Interventions to Aid Older Adults’ Functional Abilities

By Linda Sasser, PhD*

Statistics from the United States Census Bureau indicate that 20% of the population will be 65 years old or older by the year 2050. The numerous sensory, cognitive, and functional declines that often accompany aging may compromise the ability of older adults to live and operate independently. Much research has focused on strategies or interventions designed to improve older adults’ basic cognitive and functional abilities. The positive results of this research give evidence of the plasticity of the brain.

Plasticity, also called neuroplasticity, refers to the brain’s ability to reorganize neural pathways based on new experiences. Throughout life, a person’s brain undergoes functional changes as a result of learning, or acquiring new knowledge and skills through instruction or experience.  Many media sources have suggested that older adults merely need to do crossword puzzles on a regular basis to maintain cognitive vitality, but research is beginning to shed light on cognitive training interventions that are more effective than puzzles in reversing or at least reducing decline in older adults.

One area that significantly impacts one’s independence is driving, a skill dependent on both cognitive and functional abilities, including mobility. Some older adults experience difficulty getting into and out of a car, maneuvering a vehicle in traffic, or simultaneously monitoring traffic signals, other vehicles, and the operation of the car. Numerous older adults already limit their driving to daylight, non-peak traffic hours and to days without precipitation; some have stopped driving altogether. In addition, traffic convictions, crashes and fatalities per mile driven are higher among older drivers than any other age group.

It is thought that many of the changes in cognitive function with age result from a slowing of processing speed, and that cognitive speed may be strongly related to functional abilities. Processing speed can be thought of as mental quickness. The brain tends to operate at a slower speed as we get older compared to when we were younger. The same tasks take us more time to complete. Quick speed in processing is important for quick decision making in our daily lives, such as noticing and reacting to unexpected situations or events when driving.

Training programs designed to improve the speed at which older adults process information have the potential to impact older adults’ functional abilities, such as driving. Driving also involves using divided attention skills, along with attention switching and self-monitoring. Other research has investigated training for dual-task performance. Studies of cognitive interventions have shown that older adults improve on tasks such as those practiced in training, but the benefits of training do not always transfer to dissimilar tasks.

Research has demonstrated that the driving performance of older adults (ranging in age from 62 to 94) is related to a specific functional measure of visual processing speed, called the field of view test (UFOV) test. In addition, Ball and her colleagues have shown that the size of the UFOV can be expanded with training. The “useful field of view” refers to the area from which one can extract visual information in a single glance without moving the eyes or the head. It is a measure of processing speed and visual attention that is critical for driving performance.  Millions of senior drivers experience impairment in the UFOV, and this affects their ability to drive safely.

A similar study determined that the speed-of-processing training also produced an improvement in actual driving performance. In this particular study, elderly adults participated in either a traditional driver-training program (performed in a simulator) or a speed-of-processing training program. Drivers’ skills were assessed through behavioral ratings and by an actual driving test (a 14 mile open road evaluation). When assessed using the driving simulator, the speed-of-processing-trained group improved their ability to scan a visual scene, detect changes in stimuli, and quickly react to those changes. They also made fewer dangerous maneuvers during the post training drives than before receiving the training. Most of the benefits of this training were still present 18 months later; some sort of “booster” training was recommended for those who did not retain the benefits.

The speed-of-processing training was immediately beneficial for older adults who showed difficulty in this area. The training improved UFOV performance and also transferred to timed IADL performance, a speeded task that simulates cognitively demanding everyday activities integral to independent living. The timed IADL tests simulate tasks routinely performed in everyday life, such as looking up phone numbers, counting out change, and reading medicine bottles. Participants in the training benefited regardless of whether they were trained in groups or individually. The researchers suggested that this type of training may also benefit older adults who are not experiencing speed of processing challenges, and may improve function on other everyday tasks.

Correcting underlying sensory and/or cognitive deficits that occur with aging may improve not only these basic abilities, but also the functional abilities which depend on them. This suggests that many older adults may benefit from training to improve these abilities, quite possibly allowing them to retain their driving ability and independence to later ages.  Science is saying we need more than crossword puzzles.

 

References

Edwards, J.D., Wadley, V.G., Vance, D.E., Wood, K., Roenker, D.L., & Ball, K.K.  (May 2005).  The Impact of Speed of Processing Training on Cognitive and Everyday Performance.  Aging & Mental Health, 9(3), 262-271.
Roenker, D.L., Cissell, G.M., Ball, K.K., Wadley, V.G.,  & Edwards, J.D. (2003).  Speed-of-Processing and Driving Simulator Training Result in Improved Driving Performance.  Human Factors, 45(2), 218-233.
Wood, K.M., Edwards, J.M., Clay, O.J., Wadley, V.G., Roenker, D.L. & Ball, K.K.  (2005).  Sensory and Cognitive Factors Influencing Functional Ability in Older Adults.  Gerontology, 51, 131-141.

*Update 8/12/13 — This article was incorrectly posted as authored by Dr. Michael Parker.