Thursday, June 13, 2013
Older Adults and Behavior Change
Many older adults are aware of changes in their ability to remember new information, and most are not comfortable with that loss. Because older adults experience changes in cognition, specifically short-term memory, this would have to be a crucial consideration to teaching any training program. For example, if the training consists of six hour-long classes, once per week, after a week has passed, some amount of the training will have been lost. Aguilera, Dailey, & Perez (2008) suggest creating a shame-free environment for learning. Additionally, Green and Bavelier (2008) found older individuals have a difficult time transferring knowledge learned in one specific task to other similar tasks. For example, an individual may be taught to navigate a computer in a class, but when they go home, they may not be able to transfer and apply the knowledge to their computer.
I am partial to Huang, Chen, Wu, Chen and Lin's (2002) idea to utilize short-term classes and long-term, in-home instruction. Huang et al., (2002) found the combination of home-based instruction over the long-term and short-term class instruction supports durable change, at least in health maintenance behaviors. For computer-related learning, a home-based class might be helpful, especially combined with classes. This might be easily accomplished with programs such as Team Viewer which allows an individual to manipulate a computer in a different location. I use this with my 84-year-old grandmother who lives over 5,000 miles away from me. I can show her how to send an email (which I have done dozens of times before), and she remembers, unless she touches the wrong key, and then becomes afraid that "they" did something, and forgets most of what she has learned. This may be like Green and Bavelier's (2008) findings that transferring knowledge is challenging for older adults.
Additionally, I think the cognitive-overload theory explains many of the problems associated with older adults learning new tasks (Hartley, 1999). Their decline in working memory capacity makes it difficult to learn new tasks that are complex and require working memory to retain and implement various cognitive processes (Hartley, 1999). Computers are complex, and although for those of us who have the experience deeply ingrained in our cognitive processes, for older adults, learning these new computer-related tasks is challenging, at best.
Another reason this program received little attention may have been because many older adults have a reduced desire for information-seeking (Aguilera, Dailey, & Perez, 2008). Whereas Baby Boomers want to understand and be involved in every aspect of their health care, older adults are not as inclined to want access to health-related information. Additionally, health literacy seems to decline with age (Aguilera et al., 2008). Older adults, in general, are not inclined to understand or make medical decisions on their behalf, but rather the doctor offer them a few options for treatment. This may reflect an adaptive response of older adults to want fewer options because of their inability to process information specifically for decision making (Reed, Mikels, & Simon, 2008).
Hartley (1999) made an interesting point in the discussion of reading medical text. If older adults have had unfavorable experiences with trying to understand written medical information, they may not be willing to engage in trying to decipher any information related to their health care. I don't think this is necessarily the reason for the lack of success of the program, but it is likely that older adults do not have the same interest in medical information.
Perhaps all of these challenges could be resolved through collaboration with older adults for whom the program has been designed. If the program had been tested briefly on a small group of five older adults, and they showed no interest in the program, modifications may have been made, with their help, to develop a program that would be useful and valuable for them. I would have marketed the program's goal to teach them to send emails to their friends and family. This may have garnered more support. In addition, it would be a way for them to eliminate feelings of isolation that are common in many older adults (Zunzunegui, Béland, & Otero, 2001). This training, I think, would have considerable value for this population.
Aguilera, C., Dailey, W. H., & Perez, M. A. (2008). Aging and health education: Partners for learning. In M. A. Pérez & R. R. Luquis (Eds.), Cultural competence in health education and health promotion (pp. 201–2 12). San Francisco, CA: Jossey-Bass.
Green, C. S., & Bavelier, D. (2008). Exercising your brain: A review of human brain plasticity and training-induced learning. Psychology and Aging, 23(4), 692–701.
Huang, L.-H., Chen, S.-W., Yu, Y.-P., Chen, P.-R., & Lin, Y.-C. (2002). The effectiveness of health promotion education programs for community elderly. Journal of Nursing Research, 10(4), 261–270.
Hartley, J. (1999). What does it say? Text design, medical information, and older readers. In D. C. Park, R. W. Morrell, & K. Shifren (Eds.), Processing of medical information in aging patients: Cognitive and human factors perspectives (pp. 233–247). Mahwah, NJ: Erlbaum.
Reed, A. E., Mikels, J. A., & Simon, K. I. (2008). Older adults prefer less choice than younger adults. Psychology and Aging, 23(3), 671-675.
Zunzunegui, M. V., Béland, F., & Otero, A. (2001). Support from children, living arrangements, self-rated health and depressive symptoms of older people in Spain. International Journal of Epidemiology, 30, 1090–1099. doi:10.1093/ije/30.5.1090