The SeniorWISE Study: Improving Everyday Memory in Older Adults

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We tested whether at-risk older adults receiving memory training showed better memory self-efficacy, metamemory, memory performance, and function in instrumental activities of daily living than participants receiving a health promotion training comparison condition. We followed participants for 26 months. The sample was mostly female (79%) and Caucasian (71%), with 17% Hispanics and 12% African Americans; average age was 75 years, and average education was 13 years. The memory training group made greater gains on global cognition and had fewer memory complaints, but both groups generally maintained their performance on the other cognitive measures and instrumental activities of daily living (IADLs) throughout the 24-month study period. Black and Hispanic participants made greater gains than Whites did on some memory performance measures but not on memory self-efficacy. The unexpected finding that minority elders made the largest gains merits further study. This study contributed to the knowledge base of geropsychiatric nursing by providing evidence for an effective psychosocial intervention that could be delivered by advanced practice nurses.

Section snippets

Settings and Sample

Independent adults were recruited from a metropolitan area in Central Texas via print and television media, as well as directly from city-run senior activity centers, churches, health fairs, and festivals. The trainings were implemented at seven sites in the community: four senior centers, a university-based wellness clinic, and two apartment complexes for low-income older adults.

Eligibility criteria included age 65 years or more, ability to speak and understand English, no sensory loss or

Baseline Comparisons

The analytic sample consisted of 265 randomized participants: 135 in the memory training and 130 in the health promotion training (Figure 1, Table 1). Eight deaths occurred during the study unrelated to the protocol. Ninety-five percent of participants completed the memory training; 87% completed the health promotion training (six or more of the eight training sessions). At the final testing, 108 and 101 individuals were in the memory training and the health promotion groups, respectively.

Training effects from baseline to postclass: performance measures

The memory and health promotion groups did not differ significantly in gains on visual memory from baseline to postclasses (Table 3). Performance for the entire group also did not change significantly (b = −0.20, P =.50). The memory and health groups did differ significantly in gains from baseline to postclasses on the DAFS performance measure, although both groups improved on the DAFS (b = 0.23, P = .04). On verbal memory, overall performance did not significantly change from baseline to end

Training effects from baseline to end of study: performance measures

Overall performance on visual memory did not significantly increase or decline for the sample as a whole (b = −0.08, P = .11). Hispanic and Black participants gained more than Whites did, and individuals with less education also gained relatively more.

Participants showed no significant changes in DAFS scores from baseline to end of study (b = −0.01, P = .68). However, those with initially higher DAFS scores and those who attended more classes gained more from baseline to end of study. Those

Training effects from baseline to posttest classes: self-report measures

Table 4 presents the HLM results for the self-report measures of memory complaints, self-efficacy, and strategies. Memory group participants reported a greater reduction in memory complaints from baseline to postclasses. Memory self-efficacy gains, however, did not significantly differ by training group (b = 0.53, P = .17). For internal strategies, scores for the sample did not significantly increase or decline (b = 0.01, P = .33). However, those who attended more classes reported greater use

Training effects from baseline to end of study: self-report measures

Memory training participants who were younger reported a greater reduction in memory complaints than older participants. On the memory self-efficacy measure, Whites made relatively greater gains than Blacks did, but neither group changed significantly (b = 0.07, P = .33). Both groups improved their use of external and internal memory strategies over time. Internal strategies increased significantly (b = 0.004, P < .01), as did external strategies (b = 0.004, P = .03). The memory group did not

Discussion

This study had many strengths. First, the triethnic sample was recruited in the community, and volunteer participants were highly motivated and maintained their interest in the study, as evidenced by a 79% retention rate over the 26-month study. The ACTIVE trials reported 80% retention at 24-month follow-up (Ball et al., 2002). Further, derived from Bandura's (1997) self-efficacy theory, CBMEM intervention provided a unique package of cognitive skills development in exposure, repeated practice,

AcknowlEdgment

Support for this research was provided by NIA Grant R01 AG 15384.

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