Clinical decision making in the prediction of falls.

Objective: Examine rehabilitation professionals' capacity to identify risk factors for patient falls. Design: Survey study. Setting: Three academic medical center rehabilitation departments. Participants: Fifty-six rehabilitation specialists representing disciplines typically involved in patient care, including physiatry and occupational, physical, recreation, and speech therapy. Measures: A 2-part, self-report questionnaire with spontaneous and cued rank-order listing of factors related to fall risk. Results: Clinicians did not consider advanced age and history of falling when spontaneously delineating risks for falls. The importance of fall history, but not of advanced age, was recognized through cueing. Conclusions: Clinicians appear aware of strong predictors of fall risk but require cueing to consistently use them. Cueing increased hypothetical predictive accuracy, although clinicians still downplayed some of the most salient predictive factors. Staff education regarding validated fall risk factors and potential errors in clinical decision making can improve patient care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Explanations for side effect aversion in preventive medical treatment decisions.

Objective: Many laypeople demonstrate excessive sensitivity to negative side effects of medical treatments, which may lead them to refuse beneficial therapies. This Internet-based experiment investigated three possible explanations for such “side effect aversion.” One was derived from mental accounting, one examined the mere presence of a side effect, and one focused on computational difficulties. Design: Participants (N = 5,379) were presented with a hypothetical cancer preventive treatment situation that was or was not accompanied by one or two small side effects. The side effects were either beneficial or harmful. In all conditions, the net absolute risk reduction associated with the treatment was 15%. Main Outcome Measures: Participants indicated their willingness to accept treatment and their perceptions of the treatment's effects on their overall cancer risk. Results: Data were consistent only with the “mere presence” explanation of side effect aversion, the idea that side effects act as a strong negative cue that directly affects treatment appraisal. The number of negative side effects did not influence treatment willingness. Conclusion: Side effect aversion is a challenge to informed decision making. Specific mechanisms that produce side effect aversion should be identified. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Learning to choose: Cognitive aging and strategy selection learning in decision making.

Decision makers often have to learn from experience. In these situations, people must use the available feedback to select the appropriate decision strategy. How does the ability to select decision strategies on the basis of experience change with age? We examined younger and older adults' strategy selection learning in a probabilistic inference task using a computational model of strategy selection learning. Older adults showed poorer decision performance compared with younger adults. In particular, older adults performed poorly in an environment favoring the use of a more cognitively demanding strategy. The results suggest that the impact of cognitive aging on strategy selection learning depends on the structure of the decision environment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reducing aversion to side effects in preventive medical treatment decisions.

Laypeople tend to be overly sensitive to side effects of treatments that prevent illness, possibly leading them to refuse beneficial therapies. This Internet-based study attempted to reduce such side effect aversion by adding graphic displays to the numerical risk probabilities. It also explored whether graphics reduce side effect aversion by making it easier for respondents to determine how the treatment might change their net cancer risk. Participants (N=4,248) were presented with a hypothetical preventive treatment situation that was or was not accompanied by a small side effect. In both conditions, the net absolute risk reduction was 12%. Adding an array of stick figures to risk probabilities reduced side effect aversion substantially, but adding a bar graph was not beneficial. The ability of arrays to reduce side effect aversion was not attributable to greater accuracy in evaluating the treatment's net benefit. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Affective and deliberative processes in risky choice: Age differences in risk taking in the Columbia Card Task.

The authors investigated risk taking and underlying information use in 13- to 16- and 17- to 19-year-old adolescents and in adults in 4 experiments, using a novel dynamic risk-taking task, the Columbia Card Task (CCT). The authors investigated risk taking under differential involvement of affective versus deliberative processes with 2 versions of the CCT, constituting the most direct test of a dual-system explanation of adolescent risk taking in the literature so far. The “hot” CCT was designed to trigger more affective decision making, whereas the “cold” CCT was designed to trigger more deliberative decision making. Differential involvement of affective versus deliberative processes in the 2 CCT versions was established by self-reports and assessment of electrodermal activity. Increased adolescent risk taking, coupled with simplified information use, was found in the hot but not the cold condition. Need-for-arousal predicted risk taking only in the hot condition, whereas executive functions predicted information use in the cold condition. Results are consistent with recent dual-system explanations of risk taking as the result of competition between affective processes and deliberative cognitive-control processes, with adolescents’ affective system tending to override the deliberative system in states of heightened emotional arousal. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intraindividual variability is related to cognitive change in older adults: Evidence for within-person coupling.

In this study, the authors addressed the longitudinal nature of intraindividual variability over 3 years. A sample of 304 community-dwelling older adults, initially between the ages of 64 and 92 years, completed 4 waves of annual testing on a battery of accuracy- and latency-based tests covering a wide range of cognitive complexity. Increases in response-time inconsistency on moderately and highly complex tasks were associated with increasing age, but there were significant individual differences in change across the entire sample. The time-varying covariation between cognition and inconsistency was significant across the 1-year intervals and remained stable across both time and age. On occasions when intraindividual variability was high, participants' cognitive performance was correspondingly low. The strength of the coupling relationship was greater for more fluid cognitive domains such as memory, reasoning, and processing speed than for more crystallized domains such as verbal ability. Variability based on moderately and highly complex tasks provided the strongest prediction. These results suggest that intraindividual variability is highly sensitive to even subtle changes in cognitive ability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A cognitive and social psychological analysis of disclosure laws and call for mortgage counseling to prevent predatory lending.

The federal government’s primary method of protecting consumers from “predatory lending” has been to enact disclosure laws that were supposed to enable consumers to make informed decisions. This article contends that notwithstanding these disclosure laws, unscrupulous mortgage brokers and lenders have been able to take advantage of certain described cognitive and social psychological phenomena to induce borrowers to enter into predatory loans, and argues that disclosures alone—even the recently revised disclosure forms—are inadequate. To better empower consumers to make informed decisions on their home loans, this article proposes and details a mortgage counseling intervention that contains both “in-person” and interactive computer counseling as a necessary supplement to disclosure laws. Designed properly, such an intervention would more effectively address the cognitive and social psychological barriers to rational decision making than disclosure alone. The article also examines the likely costs and benefits of the proposed mortgage counseling intervention in light of Illinois experience with mortgage counseling and urges policymakers to consider not only the costs of implementing mortgage counseling but also the costs of not providing for this counseling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prospective incidence of first onsets and recurrences of depression in individuals at high and low cognitive risk for depression.

Do negative cognitive styles provide similar vulnerability to first onsets versus recurrences of depressive disorders, and are these associations specific to depression? The authors followed for 2.5 years prospectively college freshmen (N = 347) with no initial psychiatric disorders at high-risk (HR) versus low-risk (LR) for depression on the basis of their cognitive styles. HR participants had odds of major, minor, and hopelessness depression that were 3.5-6.8 times greater than the odds for LR individuals. Negative cognitive styles were similarly predictive of first onsets and recurrences of major depression and hopelessness depression but predicted first onsets of minor depression more strongly than recurrences. The risk groups did not differ in incidence of anxiety disorders not comorbid with depression or other disorders, but HR participants were more likely to have an onset of anxiety comorbid with depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patients' competence in and performance of cognitive therapy skills: Relation to the reduction of relapse risk following treatment for depression.

Cognitive therapy (CT) for depression is designed to teach patients material that is believed to help prevent relapse following successful treatment. This study of 35 moderately to severely depressed patients who responded to CT provides the 1st evidence to suggest that both development and independent use of these competencies predict reduced risk for relapse. Among patients who responded to treatment, both CT coping skills and in-session evidence of the independent implementation of CT material predicted lower risk for relapse in the year following treatment. These relationships were not accounted for by either symptom severity at the end of treatment or symptom change from pre- to posttreatment. Self-esteem, assessed at posttreatment, failed to predict risk for relapse in the year following treatment. Thus, CT coping skills and independent use of CT principles, but not overall satisfaction with oneself, appear to play an important role in relapse prevention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of slight to moderate risk for birth hypoxia on acquisition of cognitive and language function in the preterm infant: A cross-sectional comparison with preterm-birth controls.

The cognitive and language performance of a group of 26 preterm-birth preschool and early school-age children with slight to moderate risk for perinatal hypoxia was compared with the performance of a preterm-birth comparison group of 26 children. Despite the relatively small discrepancy in degree of risk, the cognitive performance of the 2 groups diverged significantly. When data for children with known perinatal arterial pH were combined, a curvilinear (quadratic) regression model provided the best fit. Increasing acidosis was linearly related to decreases in cognitive skills, with the bend in the curve occurring well within the normal range of pH values. Hence, in the preterm infant, even minor risk for birth hypoxia may result in discernible deviation from the expected developmental trajectory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Context processing in older adults: Evidence for a theory relating cognitive control to neurobiology in healthy aging.

A theory of cognitive aging is presented in which healthy older adults are hypothesized to suffer from disturbances in the processing of context that impair cognitive control function across multiple domains, including attention, inhibition, and working memory. These cognitive disturbances are postulated to be directly related to age-related decline in the function of the dopamine (DA) system in the prefrontal cortex (PFC). A connectionist computational model is described that implements specific mechanisms for the role of DA and PFC in context processing. The behavioral predictions of the model were tested in a large sample of older (N = 81) and young (N = 175) adults performing variants of a simple cognitive control task that placed differential demands on context processing. Older adults exhibited both performance decrements and, counterintuitively, performance improvements that are in close agreement with model predictions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using the common-sense model to predict risk perception and disease-related worry in individuals at increased risk for venous thrombosis.

Objective: This study applied the Common-Sense Model (CSM) to predict risk perception and disease-related worry in 174 individuals with a genetic predisposition to venous thrombosis (thrombophilia). Design: Participants completed an adapted version of the Illness Perception Questionnaire-Revised (IPQ-R) and measures assessing risk perception and worry. Results: Regression analyses revealed that illness perceptions were predictors of risk perception and thrombosis worry. The hypothesis that illness perceptions mediate the relationship between a person's experience of venous thrombosis and perceived risk and thrombosis worry could not be confirmed. Conclusions: Further research should refine the IPQ-R for populations at risk of a disease and examine the value of the CSM in explaining the relationship between risk perception, worry, and health behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)