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Gambles that involve a large but unlikely gain coupled with a small but likely loss-like a lottery ticket-are known as positively-skewed. There is evidence that people tend to prefer these positively skewed choices, leading to what is called a positive-skew bias. In this study, we attempt to better understand under what conditions people are more drawn toward positively skewed, relative to symmetric, gambles. Based on the animal literature, there is reason to believe that preference for skewed gambles is dependent on the strength of the skew, with a greater preference for more strongly skewed options. In two online studies (Study 1: N = 209; Study 2: N = 210), healthy participants across the lifespan (ages 22-85) made a series of choices between a positively skewed risky gamble and either a certain outcome (Study 1) or risky symmetric gamble (Study 2). Logistic regression analyses revealed that people were more likely to choose moderately- and strongly skewed gambles over certain outcomes, with the exception of when there were large potential losses (Study 1). However, a stronger skewness did not increase preference for positively skewed gambles over symmetric gambles, findings which also may depend on the valence of the expected outcome (Study 2). Taken together, these results suggest that there may be a greater preference for more strongly positively skewed gambles but it 1) is dependent on what other gamble is presented and 2) is most prevalent for positive expected values. Additionally, contrary to previous findings, we did not find strong evidence of an age-related increase in positive skew bias in either study. However, exploratory analyses revealed that decision making strategy and cognitive abilities may play a role.

Developmental literature suggests that susceptibility to social conformity pressure peaks in adolescence and disappears with maturity into early adulthood. Predictions about these behaviors are less clear for middle-aged and older adults. On the one hand, while age-related increases in prioritization of socioemotional goals might predict greater susceptibility to social conformity pressures, aging is also associated with enhanced emotion regulation that could support resistance to conformity pressures. In this exploratory research study, we used mobile experience sampling surveys to naturalistically track how 157 healthy adults between the ages of 18 and 80 practice self-control over spontaneous desires in daily life. Many of these desires were experienced in the presence of others enacting that desire. Results showed that middle-aged and older adults were better at controlling their desires than younger adults when desires were experienced in the presence of others enacting that desire. Consistent with the literature on improved emotion regulation with age, these results provide evidence that the ability to resist social conformity pressure is enhanced across the adult life span. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objectives: Facial expressions are powerful social signals that motivate feelings and actions in the observer. Research on face processing has overwhelmingly used static facial images, which have limited ecological validity. Previous research on the age-related positivity effect and age differences in social motivation suggest that older adults might experience different evoked emotional responses to facial expressions than younger adults. Here, we introduce a new method to explore age-related differences in evoked responses to dynamic facial expressions across adulthood., Methods: We used dynamic facial expressions which varied by expression type (happy, sad, and angry) and expression magnitude (low, medium, and full) to gather participant ratings on their evoked emotional response to these stimuli along the dimensions of valence (positive vs negative) and arousal., Results: As predicted, older adults rated the emotions evoked by positive facial expressions (happy) more positively than younger adults. Furthermore, older adults rated the emotion evoked by negative facial expressions (angry and sad) more negatively than younger adults. Contrary to our predictions, older adults did not differ significantly in arousal to negative expressions compared with younger adults. Across all ages, individuals rated positive expressions as more arousing than negative expressions., Discussion: The findings provide some evidence that older adults may be more sensitive to variations in dynamic facial expressions than younger adults, particularly in terms of their estimates of valence. These dynamic facial stimuli that vary in magnitude are promising for future studies of more naturalistic affect elicitation, studies of social incentive processing, and use in incentive-driven choice tasks., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

There is a great deal of uncertainty in the world. One common source of uncertainty results from incomplete or missing information about probabilistic outcomes (i.e., outcomes that may occur), which influences how people make decisions. The impact of this type of uncertainty may particularly pronounced for older adults, who, as the primary leaders around the world, make highly impactful decisions with lasting outcomes. This review examines the ways in which uncertainty about probabilistic outcomes is perceived, handled, and represented in the aging brain, with an emphasis on how uncertainty may specifically affect decision making in later life. We describe the role of uncertainty in decision making and aging from four perspectives, including 1) theoretical, 2) self-report, 3) behavioral, and 4) neuroscientific. We report evidence of any age-related differences in uncertainty among these contexts and describe how these changes may affect decision making. We then integrate the findings across the distinct perspectives, followed by a discussion of important future directions for research on aging and uncertainty, including prospection, domain-specificity in risk-taking behaviors, and choice overload., (© 2023. The Psychonomic Society, Inc.)

Enhancing dopamine increases financial risk taking across adulthood but it is unclear whether baseline individual differences in dopamine function are related to risky financial decisions. Here, thirty-five healthy adults completed an incentive-compatible risky investment decision task and a PET scan at rest using [11C]FLB457 to assess dopamine D2-like receptor availability. Participants made choices between a safe asset (bond) and a risky asset (stock) with either an expected value less than the bond ("bad stock") or expected value greater than the bond ("good stock"). Five measures of behavior (choice inflexibility, risk seeking, suboptimal investment) and beliefs (absolute error, optimism) were computed and D2-like binding potential was extracted from four brain regions of interest (midbrain, amygdala, anterior cingulate, insula). We used canonical correlation analysis to evaluate multivariate associations between decision-making and dopamine function controlling for age. Decomposition of the first dimension ( r  = 0.76) revealed that the strongest associations were between measures of choice inflexibility, incorrect choice, optimism, amygdala binding potential, and age. Follow-up univariate analyses revealed that amygdala binding potential and age were both independently associated with choice inflexibility. The findings suggest that individual differences in dopamine function may be associated with financial risk taking in healthy adults., (© The Author(s) 2023. Published by Oxford University Press.)

Trust is a key component of social interaction. Older adults, however, often exhibit excessive trust relative to younger adults. One explanation is that older adults may learn to trust differently than younger adults. Here, we examine how younger (N = 33) and older adults (N = 30) learn to trust over time. Participants completed a classic iterative trust game with 3 partners. Younger and older adults shared similar amounts but differed in how they shared money. Compared to younger adults, older adults invested more with untrustworthy partners and less with trustworthy partners. As a group, older adults displayed less learning than younger adults. However, computational modeling suggests that this is not because older adults learn differently from positive and negative feedback than younger adults. Model-based fMRI analyses revealed several age- and learning-related differences in neural processing. Specifically, we found that older learners (N = 19), relative to older non-learners (N = 11), had greater reputation-related activity in metalizing/memory areas while making their decisions. Collectively, these findings suggest that older adult learners use social cues differently from non-learners., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Older populations in residential aged care facilities (RACFs) in many immigrant-receiving countries are now being increasingly culturally and linguistically diverse (CALD). CALD populations require tailored social and health services to support their needs and improve health outcomes. Falls among the elderly are common and can have significant health and psychosocial consequences. There is some evidence to suggest that country of birth may influence risk of falls among older people, but such evidence has been scarce. This study aimed to determine the association between place of birth and the incidence of falls in RACFs., Methods: Routinely collected incident data relating to 5,628 residents aged ≥ 65 years in 25 RACFs in Sydney, New South Wales, Australia were used. RACF residents were classified into two groups, Australia-born (N = 4,086) and overseas-born (N = 1,542). Overseas-born RACF residents were further categorised into two subgroups: overseas-English-speaking-country (N = 743) and overseas-non-English-speaking-country (N = 799). Outcomes measures were rate of all falls, injurious falls and falls requiring hospitalisation. Multilevel binary negative regression was used to examine the relationship between fall risk and place of birth., Results: Incidence rates of all falls, injurious falls and falls requiring hospitalisation were 8.62, 3.72 and 1.07 incidents per 1,000 resident days, respectively, among the Australia-born RACF residents, but were higher at 11.02, 4.13 and 1.65, respectively, among the overseas-born RACF residents. Within those born overseas, fall rates were higher among the overseas-non-English-speaking-country-born residents (11.32, 4.29 and 2.22, respectively) than those overseas-English-speaking-country-born (10.70, 3.96 and 1.05, respectively). After controlling for confounders, the overseas-born RACF residents overall experienced a higher risk of all three types of falls (incidence rate ratios: [IRR] = 1.278, 95% confidence interval [CI] = 1.131, 1.443; injurious falls: IRR = 1.164 [95% CI = 1.013, 1.338]; falls requiring hospitalisation: IRR = 1.460 [95% CI = 1.199, 1.777]) than the Australia-born RACF residents. Among the overseas-born RACF residents, males, respite residents and those overseas-non-English-speaking-country-born experienced higher rates of falls., Conclusions: Fall incidence in RACFs varies significantly by place of birth. With increasingly diverse RACF populations, fall intervention and prevention programs should consider cultural and linguistical backgrounds of RACF residents. Greater attention to understand the mechanisms for the differences by place of birth in risk profiles is warranted., (© 2023. The Author(s).)

Objectives: Antibiotic prescribing in primary care contributes significantly to antibiotic overuse. Nudge interventions alter the decision-making environment to achieve behaviour change without restricting options. Our objectives were to conduct a systematic review to describe the types of nudge interventions used to reduce unnecessary antibiotic prescribing in primary care, their key features, and their effects on antibiotic prescribing overall., Methods: Medline, Embase and grey literature were searched for randomised trials or regression discontinuity studies in April 2021. Risk of bias was assessed independently by two researchers using the Cochrane Effective Practice and Organisation of Care group's tool. Results were synthesised to report the percentage of studies demonstrating a reduction in overall antibiotic prescribing for different types of nudges. Effects of social norm nudges were examined for features that may enhance effectiveness., Results: Nineteen studies were included, testing 23 nudge interventions. Four studies were rated as having a high risk of bias, nine as moderate risk of bias and six as at low risk. Overall, 78.3% (n=18, 95% CI 58.1 to 90.3) of the nudges evaluated resulted in a reduction in overall antibiotic prescribing. Social norm feedback was the most frequently applied nudge (n=17), with 76.5% (n=13; 95% CI 52.7 to 90.4) of these studies reporting a reduction. Other nudges applied were changing option consequences (n=3; with 2 reporting a reduction), providing reminders (n=2; 2 reporting a reduction) and facilitating commitment (n=1; reporting a reduction). Successful social norm nudges typically either included an injunctive norm, compared prescribing to physicians with the lowest prescribers or targeted high prescribers., Conclusions: Nudge interventions are effective for improving antibiotic prescribing in primary care. Expanding the use of nudge interventions beyond social norm nudges could reap further improvements in antibiotic prescribing practices. Policy-makers and managers need to be mindful of how social norm nudges are implemented to enhance intervention effects., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Covid-19-related social-distancing measures have dramatically limited physical social contact between individuals and increased monetary and health concerns for individuals of all ages. We wondered how these new societal conditions would impact the choices individuals make about monetary, health, and social rewards, and if these unprecedented conditions would have a differential impact on older individuals. We conducted two online studies to examine temporal discounting of monetary, health, and social rewards; stated preferences for monetary, health, and social rewards; and physical distancing behaviors. Both studies recruited equal numbers of White/Caucasian, Black/African American, and Hispanic/Latinx participants. We found that older adults were more likely to prefer smaller, sooner social and health-related rewards in decision-making tasks. These data further support the assertion that older adults have increased motivation for social and health rewards compared to younger individuals and that these age differences in motivation are important to consider when examining decision-making across the adult life span.

Background: Falls are frequent among older adults and have significant health and economic consequences. There have been few studies on the epidemiology of falls in residential aged care facilities (RACFs)., Objective: To determine the incidence of falls in RACFs using longitudinal routinely collected incident data over 5 years (July 2014-December 2019)., Methods: A retrospective cohort study is conducted using fall incident data from 25 RACFs in Sydney, NSW, Australia. Incidents relating to a population of 6163 aged care residents aged ≥65 years were included. Outcome measures were incidents of all falls, injurious falls and falls requiring hospitalization. The risk-adjusted incidence rate (IR) for each outcome indicator for each of the 25 facilities was calculated., Results: A total of 27 878 falls were reported over 3 906 772 resident days (a crude rate of 7.14 incidents per 1000 resident days; 95% confidence interval (CI) 6.81-7.48). Of these, 10 365 (37.2%) were injurious and 2733 (9.8%) required hospitalization. The crude IRs were 2.65 incidents per 1000 resident days (95% CI 2.53-2.78) for injurious falls and 0.70 incidents per 1000 resident days (95% CI 0.66-0.74) for falls requiring hospitalization. The incidence of falls was significantly higher in respite compared to permanent residents for all falls (adjusted IR ratio (aIRR) 1.33; 95% CI 1.18-1.51) and injurious falls (aIRR 1.30; 95% CI 1.14-1.48) and for men compared to women for all outcomes (all falls aIRR 1.69; 95% CI 1.54-1.86; injurious falls aIRR 1.87; 95% CI 1.71-2.04 and falls requiring hospitalization aIRR 1.29; 95% CI 1.12-1.48). The risk-adjusted IRs per 1000 resident days between facilities varied substantially (all falls 0.57-12.93 falls; injurious falls 0.25-4.47 and falls requiring hospitalization 0.10-1.70)., Conclusion: Falls are frequent in RACFs, often resulting in injury and hospitalization. The study provides robust and comprehensive information that may help inform future initiatives to minimize the incidence of falls in RACFs., (© The Author(s) 2022. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The Peninsula Health Falls Risk Assessment Tool (PH-FRAT) is a validated and widely applied tool in residential aged care facilities (RACFs) in Australia. However, research regarding its use and predictive performance is limited. This study aimed to determine the use and performance of PH-FRAT in predicting falls in RACF residents., Methods: A retrospective cohort study using routinely-collected data from 25 RACFs in metropolitan Sydney, Australia from Jul 2014-Dec 2019. A total of 5888 residents aged ≥65 years who were assessed at least once using the PH-FRAT were included in the study. The PH-FRAT risk score ranges from 5 to 20 with a score > 14 indicating fallers and ≤ 14 non-fallers. The predictive performance of PH-FRAT was determined using metrics including area under receiver operating characteristics curve (AUROC), sensitivity, specificity, sensitivity Event Rate(ER) and specificity ER ., Results: A total of 27,696 falls were reported over 3,689,561 resident days (a crude incident rate of 7.5 falls /1000 resident days). A total of 38,931 PH-FRAT assessments were conducted with a median of 4 assessments per resident, a median of 43.8 days between assessments, and an overall median fall risk score of 14. Residents with multiple assessments had increased risk scores over time. The baseline PH-FRAT demonstrated a low AUROC of 0.57, sensitivity of 26.0% (sensitivity ER 33.6%) and specificity of 88.8% (specificity ER 82.0%). The follow-up PH-FRAT assessments increased sensitivity ER values although the specificity ER decreased. The performance of PH-FRAT improved using a lower risk score cut-off of 10 with AUROC of 0.61, sensitivity of 67.5% (sensitivity ER 74.4%) and specificity of 55.2% (specificity ER 45.6%)., Conclusions: Although PH-FRAT is frequently used in RACFs, it demonstrated poor predictive performance raising concerns about its value. Introducing a lower PH-FRAT cut-off score of 10 marginally enhanced its predictive performance. Future research should focus on understanding the feasibility and accuracy of dynamic fall risk predictive tools, which may serve to better identify residents at risk of falls., (© 2022. The Author(s).)

A number of developmental theories have been proposed that make differential predictions about the links between age and temporal discounting, or the devaluation of future rewards. Most empirical studies examining adult age differences in temporal discounting have relied on economic intertemporal choice tasks, which pit choosing a smaller, sooner monetary reward against choosing a larger, later one. Although initial studies using these tasks suggested older adults discount less than younger adults, follow-up studies provided heterogeneous, and thus inconclusive, results. Using an open science approach, we test the replicability of adult age differences in temporal discounting by conducting a preregistered systematic literature search and meta-analysis of adult age differences in intertemporal choice tasks. Across 37 cross-sectional studies (Total N = 104,737), a planned meta-analysis found no sizeable relation between age and temporal discounting, r = -0.068, 95% CI [-0.170, 0.035]. We also found little evidence of publication bias or p-hacking. Exploratory analyses of moderators found no effect of research design (e.g., extreme-group vs. continuous age), incentives (hypothetical vs. real rewards), duration of delay (e.g., days, weeks, months, or years), or quantification of discounting behavior (e.g., proportion of immediate choices vs. parameters from computational modeling). Additional analyses of 12 participant-level data sets found little support for a nonlinear relation between age and temporal discounting across adulthood. Overall, the results suggest that younger, middle-aged, and older adults show similar preferences for smaller, sooner over larger, later rewards. We provide recommendations for future empirical work on temporal discounting across the adult life span. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Objectives: Patient contributions (co-payments) for one months' supply of a publicly-subsidised medicine in Australia were increased by 21% in January 2005 (US$2.73-$3.31 for social security recipients and $17.05-$20.58 for others). This study investigates the relationship between patients' use of statin medication and hospitalisation for acute coronary syndrome and stroke, following this large increase in co-payments., Methods: We designed a retrospective cohort study of all patients in Western Australia who were dispensed statin medication between 2004 and 05. Data for the cohort was obtained from State and Federal linked databases. We divided the cohort into those who discontinued, reduced or continued statin therapy in the first six months after the co-payment increase. The primary outcome was two-year hospitalisation for acute coronary syndrome or stroke-related event. Analysis was conducted using Fine and Gray competing risk methods, with death as the competing risk., Results: There were 207,066 patients using statins prior to the co-payment increase. Following the increase, 12.5% of patients reduced their use of statin medication, 3.3% of patients discontinued therapy, and 84.2% continued therapy. There were 4343 acute coronary syndrome and stroke-related hospitalisations in the two-year follow-up period. Multivariate analysis demonstrated that discontinuing statins increased the risk of hospitalisation for acute coronary syndrome or stroke-related events by 18% (95%CI = 0.1%-40%) compared to continuing therapy. Subgroup analysis showed that men aged <70 years were at increased risk of 54-63% after discontinuing statins compared to those continuing, but that women and older men were not., Conclusion: Discontinuing statin medication after a large increase patient cost contribution was associated with higher rates of acute coronary syndrome and stroke-related hospitalisation in men under 70 years. The findings highlight the importance of continued adherence to prescribed statin medication, and that discontinuing therapy for non-clinical reasons (such as cost) can possibly have negative consequences particularly for younger men., (Crown Copyright © 2021. Published by Elsevier Inc. All rights reserved.)

Electronic information systems are becoming increasingly common in residential aged care in Australia. These systems contain valuable data generated during day-to-day care delivery for older adults. These data (termed 'routinely collected residential aged care provider data') are currently underutilised, however have potential significant benefits for both care delivery and research purposes. Routinely collected residential aged care provider data are more readily accessible, contain up-to-date information and can be linked to existing national or state-based administrative data sets, while providing more granular details about care delivered at the coalface. The aim of this paper is to provide clinicians, researchers, policymakers and providers with an understanding of the strengths of these types of data, as well as identifying areas that require future development to maximise their potential to drive improvements in resident care and outcomes. These considerations include data quality, data standardisation and models for data governance, consent and consumer involvement., (© 2021 AJA Inc.)

Objective This study assessed the effect of the frequency of general practitioner (GP) visitation in the 12 months before a 21% consumer copayment increase in the Pharmaceutical Benefits Scheme (PBS; January 2005) on the reduction or discontinuation of statin dispensing for tertiary prevention. Methods The study used routinely collected, whole-population linked PBS, Medicare, mortality and hospital data from Western Australia. From 2004 to 2005, individuals were classified as having discontinued, reduced or continued their use of statins in the first six months of 2005 following the 21% consumer copayment increase on 1 January 2005. The frequency of GP visits was calculated in 2004 from Medicare data. Multivariate logistic regression models were used to determine the association between GP visits and statin use following the copayment increase. Results In December 2004, there were 22495 stable statin users for tertiary prevention of prior coronary heart disease, prior stroke or prior coronary artery revascularisation procedure. Following the copayment increase, patients either discontinued (3%), reduced (12%) or continued (85%) their statins. Individuals who visited a GP three or more times in 2004 were 47% less likely to discontinue their statins in 2005 than people attending only once. Subgroup analysis showed the effect was apparent in men, and long-term or new statin users. The frequency of GP visits did not affect the proportion of patients reducing their statin therapy. Conclusions Patients who visited their GP at least three times per year had a lower risk of ceasing their statins in the year following the copayment increase. GPs can help patients maintain treatment following rises in medicines costs. What is known about the topic? Following the 21% increase in medication copayment in 2005, individuals discontinued or reduced their statin usage, including for tertiary prevention. What does this paper add? Patients who visited their GP at least three times per year were less likely to discontinue their statin therapy for tertiary prevention following a large copayment increase. What are the implications for practitioners? This paper identifies the important role that GPs have in maintaining the continued use of important medications following rises in medicines costs.

Background and Objectives: Information-seeking (IS) and emotion-regulatory (ER) motivation play meaningful roles in age-related changes in social interaction across adulthood. This study aimed to develop and validate the Social Motivation Questionnaire (SMQ) to assess these two types of motivation., Research Design and Methods: Ten items were selected from a pool as the candidate items of SMQ and were administered to 480 German adults (20-91 years old) for validation. These items were also administered to 150 U.S. (18-40 years old) and 131 Hong Kong younger adults (18 to 26 years old) for cultural-invariance examination., Results: Exploratory and confirmatory factor analyses showed that a two-factor, eight-item structure fits the German adults' data well with satisfactory reliability. Multigroup comparisons showed cross-age invariance among younger, middle-aged, and older German adults, as well as cross-cultural invariance among German, U.S., and Hong Kong younger adults., Discussion and Implications: A new questionnaire, SMQ, was developed and validated to measure IS and ER social motivation across adulthood and across cultures., (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The evidence that dopamine function mediates the association between aging and cognition is one of the most cited findings in the cognitive neuroscience of aging. However, few and relatively small studies have directly examined these associations. Here we examined correlations among adult age, dopamine D2-like receptor (D2R) availability, and cognition in two cross-sectional studies of healthy human adults. Participants completed a short cognitive test battery and, on a separate day, a PET scan with either the high-affinity D2R tracer [18F]Fallypride (Study 1) or [11C]FLB457 (Study 2). Digit span, a measure of short-term memory maintenance and working memory, was the only cognitive test for which dopamine D2R availability partially mediated the age effect on cognition. In Study 1, age was negatively correlated with digit span. Striatal D2R availability was positively correlated with digit span controlling for age. The age effect on digit span was smaller when controlling for striatal D2R availability. Although other cognitive measures used here have individually been associated with age and D2R availability in prior studies, we found no consistent evidence for significant associations between low D2R availability and low cognitive performance on these measures. These results at best only partially supported the correlative triad of age, dopamine D2R availability, and cognition. While a wealth of other research in human and nonhuman animals demonstrates that dopamine makes critical contributions to cognition, the present studies suggest caution in interpreting PET findings as evidence that dopamine D2R loss is a primary cause of broad age-related declines in fluid cognition. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Theories of adult brain development, based on neuropsychological test results and structural neuroimaging, suggest differential rates of age-related change in function across cortical and subcortical sub-regions. However, it remains unclear if these trends also extend to the aging dopamine system. Here we examined cross-sectional adult age differences in estimates of D2-like receptor binding potential across several cortical and subcortical brain regions using PET imaging and the radiotracer [ 18 F]Fallypride in two samples of healthy human adults (combined N = 132). After accounting for regional differences in overall radioligand binding, estimated percent difference in receptor binding potential by decade (linear effects) were highest in most temporal and frontal cortical regions (~6-16% per decade), moderate in parahippocampal gyrus, pregenual frontal cortex, fusiform gyrus, caudate, putamen, thalamus, and amygdala (~3-5%), and weakest in subcallosal frontal cortex, ventral striatum, pallidum, and hippocampus (~0-2%). Some regions showed linear effects of age while many showed curvilinear effects such that binding potential declined from young adulthood to middle age and then was relatively stable until old age. Overall, these data indicate that the rate and pattern of decline in D2 receptor availability is regionally heterogeneous. However, the differences across regions were challenging to organize within existing theories of brain development and did not show the same pattern of regional change that has been observed in gray matter volume, white matter integrity, or cognitive performance. This variation suggests that existing theories of adult brain development may need to be modified to better account for the spatial dynamics of dopaminergic system aging., (© 2019 Wiley Periodicals, Inc.)

The relatively modest spatial resolution of positron emission tomography (PET) increases the likelihood of partial volume effects such that binding potential (BP ND ) may be underestimated. Given structural grey matter losses across adulthood, partial volume effects may be even more problematic in older age leading to overestimation of adult age differences. Here we examined the effects of partial volume correction (PVC) in two studies from different sites using different high-affinity D2-like radioligands (18 F-Fallypride, 11C-FLB457) and different PET camera resolutions (∼5 mm, 2.5 mm). Results across both data sets revealed that PVC increased estimated BP ND and reduced, though did not eliminate, age effects on BP ND . As expected, the effects of PVC were smaller in higher compared to lower resolution data. Analyses using uncorrected data that controlled for grey matter volume in each region of interest approximated PVC corrected data for some but not all regions. Overall, the findings suggest that PVC increases estimated BP ND in general and reduces adult age differences especially when using lower resolution cameras. The findings suggest that the past 30 years of research on dopamine receptor availability, for which very few studies use PVC, may overestimate effects of aging on dopamine receptor availability.

Some people are more willing to make immediate, risky, or costly reward-focused choices than others, which has been hypothesized to be associated with individual differences in dopamine (DA) function. In two studies using PET imaging, one empirical (Study 1: N = 144 males and females across 3 samples) and one meta-analytic (Study 2: N = 307 across 12 samples), we sought to characterize associations between individual differences in DA and time, probability, and physical effort discounting in human adults. Study 1 demonstrated that individual differences in DA D2-like receptors were not associated with time or probability discounting of monetary rewards in healthy humans, and associations with physical effort discounting were inconsistent across adults of different ages. Meta-analytic results for temporal discounting corroborated our empirical finding for minimal effect of DA measures on discounting in healthy individuals but suggested that associations between individual differences in DA and reward discounting depend on clinical features. Addictions were characterized by negative correlations between DA and discounting, but other clinical conditions, such as Parkinson's disease, obesity, and attention-deficit/hyperactivity disorder, were characterized by positive correlations between DA and discounting. Together, the results suggest that trait differences in discounting in healthy adults do not appear to be strongly associated with individual differences in D2-like receptors. The difference in meta-analytic correlation effects between healthy controls and individuals with psychopathology suggests that individual difference findings related to DA and reward discounting in clinical samples may not be reliably generalized to healthy controls, and vice versa. SIGNIFICANCE STATEMENT Decisions to forgo large rewards for smaller ones due to increasing time delays, uncertainty, or physical effort have been linked to differences in dopamine (DA) function, which is disrupted in some forms of psychopathology. It remains unclear whether alterations in DA function associated with psychopathology also extend to explaining associations between DA function and decision making in healthy individuals. We show that individual differences in DA D2 receptor availability are not consistently related to monetary discounting of time, probability, or physical effort in healthy individuals across a broad age range. By contrast, we suggest that psychopathology accounts for observed inconsistencies in the relationship between measures of DA function and reward discounting behavior., (Copyright © 2019 Castrellon et al.)

In a previous study, we found adult age differences in the tendency to accept more positively skewed gambles (with a small chance of a large win) than other equivalent risks, or an age-related positive-skew bias. In the present study, we examined whether loss aversion explained this bias. A total of 508 healthy participants (ages 21-82) completed measures of loss aversion and skew preference. Age was not related to loss aversion. Although loss aversion was a significant predictor of gamble acceptance, it did not influence the age-related positive-skew bias. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Every day, humans make countless decisions that require the integration of information about potential benefits (i.e. rewards) with other decision features (i.e. effort required, probability of an outcome or time delays). Here, we examine the overlap and dissociation of behavioral preferences and neural representations of subjective value in the context of three different decision features (physical effort, probability and time delays) in a healthy adult life span sample. While undergoing functional neuroimaging, participants (N = 75) made incentive compatible choices between a smaller monetary reward with lower physical effort, higher probability, or a shorter time delay versus a larger monetary reward with higher physical effort, lower probability, or a longer time delay. Behavioral preferences were estimated from observed choices, and subjective values were computed using individual hyperbolic discount functions. We found that discount rates were uncorrelated across tasks. Despite this apparent behavioral dissociation between preferences, we found overlapping subjective value-related activity in the medial prefrontal cortex across all three tasks. We found no consistent evidence for age differences in either preferences or the neural representations of subjective value across adulthood. These results suggest that while the tolerance of decision features is behaviorally dissociable, subjective value signals share a common representation across adulthood.

Older adults are disproportionately targeted by fraud schemes that advertise unlikely but large returns (positively skewed risks). We examined adult age differences in choice and neural activity as individuals considered risky gambles. Gambles were symmetric (50% chance of modest win or loss), positively skewed (25% chance of large gain), or negatively skewed (25% chance of large loss). The willingness to accept positively skewed relative to symmetric gambles increased with age, and this effect replicated in an independent behavioral study. Whole-brain functional magnetic resonance imaging analyses comparing positively (vs. negatively) skewed trials revealed that relative to younger adults, older adults showed increased anticipatory activity for negatively skewed gambles but reduced activity for positively skewed gambles in the anterior cingulate and lateral prefrontal regions. Individuals who were more biased toward positively skewed gambles showed increased activity in a network of regions including the nucleus accumbens. These results reveal age biases toward positively skewed gambles and age differences in corticostriatal regions during skewed risk-taking, and have implications for identifying financial decision biases across adulthood.

Introduction: Across the world, health systems are adopting approaches to manage rising healthcare costs. One common strategy is a medication copayments scheme where consumers make a contribution (copayment) towards the cost of their dispensed medicines, with remaining costs subsidised by the health insurance service, which in Australia is the Federal Government.In Australia, copayments have tended to increase in proportion to inflation, but in January 2005, the copayment increased substantially more than inflation. Results from aggregated dispensing data showed that this increase led to a significant decrease in the use of several medicines. The aim of this study is to determine the demographic and clinical characteristics of individuals ceasing or reducing statin medication use following the January 2005 Pharmaceutical Benefit Scheme (PBS) copayment increase and the effects on their health outcomes., Methods and Analysis: This whole-of-population study comprises a series of retrospective, observational investigations using linked administrative health data on a cohort of West Australians (WA) who had at least one statin dispensed between 1 May 2002 and 30 June 2010. Individual-level data on the use of pharmaceuticals, general practitioner (GP) visits, hospitalisations and death are used.This study will identify patients who were stable users of statin medication in 2004 with follow-up commencing from 2005 onwards. Subgroups determined by change in adherence levels of statin medication from 2004 to 2005 will be classified as continuation, reduction or cessation of statin therapy and explored for differences in health outcomes and health service utilisation after the 2005 copayment change., Ethics and Dissemination: Ethics approvals have been obtained from the Western Australian Department of Health (#2007/33), University of Western Australia (RA/4/1/1775) and University of Notre Dame (0 14 167F). Outputs from the findings will be published in peer reviewed journals designed for a policy audience and presented at state, national and international conferences., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Eight percent of Australians aged 65 years and over receive residential aged care each year. Residents are increasingly older, frailer and have complex care needs on entry to residential aged care. Up to 63% of Australian residents of aged care facilities take nine or more medications regularly. Together, these factors place residents at high risk of adverse drug events. This paper reviews medication-related policies, practices and research in Australian residential aged care. Complex processes underpin prescribing, supply and administration of medications in aged care facilities. A broad range of policies and resources are available to assist health professionals, aged care facilities and residents to optimise medication management. These include national guiding principles, a standardised national medication chart, clinical medication reviews and facility accreditation standards. Recent Australian interventions have improved medication use in residential aged care facilities. Generating evidence for prescribing and deprescribing that is specific to residential aged care, health workforce reform, medication-related quality indicators and inter-professional education in aged care are important steps toward optimising medication use in this setting., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Although research on aging and decision making continues to grow, the majority of studies examine decisions made to maximize monetary earnings or points. It is not clear whether these results generalize to other types of rewards. To investigate this, we examined adult age differences in 92 healthy participants aged 22 to 83. Participants completed 9 hypothetical discounting tasks, which included 3 types of discounting factors (time, probability, effort) across 3 reward domains (monetary, social, health). Participants made choices between a smaller magnitude reward with a shorter time delay/higher probability/lower level of physical effort required and a larger magnitude reward with a longer time delay/lower probability/higher level of physical effort required. Older compared with younger individuals were more likely to choose options that involved shorter time delays or higher probabilities of experiencing an interaction with a close social partner or receiving health benefits from a hypothetical drug. These findings suggest that older adults may be more motivated than young adults to obtain social and health rewards immediately and with certainty. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

Accumulating evidence shows a positive relationship between mindfulness and explicit cognitive functioning, i.e., that which occurs with conscious intent and awareness. However, recent evidence suggests that there may be a negative relationship between mindfulness and implicit types of learning, or those that occur without conscious awareness or intent. Here we examined the neural mechanisms underlying the recently reported negative relationship between dispositional mindfulness and implicit probabilistic sequence learning in both younger and older adults. We tested the hypothesis that the relationship is mediated by communication, or functional connectivity, of brain regions once traditionally considered to be central to dissociable learning systems: the caudate, medial temporal lobe (MTL), and prefrontal cortex (PFC). We first replicated the negative relationship between mindfulness and implicit learning in a sample of healthy older adults (60-90 years old) who completed three event-related runs of an implicit sequence learning task. Then, using a seed-based connectivity approach, we identified task-related connectivity associated with individual differences in both learning and mindfulness. The main finding was that caudate-MTL connectivity (bilaterally) was positively correlated with learning and negatively correlated with mindfulness. Further, the strength of task-related connectivity between these regions mediated the negative relationship between mindfulness and learning. This pattern of results was limited to the older adults. Thus, at least in healthy older adults, the functional communication between two interactive learning-relevant systems can account for the relationship between mindfulness and implicit probabilistic sequence learning.

As our society becomes more mobile and people reside farther away from their immediate families, competent decision-making has become critical for the older adults wishing to maintain their independence. However, very little is known about the relationship between residential choice and decision-making. Here we use the Balloon Analog Risk Task (BART) to examine risk-taking in two samples of older adults, one living in a retirement community and another living independently. We also used a cognitive model to gain insight into the cognitive factors underlying decision-making in these groups. We found that older adults living in a retirement community were more risk averse than their independent counterparts. Furthermore, this difference appeared to be motivated by group differences in initial perception of risk. This study suggests an intriguing difference between these two residential groups, and also points to the utility of using laboratory methods in research on real-world problems.

Differences in strategy use are thought to underlie age-related performance deficits on many learning and decision-making tasks. Recently, age-related differences in learning to make predictions were reported on the Triplets Prediction Task (TPT). Notably, deficits appeared early in training and continued with experience. To assess if age differences were due to early strategy use, neural networks were used to objectively assess the strategies implemented by participants during Session 1. Then, the relationship between these strategies and performance was examined. Results revealed that older adults were more likely to implement a disadvantageous strategy early in learning, and this led to poorer task performance. Importantly, the relationship between age and task performance was partially mediated by early strategy use, suggesting that early strategy selection played a role in the lower quality of predictions in older adults.

Since 2010, a residential aged care provider has been in collaboration with universities in Western Australia to deliver an interprofessional education (IPE) program in residential aged care facilities. The program takes place within a residential aged care setting where university student placements from seven disciplines are integrated into a dynamic interdisciplinary team approach for care delivery. This approach provides the opportunity for two or more professionals to learn together to provide optimal care for residents. In 2012, an extensive research evaluation was performed to demonstrate, among other outcomes, the benefits to the residents and staff involved in the program. Residents, family members and staff from a residential aged care facility were invited to participate in the mixed methods evaluation. The qualitative aspects were digitally recorded, transcribed and thematically analysed. SPSS (SPSS Inc., Chicago, IL, USA) was used to analyse the quantitative data. All were exceptionally satisfied with the IPE program.

Objectives: Much of adaptive behavior relies on the ability to learn and generate predictions about relationships in the environment. Research on aging suggests both that there is an age deficit in the ability to learn sequential relationships and that this deficit in learning could underlie age differences reported in many decision-making tasks. This article introduces the Triplets Prediction Task (TPT) to investigate the learning of sequential relationships that underlies adaptive behavior., Method: In the TPT, participants see 2 successive visual cues and then predict which target will follow. Unknown to participants, there is a predictive relationship between the first cue and the target such that each of 4 cues predicts 1 of 4 targets 85% of the time., Results: Although both age groups demonstrated learning on this task, an age deficit in learning appeared early and performance differences persisted throughout training. There was also evidence of age differences in the learning systems engaged during the task., Discussion: These results are consistent with previous studies of learning and prediction, and they support the growing literature showing adult age differences in decision making from experience., (© The Author 2013. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Recent studies have shown age-related deficits in learning subtle probabilistic sequential relationships. However, virtually all sequence learning studies have displayed successive events one at a time. Here we used a modified Triplets Learning Task to investigate if an age deficit occurs even when sequentially-presented predictive events remain in view simultaneously. Twelve young and 12 old adults observed two cue events and responded to a target event on each of a series of trials. All three events remained in view until the subject responded. Unbeknownst to participants, the first cue predicted one of four targets on 80% of the trials. Learning was indicated by faster and more accurate responding to these high-probability targets than to low-probability targets. Results revealed age deficits in sequence learning even with this simultaneous display, suggesting that age differences are not due solely to general processing declines, but rather reflect an age-related deficit in associative learning.

Hemodynamic relationships between flows, pressures, and blood volume have been examined in the denervated liver of cats anesthetized with pentobarbital. Portal and hepatic lobar venous pressures, portal and total hepatic flows, and hepatic blood volume were recorded when portal flow was varied from 0 to 240 ml X min-1 X 100 g liver-1 and when hepatic outflow pressure was varied from 0 to 9.5 mmHg, before, during, and after intravenous infusion of norepinephrine (2 micrograms X min-1 X kg body wt-1). Portal pressure was 1-2 mmHg higher than lobar venous pressure and 8-9 mmHg higher than inferior vena caval pressure, showing that the major site of resistance in the portal circuit was in the large hepatic veins. Intrahepatic pressure was linearly related to total hepatic flow, and norepinephrine increased the intercept but not the slope of this relationship. Hepatic blood volume was linearly related to intrahepatic pressure with a calculated compliance of 2.5-3.0 ml X mmHg-1 X 100 g liver-1 and a calculated unstressed volume at zero pressure of 10-15 ml/100 g liver. Norepinephrine did not significantly change vascular compliance but caused a marked reduction of 15-20 ml/100 g liver in calculated unstressed volume. Thus norepinephrine reduced hepatic blood volume by 15-20 ml/100 g liver at any given intrahepatic pressure. It is concluded that venoconstriction in the hepatic bed occurs by a decrease in unstressed volume with little change in compliance. Unstressed volume represents a true blood volume reserve, independent of passive influences, which can be mobilized by the central nervous system.

In cats anesthetized with pentobarbital, isoproterenol infused into a peripheral vein causes a reduction in hepatic blood volume measured by plethysmography. As this response is accompanied by increases in portal and hepatic lobar venous pressures, the decrease in hepatic volume cannot be a passive emptying secondary to reduced intrahepatic pressure. We conclude that intravenous isoproterenol causes an active hepatic venoconstriction. Nifedipine produced similar responses. From this and our previous data, we conclude that in anesthetized cats, arteriolar vasodilators which increase cardiac output cause hepatic venoconstriction (hydralazine, adrenaline, dopamine, isoproterenol, and nifedipine), while those which do not increase cardiac output have no effect on the hepatic venous bed (nitroprusside and diazoxide) or cause venodilatation (nitroglycerine). The mechanism of the hepatic venoconstrictor effect of isoproterenol was investigated further. Because previous work has shown that this response does not occur when isoproterenol is infused locally into the hepatic artery or portal vein, the venoconstrictor effect of peripheral intravenous infusions must be indirectly mediated. The response was still present after hepatic denervation, adrenalectomy, nephrectomy, and after indomethacin administration indicating it is not mediated by the hepatic nerves, adrenal catecholamines, the renal renin-angiotensin system, or prostaglandins. The mechanism remains unknown.

Endotoxin (from Salmonella enteriditis ) was administered either as an intravenous bolus injection after administration of indomethacin to prevent the acute anaphylactoid response or as a slow intravenous infusion to cats anesthetized with pentobarbital. Within 30 min, hepatic blood volume measured by plethysmography increased by 30%. However, unlike the outflow block seen in dogs after endotoxin, this increase in blood volume was associated with a fall in portal and hepatic lobar venous pressures. Responses to hepatic nerve stimulation (1-8 Hz), to intravenous infusions of norepinephrine (0.2-1.0 microgram X kg-1 X min-1), and to infusions into the hepatic artery of norepinephrine (0.1-0.5 microgram X kg-1 X min-1) and angiotensin II (0.1-0.5 microgram X kg-1 X min-1) were compared before and 150 min after endotoxin administration. Both portal pressure and hepatic blood volume responses to these stimuli were markedly depressed by 150 min after endotoxin. We conclude that in cats endotoxin causes a markedly depressed responsiveness of hepatic venous smooth muscle to agonists and a modest pooling of blood in the liver probably due to impairment of preexisting sympathetic tone. Although these hepatic venous effects were observed at a time when cardiac output was not markedly depressed, it is suggested that they may play a significant role in the later development of reduced cardiac output and shock.

Intravenous administration of hypotensive doses (30-200 micrograms/kg) of nifedipine to cats anesthetized with pentobarbital caused an increase in cardiac output accompanied by hepatic venoconstriction. The hepatic venoconstriction and the increase in cardiac output were abolished in animals in which the hepatic sympathetic nerves were cut, the adrenal glands were excluded, and the kidneys were removed. This contrasts with the indirect hepatic venoconstrictor action of isoproterenol which was shown previously not to be abolished by these procedures. Further experiments showed that the hepatic venoconstrictor effect of nifedipine was blocked by removal of the kidneys, but not by removal of the hepatic sympathetic nerves and adrenals. These results support the hypothesis that venoconstriction plays an important role when drugs produce increased cardiac output. In nephrectomized animals, nifedipine had no direct effects on hepatic blood volume and it did not alter the effects of infusions of norepinephrine on hepatic blood volume, which have previously been shown to be mediated through alpha 2-adrenoceptors. However, it did reduce the hepatic venous responses to hepatic sympathetic nerve stimulation by 30%.