Strain on those caring for the elderly

Although there has been an emphasis on the development of day-hospital and community provisions, there is little evidence that such facilities provide an alternative to hospital care or relieve the strain on the carers, which is the main reason for referral (Greene & Timbury, 1979). It is well recognized that there is severe strain on carers, and there are deleterious effects on their health. Gilleard (1984) reported that on the General Health Questionnaire (GHQ) (Goldberg, 1978), 73% of persons caring for patients attending a geriatric or psychogeriatric day hospital probably were suffering from some degree of psychiatric disturbance. The reported level of distress among those caring for psychogeriatric patients was only just higher than the level for those caring for geriatric patients (Table 34.1).

Gilleard also noted that there was no significant difference between the two groups of carers in regard to the numbers of problems reported. However, the nature of the problems did distinguish between the two groups. In general, the geriatric patients experienced greater impairments of mobility, which have been shown to be reasonably well tolerated by carers (Isaacs, 1971). This group of carers also described significant levels of behavioral disturbance and/or communications problems, although these were less frequent than those reported by people caring for psychogeriatric patients. These behavioral and communications problems are particular sources of strain for carers.

As a scientific enterprise, the study of memory is relatively new and fairly successful. The methods set out by Ebbinghaus only a century ago are adequate to demonstrate that the psychological study of memory can be scientific. As we progress and try to demonstrate that psychology can also increase our practical and theoretical understandings, Ebbinghaus's laboratory methods often seem insufficient. Our own progress and confidence have led us to broaden the research we do.

One aspect of this progress has been the call for cognitive and experimental psychologists to move out of the laboratory. Recent examples include this book, Neisser's attacks on the kind of laboratory studies he carried out in 1967, numerous American Psychologist articles on basic methodological issues, and even the “Call for Papers” of the Psychonomic Society. Possibly independent of all of this, academic and research psychologists are spending a greater proportion of their time studying practical, complex, real-world problems in the name of science. Is this really a good idea, or just the latest fad? Psychology is fond of the theory of pendulum swings. Can a little forethought dampen the pendulum?

Part I of this book provides a rationale, or, more accurately, a set of rationales, for studying cognition in the “real world” rather than in the laboratory. Unlike Parts II and III, Part I does not provide reviews of the literature, but rather provides arguments for pursuing science in various ways.

Definition of world knowledge

I distinctly remember an event that took place when I was a graduate student. I was giving an older gentleman in a retirement home the Information subtest of the Wechsler Adult Intelligence Scale (Wechsler, 1955) and asked the question, “How far is it from Paris to New York? ” My respondent waited a moment and then said in a steady and deliberate voice, “Well, Lindbergh flew there in about 36 hours, with an average air speed of about 100 m.p.h., so I'll say that it's about 3600 miles. ” His response surprised me, for I had asked many younger adults this question, but had never encountered either this level of accuracy or this particular approach to deriving the answer. This older gentleman had retrieved facts from what appeared to be an impressive base of knowledge about his life and world (i.e., “world knowledge ”) and additionally had created a new piece of information to be retained for future use. Three interrelated questions immediately came to mind: (1) How is this knowledge base created? (2) What processes influence the utilization of this knowledge base? (3) How does human aging influence these mental structures and processes? The search for answers to these questions has led to a series of studies in a relatively new but rapidly growing area of research.

In a recent paper (Bäckman, 1985a), I introduced a conceptual frame of reference for research on adult aging and episodic remembering based on the superordinate concepts of compensation and recoding. This chapter constitutes an extension and elaboration of the framework proposed there. One basic point of departure for the discussion here concerns the fact that older adults possess the ability to compensate for various deficits in episodic remembering through different types of contextual and cognitive support. A classification scheme comprising three basic categories of memory compensation in later adulthood is presented: compensation via experimenter-provided support, compensation via inherent task properties, and compensation via cognitive-support systems. These categories deal with proximal interactions between the capabilities of the learner and the actual task demands. It is also suggested that younger adults, because of superior ability in various recoding operations, are less dependent on contextual and cognitive support in order to remember successfully. “Recoding ” is here defined as “all the processes and operations an individual possesses that, when applied, bring about a richer and more elaborate representation of the initially registered information to be remembered ” (Tulving, 1983).

It is argued that a multifactorial approach is a necessary prerequisite for gaining the best understanding of what happens with memory as one gets older. Accordingly, some aspects of memory compensation in later adulthood other than those falling under the aforementioned categories are described.

Spatial activities form such an integral part of everyday life that they are rarely noticed as phenomena unto themselves. However, we are reminded of the critical roles that spatial thought and behavior play in the quality of life when problems occur in the course of these activities, as, for example, when we search for but cannot find a desired object or when we become disoriented in an unfamiliar part of town. Relatively little is known about the effects of aging on human spatial abilities, especially those cognitive skills involved in spatial activities. Consequently, we can make only the most general of inferences regarding the impact of spatial cognition and behavior on the quality of life for elderly adults.

Clearly, additional research is needed in this area, but in order to be of optimal value, this research should be guided by a general conceptual framework that can be used to evaluate previous empirical work and point to promising avenues for future inquiry. The purpose of this chapter is to delineate a potentially valuable approach to the scientific study of spatial cognition and behavior in elderly adults, with particular emphasis on the spatial tasks that confront them in the course of their daily lives. Fundamental to this approach is the proposition that meaningful research in this area should be based on an understanding of real-world situations, that is, psychological events in their ecological context.

This literature review will examine the effects of motivation on mental activity in the aged. It will show that motivation significantly affects performance on a variety of tasks, but does not eliminate age-related cognitive deficits. The findings demonstrate that failure to consider the influence of motivation on performance in the aged can lead to an exaggeration of the magnitude of the deleterious effects of aging on cognitive functioning, and an increase in motivation can improve memory functioning in aged individuals, including those who are experiencing memory problems.

Statement of the problem

Historically, one of the major foci of experimental psychology was on variables associated with the phenomenon of learning. Because learning was differentiated from performance, an attempt was made to identify variables that affected performance versus those that affected learning. Specifically, it was recognized (Hull, 1943) that learning, defined as a relatively permanent change in behavioral potential, needed to be distinguished from performance, defined as the measurable expression of that which an organism had learned. Moreover, performance was not considered to be isomorphic with learning; rather, learning set an upper bound on performance. An organism could not display (perform) more than it had learned. On the other hand, an organism could and in most cases did perform at a lower level than that attained by learning.

The title of this chapter is so commodious that it may be useful to begin by tidying up the domain of interest. First, there are two chapters in this section devoted to metamemory and aging; the other is Chapter 23 by John Cavanaugh. The field has been divided in a convenient way, and perhaps a theoretically and methodologically meaningful way. Specifically, Cavanaugh presents a discussion of the literature on metamemory and aging, where “metamemory” is operationally defined with any of multiple experimental (often on-line laboratory) tasks. I, on the other hand, have been charged with introducing the topic in a general (and certainly all too brief) manner and focusing attention on the metamemory and aging literature, where “metamemory” is indicated by verbal-report data (especially questionnaire data).

There is one further delineation in my topic I should note. Within the realm of verbal-report memory data, there are several domains, each of which is at least indirectly relevant to the issue at hand, but only one of which is immediately pertinent. These topics are summarized in Table 22.1. With the additional criterion of the consideration of developmental (especially aging) questions, this delineation follows closely that of Herrmann (1984). For the most part, I shall not address topic 1 (semantic-memory questionnaires), even those in which developmental (or aging) issues are paramount (Botwinick & Storandt, 1980; Erber, 1981; Perlmutter, Metzger, Miller, & Nezworski, 1980; Poon, Fozard, Paulshock, & Thomas, 1979; Riegel, 1973), and even though there is clear evidence that these techniques, which are verifiable against established facts, can represent valid ways of investigating memory (Herrmann, 1984).

During the last five years, a substantial increase has occurred in the number of studies investigating aging effects in processing prose. As noted by Hartley in Chapter 11, many recent studies have reported age-related differences in quantity and quality of recall, whereas others have found no differences. In attempts to understand these discrepancies, analyses of this literature (Hultsch & Dixon, 1984; Meyer & Rice, 1983a) have been cast in terms of an interactional scheme among text, learner, and task variables (Figure 12.1). Because these variables interact in the comprehension process, it is impossible to discuss them adequately in isolation. However, this chapter emphasizes text variables, whereas Chapter 11 emphasized learner variables. Before examining text variables, we shall discuss learner and task variables, because their consideration is critical in understanding discrepancies in the literature on aging and prose learning.

Learner variables

Education and vocabulary

In considering the learner variables of education and vocabulary as partially responsible for the contradictory aging effects in prose learning, we are considering the long-standing problem in aging research of how to make old and younger age groups equivalent on cultural variables in cross-sectional studies (Birren & Morrison, 1961; Botwinick, 1978; Krauss, 1980). If studies examine only old adults with college degrees, their findings may not hold for the majority of old adults, who lack these degrees. In addition, degrees from various institutions and generations differ in educational value.

Increasing numbers of cognitive psychologists and neuropsychologists are moving beyond the laboratory and attempting to understand human cognitive abilities as they are manifest in natural contexts. This volume offers a comprehensive overview of research on “everyday” cognition in the adult phases of the life course by integrating theoretical and methodological issues in everydaycognition research with findings in real-life situations. In this manner, this book will outline for the reader theoretical and methodological trade-offs and dilemmas along the continuum between laboratory research and naturalistic or real-world research.

The book is divided into three parts. Part I addresses fundamental conceptual issues in everyday-cognition research. The first five chapters outline competing theoretical reasons for choosing different approaches in cognitive studies. The next four chapters provide examples of research combining laboratory and realworld strategies.

Part II reviews findings on everyday cognitive behaviors. These chapters concentrate on the everyday cognitive behaviors of adults from early to late adulthood. The first eleven chapters in Part II review and summarize findings from a wide assortment of everyday cognitive activities, and the last six chapters examine the major concomitant factors that could influence the observed outcomes. Whenever possible, generalizations between classic experimental and real-world stimuli and techniques are contrasted.

Part III concentrates on applications of findings in everyday cognition to cognitive-enhancement procedures in everyday and clinical situations. The first two chapters after the introduction review models and theories associated with compensation and remediation.

The explosion of interest in everyday memory over the past few years has enormously enriched the field. Entire areas of investigation that were unknown a few years ago – prospective memory, for instance – are boiling with ideas and findings. The excitement of new horizons has been a large part of what has made this conference a delightful intellectual experience.

The new wave of real-world research in memory is, of course, part of a more general trend toward application and social relevance in psychology. Bahrick (Chapter 6, this volume) discusses the history of this trend as a reflection of social forces that affected the scientific enterprise across the board. Specifically within psychology, it is tempting to see it also as a continuation of our progressive liberation from the “snaffles and curbs” of orthodoxy – first structuralism, then behaviorism, then laboratory rigorism (Baddeley, Chapter 8, this volume). Cognitive scientists breathed a sigh of relief when they were given permission to study the mind. We are breathing another sigh of relief as we find that we are allowed, even encouraged (Neisser, 1976), to study interesting things about the mind. We have been turned loose to seek the bloody horse, and we love it.

What is worrisome about this development, however, is that it appears to be hardening into an orthodoxy of its own. Experimenters are being told that their research ought to have real-world relevance, that it must be generalizable to real life, and that a measure of its value is the variance accounted for by its manipulations and measures.

In recent years, considerable attention has been paid to pharmacologic treatments for senile dementias (Reisberg, Ferris, & Gershon, 1979). Many researchers have also studied memory complaints as a sign of depression in the elderly and have attempted to differentiate them from dementia (Kahn et al., 1975; Kiloh, 1961; Wells, 1979). Little work, however, has been done toward developing practical strategies to help nondepressed elderly people experiencing age-related cognitive decline.

Researchers have documented that nondepressed elderly people may score in the “normal” range on screening tests for senile dementia, though still experiencing age-related cognitive declines, a phenomenon recently described in a series of meetings of the National Institute of Mental Health (NIMH) as “minimal memory impairment” (MMI) (Annapolis and Key West, November 1985). Craik's classic review of memory and aging (1977) and Poon's extensive recent review (1985) list a wide variety of significant and substantial declines in memory function in old versus young “normals.” Elders who want to continue to work as long as possible may be appropriately concerned if these “normal” losses lead to reduced ability to function professionally or lead to social embarrassment. The purpose of this chapter is to review the cognitive changes that occur with normal aging, critically discuss prior attempts to reduce these losses, present some recent modifications to these attempts, and then finally focus on the limitations of current studies with implications for future research.

Discussions of perception or memory seldom begin by defining a percept or a memory. Discussions of problem solving, however, almost always begin by attempting to define a problem. Yet the term “problem” is in the everyday vocabulary of virtually every adult. When a term that is commonly used must be explicitly defined, usually it is because the meaning that is intended differs from the common usage. The difference may be connotative. For example, the term “relativity” has almost completely different connotations for the theoretical physicist and for the layperson. The difference may also be denotative. For example, the term “flu” denotes different sets of disorders for the epidemiologist and for the layperson. It seems unlikely that two concepts would denote the same things but have different connotations. It is likely, then, but not assured, that the scientific and the lay concepts of a problem denote different things. It is an open question whether or not the two concepts have similar connotations. If the connotations are similar, then we must ask if the problems we, as scientists, study are sufficiently similar to the problems people experience that we can generalize what we learn about how problems are solved and how to assist the process. If the connotations are not similar, the questions are more serious: If our problems are not like people's problems, to what aspect of human experience do they generalize? What fields of scientific inquiry do address problems that people experience?