardiovascular Health Study (CHS) frailty criteria (weight loss, weak grip, exhaustion, slow gait, and low physical activity) in 1991 were classified as having the CHS frailty phenotype. To identify frailty subdimensions, factor analysis was conducted using the CHS variables and an expanded set including the CHS variables, cognitive impairment, interleukin-6 (IL-6), C-reactive protein (CRP), subjective weakness, and anorexia. Participants with four or more of 10 criteria were classified as having an expanded frailty phenotype. Predictive validity of each identified frailty subdimension was assessed using regression models for 4-year disability and 9-year mortality.

RESULTS

Two subdimensions of the CHS phenotype and four subdimensions of the expanded frailty phenotype were identified. Cognitive function was consistently part of a subdimension including slower gait, weaker grip, and lower physical activity. The CHS subdimension of slower gait, weaker grip, and lower physical activity predicted disability (adjusted odds ratio (AOR)=1.7, 95% confidence interval (CI)=1.3-2.2) and mortality (AOR=1.5, 95% CI=1.3-1.8). Subdimensions of the expanded model with predictive validity were higher IL-6 and CRP (AOR=1.2 for mortality); slower gait, weaker grip, lower physical activity, and lower cognitive function (AOR=1.8 for disability; AOR=1.5 for mortality), and anorexia and weight loss (AOR=1.2 for disability).

CONCLUSION

This study provides preliminary empirical support for subdimensions of geriatric frailty, suggesting that pathways to frailty differ and that subdimension-adapted care might enhance care of frail seniors.

Item response theory facilitated cocalibrating cognitive tests and reduced bias in estimated rates of decline

OBJECTIVE

To cocalibrate the Mini-Mental State Examination, the Modified Mini-Mental State, the Cognitive Abilities Screening Instrument, and the Community Screening Instrument for Dementia using item response theory (IRT) to compare screening cut points used to identify cases of dementia from different studies, to compare measurement properties of the tests, and to explore the implications of these measurement properties on longitudinal studies of cognitive functioning over time.

STUDY DESIGN AND SETTING

We used cross-sectional data from three large (n>1000) community-based studies of cognitive functioning in the elderly. We used IRT to cocalibrate the scales and performed simulations of longitudinal studies.

RESULTS

Screening cut points varied quite widely across studies. The four tests have curvilinear scaling and varied levels of measurement precision, with more measurement error at higher levels of cognitive functioning. In longitudinal simulations, IRT scores always performed better than standard scoring, whereas a strategy to account for varying measurement precision had mixed results.

CONCLUSION

Cocalibration allows direct comparison of cognitive functioning in studies using any of these four tests. Standard scoring appears to be a poor choice for analysis of longitudinal cognitive testing data. More research is needed into the implications of varying levels of measurement precision.

Self-efficacy effects on neuroelectric and behavioral indices of action monitoring in older adults

The relationships between self-efficacy (SE), i.e., beliefs in personal capabilities, and behavioral and neuroelectric (i.e., ERN, Pe) indices of action monitoring were investigated in 40 older adults (13 male) during the completion of a flanker paradigm performed under task conditions emphasizing either accuracy or speed. SE relative to task performance during both conditions was assessed prior to each cognitive task. Results indicated that high-SE older adults exhibited larger ERN and Pe amplitudes compared to low-SE older adults under the accuracy instruction condition. Additionally, a moderating effect of SE on the relationship between ERN and post-error response accuracy was revealed in the accuracy condition, with greater ERN amplitude associated with greater post-error accuracy in the high-SE group. No significant relationships were evident between ERN and post-error accuracy in the low-SE group. Further, no significant relationships involving SE were observed in the speed condition. The findings suggest that SE may be related to neuroelectric and behavioral indices of action monitoring in older adults when task demands require greater attention to action monitoring processes.

Lay perceptions of successful ageing: findings from a national survey of middle aged and older adults in Britain

The main aim of the research presented here was to identify perceptions of successful ageing among people in middle and older age groups. The method was a British population survey of 854 community-dwelling men and women aged 50 or more. Just over three-quarters of respondents rated themselves as ageing successfully ("very well" or "well"). Respondents' definitions of successful ageing, and the reasons given for their self-ratings, based on open-ended questioning, illustrated the multidimensionality of the concept. Definitions varied with respondents' characteristics. Self-rated health status and quality of life consistently retained significance in the multivariate models of predictors of self-rated successful ageing, while self-rated quality of life made the greatest contribution to the models. Reporting a longstanding, limiting illness was not significant. The overall models explained about a third of the variation in self-rated successful aging. Lay definitions of successful ageing were multidimensional. A biomedical perspective of successful ageing therefore needs balancing with a psycho-social perspective, and vice versa. This is particularly relevant for biomedical approaches which have largely ignored the rich tradition of social and psychological research on this topic. Self-rated successful ageing should be included in measuring instruments to enhance social relevance. This research, with the use of open-ended questioning, makes a novel methodological contribution to the literature, is unique in questioning middle aged as well as older people, and provides a British perspective on a largely US and German topic.

Memory self-efficacy and memory performance among black and white elders

BACKGROUND

The ability to differentiate between normal functioning and pathologic changes in cognitive aging will be enhanced by descriptive studies providing data from diverse samples of older adults.

METHODS

In this study, demographics, depression, health, memory self-efficacy, and metamemory were studied in relation to the memory performance of Black and White American older adults. Community-living adults participated in face-to-face interviews in their apartments or homes. Trained registered nurse interviewers administered all structured questionnaires (subjective) and performance tests (objective), including the Rivermead Behavioural Memory Test. Descriptive statistics, independent sample t-tests, Pearson correlations, and hierarchical regression were used in the analyses.

RESULTS

The sample consisted of 89 Black and 83 White adults (mean age, 76.52 years), and their Mini-Mental State Examination scores were in the nonimpaired range. The memory self-efficacy scores of the entire sample were low (M = 31.95 +/- 18.20). The Black elders scored lower on memory self-efficacy and memory performance. Memory self-efficacy predicted memory performance in the White group (r [83] =.41; p < or =.05), but the correlation for the Black group was nonsignificant (r [89] =.16). However, when the entire sample was combined for the regression analyses, the relation was significant (r [173] =.30; p < or =.05). Age, education, and memory self-efficacy accounted for 13% of the variance in memory performance.

CONCLUSIONS

Objective and subjective memory scores were decreased, and both measures provided insight into the participants' everyday memory function. The sample had low confidence in their memory ability, and this negatively influenced their everyday memory performance. The recruitment of minority elders into cognitive aging studies will continue to challenge researchers.

African American church participation and health care practices

BACKGROUND

While religious involvement is associated with improvements in health, little is known about the relationship between church participation and health care practices.

OBJECTIVES

To determine 1) the prevalence of church participation; 2) whether church participation influences positive health care practices; and 3) whether gender, age, insurance status, and levels of comorbidity modified these relationships.

DESIGN

A cross-sectional analysis using survey data from 2196 residents of a low-income, African-American neighborhood.

MEASUREMENTS

Our independent variable measured the frequency of church attendance. Dependent variables were: 1) Pap smear; 2) mammogram; and 3) dental visit-all taking place within 2 years; 4) blood pressure measurement within 1 year, 5) having a regular source of care, and 6) no perceived delays in care in the previous year. We controlled for socioeconomic factors and the number of comorbid conditions and also tested for interactions.

RESULTS

Thirty-seven percent of community members went to church at least monthly. Church attendance was associated with increased likelihood of positive health care practices by 20% to 80%. In multivariate analyses, church attendance was related to dental visits (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.3 to 1.9) and blood pressure measurements (OR, 1.6; 95% CI, 1.2 to 2.1). Insurance status and number of comorbid conditions modified the relationship between church attendance and Pap smear, with increased practices noted for the uninsured (OR, 2.3; 95% CI, 1.2 to 4.1) and for women with 2 or more comorbid conditions (OR, 1.9; 95% CI, 1.1 to 3.5).

CONCLUSION

Church attendance is an important correlate of positive health care practices, especially for the most vulnerable subgroups, the uninsured and chronically ill. Community- and faith-based organizations present additional opportunities to improve the health of low-income and minority populations.

Memory Self-Efficacy and Memory Performance in Older Males

The study reported here was a secondary analysis of data on 157 males from a larger study of predictors of memory performance in community-dwelling elders. The males' average age was 76 years, with 13 years of education and a Mini-Mental State Exam score of 26. Measures included depression, memory performance, metamemory, and memory self-efficacy. An unusual finding was the multimodal distribution of memory self-efficacy strength scores. Using a median split, the sample was divided into low and high memory self-efficacy groups. The high efficacy group were significantly younger, had larger scores on capacity (+ = high capacity) and change (+ = greater stability). These findings provide new evidence that the memory self-efficacy of aging males influences their perceptions of cognitive performance related to memory.