Developing a tool for measuring the decision-making competence of older adults

Factors Associated With Healthcare and Financial Decision Making Among Older Black Adults Without Dementia

OBJECTIVES

The study aims to identify factors associated with health care and financial decision-making among older Black adults without dementia.

METHODS

Participants (N = 326) underwent assessments of decision-making and completed measurements of factors from four categories: cognitive, contextual, psychosocial, and personality. We performed separate linear regression models to examine the association between each factor and decision-making and created a fully adjusted model.

RESULTS

Higher global cognition (estimate = 1.92, SE = 0.21, p < .0001) was associated with better decision-making. Contextual factors including higher current annual income (estimate = 0.23, SE = 0.05, p < .0001), higher childhood socioeconomic status (estimate = 0.48, SE = 0.18, p = .006), higher health and financial literacy (estimate = 0.08, SE = 0.01, p < .0001), and lower financial stress (estimate = -0.19, SE = 0.07, p = .01) were associated with better decision-making. More psychological well-being (estimate = 0.07, SE = 0.22, p = .001), a psychosocial factor, and less neuroticism (estimate = -0.06, SE = 0.02, p = .002), a personality factor, were associated with better decision-making. In the fully adjusted model, two factors, higher global cognition and higher literacy (health and financial), remained associated with better decision-making.

CONCLUSIONS

Cognitive and contextual factors serve as drivers of decision-making among older Black adults.

CLINICAL IMPLICATIONS

Clinicians may implement strategies to bolster cognition and improve health and financial literacy to facilitate optimal decision-making among older Black adults.

Measures of decision-making ability and functional outcomes in older adults: results from a scoping review in the ARMCADA study

Background

Though often not routinely assessed in older adults, declines in decision-making (DM) abilities are often observed in aging and may lead to adverse outcomes in multiple aspects of daily functioning. The Advancing Reliable Measurement in Cognitive Aging and Decision-making Ability (ARMCADA) research initiative seeks to address these issues. This scoping review investigates the current published literature on existing DM measures in aging samples, with emphasis on the domain of functional outcomes, defined as skills or behaviors related to one's ability to live independently.

Methods

We identified studies published between 2018-2023 using key words related to DM abilities and functional outcomes in aging populations through multiple databases. Titles and abstracts were first reviewed by two reviewers, full texts were then screened, and data were extracted from included articles.

Results

The scoping review identified 16,278 articles across domains with adults aged 45 and older. After screening and extraction, 705 total articles were included; 301 were related to functional outcomes and, from these, 231 distinct measures were identified. Mode of administration of most measures were self-administered with supervision, followed by examiner-administered, and most were conducted with clinical samples (e.g., MCI/AD, chronic health conditions, and Parkinson's disease, or clinical samples and a control group).

Discussion

The goal of the current scoping review is to provide a comprehensive examination of the current DM measures in older adults; this article focuses on the domain of functional outcomes. This scoping review guides a project to create and validate measures that can efficiently assess DM abilities in older adults across the cognitive aging spectrum.

A scoping review of financial decision-making measures in midlife and beyond: results from the advancing reliable measurement in cognitive aging and decision-making ability (ARMCADA) study

Background

Cognitive decline in older adults affects key functions such as memory, concentration, planning, reasoning, and decision-making (DM). This decline in cognitive abilities compromises basic DM skills, with growing evidence that DM can decline before noticeable impairment or an official cognitive impairment diagnosis, adversely impacting quality of life and leading to negative outcomes in financial management and daily activities.

Objective

This scoping review aims to identify and evaluate existing measures of financial decision-making (FDM) abilities in clinical and community-dwelling populations aged 45 and older.

Methods

We conducted a systematic search in EMBASE (Elsevier), PsycINFO, PubMed, MEDLINE, PsychARTICLES, and Web of Science for studies published between January 2018 and November 2023. The multi-domain scoping review yielded 16,278 records. Title and abstract, as well as full-text screenings, respectively, were completed by two reviewers and conflicts were resolved by PhD level researchers. We then extracted data from the full-text articles.

Results

The scoping review yielded 154 articles with 96 unique measures. The most frequently used measures were variations of the Iowa Gambling Task (IGT), The Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS), the Decision-making Competence Assessment Tool (DMCAT), the temporal discounting paradigm, and the Short Form version of the Financial Capacity Instrument (FCI-SF). Commonly used measures of financial decision-making (FDM) often assessed specific aspects, such as risk-taking behavior and basic financial knowledge.

Discussion

Many of the FDM measures found in this scoping review were developed for use in laboratory settings, and less is known about potential for clinical use adaptation. Future work addressing this measurement gap could significantly enhance early interventions to ameliorate or mitigate decline, thereby improving financial management and quality of life for at-risk individuals.

Applying process dissociation to self-sacrificial moral dilemmas: Extending the dual-process model

There is considerable evidence linking cognitive reflection with utilitarian judgments in dilemmas that involve sacrificing someone else for the greater good. However, the evidence is mixed on the question of whether cognitive reflection is associated with utilitarian judgments in self-sacrificial dilemmas. We employed process dissociation to extract a self-sacrificial utilitarian (SU) parameter, an altruism (A) parameter, an other-sacrificial (OU) utilitarian parameter, and a deontology (D) parameter. In Study 1, the cognitive reflection test (CRT) positively correlated with both SU and OU (replicated in Studies 2 and 4, pre-registered). In Study 2, we found that instructing participants to rely on reason increased SU and OU (replicated in Study 4, pre-registered). In Study 3, we found that SU and OU positively correlated with giving in the single-game version of the public goods game (replicated in Study 4, pre-registered), which provides behavioral validation that they are genuine moral tendencies. Together, these studies constitute strong cumulative evidence that SU and OU are both valid measures that are associated with reliance on cognitive reflection.

Sex Differences in Cognitive Reflection: A Meta-Analysis

The current study presents a meta-analytic review of the differences between men and women in cognitive reflection (CR). The study also explores whether the type of CR test (i.e., numerical tests and verbal tests) moderates the relationship between CR and sex. The results showed that men score higher than women on CR, although the magnitude of these differences was small. We also found out that the type of CR test moderates the sex differences in CR, especially in the numerical tests. In addition, the results showed that the length of numerical tests (i.e., number of items) does not affect the differences between men and women in CR. Finally, the implications of these results are discussed, and future research is suggested.

Measures of Shared Decision Making for People With Mental Disorders and Limited Decisional Capacity: A Systematic Review

OBJECTIVE

Shared decision making (SDM) is a health communication model to improve treatment decision making and is underused for people with mental health conditions and limited, impaired, or fluctuating decisional capacity. SDM measures are essential to enhancing the adoption and implementation of SDM practices, yet no tools or research findings exist that explicitly focus on measuring SDM with such patients. The aim of this review was to identify instruments that measure SDM involving individuals with mental health conditions and limited decisional capacity, their family members, and their health and social care providers.

METHODS

A systematic review was performed by searching the PubMed, Embase, Web of Science, and PsycInfo databases. The authors included peer-reviewed, quantitative articles published in English during 2009-2022 that focused on adults (≥18 years old). All authors performed the screening independently.

RESULTS

A total of 7,956 records were identified, six of which met the inclusion criteria for full-text review and five of which were analyzed (one full-text article was not available). No instruments were identified that measured forms of SDM involving patients with mental health conditions and limited, impaired, or fluctuating decisional capacity.

CONCLUSIONS

Measurement instruments to address and assess SDM in health care-related communication processes involving individuals with a mental health condition and limited decisional capacity are needed.

Measures of ability to learn, grow and make decisions among older persons: a systematic review of measurement properties

OBJECTIVE

this study aims to conduct a systematic review on available instruments for measuring older persons' ability to learn, grow and make decisions and to critically review the measurement properties of the identified instruments.

METHODS

we searched six electronic databases, which include PubMed, Embase, PsycINFO, SciELO, ERIC and AgeLine, between January 2000 and April 2022. Reference lists of the included papers were also manually searched. The COSMIN (CONsensus-based Standards for the selection of health Measurement Instruments) guidelines were used to evaluate the measurement properties and the quality of evidence for each instrument.

RESULTS

13 instruments from 29 studies were included for evaluation of their measurement properties. Of the 13 reviewed, 6 were on the ability to learn, 3 were on the ability to grow and 4 were on the ability to make decisions. The review found no single instrument that measured all three constructs in unidimensional or multidimensional scales. Many of the instruments were found to have sufficient overall rating on content validity, structural validity, internal consistency and cross-cultural validity. The quality of evidence was rated as low due to a limited number of related validation studies.

CONCLUSION

a few existing instruments to assess the ability to learn, grow and make decisions of older people can be identified in the literature. Further research is needed in validating them against functional, real-world outcomes.

Change in Decision-Making Analysis and Preferences in Old Age

OBJECTIVES

To test the hypotheses that decision making ability declines in old age and that a higher level of cognitive reserve is associated with a reduced rate of decline.

METHODS

As part of an ongoing cohort study, 982 older adults without dementia at study enrollment completed measures of purpose in life and cognitive activity which were used as markers of cognitive reserve. At annual intervals thereafter, they completed 6 tests of decision making.

RESULTS

In a factor analysis of baseline decision making scores, 3 measures (financial/health literacy, financial/health decision making, scam susceptibility) loaded on an "analytic" factor and 3 (temporal discounting small stakes, temporal discounting large stakes, risk aversion) loaded on a "preferences" (for temporal discounting and avoiding risk) factor. During a mean of 4.7 years of follow-up (standard deviation = 2.9), analytic factor scores decreased (mean = 0.042-unit per year, standard error [SE] = 0.006, p < .001) and preferences factor scores increased (mean = 0.021-unit per year, SE = 0.006, p < .001), with a correlation of 0.13 (p < .001) between rates of change. Evidence of an association between cognitive reserve and decision making was mixed with purpose in life related to change in analytic decision making, whereas past (but not current) cognitive activity was related to change in decision making preferences.

DISCUSSION

Decision making analysis and preferences change over time in late life. Change over time in decision making components is relatively independent and differentially related to age and cognitive reserve.

Age differences in social decision-making preferences and perceived ability

Decision-making often occurs in a social context but is typically studied as if it were an individualistic process. In the present study, we investigated the relationships between age, perceived decision-making ability, and self-rated health with preferences for social decision-making, or making decisions with others. Adults (N = 1,075; ages 18-93) from an U.S. online national panel reported their preferences for social decision-making, perceived changes in decision-making ability over time, perceived decision-making ability compared to age peers, and self-rated health. We report on three key findings. First, older age was associated with being less likely to prefer social decision-making. Second, older age was associated with perceiving one's ability to have changed for the worse over time. Third, social decision-making preferences were associated both with older age and perceiving one's ability to make decisions was worse than age peers. Additionally, there was a significant cubic function of age, such that older age was associated with lesser preferences for social decision-making until around age 50. Preferences then increased slightly with age until about age 60, after which older age was once again associated with lesser preferences for social decision-making. Together, our findings suggest that compensating for perceived lack of competence compared to other people one's age may motivate preferences for social decision-making across the life span. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Decision Making and Blood Sugar Indicators in Older African American Adults

Objectives: Decision making is a modifiable behavior associated with health outcomes. We investigated the association of decision making with blood sugar indicators in older community-dwelling African American adults. Methods: Participants were 328 older African American adults from community-based studies (mean age = 78). Decision making was assessed using a performance-based measure (range: 0-12). Blood sugar indicators were non-fasting hemoglobin A1c and blood glucose. Using regression, we assessed the relationship between decision making and each blood sugar indicator, controlling for demographics. We additionally examined if an association varied by known diabetes diagnosis. Results: Lower decision making was associated with higher HbA1c (b: -0.05, p-value: .03), but not blood glucose. In an interaction analysis, the association of lower decision making with higher levels of HbA1c was present only among individuals with known diabetes (b (with diabetes): -0.13, p-value: <.01). Discussion: Decision making may contribute to glycemic control in African American older adults with diabetes.

Psychological Well-being Relates to Healthcare and Financial Decision Making in a Study of Predominantly White Older Adults

The purpose of this study was to test the hypotheses that psychological well-being is associated with healthcare and financial decision making in older adults and that this association varies by the level of cognitive function. Participants were 1082 older adults (97% non-Latino White; 76% women; mean age = 81.04 years; SD = 7.53) without dementia (median MMSE score = 29.00, IQR = 27.86-30.00). In a regression model adjusted for age, gender, and years of education, higher levels of psychological well-being were associated with better decision making (estimate = 0.39, standard error [SE] = 0.11, p < .001), as was better cognitive function (estimate = 2.37, SE = 0.14, p < .0001). In an additional model, an interaction of psychological well-being and cognitive function was significant (estimate = -0.68, SE = 0.20, p < .001), such that higher levels of psychological well-being were most beneficial for decision making among participants with lower levels of cognitive function. Higher levels of psychological well-being may help sustain decision making among older persons, particularly those with lower levels of cognitive function.

Actively Open-Minded Thinking and Its Measurement

Actively open-minded thinking (AOT) is measured by items that tap the willingness to consider alternative opinions, sensitivity to evidence contradictory to current beliefs, the willingness to postpone closure, and reflective thought. AOT scales are strong predictors of performance on heuristics and biases tasks and of the avoidance of reasoning traps such as superstitious thinking and belief in conspiracy theories. Nevertheless, AOT is most commonly measured with questionnaires rather than performance indicators. Questionnaire contamination becomes even more of a danger as the AOT concept is expanded into new areas such as the study of fake news, misinformation, ideology, and civic attitudes. We review our 25-year history of studying the AOT concept and developing our own AOT scale. We present a 13-item scale that both is brief and accommodates many previous criticisms and refinements. We include a discussion of why AOT scales are such good predictors of performance on heuristics and biases tasks. We conclude that it is because such scales tap important processes of cognitive decoupling and decontextualization that modernity increasingly requires. We conclude by discussing the paradox that although AOT scales are potent predictors of performance on most rational thinking tasks, they do not predict the avoidance of myside thinking, even though it is virtually the quintessence of the AOT concept.

Cognitive reflection test: The effects of the items sequence on scores and response time

This paper aims to expand the literature on the determinants of the Cognitive Reflection Test scores, exploring the effects that the items sequence has on (1) Cognitive Reflection Test scores, (2) response time, (3) the relationship between Cognitive Reflection Test scores and response time, and (4) Cognitive Reflection scores, response time, and the relationship between both variables on men and women. The current study also explored the sex differences on Cognitive Reflection Test and response time according to items sequence. The results showed that manipulating the items sequence, the performance on the Cognitive Reflection Test improved significantly, but the response time were not significantly affected, although the results suggest that first items of the sequence could be working as training items. A positive relationship between Cognitive Reflection Test scores and response time was also found, except when the scores were maximized. Finally, some differences between men and women on the results were also found. The implications of these findings are discussed.

Does cognitive reflection predict attentional control in visual tasks?

The cognitive reflection test (CRT) measures the ability to suppress an intuitive, but incorrect, answer that easily comes to mind. The relationship between the CRT and different cognitive biases has been widely studied. However, whether cognitive reflection is related to attentional control is less well studied. The aim of this paper is to investigate whether the inhibitory component of the CRT, measured by the number of non-intuitive answers of the CRT (Inhibitory Control Score), is related to the control of visual attention in visual tasks that involve overriding a bias in what to attend: an anti-saccade task and a visual search task. To test this possibility, we analyzed whether the CRT-Inhibitory Control Score (CRT-ICS) predicted attention allocation in each task. We compared the relationship between the CRT-ICS to two other potential predictors of attentional control: numeracy and visual working memory (VWM). Participants who scored lower on the CRT-ICS made more errors in the "look-away" trials in the anti-saccade task. Participants who scored higher on the CRT-ICS looked more often towards more informative color subsets in the visual search task. However, when controlling for numeracy and visual working memory, CRT-ICS scores were only related to the control of visual attention in the anti-saccade task.

Effects of psychological stress and cortisol on decision making and modulating factors: a systematic review

Evidence suggests that psychological stress has effects on decision making, but the results are inconsistent, and the influence of cortisol and other modulating factors remains unclear. Based on the PRISMA criteria, 18 studies carried out between 2015 and 2020 that examined the effects of psychological stress on decision making and measured cortisol levels were selected. Eight studies employed uncertainty-based economic tasks, five studies used decision-making tasks in hypothetical situations that can be encountered in real life or in a specific setting, and five studies employed prosocial decision tasks. Seventeen studies assessed acute stress, and two assessed chronic stress; eight evaluated the influence of sex. Most of the studies that explored the association between stress and decision making using uncertainty-based economic tasks found statistically significant differences as a function of stress exposure and the cortisol response to stress, whereas most of the studies that employed non-economic decision-making tasks in hypothetical situations did not find statistically significant differences. When prosocial decision making was evaluated, more altruistic decisions were found after acute stress, and these decisions were positively associated with cortisol. Half of the studies that assessed the role of sex observed a greater impact on decision making after stress in women. Results suggest that it is important to consider modulating factors - the type of decision-making task, the cortisol response to stress, the characteristics of the psychological stressor, or the subject's sex - when trying to understand psychosocial stress phenomena.

Purpose in Life and Cognition Interact to Impact Healthcare and Financial Decision Making in Old Age

Objectives: Little is known about the contribution of positive psychological factors, such as purpose in life, to healthcare and financial decision making in aging. Here, we examined the relationship between purpose and decision making and tested the hypothesis that purpose benefits decision making, particularly when cognition is limited. Methods: Participants were 1081 community-based older adults without dementia. Healthcare and financial decision making was measured via a 12-item performance-based instrument. Purpose was measured via a 10-item scale. Results: In a linear regression model adjusted for age, sex, and education, higher global cognition was associated with better performance on the decision making measure, as expected. Purpose was not directly related to decision making. However, the interaction of purpose with cognition was significant, such that greater purpose was associated with better decision making among persons with lower cognition. Discussion: Purpose in life may promote better decision making among older adults with lower cognition.

Metamemory and financial decision making in older adults without dementia

OBJECTIVE

Metamemory refers to self-awareness of one's memory function, and the extent to which metamemory deficit impacts financial decision making is unknown. This study tested the hypothesis that metamemory deficit is associated with poor financial decision making among older adults without dementia.

METHOD

Data came from 502 community-dwelling older adults participating in the Rush Memory and Aging Project. Metamemory deficit was determined empirically by contrasting subjective memory ratings with performance on objective memory tests. Larger discrepancy of self-rated memory scores from performance-based testing scores indicates greater deficit. Financial decision making was assessed using a performance-based measure. Multivariable regression analyses examined the association of metamemory deficit with financial decision making.

RESULTS

Participants had a mean age of 83 years and a mean education of 15 years. Approximately 75% were female. On average, participants answered two thirds of the financial decision making questions correctly. Female sex, older age, lower education, and lower financial literacy were correlated with poorer financial decision making. In an ordinal logistic regression model controlled for demographics and financial literacy, an 1SD increase in metamemory deficit reduced the odds of having better financial decision making by approximately 15%, OR: 0.844, 95% CI [0.719-0.991]. This association persisted after further controlling for family income, early life socioeconomic status, depressive symptoms and executive function.

CONCLUSIONS

Metamemory deficit in older adults is a potential indicator of impaired financial decision making. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Testing the Foreign Language Effect on Cognitive Reflection in Older Adults

An increasing number of people around the world communicate in more than one language, resulting in them having to make decisions in a foreign language on a daily basis. Interestingly, a burgeoning body of literature suggests that people’s decision-making is affected by whether they are reasoning in their native language (NL) or their foreign language (FL). According to the foreign language effect (FLe), people are less susceptible to bias in many decision-making tasks and more likely to display utilitarian cost-benefit analysis in moral decision-making when reasoning in a FL. While these differences have often been attributed to a reduced emotionality in the FL, an emerging body of literature has started to test the extent to which these could be attributable to increased deliberation in the FL. The present study tests whether increased deliberation leads to a FLe on cognitive reflection in a population of older adults (M_age = 65.1), from the successful aging project in Umeå, Sweden. We explored whether performance on a 6-item version of the cognitive reflection test (CRT) adapted to Swedish would differ between participants for whom Swedish was their NL and those for whom Swedish was their FL. The CRT is a task designed to elicit an incorrect, intuitive answer. In order to override the intuitive answer, one requires engaging in deliberative, analytical thinking to determine the correct answer. Therefore, we hypothesized that if thinking in a FL increases deliberation, then those performing the task in their FL would exhibit higher accuracy rates than those performing in their NL. Our results showed that age and level of education predicted performance on the task but performance on the CRT did not differ between the NL and the FL groups. In addition, in the FL group, proficiency in the FL was not related to performance in the CRT. Our results, therefore, do not provide evidence that thinking in a FL increases deliberation in a group of older adults performing a logical reasoning task that is not typically associated with an emotional connotation.

Adverse Impacts of Declining Financial and Health Literacy in Old Age

OBJECTIVES

Inadequate financial and health literacy presents a formidable public health and economic challenge in old age. This study investigated declining financial and health literacy in relation to decision making performance, scam susceptibility and psychological wellbeing.

DESIGN

Longitudinal study.

SETTING

A community-based cohort in Northeastern Illinois, USA.

PARTICIPANTS

One thousand fourty-six older adults who were free of dementia at baseline and underwent annual clinical and literacy assessments.

MEASUREMENTS

Financial and health literacy, decision making, scam susceptibility, and psychological wellbeing were assessed using validated instruments. Linear mixed effects models estimated person-specific rates of change in financial and health literacy, and multivariable regression analyses examined the associations of declining literacy with subsequent levels of decision making, scam susceptibility, and psychological wellbeing.

RESULTS

The mean age was 81 years and 76% were female. Over up to 10 years of annual follow-ups, the average financial and health literacy score dropped 1 percentage point a year. Substantial variability in decline was observed between participants. Faster decline in financial and health literacy was associated with poorer decision making, higher scam susceptibility, and lower psychological wellbeing. Notably, these associations were above and beyond the baseline literacy level and persisted even after controlling for cognition.

CONCLUSIONS

Most community-dwelling older adults experience decline in financial and health literacy over time, but decline is not inevitable. Declining literacy is related to poorer decision making, greater scam susceptibility and lower wellbeing. These findings suggest that efforts to mitigate declining financial and health literacy may promote independence and wellbeing in old age.

Decision making in Parkinson's disease: An analysis of the studies using the Iowa Gambling Task

In Parkinson's disease (PD) impairments in decision making can occur, in particular because of the tendency toward risky and rewarding options. The Iowa Gambling Task has been widely used to investigate decision processes involving these options. The task assesses the ability to manage risk and to learn from feedback. The present paper aims at critically examining those studies in which this task has been administered to PD patients, in order to understand possible anomalies in patients' decision processes and which variables are responsible for that. A meta‐analysis has been conducted as well. Features of the task, sociodemographic and clinical aspects (including daily drugs intake), cognitive conditions and emotional disorders of the patients have been taken into account. Neural correlates of decision‐making competences were considered. It emerged that PD patients show a trend of preference toward risky choices, probably due to an impairment in anticipating the unrewarding consequences or to an insensitiveness to punishment. The possible role played by dopamine medications in decision making under uncertain conditions, affecting basal ganglia and structures involved in the limbic loop, was discussed. Attention has been focused on some aspects that need to be investigated in further research, in order to delve into this issue and promote patients' quality of life.

Association of Amyloid-β Pathology with Decision Making and Scam Susceptibility

BACKGROUND

Recent findings suggest that poor decision making and increased scam susceptibility are harbingers of Alzheimer's disease (AD) dementia and may be among the earliest behavioral manifestations of pathologic cognitive aging. However, the degree to which poor decision making and scam susceptibility reflect accumulating Alzheimer's disease (AD) pathology remains unclear.

OBJECTIVE

To investigate the associations of AD pathology with decision making and scam susceptibility in older adults without dementia.

METHODS

Data came from 198 deceased participants without clinical dementia (mean age at death = 90 years; 69%women) from two ongoing studies of aging. All underwent annual clinical evaluations, completed assessments of healthcare and financial decision making and scam susceptibility, and brain donation. Neuropathologic evaluations quantified pathologic hallmarks of AD, amyloid-β and tau-tangles, Lewy body pathology, and TDP-43 proteinopathy.

RESULTS

In linear regression models adjusted for demographics, amyloid-β pathology was associated with lower decision making (estimate = -0.35; SE = 0.16, p = 0.03), particularly healthcare decision making (estimate = -0.20; SE = 0.09, p = 0.03), as well as greater scam susceptibility (estimate = 0.12; SE = 0.04, p = 0.003); tau-tangle pathology was not related. Further, TDP-43 pathology was associated with greater scam susceptibility (estimate = 0.10; SE = 0.04; p = 0.02).

CONCLUSION

Accumulating AD pathology, particularly amyloid-β, is associated with poor decision making and increased scam susceptibility among older persons without overt cognitive impairment. These findings provide compelling evidence that decision making and scam susceptibility are sensitive to the earliest pathological changes of AD.

Reasoning supports forgiving accidental harms

People experience a strong conflict while evaluating actors who unintentionally harmed someone-her innocent intention exonerating her, while the harmful outcome incriminating her. Different people solve this conflict differently, suggesting the presence of dispositional moderators of the way the conflict is processed. In the present research, we explore how reasoning ability and cognitive style relate to how people choose to resolve this conflict and judge accidental harms. We conducted three studies in which we utilized varied reasoning measures and populations. The results showed that individual differences in reasoning ability and cognitive style predicted severity of judgments in fictitious accidental harms scenarios, with better reasoners being less harsh in their judgments. Internal meta-analysis confirmed that this effect was robust only for accidental harms. We discuss the importance of individual differences in reasoning ability in the assessment of accidental harms.

Criterion Validity of Cognitive Reflection for Predicting Job Performance and Training Proficiency: A Meta-Analysis

This article presents a meta-analysis of the validity of cognitive reflection (CR) for predicting job performance and training proficiency. It also examines the incremental validity of CR over cognitive intelligence (CI) for predicting these two occupational criteria. CR proved to be an excellent predictor of job performance and training proficiency, and the magnitude of the true validity was very similar across the two criteria. Results also showed that the type of CR is not a moderator of CR validity. We also found that CR showed incremental variance over CI for the explanation of job performance, although the magnitude of the contribution is small. However, CR shows practically no incremental validity over CI validity in the explanation of training proficiency. Finally, we discuss the implications of these findings for the research and practice of personnel selection.

How well do people living with neurodegenerative diseases manage their finances? A meta-analysis and systematic review on the capacity to make financial decisions in people living with neurodegenerative diseases

Self and proxy reported questionnaires indicate that people living with a neurodegenerative disease (NDD) have more difficulties with financial decision-making (FDM) than healthy controls. Self-reports, however, rely on adequate insight into everyday functioning and might, therefore, be less reliable. The present study provides a comprehensive overview and meta-analysis of studies evaluating FDM in people living with an NDD. For this, the reliability of performance-based tests to consistently identify FDM difficulties in people living with an NDD compared to healthy controls is evaluated. Furthermore, the associations between FDM and disease severity, performances on standard measures of cognition and demographics are evaluated. All 47 included articles, consistently reported lower performances on performance-based FDM tests of people living with an NDD (including Alzheimer's disease, mild cognitive impairment, frontotemporal dementia, Parkinson's disease, multiple sclerosis or Huntington's disease) compared to healthy controls. The majority of studies, however, focused on Alzheimer's disease and mild cognitive impairment (k = 38). FDM performance appears to be related to cognitive decline, specifically in working memory, processing speed and numeracy.

Impact of Early Life Socioeconomic Status on Decision Making in Older Adults Without Dementia

OBJECTIVES

A growing body of evidence points to the negative impact of early life socioeconomic status (SES) on health and cognitive outcomes in later life. However, the effect of early life SES on decision making in old age is not well understood. This study investigated the association of early life SES with decision making in a large community-based cohort of older adults without dementia from the Rush Memory and Aging Project.

MATERIALS AND METHODS

Cross-sectional data from the Rush Alzheimer's Disease Center Memory and Aging Project was analyzed. Participants were 1044 community-dwelling older adults without dementia (M age = 81.15, SD = 7.49; 75.8% female; 5.4% non-White). Measures of financial and healthcare decision making and early life SES were collected, along with demographics, global cognition, and financial and health literacy.

RESULTS

Early life SES was positively associated with decision making (estimate = 0.218, p = 0.027), after adjustments for demographic covariates and global cognition, such that a one-unit increase in early life SES was equivalent to the effect of being four years younger in age as it pertains to decision making. A subsequent model demonstrated that the relationship was strongest in those with low literacy, and weakest for those with high literacy (estimate = -0.013, p = 0.029).

CONCLUSIONS

Findings from this study suggest that early life SES is associated with late life decision making and that improving literacy, a modifiable target for intervention, may buffer the negative impact of low early life SES on decision making in older adulthood.

Loneliness Interacts With Cognition in Relation to Healthcare and Financial Decision Making Among Community-Dwelling Older Adults

BACKGROUND AND OBJECTIVES

Cognition is a known determinant of healthcare and financial decision making in old age. Social vulnerabilities also might play a role in such decisions; however, the evidence for this is less clear. Here, we examined the association of loneliness with decision making and tested the hypothesis that loneliness is associated with decision making via its interaction with global cognition.

RESEARCH DESIGN AND METHODS

Participants were 1,121 nondemented older adults from the Rush Memory and Aging Project. Healthcare and financial decision making was assessed via a performance-based measure; loneliness was assessed via the De Jong Gierveld Loneliness Scale; and cognition was assessed via a 19-test neuropsychological battery.

RESULTS

In a regression model adjusted for age, sex, and education, global cognition was associated with decision making (B = 2.43, SE = 0.14, p < .001) but loneliness was not (B = -0.04, SE = 0.11, p = .72). However, in a model including the interaction of loneliness with global cognition, the interaction was significant (B = 0.44, SE = 0.20, p = .03), such that the detrimental effect of loneliness on decision making was stronger when cognition was low. In secondary analyses examining the interaction of loneliness with 5 specific cognitive domains, the interaction between loneliness and working memory with decision making was significant (B = 0.35, SE = 0.15, p = .02).

DISCUSSION AND IMPLICATIONS

Our results suggest that loneliness compromises healthcare and financial decision making among older adults with lower global cognition and, more specifically, lower working memory.

Exploring the risk-taking tendency among migrant workers in the COVID-19 pandemic: The role of ontological security

BACKGROUND

The COVID-19 pandemic has changed the social environment of most laborers around the world and has profoundly affected people's ontological security and behavior choices. Among them, the migrant workers are one of the groups most affected by the pandemic.

OBJECTIVE

This study explored the mechanism of the impact of the scarcity of ontological security caused by the pandemic on the risk-taking tendency of migrant workers in China through two studies.

METHODS

This study adopts two experimental method, with 514 participants in the first study and 357 participants in the second study.

RESULTS

The results show that the pandemic-induced scarcity perception of ontological security promotes their risk-taking tendency, and the migrant workers' cognitive reflection ability, sense of unfairness and expected benefits play a significant mediating role in this process. The scarcity perception of ontological security promotes migrant workers' risk-taking tendency by reducing the cognitive reflection ability, triggering the sense of unfairness and overstating expected benefits.

CONCLUSIONS

The conclusion of this study can help migrant workers, enterprises and government to avoid potential workplace and social bad behavior.

The Association of Late Life Cognitive Activity with Healthcare and Financial Decision-Making in Community-Dwelling, Nondemented Older Adults

OBJECTIVE

The purpose of this study was to test the hypothesis that late life cognitive activity is associated with decision-making in older adults and to examine whether this association varies by level of cognitive function.

DESIGN

This study employed a cross-sectional design.

SETTING

All data were collected in participants' community-based residences.

PARTICIPANTS

Participants were 1,084 older adults (mean age = 81.05 years, standard deviation = 7.53) without dementia (median Mini-Mental State Examination score = 29, interquartile range = 27.86-30.00).

MEASUREMENTS

Participants completed assessments of late life cognitive activity, cognitive function, and decision-making. We used linear regression models to examine the associations of late life cognitive activity and cognitive function with decision-making.

RESULTS

In a regression model adjusted for age, gender, and education, more frequent late life cognitive activity was associated with better decision-making, as was higher cognitive function. Furthermore, in an additional model that included the interaction of late life cognitive activity and cognitive function, the interaction was significant, such that late life cognitive activity was most strongly associated with decision-making among participants with lower levels of cognitive function.

CONCLUSION

Frequent engagement in late life cognitive activity may help maintain decision-making among older persons, particularly among those with lower levels of cognitive function.

Private Long-Term Care Insurance Decision: The Role of Income, Risk Propensity, Personality, and Life Experience

The rising aging population contributes to increased caregiver burden and a greater need for long-term care services, thereby posing stronger financial burden. The current study aimed to examine the effect of income, risk-taking propensity, personality traits, and life experience on the ownership of and intention to own private long-term care insurance (LTCI). Primary data were collected from 1373 registered nurses with a minimum of two years of full-time working experience. Multinomial logistic regression was used to examine the relationships between ownership of LTCI and personal discretionary income, risk propensity, openness to experience, and life experience. Personal discretionary income was a crucial positive indicator in predicting ownership of LTCI. Higher risk-taking propensity was found to be negatively related to both currently own and future intention to own private LTCI. Participants who currently live with elders and who agree to caregiving responsibilities with government-provided cash allowance showed future intention to purchase LTCI. Little evidence was found for an association between life experience and future intention to own LTCI. Income, risk-taking propensity, and personality traits differ in their impact on ownership of and future intention to own LTCI. Our results provide policy makers with a better understanding of the forces driving demand in the private LTCI market, as well as the accompanying implications for public LTCI.

RETRACTED: Beyond moral dilemmas: The role of reasoning in five categories of utilitarian judgment

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). The authors discovered from comments on their open data that Studies 1 and 2 of their manuscript suffered from a serious flaw. There was a mistake in the Python code they used, and the items (vignettes) were not properly randomized across conditions. In Study 1 (which investigated the effect of cognitive load on moral judgment), all participants in the Load condition received one set of items, whereas all participants in the No Load condition received a different set of items. This meant that they cannot determine whether the difference they observed between the Load and No Load conditions was due to the manipulation (Load vs. No Load) or to a simple difference between items. Given these problems, the authors cannot guarantee that the conclusions of their paper are valid. Because of this error, the authors have requested retraction of their manuscript.

“Quick and dirty”: Intuitive cognitive style predicts trust in Didier Raoult and his hydroxychloroquine-based treatment against COVID-19

In the context of the COVID-19 pandemic, French public opinion has been divided about Pr. Didier Raoult and his hydroxychloroquine-based treatment against COVID-19. In this paper, our aim is to contribute to the understanding of this polarization of public opinion by investigating the relationship between (analytic vs. intuitive) cognitive style and trust in Didier Raoult and his treatment. Through three studies (total N after exclusion = 950), we found that a more intuitive cognitive style predicted higher trust in Didier Raoult and his treatment. Moreover, we found that Trust in Raoult was positively associated with belief that truth is political, belief in conspiracy theories, belief in pseudo-medicines and pseudo-medical and conspiratorial beliefs regarding the COVID-19 pandemic. We also found a negative association with knowledge of scientific methods and regard for scientific method over personal experience. However, higher trust in Didier Raoult was not associated with self-reported compliance with official regulations concerning the COVID-19 pandemic.

Examining aging and numerosity using an integrated diffusion model

Two experiments are presented that use tasks common in research in numerical cognition with young adults and older adults as subjects. In these tasks, one or two arrays of dots are displayed, and subjects decide whether there are more or fewer dots of one kind than another. Results show that older adults, relative to young adults, tend to rely more on the perceptual feature, area, in making numerosity judgments when area is correlated with numerosity. Also, convex hull unexpectedly shows different effects depending on the task (being either correlated with numerosity or anticorrelated). Accuracy and response time (RT) data are interpreted with the integration of the diffusion decision model with models for the representation of numerosity. One model assumes that the representation of the difference depends on the difference between the numerosities and that standard deviations (SDs) increase linearly with numerosity, and the other model assumes a log representation with constant SDs. The representational models have coefficients that are applied to differences between two numerosities to produce drift rates and SDs in drift rates in the decision process. The two tasks produce qualitatively different patterns of RTs: One model fits results from one task, but the results are mixed for the other task. The effects of age on model parameters show a modest decrease in evidence driving the decision process, an increase in the duration of processes outside the decision process (nondecision time), and an increase in the amount of evidence needed to make a decision (boundary separation). (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A reflection on cognitive reflection – testing convergent/divergent validity of two measures of cognitive reflection

The aim of the study was to test convergent/discriminant validity of two measures of cognitive reflection, cognitive reflection test (CRT) and belief bias syllogisms (BBS) and to investigate whether their distinctive characteristic of luring participants into giving wrong intuitive responses explains their relationships with various abilities and disposition measures. Our results show that the same traits largely account for performance on both non-lure task, the Berlin Numeracy Test (BNT), and CRT and explain their correlations with other variables. These results also imply that the predictive validity of CRT for wide range of outcomes does not stem from lures. Regarding the BBS, we found that its correlations with other measures were substantially diminished once we accounted for the effects of BNT. This also implies that the lures are not the reason for the correlation between BBS and these measure. We conclude that the lures are not the reason why cognitive reflection tasks correlate with different outcomes. Our results call into question an original definition of CRT as a measure of ability or disposition to resist reporting first response that comes to mind, as well as the validity of results of studies showing “incremental validity” of CRT over numeracy.

Adapting Online Patient Decision Aids: Effects of Modality and Narration Style on Patients' Satisfaction, Information Recall and Informed Decision Making

Audiovisual and narrative information are often used in online decision aids. However, few studies have tested whether these strategies are more effective compared to other types of information. We tested the effect of these strategies on satisfaction with the information, recall and informed decision-making in a 2 (Modality: audiovisual vs. textual) x 2 (Narration style: narrative vs. factual) experimental design. Data was collected in an online experiment among 262 analogue cancer patients. Since most cancer patients are older people, we also assessed if the effectiveness of these strategies differs depending on the patient's age. Data was analyzed using Structural Equation Modeling. Findings showed audiovisual modality had a positive effect on satisfaction. Moreover, audiovisual modality improved recall, both directly and indirectly via satisfaction, which subsequently resulted in better-informed decision-making. Narratives resulted in more satisfaction, but not better recall or informed decision-making. These effects were found in patients of all ages.

Literacy Mediates Racial Differences in Financial and Healthcare Decision Making in Older Adults

BACKGROUND/OBJECTIVES

Decision making in financial and healthcare matters is of critical importance for well-being in old age. Preliminary work suggests racial differences in decision making; however, the factors that drive racial differences in decision making remain unclear. We hypothesized literacy, particularly financial and health literacy, mediates racial differences in decision making.

DESIGN

Community-based epidemiologic cohort study.

SETTING

Communities in northeastern Illinois.

PARTICIPANTS

Nondemented Black participants (N = 138) of the Rush Alzheimer's Disease Center Minority Aging Research Study and the Rush Memory and Aging Project who completed decision-making and literacy measures were matched to White participants (N = 138) according to age, education, sex, and global cognition using Mahalanobis distance (total N = 276).

MEASUREMENTS

All participants completed clinical assessments, a decision-making measure that resembles real-world materials relevant to finance and healthcare, and a financial and health literacy measure. Regression models were used to examine racial differences in decision making and test the hypothesis that literacy mediates this association. In secondary analyses, we examined the impact of literacy in specific domains of decision making (financial and healthcare).

RESULTS

In models adjusted for age, education, sex, and global cognition, older Black adults performed lower than older White adults on literacy (β = -8.20; SE = 1.34; 95% CI = -10.82 to -5.57; P < .01) and separately on decision making (β = -.80; SE = .23; 95% CI = -1.25 to -.34; P < .01). However, when decision making was regressed on both race and literacy, the association of race was attenuated and became nonsignificant (β = -.45; SE = .24; 95% CI = -.93 to .02; P = .06), but literacy remained significantly associated with decision making (β = .04; SE = .01; 95% CI = .02-.06; P < .01). In secondary models, a similar pattern was observed for both financial and healthcare decision making.

CONCLUSIONS

Racial differences in decision making are largely mediated by literacy. These findings suggest that efforts to improve literacy may help reduce racial differences in decision making and improve health and well-being for diverse populations. J Am Geriatr Soc 68:1279-1285, 2020.

The false allure of fast lures

The Cognitive Reflection Test (CRT) allegedly measures the tendency to override the prepotent incorrect answers to some special problems, and to engage in further reflection. A growing literature suggests that the CRT is a powerful predictor of performance in a wide range of tasks. This research has mostly glossed over the fact that the CRT is composed of math problems. The purpose of this paper is to investigate whether numerical CRT items do indeed call upon more than is required by standard math problems, and whether the latter predict performance in other tasks as well as the CRT. In Study 1 we selected from a bank of standard math problems items that, like CRT items, have a fast lure, as well as others which do not. A 1-factor model was the best supported measurement model for the underlying abilities required by all three item types. Moreover, the quality of all these items – CRT and math problems alike – as predictors of performance on a set of choice and reasoning tasks did not depend on whether or not they had a fast lure, but rather only on their quality as math items. In other words, CRT items seem not to be a “special” category of math problems, although they are quite excellent ones. Study 2 replicated these results with a different population and a different set of math problems.

Upon Repeated Reflection: Consequences of Frequent Exposure to the Cognitive Reflection Test for Mechanical Turk Participants

Participants from public participant panels, such as Amazon Mechanical Turk, are shared across many labs and participate in many studies during their panel tenure. Here, I demonstrate direct and indirect downstream consequences of frequent exposure in three studies (N₁₋₃ = 3, 660), focusing on the cognitive reflection test (CRT), one of the most frequently used cognitive measures in online research. Study 1 explored several variants of the signature bat-and-ball item in samples recruited from Mechanical Turk. Panel tenure was shown to impact responses to both the original and merely similar items. Solution rates were not found to be higher than in a commercial online panel with less exposure to the CRT (Qualtrics panels, n = 1, 238). In Study 2, an alternative test with transformed numeric values showed higher correlations with validation measures than the original test. Finally, Study 3 investigated sources of item familiarity and measured performance on novel lure items.

Validation of health literacy domains for informed decision making about colorectal cancer screening using classical test theory and item response theory

OBJECTIVE

To construct and validate a computer-based and performance-based instrument to assess health literacy skills for informed decision making in colorectal cancer screening among screening invitees.

METHODS

An instrument was constructed based on a conceptual framework of health literacy skills in colorectal cancer screening and findings from an expert survey. The instrument was field-tested among individuals with low health literacy (n = 28). Its validity and reliability was assessed using classical test theory and item response theory approaches in an online panel of colorectal cancer screening invitees (n = 696).

RESULTS

Confirmatory factor analysis confirmed four separate factors: Comprehension, Application, Numeracy and Communication. A fifth domain (Appraisal) demonstrated poor reliability and validity and was omitted in further analyses. Internal consistency (Cronbach's alpha > 0.6 for the four scales) was acceptable and test-retest reliability was moderate. The four factors were measurement invariant for age, sex and educational level.

CONCLUSION

The computer-based measures were acceptable for self-administration. The constructed multidimensional health literacy instrument showed acceptable measurement properties.

PRACTICE IMPLICATIONS

Our findings imply that the computer-based instrument can be used for the development of interventions to support informed decision making about colorectal cancer screening among individuals with varying health literacy levels. Further research is needed for optimizing performance-based measurement of the Appraisal and Communication domains.

Cognitive Reflection and General Mental Ability as Predictors of Job Performance

This paper presents a study with four independent samples on the validity of cognitive reflection (CR) for predicting job performance and academic outcomes. The results showed that CR was a valid predictor of academic outcomes (i.e., grades and exam marks) and job performance (i.e., assessment center ratings). The magnitude of the CR validity was similar to the validity of GMA. Moreover, we found that CR and GMA were moderately correlated, and multiple regression analyses showed that CR added a small amount of validity over GMA validity for predicting both types of performance. Finally, we discuss the implications of the findings for the theory and practice of predicting performance and organizational sustainability.

The Fatalistic Decision Maker: Time Perspective, Working Memory, and Older Adults' Decision-Making Competence

Prior research indicates that time perspective (TP; views of past, present, and future) is related to decision-making style. By contrast, no prior study considered relations between TP and decision-making competence. We therefore investigated associations between dimensions of the Swedish Zimbardo Time Perspective Inventory (S-ZTPI) and performance on the Adult Decision-Making Competence (A-DMC) battery in a sample of older adults (60–90 years, N = 346). A structural equation model involving four A-DMC components as indicators of a general DMC factor and the six TP dimensions as the predictors revealed a significant negative association between the Present Fatalistic dimension and DMC. Given that age-related differences were apparent in DMC and that Present Fatalistic orientation increased with age, we tested a model by which the age-related differences in DMC were mediated by age-related differences in Present Fatalistic attitudes and in working memory. The results were consistent with full mediation of the age effects, with Present Fatalistic and working memory jointly accounting for a substantial amount of the variance in DMC (51%). The finding that DMC among older adults, in particular more cognitively demanding aspects such as applying decision rules, can be undermined by increased present fatalistic attitudes and declines in working memory is discussed in terms of theoretical frameworks highlighting the contribution of both motivational and cognitive factors to effective decision making.

Associations of decision making abilities with blood pressure values in older adults

OBJECTIVES

Decision making, key to successful aging, has implications for financial success, physical health, and well being. While poor decision making has been linked with increased risk of mortality, age-related cognitive decline, and dementia, less is known regarding its associations with chronic disease indicators. We investigated the associations of decision making with blood pressure (BP) values [i.e., SBP, mean arterial pressure (MAP), and pulse pressure (PP), separately] in a community-based cohort study of aging.

METHODS

Participants were 908 nondemented older adults (age ∼81 years; 75% women) from the Rush Memory and Aging Project. Decision making was measured using questions designed to simulate materials used in financial and healthcare settings in the real world and yielded a total score and domain-specific health and financial decision making scores. Two seated and one standing BP measurement were taken with all three contributing to average SBP, MAP that is, [SBP + (2 × DBP)]/3, and PP, that is, SBP - DBP. Participants were queried about hypertension status and antihypertension medications were visually inspected and coded. Participants also underwent medical history and cognitive assessments.

RESULTS

In separate multivariable linear regression models, total decision making scores were inversely associated with SBP, MAP, and PP after adjusting for age, sex, education, antihypertension medication use, diabetes, and cumulative cardiovascular disease burden (P values = 0.03). Decision making remained associated with these BP values after additional adjustment for global cognition.

CONCLUSION

Poorer decision making is associated with higher BP values in nondemented older adults.

Developing a Better and More User-Friendly Numeracy Scale for Patients

Background

A person's ability to work with and understand numerical information (i.e., numeracy) is increasingly important in everyday health and other decision-making contexts. Several survey measures of numeracy have been developed to address this trend, including the widely used General Numeracy Scale (GNS), which is thematically focused on health decision-making and is assumed to measure a unidimensional construct of numeracy.

Objective

The present research was designed to evaluate this proposed unidimensional structure of general numeracy, for which prior data have given mixed empirical support.

Methods

Three samples completed the GNS, in different forms, and responses were analyzed in terms of underlying factor structure.

Key Results

We show that both one-factor and four-factor models of numeracy are plausible based on the GNS (Study 1), and then develop a multiple-choice version of the GNS (i.e., the MC-GNS) that demonstrates some increased clarity in factor structure due to the consistent response format (Study 2). A further study evaluated the convergent and discriminant validity of the MC-GNS (Study 3), finding it to be as good as or better than the prior scale.

Conclusions

Additionally, the MC-GNS is easier for people to take, likely to be less stressful, and easier for practitioners to score. Collectively, this research identifies a problem with the GNS measure, develops improvements to help address this problem, and in the process creates a way to more easily measure numeracy in practical settings. [HLRP: Health Literacy Research and Practice. 2019;3(3):e174-e180.].

Plain Language Summary

Numeracy is important across health contexts. Prevalent numeracy scales assumedly measure a single construct but empirical support for this is lacking. We find both one- and four-factor models are consistent with one scale and develop a revision that clarifies this structure without sacrificing validity. This revised numeracy scale is easier to administer and score, and therefore preferable in practical settings.

Healthcare and Financial Decision Making and Incident Adverse Cognitive Outcomes among Older Adults

OBJECTIVES

To determine if poorer healthcare and financial decision making forecasts adverse cognitive outcomes in old age. Specifically, we hypothesized that poorer decision making would be associated with an increased risk of incident Alzheimer's dementia, an increased risk of incident mild cognitive impairment (MCI), and a more rapid decline in cognition.

DESIGN

An ongoing prospective observational cohort study of aging (the Rush Memory and Aging Project).

SETTING

The greater Chicago area.

PARTICIPANTS

A total of 952 community-based older adults without dementia at baseline.

MEASUREMENTS

Participants completed a measure of healthcare and financial decision making at baseline and underwent annual standardized evaluations to track clinical status and cognitive functions (global cognition, episodic memory, semantic memory, working memory, perceptual speed, and visuospatial ability).

RESULTS

During up to 9 years of follow-up (M = 5.2 y; standard deviation = 2.7), 156 participants developed Alzheimer's dementia (16.4% of 952), 253 participants developed MCI (33.2% of 760), and each cognitive measure declined (all Ps < .001). In Cox proportional hazards models adjusted for age, sex, and education, poorer decision making was associated with an increased risk of incident Alzheimer's dementia (hazard ratio [HR] = 1.17; 95% confidence interval [CI] = 1.10-1.24; P < .001) and incident MCI (HR = 1.16; 95% CI = 1.10-1.22; P < .001). Further, in linear mixed-effects models, poorer decision making among those who were initially free of cognitive impairment was associated with a more rapid decline in global cognition and four of five specific cognitive domains (all Ps < .05).

CONCLUSION

Our results suggest that poorer healthcare and financial decision making heralds adverse cognitive outcomes in old age. J Am Geriatr Soc 67:1590-1595, 2019.

Not all who ponder count costs: Arithmetic reflection predicts utilitarian tendencies, but logical reflection predicts both deontological and utilitarian tendencies

Conventional sacrificial moral dilemmas propose directly causing some harm to prevent greater harm. Theory suggests that accepting such actions (consistent with utilitarian philosophy) involves more reflective reasoning than rejecting such actions (consistent with deontological philosophy). However, past findings do not always replicate, confound different kinds of reflection, and employ conventional sacrificial dilemmas that treat utilitarian and deontological considerations as opposite. In two studies, we examined whether past findings would replicate when employing process dissociation to assess deontological and utilitarian inclinations independently. Findings suggested two categorically different impacts of reflection: measures of arithmetic reflection, such as the Cognitive Reflection Test, predicted only utilitarian, not deontological, response tendencies. However, measures of logical reflection, such as performance on logical syllogisms, positively predicted both utilitarian and deontological tendencies. These studies replicate some findings, clarify others, and reveal opportunity for additional nuance in dual process theorist's claims about the link between reflection and dilemma judgments.

The link between intuitive thinking and social conservatism is stronger in WEIRD societies

While previous studies reveal mixed findings on the relationship between analytic cognitive style (ACS) and right-wing (conservative) political orientation, the correlation is generally negative. However, most of these studies are based on Western, educated, industrialized, rich, and democratic (WEIRD) societies, and it is not clear whether this relationship is a cross-culturally stable phenomenon. In order to test cross-cultural generalizability of this finding, we re-analyzed the data collected by the Many Labs 2 Project from 30 politically diverse societies (N = 7,263). Social conservatism is measured with the binding foundations scale, comprising of loyalty (patriotism), authority (respect for traditions), and sanctity (respect for the sacred), as proposed by the moral foundations theory, while ACS is measured by the three-item modified cognitive reflection task. The level of WEIRDness of each country was calculated by scoring how much a culture is Western, educated, industrialized, rich, and democratic. Although social conservatism is negatively associated with ACS in the aggregate, analysis indicates that the relationship is significantly stronger among WEIRD and remains negligible among non-WEIRD cultures. These findings show the cross-cultural variability of this relationship and emphasize the limitations of studying only WEIRD cultures.