VITABachelor of Arts Psychology Magna Cum Laude Willamette Universi - PDF document

VITABachelor of Arts, Psychology, Magna Cum Laude, Willamette University 2011 Master of Arts, Psychology, San Diego State University 2014 Master of Science, Clinical Psychology, Joint Doctoral Program in Clinical Psychology, San Diego State University 2017-2018 Pre-doctoral Intern, Salem VA Medical Center 2018 Doctor of Philosophy, Clinical Psychology, Joint D

octoral Program in Clinical Attitudes toward aging were assessed with the Age Implicit Association Test and the Attitudes to Ageing Questionnaire (AAQ). Balance was operationalized as postural sway and assessed with a force platform. The relationships among attitudes toward aging, FoF, and balance were examined with linear regression analyses. Study 2 was a sec

ondary analysis of 136 are known to affect mental, physical, and cognitive health in older adults (Bryant et al., 2012; Robertson, King-Kallimanis, & Kenny, 2016). Explicit attitudes are introspective and self-reported, and as such, they are subject to social desirability biases. Implicit attitudes are mental associations that operate automatically, outside of

conscious control or awareness event (Wurm, Warner, Ziegelmann, Wolff, & Schuz, 2013), and one study found that individuals who hold positive stereotypes about aging are 44% more likely to recover from a serious disability than those who endorse negative stereotypes (B. R. Levy, Slade, Murphy, & Gill, 2012). Although the mechanism of action through which attitu

des toward aging affect health outcomes has not been empirically elucidated, the stereotype embodiment theory (SET) proposed by Levy (2009) is widely regarded as a potential process through which stereotypes that are acquired early in life become internalized as part of oneÕs self-concept in old age, thereby affecting self-perception and behavior. Although bo

th explicit and implicit attitudes toward aging affect health and behavior in later life, previous research suggests that they may be distinct, albeit related, constructs (Nosek & Smyth, 2007). Correlations between implicit and explicit attitudes toward age are low and nonsignificant 's .20; Greenwald & Nosek, 2001; Hummert, Garstka, O'Brien, Greenwald, & Mell

ott, 2002), and effect sizes for explicit measures of attitude tend to be different than for implicit measures (Greenwald et al., 1998). An alternative explanation is that the distinction between explicit and implicit is one of measurement method rather than the presence of distinct, conflicting (2007) attempted to address this issue using a multitrait-multimet

hod approach to par 2014; Moser, Spagnoli, & Santos-Eggimann, 2011; SargentCox et al., 2012). If there is a relationship between FoF and attitudes toward aging, future research could begin to explore the direction of the association and test whether interventions that moderate aging attitudes (Maki, Holliday, & Topper, 1991; Sturnieks et al., 2016). Additionall

y, older adults with FoF demonstrate a more cautious gait, which is characterized by slower velocity, longer time spent in double-support phase, and decreased step length (Chamberlin, Fulwider, Sanders, & Medeiros, 2005; Delbaere, Sturnieks, Crombez, & Lord, 2009; Kirkwood et al., 2011; Maki, 1997). This association has been reported even in older adults with re

latively low fall risk (Binda, Culham, & Brouwer, 2003). The relationship between balance and FoF is likely complex and bidirectional. For some older adults, FoF could develop from realistic appraisals of impaired balance ability, whereas for others FoF may be excessive relative to actual fall risk. In either case, FoF can lead to behavioral changes that negativ

ely affect postural control strategies, thereby promoting or exacerbating instability that can feed back to increase anxiety (Maki et al., 1991) differences among healthy older adults and may be affected by experimenter bias, whereas the TUG demonstrates good sensitivity but does not indicate the specific components of balance and gait that contribute to perform

ance differences (Mancini & Horak, 2010; Yim-Chiplis & Talbot, 2000). Objective assessments, such as the use of force plates to measure postural sway, overcome some of the limitations of subjective and functional assessments such as experimenter bias and subjective scoring, and provide more precise measurements for detecting subclinical balance deficits (Yim , y

et performance under the condition of divided attention; more research is needed, however, to confirm and extend these findings to other cognitive domains. When cognitive function has been assessed in relation to FoF, it is often measured with a brief or global cognitive assessment (e.g., Austin, Devine, Dick, Prince, & Bruce, 2007; Friedman et al., 2002). A f

ew studies have explored the relationship of FoF with specific domains of cognitive abilit oF. The first study evaluated the associations among FoF, attitudes toward aging, and balance performance in older adults, and was novel in several ways. In regards to the relationship between FoF and balance, the study 1) tested the relationship using a new, simple, obje

ctive method of balance assessment (i.e., the BBT) and 2) explored the effect of general anxiety on the relationship between FoF and balance. The relationship between attitudes toward aging and subjectively measured balance performance has been reported in an implicit priming study (B. R. Levy et al., 2014), but the current study added to the literature by evalu

ating the relationship between an objective measure of balance and explicit attitudes toward aging as well as evaluating the relationship between postural sway and the IAT, which have not previously been reported. The association between FoF and attitudes toward aging has not been reported and is a novel contribution to the literature. Importantly, attitudes tow

ard aging may promote or exacerbate FoF, and thus attitudes toward aging are a potential causal factor of FoF. In theory, if attitudes toward aging were causally related to FoF, FoF could function as a partial mediator of the relationship between attitudes toward aging and balance performance. This hypothesized relationship is especially intriguing because of th

e possibility for intervention to modify attitudes toward aging and reduce FoF balance performance associated with individual differences in FoF and attitudes toward aging. Age Implicit Association Test (IAT; Greenwald et al., 1998) and explicit beliefs were and balance performance such that negative attitudes would be associated with poorer performance (i.e.,

greater postural sway). Hypothesis 3. It was hypothesized that there would be a negative association between FoF and attitudes toward aging such that negative attitudes would be associated with higher FoF. Exploratory Aim 1: To evaluate the potential moderating effect of attitudes toward aging on the relationship between fear of falling and balance performanc

e. Exploratory Aim 2: To test the plausibility that fear of falling partially mediates the relationship between attitudes toward aging and balance performance. Study 2: Neuropsychological correlates of fear of falling in community-dwelling older adults. Aim 1: To determine the associations among fear of falling, anxiety, depression, executive function, process

ing speed, episodic memory, and working memoryUsing a sample of 136 older a Diego area and participating in a randomized control trial comparing the effect of multi-component intensity-based aerobic exercise and Mindfulness-Based Stress Reduction psychotherapy on age- Fear of falling was measured with the short version of the Falls Efficacy Scale International

(FES Neuropsychological testing was completed with the NIH Toolbox Cognition Battery (NIHTB-CB; Weintraub et al., 2014). The NIH Toolbox recently switched from an internet easurement Information System (PROMIS) Anxiety Short Form and Depression Ð Short Form, respectively (www.nihpromis.org). Participants were asked to rate how often over the past 7 days they fel

t Data analysis All models were adjusted for age because age has been shown to be associated with FoF, balance, and attitudes toward aging in other studies (Arfken et al., 1994; Hummert et al., 2002; Laufer, Barak, & Chemel, 2006). Sample characteristics were described using measures of central tendency and variability for continuous measures and frequencies fo

r categorical measures. Residuals were examined to test for assumptions of linearity, normality, and homogeneity of variance. Transformations on the dependent variables were conducted where applicable. Results were not changed in cases where log transformation of the dependent variable was needed to normalize residuals, so all results are reported using nontrans

formed data for ease of interpretation. Sensitivity analyses were conducted for cases with high influence (based on CookÕs distance) and findings are reported where applicable. Power analyses and effect sizes were conducted with G*Power 3.1. All analyses were powered for at least 80% power to detect a medium effect size (Ä2 = 0.15) with an error probability of !

= .05. Bonferroni adjustments were made to correct for multiple tests. Study 1. covariates considered for inclusion in the models included grip strength (average of right and left hands), gender, number of falls in the past 3 months, body mass index (BMI), and contrast sensitivity, because these variables have been found to be associ I score �10) and l

ow FoF (Delbaere, Close, Mikolaizak, et al., 2010), where applicable. Additionally, models were rerun to examine the effects of individual subscale scores for the AAQ in place of the total AAQ score, where applicable. adjusting for age, fall history, and balance were conducted using the REG procedure in SAS University Edition (SAS Institute, Inc, Cary, NC). Raw

scores for each of the executive function tests were converted to standardized z-scores and averaged to create an executive function composite score. Similarly, raw scores for each test of episodic memory wereconverted to z American Indian/Alaskan Native 0 Asian 30.2 (5.6; 16-40) PS 14.9 (5.0; 8-25) Note. Attitudes to Ageing Questionnaire, total scores ran

ge from 24-120, with higher scores indicating more positive attitudes; FES-I=Falls Efficacy Scale - International, scores range from 7-28 with higher scores indicating greater symptomology; IAT=Implicit Association Test, positive scores indicate negative attitude whereas negative scores indicate positive attitude toward aging; PC=Physical Change subscale, higher

scores indicate more positive attitude related to physical changes with age; PG=Psychological Growth subscale, higher scores indicate more positive attitude related to psychological growth with age; PS=Psychosocial Loss, higher scores indicate more negative attitude related to psychosocial loss with age; PROMIS Anxiety scores range from 7-35, with higher scores

indicating greater symptomology. a n = 67. Table 3 Study 2 Participant Demographics (n=136) M (SD; range) or % Age, years 73.0 (5.4; 62-85) Sex, % female 75.0 Race, % American Indian/Alaskan Native 0.7 Asian Study 1 Results are displayed in Tables 5-7. Participants tested at the month 6 visit were older than participants tested at baseline (s=74 vs

71 years, p=.006). No other variables differed by visit type so visit type was not included as a covariate. The hypothesis that higher fear of falling would be associated with poorer balance was not supported. The association between scores on the FES .08 1 1.02 [0.19, 1.85]0.29 2.44 .02 .10 FES-I .00 1 0.12 [-1.21, 1.43] 0.02 0.17 .86 .00

Step 2a .10 3 2.25 .09 .11 Age .09 1 0.95 [0.10, 1.81] Age 1 1.05 [0.23, 1.88] Age 1 0.004 [-0.15, 0.16] 0.006 0.05 .96 .00 BMI 1 0.19 [0.05, 0.32] 0.33 2.73 .008 .10 AAQ 1 0.03 [-0.03, 0.09] 0.12 0.96 .34 .01 Full Model .13 4 2.34 .06 .15 Age 1 -0.006 [-0.16, 0.15] -0.009 -0.08 .94 .00 BMI 1 0.

17 [0.03, 0.31]0.30 2.41 .02 .10 IAT 1 0.90 [-0.51, 2.31] 0.15 1.28 .21 .02 AAQ 1 0.03 [-0.03, 0.08] 0.12 0.95 .34 .01 Note. AAQ = Attitudes to Ageing Questionnaire, scores range from 24-120, with higher scores indicating more positive attitudes; BMI = Body Mass Index; IAT = Implicit Association Test, positive scores indicate positive attitude whereas

negative scores indicate negative attitude. Study 2 Results are displayed in Table 8. The hypothesis that higher scores on the PROMIS depression and anxiety scales would be associated with higher scores on the FES-I was not supported. The relationships between scores on the FES-I and scores on the PROMIS depression and anxiety scales, respectively, were not s

ignificant (BÕs=.02-.07, pÕs=.21-.78). Additionally, Depression !!1 0.02 [-0.10, 0.13] .03 .28 .78 .01 Anxiety !!1 0.07 [-0.04, 0.19] .15 1.25 .21 .00 Executive Function !!1 -0.19 [-0.73, 0.36] -.07 -.68 .50 .00 Working Memory !!1 0.23 [0.07, 0.38] performed within the low to moderate fall risk range on the balance test (https://balancetrackingsystems.

com/wp-content/uploads/2017/09/AB4InterpretingBBTandFallRisk.pdf). Thus, the concern about falling within the current sample may tend to represent an accurate rather than an ageist appraisal of fall risk. A stronger relationship between negative attitudes toward aging and FoF might be seen in older adults with high FoF coupled with low fall risk compared to thos

e with moderate to high resentations of aging appear to be multifaceted and complex, and future studies should include measures of multiple components of self-representations to clarify the aspects of aging that are most amenable to intervention and positive change (Bodner et al. (2017) found that high worry attenuated performance deficits on inhibitory control

that were associated with anxiety and depression symptoms. The authors postulated that worry may be associated with personality characteristics, such as perfectionism, that could increase motivation to minimize errors on cognitive testing. Although speculative, older adult worriers may be vulnerable to developing FoF due to focusing worry on issues particularly

relevant to later life, including concern about increased risk of falling and possible negative consequences of falling in to executive function was the low variability of scores on executive function tests in the current sample due to the majority of individuals scoring at or near the ceiling. The finding that higher FoF was associated with better verbal work

ing memory is a novel finding. To this authors knowledge, the relationship between verbal working memory and FoF has not been reported in the literature to date. It is possible that the low to moderate levels of FoF endorsed by the majority of the current sample might be associated with enhanced performance on working memory tasks whereas higher levels of FoF ma

y be associated with impaired performance, similar to the inverted ÒUÓ effect of arousal and performance associated with anxiety (Eysenck, Derakshan, Santos, & Calvo, 2007). The relationship between verbal working memory and FoF is not clear. One possibility is that there is a third variable related to both FoF and working memory that was not controlled for and

thus confounded the results. Another possibility is that the hypothesized impairments in working memory would be seen with a working memory task that was fear -I 1.00 CoP Postural Sway .02 1.00 IAT (D) .21 -.13 1.00 AAQ Total .05 -.07 -.01 1.00 AAQ PS .07 .14 -.04 -.82***

1.00 AAQ PC .09 .05 -.06 .85*** -.49*** 1.00 AAQ PG .11 -.12 .00 .83*** -.55*** .58*** 1.00 PROMIS Anxiety .13 -.15 -.15 -.35** .38** -.23 -.25* 1.00 Anxiety !!1 0.08 [-0.07, 0.22] .16 1.08 .28 .01 Executive Function !!1 0.07 [-0.59, 0.72] .03 0.21 .84 .00 Working Memory !!1 0.17 [-0.03, 0.38] .

18 1.69 .09 .02 Episodic Memory !!1 -0.87 [-1.47, -0.27] -.30 -2.89 .005 .07 Processing Speed !!1 0.02 [-0.02, 0.05] .10 .94 .35 .01 Note. Executive Function and Episodic Memory are composite variables. aCovariates included in the model included age, number of falls in the past 3 months, and postural sway. Table C2 Ordinary Least Squares Regression An

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