No full-text available
To read the full-text of this research,
you can request a copy directly from the author.
Memory improvement in octogenarians
Abstract
This pre-post quasiexperimental study tested the eight-session Cognitive Behavioral Model of Everyday Memory in residents (58 women, 20 men) of a retirement village in Northeast Ohio. Their average age was 82 years, with 16 years of education and Mini-Mental State Examination score of 28; 13% were depressed. All participants were pretested and posttested at 8 weeks. The largest gains were in memory self-efficacy and use of internal memory strategies. Moderate gains were made in instrumental activities and change, and smaller gains were made in locus and memory performance. The dose of the intervention (eight sessions) was adequate, and practice in each class session facilitated mastery of memory strategies and techniques.
... The social engagement hypothesis has been supported by group experiences of older adults in a traditional classroom-based learning environment (McDougall, 2002;Stine-Morrow, Parisi, Morrow, Greene, & Park, 2007). The ''use it or lose it'' hypothesis and disuse hypothesis seem to resonate with this cohort of older adults, who are comfortable with the mental discipline model of learning (Bielak, 2010). ...
... The SeniorWISE (Wisdom Is Simply Exploration) intervention consisted of eight classes for 12 hours of classroom training (McDougall, 2002(McDougall, , 2009. The training was based on the four components of selfefficacy theory: enactive mastery experience, vicarious experience, verbal persuasion, and physiologic arousal. ...
... In this study, participants were significantly older with a M age of 80.56 T 8.82 versus 74.69 T 5.74 years. Other investigators have also found significant improvement in memory performance in octogenarians (M age = 80.9 years) who participated in a mental fitness/healthy lifestyle program with 12 hours of training (McDougall, 2002;Miller et al., 2012). ...
Previous tests of the SeniorWISE intervention with community-residing older adults that were designed to improve affect and cognitive performance were successful and positively affected these outcomes. In this study, we tested whether adding yoga to the intervention would affect the outcomes. Using a quasiexperimental pre-post design, we delivered 12 hours of SeniorWISE memory training that included a 30-minute yoga component before each training session. The intervention was based on the four components of self-efficacy theory: enactive mastery experience, vicarious experience, verbal persuasion, and physiologic arousal. We recruited 133 older adults between the ages of 53 and 96 years from four retirement communities in Central Texas. Individuals were screened and tested and then attended training sessions two times a week over 4 weeks. A septuagenarian licensed psychologist taught the memory training, and a certified yoga instructor taught yoga. Eighty-three participants completed at least 9 hours (75%) of the training and completed the posttest. Those individuals who completed made significant gains in memory performance, instrumental activities of daily living, and memory self-efficacy and had fewer depressive symptoms. Thirteen individuals advanced from poor to normal memory performance, and seven improved from impaired to poor memory performance; thus, 20 individuals improved enough to advance to a higher functioning memory group. The findings from this study of a memory training intervention plus yoga training show that the benefits of multifactorial interventions had additive benefits. The combined treatments offer a unique model for brain health programs and the promotion of nonpharmacological treatment with the goals of maintaining healthy brain function and boosting brain plasticity.
... Memory decline has emotional as well as physical effects and may limit how one functions in his/her daily routines, essential to living independently (Imhof et al., 2006;Willis, Tennstedt, Marsiske, et al., 2006). Memory training interventions have been shown to significantly increase memory performance and memory self-efficacy (McDougall, 2002). Research evidence supports the effectiveness of memory strategies including mnemonic strategies, visualization, association, attention, and external memory aids as effective for improving memory in older adults (Willis et al, 2006). ...
... Saczynski and Rebok (2004) demonstrated that memory decline can be slowed or reversed with the use of memory interventions that focus on modeling and practicing strategies specific to the tasks that require memory. Interventions have been initially successful in improving both the cognitive and emotional aspects of memory performance of older adults, but to this point research has focused on community dwelling elders Limited research has tested cognitive interventions to improve memory and other cognitive functions in older adults who require supportive care in residential long term care settings (McDougall, 2002;Williams, 2008). Older adults living in AL have great potential to benefit from interventions that improve or maintain their memory and may enable them to continue living in AL in supported independence. ...
Memory loss often signifies loss of independence, which is a growing concern for residents in assisted living (AL) facilities. The purpose of this exploratory study was to characterize the memory experiences and concerns of AL residents. Six residents voluntarily participated in 1-hour recorded interviews focusing on memory and guided by eight open-ended questions. Interviews were transcribed and analyzed using qualitative content analysis. Subjects reported varying degrees of memory loss they found frightening and frustrating, but also accepted the loss as a natural part of the aging process. Concerns focused primarily on inability to recall staff and resident names and activities, schedules, and appointments. Understanding memory experiences and concerns is important for nursing staff members who care for AL residents. Memory challenges identified by these residents were used to develop a memory intervention for older adults residents of this and other AL facilities. Improving cognitive skills may help AL residents maintain their functional abilities, enabling them to "age in place" in AL.
... CBMEM-based intervention consisted of eight classes and four booster sessions (McDougall, 1998McDougall, , 1999McDougall, , 2000McDougall, , 2002). The memory training was based on the four components of self-efficacy theory: enactive mastery experience, vicarious experience, verbal persuasion, and physiologic arousal. ...
... Whites made relatively greater gains than Blacks did in memory self-efficacy. We expected memory self-efficacy to improve based on evidence from previous studies with diverse older adults (Dittmann-Kohli et al., 1990; Lachman et al., 1992; McDougall, 1998 McDougall, , 1999 McDougall, , 2000 McDougall, , 2002 Rebok, & Balcerak, 1989; West et al., 2008). However, all previous intervention studies used different memory efficacy questionnaires. ...
We tested whether at-risk older adults receiving memory training showed better memory self-efficacy, metamemory, memory performance, and function in instrumental activities of daily living than participants receiving a health promotion training comparison condition. We followed participants for 26 months. The sample was mostly female (79%) and Caucasian (71%), with 17% Hispanics and 12% African Americans; average age was 75 years, and average education was 13 years. The memory training group made greater gains on global cognition and had fewer memory complaints, but both groups generally maintained their performance on the other cognitive measures and instrumental activities of daily living (IADLs) throughout the 24-month study period. Black and Hispanic participants made greater gains than Whites did on some memory performance measures but not on memory self-efficacy. The unexpected finding that minority elders made the largest gains merits further study. This study contributed to the knowledge base of geropsychiatric nursing by providing evidence for an effective psychosocial intervention that could be delivered by advanced practice nurses.
... The current study is a secondary analysis of data from multiple memory-focused studies with older adults conducted over twenty years that describe the recruitment procedures (McDougall, 1994(McDougall, , 1998(McDougall, , 2000(McDougall, , 2001(McDougall, , 2002McDougall, Holston, & Wilke, 2001). Six independent samples of older adults (N ¼ 603) were tested on cognitive measures at several time points as cohort and intervention studies. ...
Objective: Subjective memory concerns (SMCs) might be an early indicator of future cognitive decline and conversion to dementia. However, a rich history of mixed findings, moderating factors, and heterogenous methods preclude the usefulness of SMCs in both research and clinical settings. The present study aimed to review some of the factors that might cause mixed results and pro- pose a revised version the Metamemory in Adulthood (MIA) Questionnaire that can be easily implemented to more consistently derive estimates of SMCs.
Method: We used factor analysis and regression to investigate the utility of a revised 20-item ver- sion of the MIA Change and Capacity subscales.
Results: Based on two samples of older adults (N1⁄4382 and N1⁄4221), the revised scale showed strong internal reliability and a two-factor structure. Regression analyses supported the incremental validity of the MIA-Revised Change scale in predicting performance on the Rivermead Behavioural Memory Test.
Conclusions: By establishing a revised version of a well-known and previously validated questionnaire to assess SMCs, research and clinics can better implement a psychometrically sound measure quickly and easily. Moreover, the revised Change and Capacity subscales provide sufficient divergence to be sensitive to different facets of SMCs in a community dwelling older adult sample.
... 46 It correlates highly with other depression measures, with an ! reliability coefficient of .94. 35 Scores higher than 5 are suggestive of depression and scores higher than 10 almost always indicate clinical depression. 47 Health Status Outcome: Metamemory Metamemory is an individual's knowledge, perceptions, and beliefs about the functioning, development, and capacities of his/her own memory and the human memory system. ...
Background: The rising cost of hospitalizations for heart failure (HF) care mandates intervention models to address education for self-care success. The effectiveness of memory enhancement strategies to improve self-care and learning needs further examination.
Objective: The objective of this study was to examine the effects of an education-support intervention delivered in the home setting, using strategies to improve health status and self-care in adults/older adults with class I to III HF. Our secondary purpose was to explore participants' subjective perceptions of the intervention.
Methods: This study used a randomized, 2-group design. Fifty people were enrolled for 9 months and tested at 4 time points-baseline; after a 3-month education-support intervention; at 6 months, after 3 months of telephone/e-mail support; and 9 months, after a 3-month period of no contact. Advanced practice registered nurses delivered the intervention. Memory enhancement methods were built into the teaching materials and delivery of the intervention. We measured the intervention's effectiveness on health status outcomes (functional status, self-efficacy, quality of life, emotional state/depressive symptoms, and metamemory) and self-care outcomes (knowledge/knowledge retention, self-care ability). Subjects evaluated the usefulness of the intervention at the end of the study.
Results: The mean age of the sample was 62.4 years, with a slight majority of female participants. Participants were well educated and had other concomitant diseases, including diabetes (48%) and an unexpected degree of obesity. The intervention group showed significant improvements in functional status, self-efficacy, and quality of life (Kansas City Cardiomyopathy Questionnaire); metamemory Change and Capacity subscales (Metamemory in Adulthood Questionnaire); self-care knowledge (HF Knowledge Test); and self-care (Self-care in Heart Failure Index). Participants in both groups improved in depressive scores (Geriatric Depression Scale).
Conclusions: An in-home intervention delivered by advanced practice registered nurses was successful in several health status and self-care outcomes, including functional status, self-efficacy, quality of life, metamemory, self-care status, and HF knowledge.
(C) 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
... Cognitive interventions have also been used with community-dwelling adults who did not meet formal eligibility criteria for cognitive impairment, including SeniorWISE (Wisdom is Simply Exploration; McDougall et al., 2010), ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly; Ball et al., 2002) and IMPACT (Improvement in Memory with Plasticity-based Adaptive Cognitive Training (Smith et al., 2009). These interventions have been found to be efficacious in improving various objective measures of cognition (Ball et al., 2002; McDougall et al., 2010; Smith et al., 2009) and memory complaints (McDougall, 2002), thus providing evidence that meaningful improvements in cognitive performance can be achieved. ...
Objective:
To determine whether a cognitive intervention delivered by lay health educators (LHEs) in senior centers was effective in improving cognition in obese older adults.
Methods:
This cluster randomized trial was conducted in 16 senior centers from which 228 senior adults were recruited. The centers were randomized to either the cognitive intervention or a control, weight-loss intervention. The primary outcome variable, cognitive function, was measured using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS).
Results:
Analyses of RBANS indices as continuous variables did not indicate significant differences between arms. However, after adjusting for baseline delayed memory, gender, and baseline body mass index, seniors in the cognitive intervention arm had a 2.7 times higher odds of a reliable improvement (clinically significant) in delayed memory from baseline as compared to those in the control intervention (95% CI, 1.3-5.6, p = .011). The intervention effect was not significant for the proportion showing reliable improvement in immediate memory or in attention. Attendance at the 12-session program was high with an average of 83% (67%-92%) sessions attended and 87% of participants in the cognitive arm indicating they would recommend the program.
Discussion:
Cognitive interventions can be effectively delivered in the community by LHEs.
... The Cognitive-Behavioral Model of Everyday Memory (CBMEM) served as the basis for the memory-enhancing intervention designed to improve, maintain, or prevent decline in the everyday and episodic verbal memory of older adults atrisk for memory loss (McDougall, 1999McDougall, , 2001McDougall, , 2002 ). The model proposed that memory selfefficacy , metamemory, anxiety, and depression mediate the impact of the intervention on memory performance, the proximal outcome, and on IADLs, the distal outcome. ...
This article describes the outcomes of a psychosocial intervention that tested whether health training could improve health and functional ability in a group of community-residing elderly persons. The health-training intervention consisted of eight 90-minute lecture and discussion classes conducted twice a week for 1 month. In 3 months following the posttest, an additional four booster sessions were delivered once per week for 1 month. Participants received a total of 20 hours of health training. The National Institutes of Health-funded SeniorWISE (Wisdom is Simply Exploration) study was advertised in the community as a program to learn strategies for successful aging. We describe the health curriculum and the health and functional outcomes for a 6-month period at preintervention, postintervention, and postbooster sessions. Complete data were available for 110 individuals. There was a statistically significant change on the Direct Assessment of Functional Status, F(2, 107) = 4.69, P < .012. Health variables remained stable over time. This intervention demonstrated that health training has the potential for noticeable improvement in Instrumental Activities of Daily Living function.
... Those in the memory training groups declined on average by 5 points, whereas those in the health training groups maintained their gains over time. Not surprisingly, as in other studies, those Whites with lower memory self-efficacy at baseline made greater gains over the course of the study than those who began the study with higher scores in both training conditions (McDougall, 2002; West, Bagwell, & DarkFreudeman, 2008). Whites made relatively greater gains by approximately 4 points on memory selfefficacy scores from beginning to end of the study. ...
Cognitive training improves mental abilities in older adults, but the benefit to minority elders is unclear. We conducted a subgroup analysis of subjects in the SeniorWISE (Wisdom Is Simply Exploration) trial to examine this issue.
SeniorWISE was a Phase 3 randomized trial that enrolled 265 nondemented community-dwelling older adults aged 65 years and older between 2001 and 2006. Participants were randomly assigned to 12 hr of either memory or health training.
The sample was 79% female, 71% Caucasian, 17% Hispanic, and 12% African American. On the Rivermead Behavioural Memory Test (RBMT), 28% of the sample scored normal, 47% scored poor, and 25% impaired. Memory performance changed differently over time depending on the demographic characteristics of participants. Both Hispanics and Blacks performed better than Whites on visual memory, and Blacks performed better over time on instrumental activities of daily living. On all performance measures, lower pretest scores were associated with relatively greater improvements over time.
Our analyses suggested that minority participants received differential benefits from the memory training; however, this remains speculative because the 3 ethnic groups in the sample were not equivalent in size. The question of why Black and Hispanic participants often made greater improvements needs further exploration.
... The current fi ndings form a basis for inclusion of cognitive status in caregiving research, with the need for future studies to explicate the complexity of the relationships among caregiver cognition and characteristics of the caregiving situation. Promising work in the area of cognitive enhancement ( Cassilhas et al., 2007 ; McDougall, 2002; Willis et al., 2006 ) could be an important inclusion in the armament of potential interventions to prevent cognitive decline and support caregivers as they enact their roles over the many years of the AD trajectory. Importantly, Mackenzie and colleagues (2007) observed that some caregiver defi cits in attentional regulation may not be permanent and may be reversed after the caregivers are widowed and are no longer caregivers. ...
Very few studies have examined cognitive decline in caregivers versus noncaregivers, and only 1 study has examined mediators of such decline. We evaluated the relationship between caregiver status and decline on the digit symbol test (DST; a measure of processing speed, attention, cognitive-motor translation, and visual scanning) and whether this relationship was mediated by depressed mood.
Caregivers for spouses with Alzheimer's disease (n = 122) were compared with demographically similar noncaregiver spouses (n = 117) at study entry (Time 1 = T1), T2 (1 year later), and T3 (2 years after T1).
Caregivers had lower DST scores and higher Hamilton depression scores at T1, T2, and T3 than noncaregivers (all p < .05). Hierarchical linear modeling revealed that although caregivers started well below noncaregivers, they experienced a more rapid rate of decline than noncaregivers (p = .047). Caregivers declined 4.5 times faster than noncaregivers. Greater depressed mood at T1 (p < .01) and T2 (p < .01) predicted DST decline and mediated DST decline in caregivers vs. noncaregivers.
Depressed mood in caregivers relative to noncaregivers may influence their greater risk for DST decline. This is important because the DST predicts problem solving and everyday functions necessary for independent living and the potential well-being of their care recipients.
... In another study, McDougall, Holston, and Wilke (2001) found that a mixed sample of black and white community-based older adults (average age 77 years, with an average of 12 years of education) had low memory self-efficacy scores. McDougall (2002) also found lower memory selfefficacy scores in a group of older adults living in a retirement village (average age 82). In an assisted living sample, McDougall (2000) found memory self-efficacy scores to be even lower than in the previous samples. ...
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.
... Therefore, given the lower educational attainment of the Black participants, as compared with that of the White participants, the low scores on self-efficacy are not surprising. It has been shown that White elders' beliefs about memory performance can be modified and improved through intervention, but whether minority elders can change their beliefs about cognitive aging has not been determined (Best et al., 1992;Lachman et al., 1992;McDougall, 1999McDougall, , 2002. ...
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.
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.
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.
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.
... Although most research has not specifically tested whether improving self-efficacy alone can improve memory performance, there are a few notable exceptions that support this idea. For instance, the Cognitive Behavioral Model of Everyday Memory [32,33] focuses on increasing selfefficacy to improve performance and has been successful in older adults. Other research has shown that subconscious improvements in age-related self-image (testing participants in a room that depicts active, empowered seniors) lead to better memory performance [34]. ...
The aim of this study was to investigate memory beliefs and their relationship to actual memory function in fibromyalgia (FM) patients.
Twenty-three FM patients, 23 age- and education-matched controls, and 22 older controls completed the Metamemory in Adulthood (MIA) questionnaire, which assessed beliefs about seven aspects of memory function. Group differences on the seven scales were assessed, and scores on the capacity scale were correlated with objective memory performance.
FM patients reported lower memory capacity and more memory deterioration than did either control group. Patients reported lower control or self-efficacy over memory, higher achievement motivation, higher strategy use, and higher anxiety about memory than age-matched controls did. Among the patients, perceived capacity, achievement motivation, and self-efficacy were significantly correlated with objective memory performance on a recall task.
FM patients' complaints about memory function have some accuracy.
... As studies of nutraceuticals join the trials of the National Institute of Health, more accurate evaluations could be expected, and these products could be compared with other, less drug-centered treatments for cognitive decline, such as tai chi, yoga, and aerobic exercise, and with cognitive interventions, such as social and intellectual stimulation. The results of both cross-sectional and longitudinal studies suggest that cognitive stimulation may be more effective than chemical agents in maintaining cognitive function (Ernst, 2002;Mathie, 2003;McDougall, 2002;Mundt, Kaplan, & Greist, 2001;Salthouse, Berish, & Miles, 2002;Wilson et al., 2002). ...
This article identifies a convenience sample of 14 memory-enhancing herbal products that were found to be available commercially, examines their active ingredients, states their claims, and evaluates the available evidence to determine their efficacy. The analyses identified four problematic areas. First, a majority of the products use cognitive terminology, which leads consumers to anticipate an intended cognitive benefit. Second, some ingredients are completely homeopathic and contain components not known outside of the homeopathic field. Third, the evidence of treatment efficacy is often contradictory, because products are recommended for purposes other than cognitive or memory loss. Finally, the manufacturers of the product have usually conducted the research on individual products. Until more research is available, it is suggested that holistic nursing professionals exercise caution in recommending nutraceuticals to their patients/clients for the use of cognitive improvement or memory enhancement.
... Utilizing content from Fogler and Stern (1994), the CBMEM was initially presented in eight class sessions, one and one half hours per session. It had been pilot tested with another group of elders, and the results indicated a statistically significant increase in subjective and objective memory measures following the 8 sessions (McDougall, 2002). Classes met twice a week for a total of twelve hours and incorporated the following: stress inoculation and muscle relaxation, recall of names and faces, and practice of various memory strategies designed to strengthen performance accomplishment. ...
Evidence that reduced treatment achieves similar outcomes is beneficial because shorter interventions may be more cost-effective and more acceptable to participants. We examined the effects of shortening a memory intervention for elders from eight sessions to four sessions. Shortening the intervention had little impact on either self-reported or performance measures of memory and daily living activities. Small to moderate effects were associated with positive changes in both groups. When examining cost-effectiveness, an eight-session intervention produced slightly greater gains in memory performance, but at a higher cost. Future studies should systematically vary key intervention components in more diverse samples.
A major focus of this research has been to understand the aging brain and how the subjective evaluation of memory may lead to cognitive decline. The research explains the cognitive difficulties experienced by older adults who are worried about memory loss. The research shifted the emphasis of cognitive aging from traditional models emphasizing decrements and losses to potential and gains.
Dr. McDougall has authored over 100 scientific articles and 25 chapters, delivered almost 200 invited presentations and his research and perspectives have been profiled in high-impact media: The Today Show and O, The Oprah Magazine. Awards and honors for his research include the Mind Alert Award for Mental Fitness from the American Society on Aging and Met Life Foundation; the Edge Runner from the American Academy Nursing; National Academies Keck Futures Initiative; Nurse Scientists: Committed to the Public Trust, Johnson & Johnson; Nurse Scientist Award, Friends of the National Institute of Nursing Research; and Media Award, American Academy Nursing.
A unique memory training intervention called Senior WISE (Wisdom Is Simply Exploration) was tested in a Phase III randomized clinical trial funded by the National Institutes on Aging. SeniorWISE is registered with the U. S. Patent and Trademark Office. The model has been tested with over 1000 older adults who have participated in various health promotion interventions in which they have learned strategies for successful aging.
Memory: Neuropsychological, Imaging and Psychopharmacological Perspectives reviews critically the impact of recent neuropsychological and biological discoveries on our understanding of human memory and its pathology. Too often, insights from clinical, neurological and psychopharmacological fields have remained isolated and mutually unintelligible. Therefore the first part of this book provides both clinicians and neuroscientists with a broad view of the neuropsychology of memory, and the psychobiological processes it involves, including recent advances from imaging technology and psychopharmacology research. In the second part the authors go on to cover a comprehensive range of memory assessments, dysfunctions, impairments and treatments. This compendium of current research findings will prove an invaluable resource for anyone studying, researching or practising in the field of memory and its disorders.
The mental health of cancer survivors has not always been the primary emphasis of treatment protocols since physical health outcomes have taken precedence. Older cancer survivors experience a double jeopardy since they are at risk for memory impairments and mild cognitive impairment and because they are greater than fifty-five years of age. Of the 9.6 million cancer survivors in the US who have completed active treatment, many report cognitive difficulties, with labels such as "chemo brain," "not as sharp," "woolly-headedness," or the "mind does not work as quickly". To date, most of our knowledge of cognitive impairment in cancer survivors comes from female breast cancer survivors. Studies indicate that these survivors have diminished executive function, verbal memory, and motor function. Cancer survivors want to live independently in the community for as long as possible however, these cognitive deficits may prevent this desired lifestyle. To broaden our understanding this paper reviews the literature on the cognitive impairment and memory deficits experienced by three groups of cancer survivors breast, colorectal, and prostate cancer, the latter make up 60% of all survivors nationally. Even though mental health declined after a cancer diagnosis, the long-term outcomes of cancer survivors did not differ from persons without cancer in depression or cognitive function.
Memory impairment is of great concern to middle-aged and older adults as well as their families. Memory is related to the ability to successfully perform tasks of daily living and to live independently. Longitudinal studies report conversion rates from mild cognitive impairment to a diagnosis of dementia of approximately 10% per year. Memory interventions focusing on modeling and practicing strategies specific to memory tasks show that memory decline can be retarded or reversed. Although memory interventions are often implemented outside of medical office visits because of time constraints, an office visit is a natural venue for the intervention of memory-related problems raised during the course of the visit. This article outlines the procedure for an advanced practice nurse (APN) to implement a memory intervention within the context of a 3-session office visit. Prevalence rates and risk factors for memory impairment are presented, assessments described, and treatment options offered. Strategies common to all memory tasks, as well as those specific to certain types of memory (eg, memory for names, memory for lists) are described. Case vignettes describe various types of memory impairment. Clinical implications and the role of the APN are discussed.
Purpose - Aims to investigate the effect of communicating corporate social responsibility (CSR) initiatives to young consumers in the UK on their fast-food purchasing with reference to McDonald's and Kentucky Fried Chicken (KFC). Design/methodology/approach - Focus groups were conducted to clarify themes and inform a questionnaire on fast-food purchasing behaviours and motives. Attitude statements were subjected to an exploratory factor analysis. Findings - Most respondents (82 per cent) regularly purchased fast food from one of the companies; purchases were mostly impulsive (57 per cent) or routine (26 per cent), suggesting relatively low-level involvement in each case. While there was scepticism regarding the CSR activity being promoted, expectations about socially responsible behaviour by the companies were nevertheless high. Four factors were isolated, together explaining 52 per cent of the variance in fast-food purchasing behaviour. They were brand value, nutritional value, ethical value and food quality. Research limitations/implications - The research was conducted with students, and while these represent a key-target market, any further research should target a more diverse public. Practical implications - There are important implications for global fast-food companies in terms of protecting and developing their brand value; they need to respond to the wider food-related debates in society, in particular, those concerning healthy eating and food ethics. They also need to ensure that their business practices are fully consistent with the values expressed in their CSR initiatives. Originality/value - The special value of the paper lies in its joining together of current perspectives on CSR and consumer value in the UK food industry as it explores both through the perceptions of young consumers of fast food.
Rapid changes in the field of genetics/genomics are affecting the way we practice nursing. Staying current on this dynamic field is a challenge for all healthcare professionals. This article discusses genetics/genomics issues that are likely to have a strong influence on nurses who care for patients with chronic disease. Complex diseases involving the actions of genes and environment are the most common causes of morbidity and mortality. Pharmacogenetics/pharmacogenomics has the potential to alter the way we choose both medications and appropriate doses. Nutrigenomics promises to help us understand how diet affects gene expression and how genetic variants affect the way we use nutrients. Genetic testing can be purchased through the Internet and currently is being marketed directly to consumers. Each of these topics has present and future implications for all healthcare professionals, especially those caring for people with chronic disease.
Cancer survivors 65 years of age and older experience treatment-induced memory impairments. However, clinicians do not intervene for these cognitive problems. This article describes the findings from a pilot study of a memory versus health training intervention and its adaptability for cancer survivors for symptom management.
A convenience sample of older adults was enrolled in a longitudinal study of a memory and health training intervention and tested on five occasions for 2 years postintervention. The memory training was designed to increase cognitive performance, reduce anxiety, decrease negative attributions, promote health, and increase memory self-efficacy. In this analysis, we included change over time for the first four of the five data collection points. We calculated means and standard deviations on the memory measures for cancer survivors in the intervention (n = 8) and comparison (n = 14) groups. The analysis consisted of a mixed design analysis of variance comparing the two intervention groups across four periods for 12 months.
The typical cancer survivor in the sample was a 74-year-old Caucasian female; 14% were minorities. Because of the small sample, some of the effects were not statistically significant. Moderate to large effects were revealed in everyday and verbal memory performance scores, memory self-efficacy, strategy use, and memory complaints. There were also moderate effects for group-by-time interactions on the visual memory performance measure, the memory self-efficacy measure, the depression, the trait anxiety measure, and the complaints subscale. The memory intervention group tended to improve more than the health training group, although this was not always consistent. The results suggested that the participants benefited from the memory training intervention.
Clinicians are often at a loss on how to intervene with cancer survivors who are experiencing cognitive problems following chemotherapy treatment. Evidenced-based interventions for this aspect of symptom management are almost nonexistent. The Cognitive Behavioral Model of Everyday Memory (CBMEM), derived from Self-Efficacy theory provides an evidence-based intervention for symptom management.
The association between memory self-efficacy (MSE) and memory performance is highly documented in the literature. However, previous studies have produced inconsistent results, and there is no consensus on the existence of a significant link between these two variables. In order to evaluate whether or not the effect size of the MSE-memory performance relationship in healthy adults is significant and to test several theory-driven moderators, we conducted a meta-analysis of published and unpublished studies. A random-effects model analysis of data from 107 relevant studies (673 effect sizes) indicated a low but significant weighted mean correlation between MSE and memory performance, r = .15, 95% CI [.13, .17]. In addition, the mean effect size was significantly moderated by the way MSE was assessed. Memory performance was more strongly related to concurrent MSE (perceived current ability to perform a given task) than it was to global MSE (perceived usual memory ability in general). Furthermore, we found marginally larger MSE-memory performance correlations when the memory situations used to assess MSE involved familiar stimuli. No effect of the method used to assess global MSE or domain MSE (memory rating vs. performance predictions) was found. The results also show that the resource demands of the memory tasks have a moderator effect, as the MSE-performance correlation is larger with free-recall and cued-recall tasks than it is with recognition tasks. Limitations (generalization issues, moderators not considered) and implications for future research are discussed.
Not available Nursing, School of
The human brain has the potential for self-renewal through adult neurogenesis, which is the birth of new neurons. Neural plasticity implies that the nervous system can change and grow. This understanding has created new possibilities for cognitive enhancement and rehabilitation. However, as individuals age, they have decreased confidence, or memory self-efficacy, which is directly related to their everyday memory performance. In this article, a developmental account of studies about memory self-efficacy and nonpharmacologic cognitive intervention models is presented and a cognitive intervention model, called the cognitive behavioral model of everyday memory, is proposed.
The articles included in the special series in this issue of
Developmental Psychology demonstrate that perceived self-efficacy for memory functioning is an important facet of metamemory. Self-beliefs of efficacy can enhance or impair performance through their effects on cognitive, affective, or motivational intervening processes. This commentary addresses a number of issues concerning the extension of self-efficacy theory to memory functioning. These include the following: the multidimensionality and measurement of perceived memory capabilities; the veridicality of memory self-appraisal; the efficacious exercise of personal control over memory functioning; the psychosocial processes by which people preserve a favorable sense of memory self-efficacy over the life span; and strategies for generalizing the impact of training in memory skills. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
We evaluated the hypothesis that mnemonic training would result in higher memory self-efficacy and better memory performance in young and old adults. Forty-eight young adults (17- to 19-year-olds) and 45 old adults (60- to 78-year-olds) received either training in the method of loci or no training and were given either performance feedback or no feedback on a serial-word recall task. Ss were tested at pre- and posttraining and were asked to rate their self-efficacy strength (SEST) and self-efficacy level (SEL) at each test session. Young adults recalled more than old adults and had higher self-efficacy scores. Training with feedback improved recall performance in both age groups but failed to increase SEST or SEL. When SEL scores were used to derive a measure of prediction inaccuracy, no age differences were observed. We conclude that efficacy expectations and attributions for memory performance may influence mnemonic training outcomes. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The effectiveness of memory training for the elderly was examined through a meta-analysis of pre-to-posttest gains on episodic memory tasks in healthy subjects aged 60 or above. Pre-to-posttest gains were found to be significantly larger in training groups (0.73 SD, k = 49) than in both control (0.38 SD, k = 10) and placebo (0.37 SD, k = 8) groups. Treatment gains in training groups were negatively affected by age of participants and duration of training sessions and positively affected by group treatment, pretraining, and memory-related interventions. No differences in treatment gain were obtained as a function of type of mnemonic taught nor the kind of pretraining used.
The purpose of this study was to examine the relationships of depression, health status, self-efficacy, and selected demographic variables to the metamemory of older adults. Community-residing adults (N = 169), 55 years of age and older, were recruited from continuing education programs. No relationships were found between age and seven metamemory factors, Strategy, Task, Capacity, Change, Anxiety, Achievement, and Locus. Those in the age group 65 to 74 years scored significantly higher on the metamemory Strategy factor. Memory efficacy, both level and strength, was significantly correlated (p < .01) with the Capacity, Change, Anxiety, and Locus subscales. Overall, the set of variables accounted for 4% to 21% of the total variance in metamemory factors.
The purposes of this study were to test the effects of a 2-week, four-session group intervention with older adults, designed to increase memory self-efficacy and memory performance and to evaluate the influence of depression on memory self-efficacy. A total of 145 community-dwelling older adults (M = 71 years) participated in the study. The intervention significantly increased both memory self-efficacy and memory performance in the treatment group (n = 74). In addition, the treatment group's perception of control in memory-demanding situations was strengthened, and their perception of negative changes in memory over time was diminished. The control group (n = 71) experienced a significant decline in memory self-efficacy over time. Memory performance was not significantly related to memory self-efficacy. Those individuals with depression (M = 7.5), as measured by the short Geriatric Depression Scale, had significantly lower memory self-efficacy scores than those without depression; however, there was no difference in memory performance between the depressed and nondepressed subjects. From the posttest to the follow-up period, depressed subjects receiving the intervention showed a significant decrease in memory self-efficacy, while nondepressed subjects showed no change.
The effectiveness of memory training on the subjective memory functioning and mental health of older adults was examined in a meta-analysis. Effect sizes indicated that memory training led to improved subjective memory functioning (d+2 = .19), but the magnitude of the improvement was less than that obtained on objective memory measures (d+2 = .66) in the meta-analysis of P. Verhaeghen, A. Marcoen, and L. Goossens (1992). However, no differences in effectiveness were found among mnemonic training, expectancy modification, or placebo procedures such as unstructured practice. Improvement of subjective memory functioning was enhanced by including pretraining in skills such as the use of imagery and by including interventions to improve participants' attitudes toward the effects of aging on memory functioning.
This chapter reviews psychoeducational and/or psychosocial interventions designed to improve cognitive function in adults without cognitive impairment. Included are sections on (a) meta-analyses and other reviews; (b) cognitive aging and cognitive improvement; (c) memory training; (d) depression and memory improvement; (e) self-efficacy and aging memory; (f) maintenance of gains and subject retention; (g) comprehensive memory improvement program; and (h) future research. Several aspects of memory training now known to influence outcomes, i.e., memory performance, need to be considered in future studies. First, follow-up instruction (booster sessions) facilitates the use of these newly learned memory strategies in elders' everyday lives. Second, elders' memory self-efficacy (beliefs and confidence) impacts performance. Third, the inclusion of subjective measures in memory training is recommended. Fourth, greater emphasis needs to be placed on the modification of participants' attitudes toward aging-related memory loss. Fifth, designs must emphasize the long-term outcomes of the memory training. Sixth, establishing a relationship between a memory intervention and functional ability (IADLs) is the next step in assisting older adults to remain independent. If early failure in cognitive ability can be improved through intervention, perhaps early decline in functional independence and the need for formal services, e.g., nursing home placement, can be delayed.
Part of the Cognitive Behavioral Model of Everyday Memory (CBMEM), an eight session cognitive enhancement program, entitled "Memories, Memories, Can We Improve Ours?" was tested with older adults living in an assisted living facility in the midwest. The aims of this quasi-experimental study were: to improve everyday memory, memory self-efficacy, and meta-memory. A total of 19 older adults (14 female, 5 male) with an average age of 83 years participated. For the pretest there were 16 individuals in the experimental group. The experimental group was post-tested one week after completing the intervention. At posttest memory self-efficacy scores significantly increased in the experimental group (M1 = 52.13, M2 = 68.50, where M1 represents pretest and M2 represents posttest). Total memory performance scores were not significantly different at posttest; however the prospective memory items of asking for an appointment (M1 = .56, M2 = 1.25), asking for a belonging (M1 = .62, M2 = .88), and delivering a message (M1 = 1.00, M2 = 1.19) significantly improved.
This article is an integrative review of empirical studies of cognitive self-efficacy from childhood through old age. Issues of definition and measurement are addressed and the relation of self-efficacy to personal mastery is evaluated. Research on academic achievement in children and adolescents, complex decision-making in young adults, and memory and intellectual functioning in older adults supports a variety of theoretically driven hypotheses regarding the sources and effects of self-efficacy. Percepts of self-efficacy are based on a variety of sources of information, including personal mastery and perceived control beliefs. Self-efficacy has predictable effects on a variety of task engagement variables (e.g. persistence, effort, goal setting, strategy usage, chioce) that mediate the relationship between self-efficacy and performance. Generalisations regarding the applicability of self-efficacy to understanding cognitive development across the life span are discussed in terms of age-relevant domains and it is argued that a life span treatment of self-efficacy development is particularly compelling because both life span theory and self-efficacy theory emphasise domain specificity.
Performance on the Mini-Mental State Exam (MMSE) and the Mental Status Questionnaire (MSQ) was compared among 80 Alzheimer Disease (DAT) patients, 32 of whom also met DSM- 111 criteria for Major Depressive Disorder. As expected, the MSQ and MMSE were highly correlated, with 55% of the variance shared between total scores on the tests, and 64% of the variance shared between the MMSE orientation items and total MSQ. Depressed DAT patients' performance differed significantly from nondepressed patients' on the MMSE, but not on the MSQ, with depressed patients exhibiting less cognitive impairment. It was concluded that the MSQ is a measure of orientation, and is a task subsumed by the MMSE. Consequently, the MMSE is a more sensitive test, capable of detecting more subtle impairment levels and sensitive to coexistent diagnostic issues.
Memory problems are a major source of concern among older adults. The goal of this research was to evaluate methods for improving
memory performance and beliefs about memory ability and control. Men and women between the ages of 60 and 85 were randomly
assigned to one of five treatment groups: (1) cognitive restructuring to promote adaptive beliefs about memory, (2) memory
skills training, (3) combined cognitive restructuring and memory skills training, (4) practice on memory tasks, and (5) a
no-contact control group. Beliefs about memory (ability and control) and memory performance (working memory, recall of text
materials, categorizable word list, and names and faces) were assessed at a pretest and two posttests. As predicted, those
receiving the combined treatment showed the greatest increases in their sense of control and perceived ability to improve
memory. Results indicated that all groups improved equally on the memory tasks, although those who had received memory training
were more likely to report at the second posttest that they had begun using new strategies for remembering things.
Examination of the range and limits of cognitive reserve capacity (plasticity) by means of cognitive training is proffered as a promising diagnostic strategy for the early (premorbid) identification of dementia, particularly Alzheimer's disease, in nonclinical populations. First data are presented from a sample of elderly independent-living people classified as healthy or at risk (beginning dementia) on the basis of a standardized psychiatric interview. Randomly assigned groups participated in a cognitive training program based on figural relations, a component of fluid intelligence. Stepwise regression analyses demonstrated that only healthy elderly profited from training and that only post-training scores predicted the psychiatric "at risk" diagnosis. The results hold promise for further development of testing-the-limits of individual differences in cognitive reserve capacity to identify premorbid states of dementia in nonclinical samples.
To encourage the clinical use of functional status measures, tools have been developed that are shorter and easier to administer. This study was conducted to provide empirical evidence concerning the validity of instrumental activities of daily living (IADL) scales. Similar to previous findings, this study found that a 50-item questionnaire was suitable for patient self-completion. This scale also showed good reproducibility over a 2-week period, a unidimensional factor structure, internal consistency, predictable correlations with other health status measures, and the ability to distinguish formal service users from nonusers. On the other hand, the findings also clearly demonstrate that caution is warranted when choosing rating formats and scoring procedures, and when interpreting patient responses. Ratings of difficulty, nonperformance, and assistance received should not be assumed to be interchangeable nor to reflect underlying physical ability. A great deal of sample variability was found when the process validity, or the subjective meanings of these ratings was examined. Scalogram analysis also indicated that the assumption of hierarchical ordering is not justified. Based on these findings, minimal questioning, dichotomous responses categories, and aggregate scores are not recommended for discharge planning or monitoring individual patients.
This paper describes the Rivermead Behavioural Memory Test (RMBT)-a short test of everyday memory problems with four parallel forms. It was administered to 118 control subjects aged between 16-69 years with a mean IQ of 106 (range 68-136). The limit of normal performance was established on this group and cut-off points were determined for individual components of the test. The test was also given to 176 brain-damaged people and its validity assessed both by correlating RMBT scores to performance on existing tests, to subjective ratings from patients and carers and to observation by therapists of memory lapses. Validity, parallel form and interrater reliability all proved to be high. It is concluded that the RBMT is a short, reliable, and valid test of everyday memory problems.
An assessment instrument capable of measuring the wellbeing of the aged in a number of significant domains is described. This Philadelphia Geriatric Center Multilevel Assessment Instrument (MAI) systematically assesses behavioral competence in the domains of health, activities of daily living, cognition, time use, and social interaction and in the sectors of psychological wellbeing and perceived environmental quality. Determination of the psychometric qualities of measures of different length in each of these domains and sectors was made. The performance of 590 older people in groups composed of independent community residents, in-home services clients, and people awaiting admission to an institution was determined. The MAI is seen as useful for both research and for assessment in service-giving situations.
Using The Longitudinal Study of Aging, we determined the independent effects of nine self-reported medical conditions on the likelihood of developing specific instrumental activities of daily living (IADLs) disabilities at three points in time. We controlled for demographic factors and self-reported health status. The various medical conditions differentially affect each specific IADL disability, and each IADL disability has its own set of predictors which, in general, do not vary over time. The differential effects of thse predictors need to be taken into consideration by researchers, clinicians, and policymakers when studying disability and when implementing and evaluating programs to reduce disability.
A meta-analytic literature review on adult age differences in speed of search in short-term memory (12 studies), memory span (40 studies), list recall (68 studies), paired-associate recall (21 studies), and prose recall (39 studies) is presented. Results show that age differences are quite large (depending on the task, elderly people can be situated between the 3rd and the 38th percentile of the adult age memory performance distribution) and quasi-omnipresent, even under conditions of cued recall or semantic task orientation. Evidence for age sensitivity is found for the process of categorization of lists, but not for semantic processing, association strategies, imagery, nor for extracting main points from prose material. The elderly population benefits more than the young from the possibility of reviewing lists or texts. Differences between young adults and old-old adults are larger than between young adults and the young-old for speed of search in short-term memory and prose recall only. In two out of the five tasks, lower education is reliably associated with larger age differences.
Self-efficacy: The exercise of control Memory complaint, memory performance, and psychiatric diagnosis: A community study
- A Bandura
Bandura, A. (1997). Self-efficacy: The exercise of control. New York: W. H. Freeman. Bassett, S.S., & Folstein, M.F. (1993). Memory complaint, memory performance, and psychiatric diagnosis: A community study. Journal Geriatric Psychiatry and Neurology, 6,105-111.
The Rivermead Behav-ioural Memory Test
- J Cockburn
- P T Smith
Cockburn, J., & Smith, P.T. (1989). The Rivermead Behav-ioural Memory Test. Supplement 3: Elderly people. Bury St Edmunds, Suffolk: Thames Valley Test Company.
[Memory efficacy in community elders
- M E Lachman
Lachman, M.E. (1990). [Memory efficacy in community elders.] Unpublished raw data.
Teaching memory improvement to adults
- J Fogler
- L Stern
Fogler, J., & Stern, L. (1994). Teaching memory improvement to adults (rev ed.). Baltimore: Johns Hopkins University Press.