Preferences for choice across adulthood: age trajectories and potential mechanisms

Supporting older patients in making healthcare decisions: The effectiveness of decision aids; A systematic review and meta-analysis

OBJECTIVE

To systematically review randomized controlled trials and clinical controlled trials evaluating the effectiveness of Decision Aids (DAs) compared to usual care or alternative interventions for older patients facing treatment, screening, or care decisions.

METHODS

A systematic search of several databases was conducted. Eligible studies included patients ≥ 65 years or reported a mean of ≥ 70 years. Primary outcomes were attributes of the choice made and decision making process, user experience and ways in which DAs were tailored to older patients. Meta-analysis was conducted, if possible, or outcomes were synthesized descriptively.

RESULTS

Overall, 15 studies were included. Using DAs were effective in increasing knowledge (SMD 0.90; 95% CI [0.48, 1.32]), decreasing decisional conflict (SMD -0.15; 95% CI [-0.29, -0.01]), improving patient-provider communication (RR 1.67; 95% CI [1.21, 2.29]), and preparing patients to make an individualized decision (MD 35.7%; 95% CI [26.8, 44.6]). Nine studies provided details on how the DA was tailored to older patients.

CONCLUSION

This review shows a number of favourable results for the effectiveness of DAs in decision making with older patients.

PRACTICE IMPLICATIONS

Current DAs can be used to support shared decision making with older patients when faced with treatment, screening or care decisions.

Theory of Mind Performance Predicts tDCS-Mediated Effects on the Medial Prefrontal Cortex: A Pilot Study to Investigate the Role of Sex and Age

Transcranial Direct Current Stimulation (tDCS) has become an increasingly promising tool for understanding the relationship between brain and behavior. The purpose of this study was to investigate whether the magnitude of sex- and age-related tDCS effects previously found in the medial prefrontal cortex (mPFC) during a Theory of Mind (ToM) task correlates with social cognition performance; in particular, we explored whether different patterns of activity would be detected in high- and low-performing participants. For this, young and elderly, male and female participants were categorized as a low- or high-performer according to their score on the Reading the Mind in the Eyes task. Furthermore, we explored whether sex- and age-related effects associated with active tDCS on the mPFC were related to cognitive functioning. We observed the following results: (i) elderly participants experience a significant decline in ToM performance compared to young participants; (ii) low-performing elderly females report slowing of reaction time when anodal tDCS is applied over the mPFC during a ToM task; and (iii) low-performing elderly females are characterized by lower scores in executive control functions, verbal fluency and verbal short-term memory. The relationship between tDCS results and cognitive functioning is discussed in light of the neuroscientific literature on sex- and age-related differences.

The Relationship Between Cognitive Abilities and the Decision-Making Process: The Moderating Role of Self-Relevance

This study investigated the relationship between cognitive abilities and age differences in information search and the moderating role of task self-relevance by measuring the decision-making processes of participants in both high and low self-relevance decision-making tasks. The sample included 57 young and 65 older adults. They viewed five-alternative × five-attribute decision matrices that required them to open, with a mouse click, the information cells that interested them. Processing speed, verbal fluency, working memory, and vocabulary were measured as cognitive abilities. The dependent variables were search engagement (including time-related engagement and frequency-related engagement) and search pattern (calculated based on alternative-based or attribute-based search). The results from structured equation modeling showed that age negatively predicted these cognitive abilities (processing speed, verbal fluency, working memory, and vocabulary) and positively predicted information search engagement. Processing speed mediated the effect of age on study time per cell under tasks with both high and low self-relevance. Verbal fluency, meanwhile, mediated the total search time and checking time per cell when the task was highly self-related but not when the task had low self-relevance. These results suggest that self-relevance can moderate the mediation effect of verbal fluency on the relationship between age and information search time; this means that older adults whose verbal fluency was limited require relatively more time to search information to make an informed decision. However, this effect is only sufficient when the decision-making task is highly self-related and provokes more engagement motivation toward it.

Aging and Decision-Making: A Conceptual Framework for Future Research - A Mini-Review

Age differences in decision-making are of theoretical interest and have important practical implications, but relevant lines of work are distributed across multiple disciplines and often lack integration. The present review proposes an overarching conceptual framework with the aim of connecting disjointed aspects of this field of research. The framework builds on process models of decision-making and specifies potential mechanisms behind age effects as well as relevant moderators including task characteristics and contextual factors. After summarizing the extant literature for each aspect of the framework, compensatory mechanisms and ecological fit between different components of the model are considered. Implications for real-life decision-making, remaining research gaps, and directions for future research are discussed.

Choice, freedom, and well-being: considerations for public policy

It is commonly assumed in affluent, Western, democratic societies that by enhancing opportunities for choice, we enhance freedom and well-being, both by enabling people to get exactly what they want and by enabling people to express their identities. In this paper, we review evidence that the relationships between choice, freedom, and well-being are complex. The value of choice in itself may depend on culture, and even in cultural contexts that value choice, too much choice can lead to paralysis, bad decisions, and dissatisfaction with even good decisions. Policy-makers are often in a position to enhance well-being by limiting choice. We suggest five questions that policy-makers should be asking themselves when they consider promulgating policies that will limit choice in the service of enhanced well-being. The relationships between choice, freedom, and well-being are not simple, and an appreciation of their complexity may help policy-makers target their interventions more effectively.

Choosing to be happy? Age differences in "maximizing" decision strategies and experienced emotional well-being

Maximizing is a decision strategy that seeks the very best option, which is more elaborate and potentially more regret inducing than choosing an option that is "good enough." In surveys with a large national sample, we find that older adults are less likely than younger adults to self-report maximizing, which is associated with their better experienced well-being reported 2 years later. This pattern holds after controlling for demographic characteristics and negative life events. Our findings suggest that older adults could possibly be opting for decision strategies that make them happier. We discuss implications for interventions that aim to improve decision making. (PsycINFO Database Record

How aging affects self-reports

A lot of information used in aging research relies on self-reports. Surveys or questionnaires are used to assess quality of life, attitudes toward aging, experiences of aging, subjective well-being, symptomatology, health behaviors, financial information, medication adherence, etc. Growing evidence suggests that older and younger respondents are differentially affected by questionnaire features and the cognitive tasks that question answering pose. This research has shown that age-related changes in cognitive and communicative functioning can lead to age-related differences in self-reports that are erroneously interpreted as real age differences in attitudes and behaviors. The current review highlights how the processes underlying respondents' self-report change as a function of respondents' age; it updates our previous reviews of this literature.

New perspectives for motivating better decisions in older adults

Decision-making competence in later adulthood is affected by declines in cognitive skills, and age-related changes in affect and experience can sometimes compensate. However, recent findings suggest that age-related changes in motivation also affect the extent to which adults draw from experience, affect, and deliberative skills when making decisions. To date, relatively little attention has been given to strategies for addressing age-related changes in motivation to promote better decisions in older adults. To address this limitation, we draw from diverse literatures to suggest promising intervention strategies for motivating older recipients’ motivation to make better decisions. We start by reviewing the life-span developmental literature, which suggests that older adults’ motivation to put effort into decisions depends on the perceived personal relevance of decisions as well as their self-efficacy (i.e., confidence in applying their ability and knowledge). Next, we discuss two approaches from the health intervention design literature, the mental models approach and the patient activation approach, which aim to improve motivation for decision making by improving personal relevance or by building self-efficacy or confidence to use new information and skills. Using examples from these literatures, we discuss how to construct interventions to motivate good decisions in later adulthood.