Hope for Maintaining Independence?
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Decline in cognitive ability, with the resulting loss of independence, is one of the most pervasive fears older adults face today. The marketplace has responded, and is replete with products -- everything from books to computer games to training programs -- claiming to boost brain ability. Those of us who work with and care about older adults are rightly concerned about the value of these interventions. What evidence exists to suggest that these products provide actual benefit? Can these products and programs be objectively evaluated to determine their efficacy? Do any of the approaches to training actually help older adults maintain their cognitive capacities?
In the absence of specific physical or mental issues affecting cognition, concerns about aging and the brain generally involve memory loss. Accordingly, books, games and software claiming to improve memory are the most common brain-fitness products found at bookstores and at electronics, general merchandise and discount stores. Although most of these products promote their development by experts, scientists or neurologists, they provide little evidence about what sort of testing for reliability or validity they have undergone. Those that teach mnemonic strategies, allow for practice and give supportive feedback probably are most effective; puzzles and games that tout other less specific brain-building qualities are unlikely to help adults improve any practical cognitive abilities.
In addition, several commercial cognitive-skills training programs are now under development or available on the market. These interventions, which can be either computer- or classroom-based, focus on helping elders retain or improve one specific cognitive skill or several such skills. The targeted skills generally include memory, but also reasoning and speed of processing. Compared to consumer products such as books or computer games, the often-expensive training programs currently offered do more readily provide the information about research conducted on efficacy and outcomes.
Helping With Activities of Daily Living
Academic research on such interventions has focused on whether the intervention improves an adult’s ability to pursue activities of daily living and retaining independence. The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study, a large multisite research project, provides a good example of a randomized controlled trial of cognitive training with older adults, using three different cognitive interventions. Participants who were trained in cognitive speed, memory or reasoning showed large improvements on the particular cognitive skill on which they had been trained, and a 48-month follow-up showed maintenance of those benefits.
Similarly, researchers Sherry L. Willis and K. Warner Schaie examined the effects of cognitive training with older adult participants in the Seattle Longitudinal Study, a project that has studied several aspects of intellectual function among a sample of individuals, some of whom have been followed for more than 40 years. Willis and Schaie found that training interventions were effective both in remediating cognitive decline and in improving performance on the targeted abilities.
Well-crafted studies have demonstrated that training can positively affect outcomes in cognitive processing speed, memory and reasoning. Furthermore, they demonstrate that given the right intervention, healthy elders, those who have already experienced some cognitive decline and even those in the early stages of Alzheimer’s disease can improve or maintain skills or delay declines in performance. An important caveat to all such studies: Cognitive training has demonstrable effects on performance, on views of self and on brain function -- but the results are very specific to the skills for which the individual receives training.
Enhancing Feelings of Self-Efficacy
Another factor also affects cognitive training outcomes: feelings of self-efficacy. Almost any sort of intervention that structures practice and provides feedback can help adults believe that they can improve their performance. Even the simplest of interventions might help with issues of self-efficacy, without which even the most rigorous of training likely will not stick.
So there is hope that training can improve or delay the forms of cognitive decline associated with normal and even pathological aging. The stakes are high: For older adults, maintaining or improving cognitive function can make the difference between independence and dependence. By taking into account the current state of research, both older adults and the professionals who work with them will be in a better position to separate the hope from the hype when looking at products and programs claiming to provide beneficial outcomes for elders seeking to maintain their cognitive skills.
Ara Rogers is director of the Osher Lifelong Learning Institute at the University of South Florida, Tampa.
Copyright © 2007 American Society on Aging; all rights reserved. This article may not be duplicated or distributed in any form without written permission from the publisher: American Society on Aging, 71 Stevenson St., Suite 1450, San Francisco, CA 94105-2938; e-mail: permissions@asaging.org.
