Debiasing the framing effect in younger and older adults\u27 medical decision making

The framing effect is a common decisional bias. In the current study, the framing effect and its avoidance via a debiasing questionnaire was studied with younger and older adults making decisions regarding lung cancer treatment. Participants received three cancer scenarios framed in either survival or mortality terms, with scenarios presented in cumulative probability, interval probability, and life expectancy format. There were two between-subjects factors and one within-subjects factor. Younger adults exhibited the framing effect with the cumulative and interval probability formats. No framing effect was found in the debias condition. Older adults exhibited the framing effect with the interval probability format. Older adults in the debiasing condition showed the framing effect with the cumulative and interval probability formats. Older adults who had received or provided care and those who knew someone with cancer were less likely to exhibit the framing effect. Frame was the only significant predictor of treatment choice

Decisional strategy determines whether frame influences treatment preferences for medical decisions

Decision makers are influenced by the frame of information such that preferences vary depending on whether survival or mortality data are presented. Research is inconsistent as to whether and how age impacts framing effects. This paper presents two studies that used qualitative analyses of think-aloud protocols to understand how the type of information used in the decision making process varies by frame and age. In Study 1, 40 older adults, age 65 to 89, and 40 younger adults, age 18 to 24, responded to a hypothetical lung cancer scenario in a within-subject design. Participants received both a survival and mortality frame. Qualitative analyses revealed that two main decisional strategies were used by all participants: one strategy reflected a data-driven decisional process, whereas the other reflected an experience-driven process. Age predicted decisional strategy, with older adults less likely to use a data-driven strategy. Frame interacted with strategy to predict treatment choice; only those using a data-driven strategy demonstrated framing effects. In Study 2, 61 older adults, age 65 to 98, and 63 younger adults, age 18 to 30, responded to the same scenarios as in Study 1 in a between-subject design. The results of Study 1 were replicated, with age significantly predicting decisional strategy and frame interacting with strategy to predict treatment choice. Findings suggest that framing effects may be more related to decisional strategy than to age

Impact of older adults’ experience with psychotherapy on treatment engagement

The goal of the study was to characterize older adults\u27 experience with psychotherapy and examine its impact on engagement in psychotherapy. The study included 50 adults over age 60 who screened positive for depression and participated in the BRIGHTEN Program, an interdisciplinary geriatric mental health program. Qualitative analyses revealed five themes leading to treatment initiation: health concerns, family issues, the experience of depressive symptoms, beliefs about what participants could get from psychotherapy, and positive outcomes seen in others. Those without a history of mental health treatment were more likely to endorse health concerns as a treatment motivator and were more likely to terminate treatment early. Future research is warranted to determine how to effectively engage older adults seeking mental health treatment for the first time

Experience Disclosing Mental Health Conditions Among College Students from Different Ethnic Backgrounds

Aim: The current study compared disclosure of mental health problems to staff, faculty, and peers among college students from different ethnic backgrounds. Background: Although there are differences in mental health stigma between college students from different ethnic backgrounds, there is limited research on whether these differences are associated with negative experiences disclosing mental health conditions on campus. Methods: The sample (N = 66) was 71% female; average age was 19.03 years (SD = 1.14). Participants identified as Latino/a (35.4%), Asian American (33.8%), Caucasian (13.8%), or other/mixed ethnicity (16.9%). Results: For disclosure to staff, there was a main effect of ethnicity. Post-hoc analyses found that Latino/a students were significantly more comfortable disclosing mental health problems to staff than Asian American students. There were no significant effects for disclosure to faculty or peers. Conclusions: This preliminary study suggests that universities must optimize outreach and mental health services for different ethnic groups to improve campus experience around mental health conditions

Longitudinal Health Outcomes and Treatment Utilization Among Emerging, Early-Mid, and Older Rural Adults Using Stimulants

There is limited knowledge about age-related differences in health outcomes and treatment utilization among rural stimulant users. The current study examined physical health, mental health, and treatment utilization (hospital, mental health, and substance use care) among 710 stimulant users living in rural areas of the United States. Generalized estimating equations (GEE) were used to examine associations between age and physical health, mental health, and treatment utilization over a 3-year period. Analyses controlled for participants’ gender, race, and education. To capture age-related differences, participants were grouped into emerging adults (18–25 years old, n = 223), early-mid adults (26–44 years old; n = 384), and older adults (45–61 years old; n = 103). At baseline, older stimulant users were in significantly poorer health even though they had significantly fewer substance use problems than emerging adult users. GEE models indicated that substance use outcomes improved for all participants over the course of the study but other outcomes remained stable. Older stimulant users continued to have worse physical health and mental health, even though they had fewer substance use problems, than the other age groups. Older adults also used more hospital and mental health services than the other age groups. White participants tended to be at higher risk for negative outcomes than nonwhite participants. We conclude that rural older adults who use stimulants have poor health despite having milder substance use problems and using more health care resources, and need targeted intervention to improve health outcomes

Decreasing physical and verbal aggression in a brain injured nursing home resident

Following a traumatic brain injury, patients often suffer a series of psychological and psychiatric sequalae. This study presents the case of Mr. K, a 52-year-old brain-injured nursing home resident who exhibited problematic physical aggression and verbal abuse toward staff and residents. His problem behaviors were intertwined with an ethical issue involving a heterosexual relationship with another resident who also was brain injured. Following a functional assessment of antecedents and consequences, a differential reinforcement of other behavior (DRO) schedule was implemented. Specifically, the resident was rewarded with short-term and long-term reinforcers following periods of time during which behaviors other than the target behavior were emitted. Although the behavior plan was successful, it resulted in a more noticeable decrease in physically aggressive behaviors than verbally abusive behaviors. Implications include increasing awareness of use of behavior plans in nursing homes and of ethical and behavioral issues associated with sexuality among nursing home residents

Behavioral and psychological symptoms of dementia: The effects of physical activity at adult day service centers

Adult day services (ADS) are an increasingly popular option for caregivers of people with dementia, but there is little research on the effects of activities on the behavior and mood of the client. This study examines participation by 94 individuals in different types of adult day-care activities and their association with changes in behavior and psychological symptoms of dementia (BPSD) for the client during a three-month span. Three domains of BPSD were examined: restless behaviors, mood behaviors, and positive behaviors. Using growth curve modeling, results show that the restless and mood behavior domains, on average, were stable over three months, whereas positive behaviors increased. For all three behavior domains there were individual differences in average level of BPSD. Average rate of change for individuals also varied from the mean for restless and mood behaviors. Physical activities, social activities, engaging activities, and watching and listening activities, along with a day-care dosage variable, were used as covariates to explain these individual differences in change. Engaging activities explained some of the individual variance for restless behaviors; as individuals increased one increment in engaging activities, they had fewer restless behavior problems over time. These results suggest that some features of programming may be related to improvements in restless behavior

A process examination of the framing effect in younger and older adult medical decision making

Older and younger adults are susceptible to a decisional bias when faced with medical decisions, which results in different treatment decisions when presented with survival or mortality data. Although this bias, termed the framing effect, has been demonstrated in multiple studies, no published studies have attempted to determine the decisional process older and younger adults engage in when presented with different information frames. The current study used a think-aloud procedure to examine decisional process differences in younger and older adults who did and did not demonstrate a framing effect. All participants were presented with two data formats (interval and cumulative probabilities) in both survival and mortality wording. Data were analyzed quantitatively to determine the presence of a framing effect. Think-aloud data were analyzed qualitatively to determine decisional process differences stratified by age and demonstration of the framing effect. Interpretation of results for the interval probability format was limited by typographical errors that were found to exist in the scenario after data collection was complete. No statistically significant framing effects were found for either format among both younger and older adults. Older and younger adults had relatively equal personal and vicarious experience with the decision. Qualitative analyses performed on a subset of the data suggest that, among those older adults who did not demonstrate the framing effect, there was a reliance on pertinent experience with the decision, and little reliance on the presented data. In contrast, among younger adults who demonstrated the framing effect, there was a tendency toward incomplete analysis of the data when younger adults had knowledge about the decision. Across age groups, those that demonstrated the framing effect were significantly more likely to reference the presented data. Older adults were significantly less likely to reference the presented data than younger adults. Younger and older adults did not differ significantly on time-to-decision or word count for the think-aloud transcripts. Results are discussed in terms of age-related differences in decision making processes