Copyright is owned by the Author of the thesis. Permission is given for a copy to be downloaded by an individual for the purpose of research and private study only. The thesis may not be reproduced elsewhere without the permission of the Author. Improving memory in midlife: A multiple case study evaluation of a group-based memory programme for healthy middle-aged individuals A dissertation presented in partial fulfilment of the requirements of the degree of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand. Gunnar Benjamin Scheibner 2012 ABSTRACT The research presented in this thesis evaluates a memory programme (N = 5) that was specifically designed for middle-aged individuals. A preliminary online survey (N = 409) examined the theory of Selective Optimisation with Compensation (SOC) in the context of everyday memory. The survey informed some aspects of the memory programme by examining the relationships between cognitive failures, memory compensation efforts, and control beliefs. Results indicated that SOC endorsement accounted for a significant reduction in everyday cognitive failures (i.e., forgetfulness, distractibility, and false triggering) and a higher sense of memory control. The beneficial effects of memory control beliefs were partially mediated by SOC endorsement. Counter to expectations, SOC endorsement did not affect the forgetfulness/memory compensation relationship. The Midlife Memory Programme, containing four treatment components (i.e., goal pursuit, memory and ageing education, strategy training, and group discussions), was evaluated by a before/after design with a three month follow-up. The data showed improvements in objective and subjective memory performance and worries about memory performance decrements diminished. While the findings were encouraging, a larger scale study is needed to establish the efficacy of the programme. i ACKNOWLEDGMENTS I would like to thank Professor Janet Leathem for her encouragement, ideas, and support throughout the completion of this thesis. I am also grateful to Associate Professor Paul Merrick for his advice and feedback and Dr Steven Humphries for his statistical advice. Finally, I would also like to thank all of the participants who took part in the research presented in this thesis. TABLE OF CONTENTS ACKNOWELDGEMENTS............................................................................................ i LIST OF FIGURES........................................................................................................ ii LIST OF TABLES......................................................................................................... ii LIST OF APPENDICES................................................................................................ iii OVERVIEW................................................................................................................... iv CHAPTER I MIDLIFE AND SUCCESS COGNITIVE AGEING: THEORY AND RESEARCH 1 Introduction....................................................................................... 1 1.1 The population ageing process.................................................... 1 1.2 Age categories and ageing research: A scientific dilemma......... 2 1.3 Midlife: A developmental stage of stability and change............. 4 1.4 Theories of the ageing process.................................................... 8 1.4.1 Biological perspectives on the ageing process............. 8 1.4.2 Lifespan psychology: Perspectives on the ageing process................................................................................... 12 1.5 Conclusion................................................................................... 22 II THE INFORMATION PROCESSING APPROACH TO MEMORY AND AGEING: MEMORY SYSTEMS AND MECHANISMS OF AGEING-RELATED CHANGE 25 Introduction..................................................................................... 25 2.1 System theories of memory....................................................... 26 2.1.1 Atkinson and Shiffrin?s three-part model................... 26 2.1.2 Tulving?s five-part model........................................... 28 2.2 Age-related changes in memory................................................ 29 2.2.1 Procedural memory...................................................... 30 2.2.2 Perceptual representational system.............................. 30 2.2.3 Working memory......................................................... 30 2.2.4 Semantic memory........................................................ 31 2.2.5 Episodic memory......................................................... 32 2.3 Memory in midlife..................................................................... 33 2.4 The construct of memory: Conceptual distinctions and elementary processes....................................................................... 35 2.4.1 Explicit and implicit memory...................................... 35 2.4.2 Retrospective and prospective memory....................... 36 2.4.3 Attention, learning, and memory................................. 37 2.4.4 Memory encoding........................................................ 40 2.4.5 Memory retrieval.......................................................... 40 2.5 Memory assessment................................................................... 42 2.5.1 Types of memory assessment...................................... 43 2.5.2 Neuropsychological assessment of basic memory skills....................................................................................... 44 2.5.3 Neuropsychological assessment of everyday memory. 45 2.6 Conclusion................................................................................... 49 III CONTEXTUAL DETERMINANTS OF INDIVIDUAL DIFFERENCES IN MEMORY PERFORMANCE 51 Introduction...................................................................................... 51 3.1 Education and memory performance......................................... 51 3.2 Health and lifestyle-related moderators of memory performance..................................................................................... 52 3.2.1 Dementias.................................................................... 52 3.2.2 Alcohol use.................................................................. 53 3.2.3 Exercise........................................................................ 54 3.2.4 Stress and memory....................................................... 55 3.2.5 Social engagement and relationships........................... 56 3.3 Motivational and cognitive moderators of memory performance....................................................................................... 56 3.3.1 Memory goals................................................................ 56 3.3.2 Emotional well-being.................................................... 57 3.3.3 Stereotypes about ageing and memory.......................... 58 3.3.4 Memory self-efficacy.................................................... 58 3.3.5 A sense of memory control and memory beliefs........... 59 3.4 Conclusion................................................................................... 60 IV SUCCESSFUL AGEING AND MEMORY IMPROVEMENT: INTERVENTIONS FOR HEALTHY POPULATIONS 62 Introduction....................................................................................... 62 4.1 Common memory improvement and expectancy change strategies............................................................................................ 63 4.1.1 Memory mnemonics....................................................... 63 4.1.2 Expectancy modifications.............................................. 65 4.2 Multifactorial memory training for healthy populations............. 67 4.2.1 Review of comprehensive memory improvement programmes............................................................................. 67 4.2.2 Programme content and treatment length...................... 68 4.3 Conclusion................................................................................... 69 V RATIONALE AND HYPOTHESES OF THIS THESIS 71 5.1 Introduction................................................................................. 71 5.2 The survey................................................................................... 72 5.3 The Midlife Memory Programme............................................... 73 VI EVERYDAY COGNITIVE FAILURES AND MEMORY COMPENSATION EFFORTS: A SELECTIVE OPTIMISATION WITH COMPENSATION (SOC) ANALYSIS 76 6.1 Abstract...................................................................................... 77 6.2 Introduction................................................................................ 78 6.3 Method....................................................................................... 82 6.4 Results........................................................................................ 85 6.5 Discussion.................................................................................. 90 VII MEMORY CONTROL BELIEFS AND EVERYDAY FORGETFULNESS IN ADULTHOOD: THE EFFECTS OF SELECTION, OPTIMISATION, AND COMPENSATION STRATEGIES 94 7.1 Abstract...................................................................................... 95 7.2 Introduction................................................................................ 96 7.3 Method....................................................................................... 100 7.4 Results........................................................................................ 105 7.5 Discussion................................................................................... 111 VIII IMPROVING MEMORY IN MIDLIFE: A MULTIPLE CASE STUDY EVALUATION OF A GROUP-BASED MEMORY PROGRAMME FOR HEALTHY MIDDLE-AGED INDIVIDUALS 114 8.1 Abstract...................................................................................... 115 8.2 Introduction................................................................................ 116 8.3 Method....................................................................................... 119 8.4 Results........................................................................................ 124 8.5 Discussion.................................................................................. 128 IX GENERAL CONCLUSION AND DISCUSSION 132 9.1 Core findings and implications of this research........................ 132 9.1.1 The survey................................................................... 132 9.1.2 The Midlife Memory Programme................................ 135 9.2 Limitations................................................................................ 138 9.2.1 The survey................................................................... 138 9.2.2 The Midlife Memory Programme................................ 140 9.3 Conclusion................................................................................. 141 REFERENCES ......................................................................................................... 142 APPENDICES ......................................................................................................... 178 ii LIST OF FIGURES 1.1 Longitudinal change in six basic cognitive abilities across adulthood................. 7 1.2 Longitudinal stability in six basic cognitive abilities during midlife................... 7 1.3 The incomplete architecture of human ontogeny: Dynamics between biological and cultural evolution across the life span.................................................................. 16 1.4 Age differences in resource allocation across the adult life span......................... 18 1.5 Age differences in SOC strategy endorsement..................................................... 21 6.1 The effects of SOC endorsement and mood-ratings on frequency of cognitive failures......................................................................................................................... 89 8.1 Trajectory of outcome measure scores across pre-test, post-test and follow-up assessments for each individual participant................................................................ 126 LIST OF TABLES 1.1 The spectrum of cognitive functioning in later life.................................................. 11 1.2 The four levels of analyses of the process of psychological ageing........................ 14 1.3 Behavioural instances of selection, optimisation, and compensation...................... 21 6.1 Means, standard deviations, alpha coefficients and intercorrelations of all measures......................................................................................................................... 86 6.2 Summaries of regression analysis to examine the effects of SOC and mood on cognitive failures............................................................................................................ 88 7.1 Means and standard deviations of education and self-rated heath status by age group............................................................................................................................... 101 7.2 Items of the CFQ-Memory Scale............................................................................. 104 7.3 Means, standard deviations, alpha coefficients and intercorrelations of all psychometric measures.................................................................................................. 106 7.4 Summary of regression analyses for memory beliefs facets, optimization, and compensation as predictors of forgetfulness.................................................................. 110 8.1 Structure of the Midlife Memory Programme.......................................................... 122 8.2 Treatment evaluation measures across testing phases.............................................. 124 8.3 Means and standard deviations for all programme evaluation measures at pre- test, post-test, and three months follow-up.................................................................... 125 iii LIST OF APPENDICES A. 0 Facebook advertisement format and content........................................................ 179 A. 1 Newspaper advertisement for online survey........................................................ 181 A. 2 Online memory survey format.............................................................................. 182 A. 3 Advertisement for Midlife Memory Programme: Flyer....................................... 192 A. 4 Advertisement for Midlife Memory Programme: Poster..................................... 194 A. 5 Midlife Memory Programme Manual.................................................................. 195 A. 5.1 Programme Rationale................................................................................... 196 A. 5.2 Objectives for Facilitators............................................................................ 200 A. 5.3 Timetable...................................................................................................... 201 A. 5.4 Memory Strategy Hand-outs........................................................................ 202 A. 5.5 Session Guidelines........................................................................................ 218 A. 6 Pre-programme hand-out for clients..................................................................... 226 A. 7 Goal Selection Sheet............................................................................................. 235 A. 8 Goal Attainment Sheet......................................................................................... 236 A. 9 Memory Diary...................................................................................................... 237 A.10 PowerPoint Presentation / Hand-out Session 2................................................... 242 A. 11 PowerPoint Presentation / Hand-out Session 3.................................................. 247 A. 12 Memory in Context Hand-out 1 (Health and lifestyle factors)........................... 252 A. 13 Memory in Context Hand-out 2 (Stress, mood, anxiety, and beliefs)............... 254 A. 14 Five-part model Hand-out.................................................................................. 257 A. 15 Progressive Relaxation Hand-out....................................................................... 258 A. 16 Structured Problem Solving Hand-out............................................................... 260 A. 17 Revision and Key Points Hand-out.................................................................... 261 A. 18 Statement of contribution of published research................................................ 267 iv OVERVIEW Considering the developments of the population ageing process, knowledge about the psychology of ageing becomes increasingly important. The subject of this thesis is everyday memory with a specific focus on the memory of middle-aged individuals. While memory difficulties among the elderly may be expected, forgetfulness is also surprisingly common during midlife. Midlife refers to the period of life between 40 and 65 years of age (Lachman, Lewkowics, & Peng, 1994) and longitudinal and cross-sectional research with healthy populations pinpoints the onset of objective memory decline within the fifth decade of life (Schaie, 1996; Larrabee, Trahan, Curtiss, & Levin, 1988; West & Crook, 1990). For example, Ponds, Commissaris, and Jolles (1997) found that 33% of young middle-aged (40 to 50 years of age) and 41% of old middle-aged (55 to 65 years of age) participants considered themselves to be forgetful. Forgetfulness is not without consequences and more than half of middle-aged individuals perceive forgetfulness as an impediment, and 70% worry about it (Commissaris, Ponds, & Jolles, 1998). Because research consistently shows that memory begins to decline during midlife it may be said that this reflects an age-appropriate developmental change. Individuals who experience age-appropriate developmental changes are generally regarded as individuals who age successfully. Despite the high levels of forgetfulness among the successfully ageing middle-aged, the vast majority of memory research focuses on the elderly with moderate to severe memory impairment. As a result, very little is known about the nature of forgetfulness that more than half of successfully ageing middle-aged adults are worried about and perceive as an impediment. This lack of research extends to intervention efforts that may reduce forgetfulness among this cohort, as interventions are also primarily designed for the elderly with moderate to severe impairment. The theory chosen to explore the research in this thesis is the theory of Selective Optimisation with Compensation (SOC; Baltes & Baltes, 1990) which suggests key strategies (e.g., selection, optimisation, and compensation) that individuals may employ to adapt more successfully to developmental changes. Briefly, the process of selection denotes the course of action involved in developing, choosing, and committing oneself to specific goals (e.g., maintaining memory function). Optimisation denotes the employment v of means aimed at goal achievement (i.e., employing memory strategies); and compensation denotes the employment of means that are necessary to maintain a given level of functioning when confronted with a loss in goal-relevant means (i.e., taking part in a memory programme). In employing SOC as theoretical background, this thesis focuses on age-appropriate forgetfulness among middle-aged individuals. Essentially, individuals who endorse SOC strategies are hypothesised to adapt better to age- appropriate memory decline than those who do not. The research of this thesis is presented in three separate empirical investigations. A survey method was used for study 1 and 2 which examined a number of theoretical links between memory performance and the theory of SOC. Specifically, study 1 set out to answer questions regarding experiences of everyday cognitive failures in relation to SOC strategies and memory compensation efforts. Study 2 examined the relationships between individual?s memory control beliefs and experiences of everyday forgetfulness in the context of SOC. Study 3 comprises the main objective of this thesis ? the development and implementation of a group-based memory intervention programme that specifically aims to improve memory performance for middle-aged individuals. In summary, the fact that healthy, middle-aged adults experience worries and inconvenience because of age-appropriate forgetfulness has not been given sufficient attention by psychologists. The research presented in this thesis provides some insight into everyday memory performance for adults of all ages and a novel memory programme that was specifically designed for middle-aged individuals is introduced. The thesis is presented in nine chapters. Chapter one outlines the current status of empirical knowledge pertaining to the processes of successful cognitive ageing. Chapter 2 and 3 review the systems and functions of memory and examine the factors that may impact on memory performance and chapter 4 reviews established memory intervention programmes. These first four chapters underscore the significance of the rationale for this thesis and place it into the current frame of empirical knowledge and theoretical understanding. Chapter 5 formally describes the range of research questions that are addressed by this thesis and chapter 6, 7, and 8 comprise the research studies that have been conducted to examine the research questions that have led to the completion of this vi thesis. Finally, Chapter 9 provides a summary and conclusion of the research findings of this thesis.