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Highlighting and Reducing the Impact of Negative Aging Stereotypes During Older Adults' Cognitive Testing
Chapters
Summary January 24th, 2020
Here, we present a protocol designed to show how negative aging stereotypes can impair memory performance of older adults during cognitive testing and how to reduce this deleterious effect. This method can help older people to perform at an optimal level during testing in both lab studies and clinical settings.
Transcript
Many of the aging stereotypes are likely to bias the assessment of older adults'cognitive functioning. Our protocol helps to highlight, and then neutralizes bias in the lab and in clinical settings. By neutralizing the effects of negative aging stereotypes, our mission contributes to better discrimination between normal and pathologic cognitive decline.
These methods provide useful recommendations about how to improve other adults'cognitive assessment in clinical settings. In particular, for the diagnoses of the prodromal stage of Alzheimer's disease. The protocol can be applied to any situation where stigmatized individuals are about to perform task that relies on the stereotyped ability.
Of critical importance, the intervention was to help older adults to attribute the cause of their difficulties to the stress related to the examination rather than the presence of an illness Experiment one aims at highlighting the negative impact of aging stereotypes during older adults'memory testing. For the first experiment, begin by informing the participant that they will complete two independent tasks. The first is characterized as a memory test still under construction to minimize evaluative pressure, while the second one is characterized as a valid memory test.
Prepare two alternative versions of the reading span test with different sentences but match them in number of words and in length, frequency, and number of syllables in the last word. In the first study, present one sentence at a time and instruct the participant to read it at his or her own pace while memorizing the last word of the sentence. Ask the participant not to interrupt his reading and not to pause between two sentences.
Then have the participant recall the words immediately after he or she finished reading the last sentence of the block considered. Note participant recall does not need to be serial, however ask them to avoid starting with the final word of the last sentence read. Do not limit the recall time and invite participants to find as many words as possible.
Further, do not inform participants of their errors and do not give them a second chance to answer. Then compute the final score of each participant using the mean proportion of correctly recalled words across the twelve series. Next inform the participant that they will complete the second study that consists of a fully validated and diagnostic test of memory capacity.
Induce the stereotype threat or reduced threat based on participant's assigned group. In the threat condition, tell the participant that both younger and older adults are participating in the study. In the reduced threat condition, tell the participants that both younger and older adults are participating in the study but add that younger and older adults usually obtain the same performances on the ongoing test.
Finally, have the participant complete the second version of the reading span test and use the exact same procedure as for the first version. Older participants in the reduced threat condition obtained a better working memory score relative to those in the threat condition. Moreover in the threat condition older participants underperformed relative to younger participants, whereas the two age groups performed equally well in the reduced threat condition.
Experiment two aims at highlighting and then neutralizing the impact of negative aging stereotypes on short cognitive tests used to screen for pre-dementia in clinical settings. For the second experiment, have the participant complete two short cognitive tests, the MMSE and the MOCA, then before taking the first test, randomly assign participants to one of two threat conditions. In the threat condition inform participants that both younger and older adults are taking part in the study about memory capacity.
And in the reduced threat condition inform participants that both younger and older adults are taking part in study about memory capacity, but add that younger and older adults typically obtain the same performances on the ongoing tests. Administer the eight subtests of the MMSE to evaluate memory, orientation to time and place, attention and executive functioning, language and visual spatial abilities by following Folstein and McHugh's administration guidelines. Compute the final score by adding the scores of every subtest and obtaining a final score rated on a 30 point scale.
Then before administering the second test, the MOCA use an educational intervention to debrief the participant about age based stereotype threat regardless of the threat or reduced threat condition in which they were previously assigned. After the educational intervention administer the eight subtests of the MOCA to evaluate memory, orientation to time and place, attention and executive functioning, language and visual spacial abilities by following the administration guidelines available at www.mocatest.org. Lastly, compute the final score, adding the scores of every subtest, and obtain a final score rated on a 30 point scale.
Participants'performance was higher in the reduced threat condition than in the threat condition on the MMSE. The same pattern occurred on MOCA with participants underperforming in the threat condition as compared to the reduced threat condition. After the educational intervention, older adults performed equally well on test two be it MOCA or MMSE.
The protocol highlights the critical importance of test characterization when evaluating older adults'cognitive functioning. Simply mentioning younger adults on memory is sufficient to create stereotype effects and to make older adults perform below their true potential. With intervention can be adapted to consider other types of threat that could be simultaneously triggered by the clinical context.
For example, specific threat of someones'disease as a dramatic disease, of the threat of being at hospital, or simply the threat of the white coat. This protocol properties recommendations to improve other adults memory assessment both in lab settings and in clinical settings. Presenting the test as age fair or using educational intervention.
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