Myth #9 Brain power declines with age

The myth that brain power declines with age has been with us for decades. First, some historical perspective is in order. The story begins around the time of World War I. When war was declared, there were suddenly so many army recruits that it became necessary first to sort out the “mentally unfit” and then rank others for their ability to benefit from training for various military duties. The Army Alpha Test, usually considered the first group intelligence test, was used for this purpose. Several early research studies showed a steady age decline in scores on the Army Alpha Test from the mid-20s through the mid-60s.

By the mid-1970s, though, some researchers were questioning the assumption that age guaranteed intellectual decline. Paul Baltes and K. Warner Schaie (1974) published an article entitled “Aging and IQ: The Myth of the Twilight Years,” in which they argued that it was time to put a halt to the uncritical acceptance of the idea of age decrement in intellectual abilities. In a subsequent article in the American Psychologist, Baltes and Schaie (1976) made a case for the plasticity of intelligence in the later years. (Plasticity refers to the malleability of intelligence – it generally implies the possibility of improvement with practice and training.) Horn and Donaldson (1976) countered this argument, insisting that age-related decline is not a myth, but rather is a reality given the evidence for the lower scores on tests that measure many important intellectual abilities.

As time went by, researchers continued to investigate the relationship between age and intellectual abilities, often measuring intelligence with the Primary Mental Abilities (PMA) test and the Wechsler Adult Intelligence Scale (WAIS). With the findings of these studies, a more complex picture began to emerge, one that would essentially lend some support to both of the above views: age maintenance as well as age decrement in intellectual abilities.

The PMA is a group test used by Schaie in his developmental studies (see e.g. Schaie, 1994). The PMA version that Schaie used included tests that measured five factors assumed to contribute to intellectual ability: V, or verbal meaning (selecting the correct synonym that defines a word); N, or number (solving arithmetic problems); W, or word fluency (active vocabulary, or retrieving words using a lexical rule); R, or inductive reasoning (inferring rules that are needed to solve problems); and S, or spatial orientation (visualizing how forms look when rotated in space). In general, there was minimal or no age-related decline on the V, N, and W factors. However, there was evidence for age-related decline on the R and S factors.

The WAIS is an individual “IQ” test with which many people are familiar – whether they know it or not. There have been several revisions over the years but, basically, the WAIS is composed of verbal subtests and performance subtests. The verbal subtests tap stored knowledge and abilities typically acquired from formal education or exposure to the culture in which a person lives. Examples of verbal subtests include vocabulary (word definitions), information (facts that adults have opportunities to pick up, like the capital of France); and comprehension (questions that require an understanding of social conventions, like what to do if you see someone fall off a bike and not get up). In contrast, the performance subtests call for the solution of new problems in new ways, with extra points often allotted for speed. Examples of performance subtests include digit symbol (the examinee sees a set of digit-symbol pairs and, as quickly as possible, must write the correct symbol under a new set of randomly arranged digits); block design (the examinee must copy a printed pattern using blocks with sides that are all white, all red, and red/white); and picture completion (the examinee must notice, for example, that a drawing of an elephant is missing a trunk).

In studies that employ the WAIS to measure intellectual abilities, the typical finding came to be known as the “classic aging pattern” (Botwinick, 1984). That is, scores on the verbal subtests generally show little or no age-related decline, so have been termed “age-insensitive.” But scores on the performance subtests do show age-related decline, so have been termed “age-sensitive.” Another way of phrasing this distinction is with the terms crystallized abilities and fluid abilities, respectively (Horn & Cattell, 1967). Verbal subtests measure abilities that can be considered knowledge that is hardened over time – like crystal. Performance subtests measure abilities that deal with new ways of working out problems – they call for thinking that is fluid. Baltes (1993) introduced the terms pragmatics of intelligence and mechanics of intelligence. Pragmatics of intelligence, which are based on cultural exposure to factual and procedural knowledge and are analogous to crystallized abilities, tend to be maintained with age. Mechanics of intelligence, which are assumed to be dependent on basic brain functioning and are similar to fluid abilities, tend to show age-related decline. Baltes emphasized that pragmatics of intelligence show little decline and may even increase with age. Furthermore, he argued that pragmatics of intelligence may actually compensate for any decline in mechanics of intelligence, which may decline to a lesser extent with the help of the pragmatics.

Recall that Baltes and Schaie (1976) introduced the concept of plasticity, which refers to the possibility that intellectual abilities can be modified with practice and training. More recently, neuropsychologists proposed the Scaffolding Theory of Aging and Cognition (STAC), a model whereby the brain adapts to any neural atrophy (wasting away of brain cells) that may occur over time by building alternative circuitry, or scaffolding. This scaffolding makes it possible for older brains to maintain a high level of functioning (Park & Reuter-Lorenz, 2009).

In addition to recognizing the importance of how intelligence is measured, investigators began to realize that the method of conducting research can be a significant factor when establishing the relationship between age and intellectual abilities. Most studies on age and intellectual abilities were (and still are) cross-sectional. Cross-sectional studies compare a group of younger adults with a group of older adults all at about the same point in time. Longitudinal studies follow the same group over time. Obviously, cross-sectional research can be completed in much less time than longitudinal research, which can stretch over decades. Despite the efficiency of cross-sectional research, Schaie (1965) pointed out (in a now classic paper on developmental research methods) that a group of people who share the same birth period (think of it in this case as a generation) make up a cohort. Depending on cohort membership, people experience specific advantages as well as specific disadvantages with regard to intellectual abilities, so there can be both positive and negative cohort effects. For example, earlier cohorts (current older adults) are probably not as well versed as are later cohorts in Internet research but their education stressed spelling and grammar much more – making them better at those than younger cohorts. Because cohort membership is associated with people's educational background, it can affect the abilities that they are likely to possess. Now think about cross-sectional research. When we compare 30-year-olds with 70-year-olds we are not only looking at age differences, we are also looking at cohort differences. If we find evidence for decline, we don't know for sure whether it is related to age, cohort membership, or both.

But even when we can afford the time and money to do longitudinal research, we are not getting a complete picture of how age may be related to intelligence. If we test the same people repeatedly, we open the door to possible learning (“practice”) effects, especially if times of testing are close together. Learning effects would minimize any age-related changes because people can improve with practice. In addition, not everyone who participates in the initial wave of a longitudinal study is willing or able to return for retesting on subsequent occasions. Some people drop out of the study, so the size of the sample diminishes over time. If the drop-out were random and not too extreme, this would not necessarily be a problem for interpreting the research results. Unfortunately, however, drop-out tends to be selective. Think about why someone might not return for a later test session (made the appointment but forgot to show up, moved out of town, got sick, maybe even died).

In an excellent demonstration of selective drop-out, Siegler and Botwinick (1979) investigated the initial test scores of participants in the Duke University Longitudinal Study. Participants who dropped out and did not complete the study were the ones who started out with lower scores, whereas those who remained in the study started out with higher scores. In light of this finding, it seems that longitudinal studies of intellectual abilities could result in an overly rosy picture – higher age-related maintenance of intellectual functioning than may have been the case if all participants in the original sample had remained in the study. Even so, decline in intellectual abilities appears to occur much later and is much less extensive when studies are longitudinal rather than cross-sectional (Schaie, 1994).

In addition to increased concern with the method used to study intellectual development, there has been growing interest in a broader view of what constitutes intellectual abilities. Until quite recently, intelligence tests had a quantitative emphasis (number of points, bonus points for speed), and test items were often academic in nature. Because younger adults are more likely than older adults to be students, such tests are more relevant to their everyday lives. As Woodruff-Pak (1989) has pointed out, there has been a gradual evolution in cognitive researchers' perspectives about intelligence. Intellectual abilities are now thought to be manifested not only in quantitative scores on tests related to academic topics, but also in qualitative measures on how people go about solving real-world dilemmas. Interest in the topic of wisdom (covered in a subsequent section) is one example of a broader perspective on intellectual abilities.

One further item that bears mentioning is that although the majority of older adults do not suffer from organic brain problems such as dementia, the incidence of such problems does increase with age (see subsequent section on this topic). Some of the older participants in the studies conducted on intellectual ability may have had mild cognitive impairment that was only diagnosed as dementia later on. Their inclusion in these studies may have inflated the extent of what was thought to be age-related decline in intellectual abilities.

Fortunately, we now have a much better understanding of the likelihood that intellectual abilities do not all follow the same age trends. The cognitive abilities that do decline do not usually do so precipitously, nor do people experience decrements in all intellectual abilities as they age. When there is decline, it tends to occur relatively late in life, and to be much smaller, when the same people are followed over time (longitudinal research) than when people differ not only in age but also in cohort membership (cross-sectional research). Decline is more likely in fluid abilities (the mechanics of intelligence) than it is in crystallized abilities (the pragmatics of intelligence). Furthermore, in studies that have reported age-related decline in intellectual abilities, there is no guarantee that every person included in the research was free of the mild cognitive impairment that can occur in the earliest stages of dementia. Finally, to the extent our definition of intellectual abilities includes real-world problem-solving (not just academic abilities), it would be inaccurate to make a blanket statement that intellectual decline occurs across the board in older adulthood.

Myth #10 Older adults can't or won't learn new things – like technology. They would rather get a stupid phone than a smart one

Look up “You can't teach an old dog new tricks” on the Internet. Google will direct you to thefreedictionary.com, and when you get there you'll find this: “You're never going to teach your father at the age of 79 to use a computer. You can't teach an old dog new tricks, you know.” Safe to say, then, that people take for granted that older people can't learn new technology.

But how accurate is the view that older adults are not receptive to innovations and that they remain attached to doing things the way they always did? Perhaps some readers of this book have never heard of passbook savings accounts and library card catalogs; they can't imagine banking without ATM cards or searching a library's holdings without using a computer. Does that mean that the old dog (your 79-year-old father or grandfather, that is) cannot or will not become well versed in the use of today's (and even tomorrow's) technology? Does he go to the bank and pass out when he can't get a passbook? Does he give up trips to the library if there is no card catalog? Of course not! Obviously, he has to get over it.

Back when few people had personal computers, Jane Ansley, a graduate student at Florida International University, was intrigued by the common notion that older adults tend to be skittish about computers and that they would be better able to succeed on a paper-and-pencil quiz than on the same quiz using a computer (Ansley & Erber, 1988). Well, they were not better off with the pencil than with the keyboard. First of all, community-living older adults ranging from 55 to 86 (mean 70) years of age were no different from undergraduates in their responses to an “attitudes toward cybernetics” self-report survey (Wagman, 1983). Second, older adults who completed a multiple-choice vocabulary quiz using (believe it or not) a now ancient Franklin Ace 1200 computer were no slower, no less accurate, and no less cautious in terms of betting “play bucks” on the correctness of their responses than were older adults who took the quiz in paper-and-pencil form. So even at the dawn of the personal computer age, there was no support for the stereotype that older adults would prefer to avoid computer technology or that they would have difficulty using it.

Older adults' technological proficiency, or lack thereof, has been a topic of particular interest with regard to employment-related issues (Czaja, 2001). Many employers expect workers to possess basic computer skills and to be willing to learn how to use new software as it is developed. Therefore, if they stereotype older people as resistant to new technology, then that is a problem – especially if the stereotype is undeserved. Czaja and Sharit (1993) compared the performance of women ranging from 25 to 70 years of age on computer-based tasks. None of the women came to the study having significant computer experience with data entry, file maintenance, or inventory management (in the 1990s this lack of experience was not as surprising as it would be today). The older women were slower than the younger ones in carrying out these tasks. However, these researchers suspected that greater experience would have helped them compensate for decline in speed. At a later date, Sharit et al. (2004) trained “younger” older adults (50–65 years) and “older” older adults (66–80) on how to use email. Over four consecutive days, both age groups improved, but the improvement was especially marked for the “older” older adults, who had started out at a lower level. This demonstrated that older adults are receptive to learning about and are capable of acquiring technological skills, although they may need more practice as they get older.

An important factor to consider is that older adults have been following certain procedures for a longer time than have young adults. Thus, the common myth that older adults are less flexible than younger adults seems a bit unfair, because they have to unlearn deeply ingrained habits in order to switch to new ways of doing things. As an example, older people almost all wear wrist watches. Young adults may wear wrist watches for decorative purposes (jewelry) but they rely much more on their handheld devices for checking the time. How long would it take you to stop checking your wrist for the time if you had recently given up wearing a watch? Would it take longer if you had been wearing a watch for 60 or 70 years? Panek (1997) contended that there is no reason to assume that older workers cannot be trained successfully, although they do benefit more when there is less pressure and more time to learn.

Technology has altered many aspects of life, and its influence extends beyond the workplace. Younger adults have been exposed to technology all through high school (laptops and tablets) and even earlier (think calculators). However, today's older adults were educated without recourse to any battery-operated learning aids, and the oldest retired before computers were used widely in the workplace. Even so, many retirees are interested in learning basic computer skills, and they are eager to take advantage of training opportunities through continuing education programs offered at community colleges, public libraries, community centers, and sometimes even on the premises of apartment buildings where they live. They know that email makes it easy to keep in touch with loved ones who live at great distances and Skype allows them to make and receive video calls. You may even know of someone's grandmother who reads stories to a little one over Skype (cybersitting as opposed to babysitting?) while mom or dad is busy doing something else. Some older people also use the Face Time app – although apps are not on their list of favorite cell phone uses. According to a Pew research survey (Duggan & Rainie, 2012), only 8% of cell phone users over 65 had downloaded an app as of 2012.

If older people were not important consumers of technology, the industry would not be marketing devices that are designed to appeal especially to them. Older adults are a fast-growing demographic for the makers of mobile phones. Check out www.snapfon.com and you'll find “the cellphone for seniors.” Big buttons! Easy-to-read screen! Enhanced volume! SOS button! High-powered LED flashlight! If you don't like that one, try the Jitterbug Plus® and get information on the same bells and whistles. Many major companies are getting on the bandwagon too. As of May 2013, 76% of adults in the U.S. aged 65 and over owned a cell phone, and 18% owned a smartphone. This compares with 91% and 56%, respectively, of all adults in the U.S. (Smith, 2013).

The Pew Research Center (2013) has compiled data on the demographics of technology use. Here are some fun facts:

• As of April, 2012, 49% of adults aged 65+ reported using the Internet, at least occasionally, compared to 79% of adults of all ages
• 47% of adults aged 65+ received email, at least occasionally, vs. 73% of all adults
• 15% of adults aged 65+ accessed the Internet on a cell phone, tablet, or other mobile handheld device, at least occasionally, vs. 53% of all adults
• 48% of adults aged 65+ owned a desktop computer vs. 58% of all adults
• 32% of adults aged 65+ owned a laptop computer vs. 61% of all adults
• Of cell phone owners
  • 32% of those aged 65+ used them to send or receive text messages vs. 79% of cell phone owners of all ages
  • 49% of those aged 65+ used them to take pictures vs. 82% of all ages

Older adults use computers to access the Internet for information about government agencies, health issues, or consumer products such as the ratings and prices of new and used cars. They use it to shop online for all manner of goods, from purchasing stocks and bonds to ordering books, clothing, and airline tickets. Online shopping is especially advantageous for older adults who no longer drive. Older adults can combat loneliness and isolation by using social networking sites. According to the Pew Research Center's survey (Hampton, Goulet, Rainie, & Purcell, 2011), in 2008, 11% of social networking site users were over 50, but by 2010 that number was 26%. Clearly, this demographic has found a place in cyberspace. Members of the over-65 age group are really active once they join Facebook: 61% of Facebook users aged 65+ have updated their status at least once; 66% of Facebook users in this age group have commented on a post at least once; 64% have “liked” something; and 40% have friended all of their core confidants.

In sum, there is good evidence that older adults have been participating in the technological revolution by learning at least the basics of computer use. Furthermore, according to Chen and Persson (2002), older Internet users express a higher level of psychological well-being compared with older adults who do not use the Internet.

Myth #11 As people grow older, they get forgetful, and this is always a sign of dementia

This belief that older adults inevitably become “senile” is so common that a reader of a New York Times blog does not expect anyone to take offense at the opinion expressed in the comments section: “So yeah, I hate it when people use umbrellas in the snow, except for the elderly. I put up with it from the elderly because they're probably weak and senile, and allowances must be made for them” (Hamid & Victor, 2014, February 13).

In the past, when people grew old and seemed ditsy, they were called senile. Senile seemed to imply a kind of inevitability, and eventually the term went out of favor – a not-nice thing to call someone. The term senile dementia had a more serious ring to it and had a brief run. After that, dementia became the common term for symptoms such as difficulties with memory, language, abstract thinking, reasoning, decision-making, and problem-solving. Now, dementia is increasingly referred to by professionals as neurocognitive disorder (American Psychiatric Association, 2013). Nevertheless, we will use the term dementia here because the majority of research to date has not yet incorporated the term neurocognitive disorder. Dementia, rather than senile dementia, makes it easier to remember that these symptoms are not confined to older adulthood – they can result from a stroke or a brain injury at any age. Similar symptoms can also occur as a result of long-term alcohol abuse, a brain tumor, Parkinson's disease (PD), HIV, or multiple sclerosis (MS). And let's not forget dementia pugilistica – aka boxer's dementia.

Even so, the rate of dementia does increase with age. Estimates are that dementia affects 6%, 8%, or even 10% of adults aged 65 and older, and it may affect 25%, 30%, or more of those over the age of 85 (Gatz, 2007; Karel, Gatz, & Smyer, 2012; Knight, Kaskie, Shurgot, & Dave, 2006). There is a higher incidence of dementia among older adults who live in institutional settings – approximately 58% of institutionalized older adults have some form of dementia. That's to be expected because dementia is a major factor in the decisions of family members and/or health-care workers to place older adults in institutions (Skoog, Blennow, & Marcusson, 1996).

Despite the rise in incidence with increasing age, the majority of community-living older adults do not suffer from dementia. But what about the forgetfulness we see in some of those community-living folks? Is forgetting always a sign of dementia? Not necessarily. Some types of forgetting seem to increase with “normal aging.” For example, older adults with no known diagnosis of dementia complain about forgetting specific facts or forgetting names, the latter being especially bothersome. They complain of increased tip-of-tongue experiences (“I know the name of that actor – it's on the tip of my tongue”). Also, older adults report a higher incidence of absentmindedness (Kausler, Kausler, & Krupshaw, 2007), such as walking into a room for some purpose but once there, forgetting what they wanted to do or what items they had planned to retrieve. (By the way, how many times have we all opened the refrigerator only to forget what we were looking for?) In most cases, forgotten facts, names, or intentions are recalled after some delay. Even though older adults themselves may find such memory failures to be annoying, forgetting specific details about an experience and being absentminded are not necessarily ominous signs.

The website www.alz.org/co/in_my_community_alzheimers_symptoms.asp offers some guidelines to help differentiate between memory loss that may be a warning sign of Alzheimer's disease (the most common type of dementia in older adulthood, as explained in the myth that follows) as opposed to typical memory loss that is not necessarily pathological (see Table 2.1).

Note that potentially pathological signs include forgetting skills and abilities that, presumably, were carried out with ease at a previous time (e.g., forgetting how to play a familiar game or find one's way around in a familiar neighborhood). The list also includes forgetting, or neglecting to perform, basic activities such as bathing. Most people are capable of performing these activities as part of everyday living. Another behavior considered ominous with regard to impending dementia is repetition of the same question or repeating the same story over and over again within a very short period of time. So when Aunt Sally tells you the same story that she told you last month, it doesn't qualify as “over and over again within a very short period of time.” Just listen politely and don't worry about her, especially if that is the only sign of trouble.

In a recent report on data from 16,964 women (aged 70–81) who participated in the Nurses' Health Study (Amariglio, Townsend, Grodstein, Sperling, & Rentz, 2011), some older adults who had not been diagnosed with dementia expressed an awareness that their memory failures went beyond normal forgetfulness. This subjective cognitive decline suggests that older adults themselves may be able to detect when their forgetting is an ominous sign of a potentially pathological process.

Nevertheless, it is not always a simple matter to differentiate forgetting that occurs with the normal aging process from that which signifies the early stages of dementia. Age-associated memory impairment (AAMI) refers to mild forms of memory loss that occur as people get older (Butler, Lewis, & Sunderland, 1998). AAMI doesn't sound like such a terrible thing, but researchers have been trying to differentiate between AAMI and memory loss that foreshadows Alzheimer's disease (AD) or some other type of dementia. Older individuals with more than the typical level of cognitive problems are usually said to have mild cognitive impairment (MCI). A subcategory of MCI is amnestic MCI. Memory impairment is the most prominent cognitive symptom, and people with this diagnosis earn lower scores on memory tests than their age peers do. However, they do not meet the criteria for AD because they do not experience confusion or difficulty with language, and they are still able to carry on with the normal activities of daily living. As of 2013, MCI is also being referred to by professionals as mild neurocognitive disorder (American Psychiatric Association, 2013).

Brain-imaging studies in which older adults complete certain cognitive tasks have shown that different regions of the brain are activated in those with amnestic MCI as opposed to those without it. Are older adults with amnestic MCI at greater than average risk for eventually developing dementia? Thus far, the answer appears to be yes. Over a 4.5-year period, approximately 55% of those classified earlier as having amnestic MCI progress to a diagnosis of dementia, as opposed to less than 5% of those classified as having normal memory (Salthouse, 2010). For this reason, amnestic MCI is now viewed as a potential precursor to dementia. Even so, it is still not possible to predict with certainty which people targeted as having MCI will eventually be diagnosed with dementia. Nor is it possible to explain why, down the road, a small percentage of individuals without amnestic MCI may end up developing dementia.

In sum, it is not necessarily the case that getting forgetful with age means dementia is inevitable. Many types of forgetting are experienced by people of all ages. Also, some kinds of forgetting that do increase with age are not necessarily ominous early signs of oncoming dementia.

Myth #12 Alzheimer's disease, dementia – they're one and the same

Many people equate dementia and Alzheimer's disease, often using the terms interchangeably. Dementia affects neurons (brain cells), their connections in the brain, or both. That organic problem causes all of the symptoms that people associate with Alzheimer's disease. In actuality, AD is just one type of dementia, although based on what we know at the present time, it does seem to be the most common type to affect older adults, accounting for approximately 50% of dementia cases in that age group (Cohen & Eisdorfer, 2011).

AD usually has a gradual onset, so initially it can be difficult to detect. Over time, there is noticeable deterioration in cognitive functioning, and eventually this cognitive impairment affects not only memory, but also language and problem-solving, and indeed the very integrity of the individual's personality. Confusion and disorientation are often seen in the late stages of AD, as is the inability to perform basic tasks of everyday living such as being able to dress, feed, and toilet oneself. These problems have been traced to the death of neurons, the breakdown of connections between them, and the extensive formation of neuritic plaques and tau (the chief component of neurofibrillary tangles), which interfere with neuron functioning and neuron survival (National Institute on Aging, National Institutes of Health, Alzheimer's Disease Education and Referral Center, n.d.). Plaques and tangles are seen in the brains of very old individuals for whom there was no behavioral evidence of dementia prior to death (Snowdon, 1997), but generally these are much less extensive than they are in the brains of AD victims (Skoog et al., 1996).

Vascular dementia (VaD), the second most common form of dementia, accounts for 15% to 20% of dementia cases in older adulthood. Risk factors for VaD are advanced age; being a smoker; having diabetes, heart disease, or a history of stroke or hypertension (Skoog et al., 1996). VaD is associated with blockage of cerebral blood vessels, which usually results in focal destruction of brain tissue (Gatz, Kasl-Godley, & Karel, 1996). Focal destruction means that one specific part of the brain is affected, as opposed to the more generalized breakdown of brain cells that occurs with AD. Multi-infarct dementia (MID) is a type of VaD resulting from strokes (Cohen & Eisdorfer, 2011). In contrast to the gradual and insidious onset of AD, VaD comes on more abruptly. Also, in contrast to AD's slow but steady downhill progression, deterioration can be stepwise and fluctuating (Skoog et al., 1996), possibly due to a series of strokes, each of which may be followed by an incomplete recovery over a period weeks or months (Knight, 2004). As well, the course of VaD is not as lengthy as that of AD – approximately 50% of those diagnosed with VaD survive less than three years (Rockwood, 2006) versus at least 10 years or longer for people diagnosed with AD prior to age 80 (National Institute on Aging, National Institutes of Health, Alzheimer's Disease Education and Referral Center, n.d.). Also, personality is more preserved to the end with VaD than it is with AD. For reasons that are not completely understood, AD affects a larger number of older women than older men, even taking into account the overall greater female longevity, whereas men are more at risk for VaD.

Even so, differential diagnosis (arriving at the correct diagnosis when several conditions with similar symptoms exist) of AD and VaD is not always straightforward because at any given point in time, the symptoms overlap. Computed tomography (CT) and magnetic resonance imaging (MRI) scans are sometimes used to make a determination. CT scans can detect areas of cerebral degeneration (or atrophy) in the structure of the brain, and MRI scans use magnetic fields to detect abnormalities in soft tissue. If scanning techniques detect small focal lesions in the brain, a diagnosis of VaD or MID is suggested. Scans that detect large spaces (vacuoles) in the brain are more indicative of advanced AD. Just to confuse matters further, it is not uncommon for people aged 85 and older to have both AD and VaD (Corey-Bloom, 2000; Rockwood, 2006; Whitehouse, 2007). Furthermore, recent thinking among scientists is that vascular risk might be a common factor for both VaD and AD (Gatz, 2007).

Another form of dementia, dementia with Lewy bodies (DLB), was named after Frederick Lewy, who was the first to identify the abnormal microscopic protein deposits found in neurons, typically only with post-mortem histology. DLB has been gaining greater attention, in part because it is more common than was previously thought. In fact, it may be the second or third most common type of dementia among older adults, accounting for 10% to 15% of autopsied dementia cases (Cohen & Eisdorfer, 2011). Lewy bodies occur both in the brain stem and the cortex, which may explain why individuals with DLB have motor as well as cognitive symptoms. With DLB, movement disorders (e.g., shuffling gait, tremors, and muscle rigidity) are similar to those found with Parkinson's disease, which may explain why DLB is often misdiagnosed as PD. With PD, however, cognitive symptoms usually do not occur for a year or more after motor symptoms appear. In the case of DLB, cognitive symptoms similar to those found with AD usually occur simultaneously with motor symptoms. As with AD, the cognitive symptoms worsen gradually over time, but there is more alternation between confusion and clear thinking with DLB. Individuals with DLB have sleep disturbances and recurrent visual hallucinations, and they are especially at risk of falling. Autonomic symptoms such as difficulty with swallowing and fluctuations in blood pressure are often seen as well. Diagnostic criteria are still being developed for DLB because of its behavioral and symptomatic overlap with both PD and AD (Block, Segal, & Segal, 2013).

Yet another form of dementia is frontotemporal dementia (FTD), which is associated with progressive neuron deterioration in the frontal or temporal lobes of brain (Snowden, Neary, & Mann, 2002). FTD (sometimes called Pick's disease after the physician who first described it in 1892), is characterized by changes in social behavior and/or problems with language. Examples of behavior changes are lack of social tact, changes in food preferences, neglect of personal hygiene, and inability to demonstrate basic emotions. Language problems might include repeated use of a word or phrase or decline of speech output altogether. Memory problems are generally absent in this disorder. Typically, FTD is diagnosed when people are between 45 and 65 years old, whereas AD, VaD, and DLB occur more commonly in the later years. Once diagnosed, FTD progresses steadily and often rapidly.

In sum, not all dementia is Alzheimer's disease, and the recommended treatment is not identical for all types of dementia. Thus, it is important to diagnose a problem as accurately as possible. For AD, prescription medications may lessen the symptoms for some amount of time, although medications have not yet been developed that lead to a cure or a permanent cessation of the downhill course of the disease. For VaD, however, timely intervention and treatment of the underlying cause (e.g., diabetes, high blood pressure, strokes, and so on) could help prevent it from progressing. For DLB, modifying the environment to ensure it is designed to prevent falls and to accommodate other movement difficulties, and carefully monitored medications, can help to control the symptoms (Block et al., 2013). Finally, dementia-like symptoms can be reversible when they are caused by such factors as nutritional deficiencies, reactions to medications, and hypoglycemia.

Myth #13 There's no help for Alzheimer's, so don't waste time or money on diagnosis of memory problems

At present, there does not seem to be a cure for AD, but that does not negate the importance of a differential diagnosis. First, medications may offer temporary relief of symptoms. Second, the environment can play an important role in how well and for how long a person with AD can continue to live with some degree of independence. Third, without early diagnosis, the success of any possible interventions is diminished. Fourth, people who are in the early phases of AD may have a lengthy period of time when they are capable of functioning at a sufficiently high level that will allow them to arrange their affairs and plan for the type of care they wish to have before they are no longer able to do so. Fifth and finally, what initially appears to be AD could in fact be a different problem, one for which there may be more effective treatment.

Research on the cause(s) of AD is still unfolding, and the effectiveness of the available medications is less than we would wish. However, some drug therapies do help many patients to a degree, and additional potentially effective medications are under development. It is certainly worthwhile to obtain a diagnosis in case one of these medications can delay any increase in the symptoms.

How can the environment influence the length of time a person with AD may be able to live independently? Certain environments can provide the support needed to bridge the difficulties that a person with AD may experience. One way to understand environmental issues is to consider the case of President Ronald Reagan. In 1994, Reagan announced to the world that he had AD (Ronald Reagan Presidential Library, 1994, November 5). There is a bit of a controversy about whether he had symptoms while still in office (see e.g., Maer, 2011). If he did, however, it is likely that the presidential environment protected him from the consequences. He didn't have to drive a car; he had a personal assistant to make sure he didn't forget appointments; he had staff to prepare meals and balance his checkbook (do presidents even have checkbooks?); he did not have to risk getting lost – the Secret Service saw to that. But what happens when an older person who lives alone starts having symptoms? At what point does that person (and his or her relatives) need to know what to expect down the line? People with AD need a plan. They cannot live alone as the disease progresses, and those who live with them need to prepare for the caregiving responsibilities.

With an early diagnosis of AD, afflicted individuals have the opportunity to make good use of the time left before the symptoms become too severe. People can make independent decisions while that is still possible. They may need to get current on health-care proxy paperwork, create or update a last will and testament, make their wishes known about who will care for them, or even take that trip to Sicily they have been looking forward to. Financial planning is also important because of the costly care they may need. Finally, people with an early diagnosis may be able to cope better with their symptoms if they understand what is to come.

An excellent reason to seek an accurate diagnosis when there are cognitive symptoms is that the problem may not in fact be AD. An article in Parade Magazine (Chen, 2012, November 11) describes the case of a 59-year-old man who had been a top-notch salesman but suddenly began to have difficulties with speech and walking, and later on with remembering familiar things such as his wife's name. Numerous consultations with doctors over the next seven years resulted in diagnoses ranging from Parkinson's disease to Alzheimer's disease. Finally, nine years after the man's symptoms first appeared, a neurologist ordered an MRI, which showed he had normal pressure hydrocephalus (NPH). With NPH, fluid surrounding the brain is not properly reabsorbed, and this eventually causes problems with walking and memory. To reduce pressure in the brain, a surgeon can treat NPH by drilling a hole in the skull and implanting a shunt that drains excess fluid. This surgery resulted in the man's recovery of the ability to walk and a dramatic improvement in his memory.

Not all cases are as dramatic as that of the 59-year-old salesman. However, if the root cause of a person's cognitive symptoms is poor circulation, high blood pressure, or a stroke or strokes, treatment could prevent these symptoms from progressing and, hopefully, improve a person's functioning. The cause of cognitive symptoms can be determined only with the proper screening procedures for cerebrovascular disease and risk factors such as smoking or hypertension. As mentioned earlier, there is recent speculation about whether vascular risk is a common factor not only for VaD but possibly AD as well (Gatz, 2007). If so, then treatment of circulatory issues could be helpful for VaD and, indirectly, for AD.

Recently, Matthews et al. (2013) reported evidence for a decline in the prevalence of dementia in the U.K. Study participants were 7,635 people aged 65 years and older who were assessed between 1989 and 1994, and 7,796 people aged 65 and older who were assessed between 2008 and 2011. The number of people with dementia in the latter group was 24% lower than would have been predicted just based on population aging alone. Certainly, we must be cautious in generalizing to the U.S., but there is good reason to believe that a similar phenomenon is occurring in developed countries in which there have been improvements in the prevention of vascular disease and education about this and related health issues.

Another potential culprit when people experience cognitive difficulties is medication side effects. Some medications may cause memory problems. For example, statins (e.g., Lipitor®, Zocor®, and Crestor®) are a class of drug used to control cholesterol. In February 2012, the U.S. Food and Drug Administration officially added a safety alert to the prescribing information, citing a risk (though rare) of memory loss. Sleep aids have also been implicated in cognitive impairment. For example, warnings for the popular drug Ambien® now include the fact that for elderly patients, the drug dose should be lower than it would be for younger patients because of the increased risk of impaired cognitive performance (Sanofi-Aventis, 2013).

What about using several drugs at once, or so-called polypharmacy? A study of adults aged 57 to 85 (Qato et al., 2008) found that 29% used at least five prescription medications concurrently – and prescription medication use was highest among those aged 75 to 85. Among those users of five prescription drugs, 46% used over-the-counter meds as well. The number of over-the-counter medications that older adults take is alarming, and when combined with prescription medications, the result could be cognitive impairment. It is worth investigating whether drug side effects, drug interactions, or both could be at the root of memory problems.

In sum, there are many reasons why early diagnosis of a memory problem is not a waste of time or money: (a) medications may be of some benefit; (b) the environment can be manipulated to buy extra time for independent living even with a progressive disease; (c) early diagnosis may reveal a condition that is amenable to intervention; (d) a patient may be able to make good use of limited time for making important decisions and fulfilling lifetime dreams or goals; and (e) the problem may not actually be AD, but could turn out to be a partially or completely reversible condition.

Myth #14 Wisdom comes with age, so older adults are wise

There is a common belief that wisdom increases with age and that, as a group, older adults are wise, or at least they are wiser than younger adults. This makes sense if we accept the premise that a person is not born wise; rather, wisdom must be honed with life experience. If it takes time to develop wisdom, and if time and age covary (change together), then the expectation is that wisdom will increase over the lifespan.

Before we can determine whether wisdom increases with age, it is important to address the question of what constitutes “wisdom.” There is no simple answer to this question. According to one school of thought, a wise person has expert knowledge that provides him or her with insight about the practicalities and vicissitudes of life, termed pragmatics of life by the late Paul Baltes (who was an international leader in the scientific study of wisdom) and his colleagues (e.g., Baltes & Staudinger, 1995; Smith & Baltes, 1990; Smith, Staudinger, & Baltes, 1994). Also, a wise individual understands how the conditions of life can vary from person to person depending on an individual's culture and developmental stage. Thus, when asked for advice, a wise person takes into consideration the context of the situation. Furthermore, a wise person can offer insightful advice, but also understands that human nature is far from perfect (Taranto, 1989). Finally, a wise person behaves admirably and morally (Birren & Fisher, 1990; Birren & Schroots, 1996).

Most people assume that wisdom is associated with intelligence (Kausler et al., 2007; Sternberg & Lubart, 2001). However, Birren and Fisher (1990) contend that wisdom is not so much how much information you have; rather, it is knowing what you do not have and being able to make good use of what you do have. The wise person weighs what is known and not known and reflects on the consequences of all the alternatives before selecting one of them. A wise person remains calm and impartial while considering all aspects of a problem because he or she understands that a reflective state of mind is needed to generate alternative solutions when confronting a problem. So wisdom requires keeping one's emotions in check and not making rash decisions. In addition, wisdom requires an appreciation that truth is not absolute; rather, truth may depend upon the perspective one takes (Sternberg & Lubart, 2001). A wise person is capable of integrating opposite points of view and considering multiple aspects of complex and uncertain situations.

Jeste et al. (2010) conducted a survey to determine whether there is any consensus among wisdom theorists regarding their conceptions of wisdom. Theorists were in agreement that wisdom is a distinct entity separate from intelligence and spirituality. They concurred that wisdom is a rare personal quality that indicates advanced cognitive and emotional development. Many also thought that wisdom requires experience.

Theories about wisdom are explicit or implicit. Explicit theories are the definitions of wisdom proposed by researchers (e.g., those interviewed by Jeste et al., 2010), whereas implicit theories refer to the conceptions lay people (that is, ordinary folks who are not researchers) hold about wisdom. Lay people's implicit theories also show considerable agreement (Ardelt, 2011), namely that wisdom is a multidimensional construct that includes being knowledgeable, having the ability to think reflectively and consider various perspectives, being concerned about others, and being capable of maintaining composure under trying circumstances.

According to Ardelt (2011), Western and Eastern implicit theories about wisdom are not that different from one another. However, the cognitive aspect (having a good knowledge base and the ability to reason abstractly) is more prominent in the Western concept of wisdom, whereas the reflective-compassionate aspect (being benevolent and having concern for others) is more prominent in the Eastern concept of wisdom. Adding further to the complexity of defining wisdom, Glück and Bluck (2011) contend that even within Western culture, people's implicit conceptions about what constitutes wisdom and how wisdom develops are not unitary and could depend on age. A large sample of lay people ranging in age from 13 to 93 (average age 47) rated the importance of various items concerning what wisdom is and also how it develops. Based on these ratings, Glück and Bluck derived two conceptions of wisdom, cognitive and integrative. In the cognitive conception, the importance of knowledge is central, as is the belief that wisdom develops mainly through learning experiences and exposure to wise persons. In the integrative conception, knowledge is important, but empathy and concern for others are equally so – there is greater emphasis on how affective factors, such as emotionally challenging life experiences, influence the development of wisdom. Glück and Bluck found that as people progress through their adult years, the affective aspects take on greater importance in their conception of wisdom – as people move beyond their early 20s, they are increasingly likely to endorse an integrative conception rather than a cognitive conception of wisdom.

Despite efforts to define wisdom, being able to measure it remains challenging, but it is necessary to do so in order to determine whether wisdom increases with age. In one effort to measure wisdom, Smith and Baltes (1990) presented highly educated Berlin residents of various ages with a hypothetical family/work dilemma faced by a fictitious character (“target”) and asked them what advice they would give the target on how to resolve the predicament. For example, how would they advise a young adult male target who just lost his job, but whose wife recently returned to her well-paid professional job after spending time as a homemaker? Research participants were instructed to think aloud as they formulated a plan of action that the target could use to resolve the dilemma. Later, trained raters evaluated the wisdom of the advice each participant would give to the target. There is no single “correct” solution to this sort of dilemma, but some kinds of advice were considered wiser than others. To attain a high wisdom rating, the plan of action would have to (a) define and discuss many aspects of the target's problem; (b) offer several alternatives about what the target could do, stating the positive and negative aspects of each one; (c) recognize that all strategies hold some uncertainty and evaluate the risks of each; and (d) suggest that the alternative selected be monitored and revised if necessary. Only 5% of the study participants' responses received high wisdom ratings, supporting the view that wisdom is rare. However, the responses that were rated as wise were evenly distributed over the young, middle-aged, and older groups. In short, the older participants' responses were no wiser than were those of the younger participants, but neither was there any age-related decline in wisdom. In general, participants' responses showed special insight when dilemmas were faced by a similar-aged target. So for dilemmas faced by a young target, the young and middle-aged participants' advice received higher wisdom ratings than did the older participants' advice. In contrast, for dilemmas faced by an older target, the older participants' advice was rated somewhat higher than the advice given by the young and middle-aged participants. In this way, Jeste et al.'s (2010) wisdom theorists' conception that wisdom requires experience was upheld.

Ardelt (2000) approached the measurement of wisdom by asking clinically trained interviewers to rate the wisdom of a group of healthy, educated, financially well-off European American older women, all of whom had participated in the longitudinal Berkeley Guidance Study. Even among this highly select group, there was considerable variation in wisdom ratings. Interestingly, those participants rated by the interviewers as higher on cognitive, reflective, and emotional indicators of wisdom also rated themselves higher in life satisfaction. Clearly, wisdom is desirable, but even in this select sample, age did not automatically lead to wisdom.

In sum, unlike the majority of myths about aging, this one has positive connotations, so it seems rather mean-spirited to poke holes in it. Nonetheless, the evidence we have at the present time does not support the myth that older adults are wiser than young adults. Some older adults are wise, and when they are, they often have a high sense of well-being. However, old age does not guarantee wisdom.

Myth #15 Older adults are suckers and are easy prey for scam artists

Given the myth that wisdom necessarily increases with age, it may seem counterintuitive when we mention another myth, which is that older adults are suckers who are easily taken in by con artists. Reports abound regarding older adults' propensity to fall victim to scams. In fact, the monthly AARP Bulletin regularly includes a column called “Scam Alerts” that reports instances in which older consumers have been taken in by fraudulent practices. These alerts are intended to educate seniors on how to identify offers that are “too good to be true” so they can protect themselves against scam artists' aggressive and often dishonest business tactics. In one such column, Sacher (2012, October) describes a scam in which a large number of older Minnesotans were persuaded to purchase deferred annuities. Sales agents told them this would make it possible for their estates to avoid probate court legal costs upon their death. Unbeknown to these older Minnesotans, their estates most likely would not have been subject to probate court costs anyhow. But more importantly, consumers who purchased these annuities had an average age of 75, yet they were prohibited from withdrawing any of their money for up to 14 years without incurring stringent penalties. This type of financial product was hardly suitable for their age or stage of life! The good news: the firm marketing these annuities was ultimately fined more than $7 million. In most instances, however, older adults are not protected against shady sales tactics – once they purchase a product, they cannot get their money back.

In the AARP Magazine, Shadel (2012, October/November) interviewed a “reformed” scam artist about his strategies for convincing victims to fall for bogus deals (e.g., gold coins worth much less than victims paid for them, home equity and reverse mortgage scams, and fake business opportunities). He claimed that older adults were prime candidates for scams because they often have nest eggs of accumulated cash or paid-off homes, which this “reformed” scam artist considered equivalent to cash ready for the taking. Also, he claimed that seniors tend to share their fears and insecurities about their finances and/or health, which gave him leverage in his sales pitch. In what appeared to be a compliment, however, he did point out that the cash and assets his victims had accumulated spoke well of their intelligence – many of the older adults he “ripped off” had been doctors, lawyers, engineers, and professors.

It is possible that older people don't so much fall for more scams than do younger people, but rather they are targeted more. For example, the FBI (Federal Bureau of Investigation, n.d.) has reported a concern that older adults are targeted because they are seen as less likely than younger adults to report a fraud. Con artists may assume that older adults will not know whom to report it to, that they may be too ashamed they were victimized, or that they may be afraid that relatives may think they have lost some of their mental capacity. Furthermore, con artists expect that older adults will make poor witnesses against them, hoping that they will fail to remember important details by the time the case gets to court.

Perhaps older adults are targeted because of the fraud opportunities that are inherent, given the needs they have at their stage of life. The reality is that older adults often face a combination of health problems and income constraints, and these offer appealing opportunities for questionable entrepreneurs (e.g., long-term care insurance, medi-gap insurance policies, life insurance policies, reverse mortgages). Sometimes pitches that older adults fall victim to are not swindles, strictly speaking. But older consumers may end up wasting their money and enriching a salesperson more than need be because of unreasonable costs or hidden fees. In addition to health care, health and life insurance, and housing scams, the FBI has made a point of warning older people to be mindful of another area in which they may be especially targeted: funeral and cemetery frauds (e.g., high-priced caskets sold for cremations when no casket is required).

But just for the sake of argument, let's assume that, all other things being equal, older adults are more likely than other age groups to fall for scams. According to research conducted by the insurer MetLife Mature Market Institute (2011), American seniors lose $2.9 billion a year to fraud, and the majority of scam victims are between the ages of 80 and 89. However, although it appears that older adults may be especially likely to fall for scams, we must be wary of concluding that their vulnerability is due to age when it could simply be due to factors associated with age.

But what characteristics of the older population (other than age per se) could render them more vulnerable to scams? As is mentioned under the next myth in this section, “Older people are extra cautious when they have to make decisions,” findings indicate that older adults tend to spend less time than younger adults do in considering a wide array of alternatives prior to making a decision. They tend to reach decisions more quickly than younger adults and they ask fewer questions along the way. If so, they may be more vulnerable to persuasion by scam artists who are pitching specific consumer products.

Another consideration is that cohort effects may render older adults more vulnerable to scams. One hypothesis is that older adults grew up in a time when people were more trustworthy, so that they are more likely than younger adults to assume that everyone who speaks to them is on the level. But Ponzi schemes and other fraudulent “opportunities” have been around for eons, and people of all ages, both now and in the past, have succumbed to the wiles of scam artists.

Perhaps older adults were brought up to be hospitable to strangers. Kirchheimer (2013, June) describes a retired couple in their 70s living on Social Security benefits of $2,200 a month. One day, the husband, who had early-stage dementia, answered a knock at the door and admitted two vacuum cleaner salesmen who said that they were also students at the local university. The wife did not have dementia but later claimed that she was raised to be gracious and felt she could not turn them away. The couple allowed the salesmen to wear them down until they agreed to finance a $4,400 vacuum cleaner over a six-year period to the tune of $8,000.

Factors related not just to age but also to stage of life could play a role in propensity to fall for scams. As a group, older people may be lonelier and less integrated into society compared with other age groups. Many live far from family members. Once retired, they are not plugged into a social network at work that would make it easy to check things out with colleagues. If they no longer work, older adults are at home more and thus available to take phone calls, a common way for scam artists to find victims. For these reasons, older adults may fall prey to people who are friendly to them, and they have no way, or little motivation, to check out the sincerity or validity of those people. According to research conducted by the Metlife Mature Market Institute (2011), most elderly victims live alone and require some help with either health care or home maintenance. Other signs that make their vulnerability obvious to strangers include limited mobility and confusion.

The majority of older adults are cognitively intact and do not suffer from dementia. Even so, there are age-related differences in how people process cognitive information. For example, older adults are more vulnerable to “false memories” (Jacoby & Rhodes, 2006), which means that they have greater difficulty than younger adults do with excluding misinformation from what they may actually remember. This tendency can render older adults vulnerable to scam artists who insist that the older adults had agreed earlier to listen to a sales pitch or had committed themselves to purchasing a product when this was not the case. If older adults have difficulty remembering what they did or did not agree to on a previous occasion, they may succumb to pressure from scam artists.

In research conducted by scientists at the UCLA Social Neuroscience Laboratory and the UCLA Brain Mapping Center (Castle et al., 2012), young adults (in their 20s) and older adults (aged 55 to 84) were first asked to look at facial photos selected to have either “trustworthy” cues (e.g., natural-looking smiles, straightforward gaze) or “untrustworthy” cues (e.g., fake-looking smiles, averted gaze) and rate them for both trustworthiness and approachability. The young and older adults made similar ratings, so had the same impression, when they looked at photos with trustworthy cues. However, the age groups did not agree on the photos with untrustworthy cues: the younger group rated such faces as untrustworthy and unapproachable, whereas the older group rated them as more trustworthy and approachable. In a follow-up study with a smaller sample of young and older adults, functional magnetic resonance imaging (fMRI) was used to measure the brain activity in the anterior insula (a brain region linked to feelings of disgust that may warn us when something does not seem quite right) that occurred while people were viewing photos of faces. The fMRI showed greater brain activity in the anterior insula in young adults than in older adults. However, this age discrepancy was magnified when the faces had cues associated with being untrustworthy. It is as if younger adults' brains are putting them on notice that they should be wary, but older adults' brains do not react to these cues in the same way. The UCLA scientists contend that the lesser activation in older adults' brains may indicate they are not picking up on cues that could protect them from scams.

Rather than focusing solely on brain processing as the basis for older adults' vulnerability to scams, it is important to consider that as people grow older, they have a tendency to become more positive (Isaacowitz, 2012). Carstensen (1995) contends that with increasing age, people feel they have less time to live, so they tend to look at the brighter side of things and do not allow themselves to stress out as much on small things. Actually, this type of emotional regulation characterizes not only older adults, but also younger adults who have been diagnosed with terminal illness. So the basis for the positivity effect is not necessarily age, but rather may be perceived time left to live. In any case, positivity could prevent older adults from reacting to warning signs that would otherwise sound an alarm and help them to steer clear of scams. Positivity can be beneficial for mental health; at the same time, it could render older adults more subject to scams. However, another interpretation of the positivity effect is that with increasing age, selective neural degeneration in the amygdala may dampen emotional responses to negative but not to positive information (Reed & Carstensen, 2012). The amydala is located in the anterior portion of the temporal lobe and is responsible for processing emotions.

In sum, it is impossible to make an accurate determination of the number of people who have been victims of scams because many, both old and young, are too embarrassed to report or admit it. But even if we were able to get an accurate count showing that older adults have a higher rate of victimization, we cannot conclude that age in and of itself is the basis for this statistic. Propensity to fall for scams could be related to the fact that scam artists specifically target older adults because of their expendable assets and their need for products that lend themselves to the fraudulent schemes. There may be cohort effects (e.g., older adults are more polite) that render them vulnerable. Also, there may be age-related differences in decision-making styles and in cognitive processing that could increase their vulnerability. Finally, being more positive may make older adults better victims of scams.

Myth #16 Older people are extra cautious when they have to make decisions

It is a common myth that older adults are overly cautious, especially when they are faced with making a decision. It is certainly true that in laboratory studies on reaction time, older people can be slower than young adults. This slowness is often more pronounced when there is more than one stimulus to react to and more than one possible response. In general, age-related differences in reaction time tend to increase as the complexity of the reaction time situation increases. Clearly, laboratory-based choice and complex reaction time tests have found that older adults are considerably slower than young adults. As a real-life example of choice reaction time, think about when you are driving and you see a traffic light just ahead of you turn green, but you also see that there is a toddler playing near the curb. You have to choose between maintaining your speed and proceeding through the green light or applying the brake, so you slow down in case the toddler runs into the street – two stimuli (green light and toddler playing) and two possible responses (maintain speed or slow down).

But based on the results of laboratory-based reaction time studies, can we conclude that older adults are always slower than younger adults when it comes to making decisions? Even if older adults are slower, can this be attributed to cautiousness? Contrary to the assumption that older adults are more cautious than younger adults when decisions must be made, several recent studies using simulated real-life situations have reported that older adults tend to review less information than young adults do before settling on an alternative. Furthermore, older adults often reach decisions more quickly than do young adults. This tendency has been found in the health field when it comes to selecting a physician and a health-care plan (Löckenhoff & Carstensen, 2007). The same phenomenon has been noted when older women were asked to select from an array of breast cancer treatments (Meyer, Russo, & Talbot, 1995) and when older men were instructed to select a treatment for prostate cancer (Meyer, Talbot, & Ranalli, 2007). In these situations, the older women and men made decisions more quickly than did the young and middle-aged women and men.

Johnson (1990) asked young adult undergraduates and older retirees to make a consumer decision that many people are faced with during their lives – deciding which kind of car to purchase. Study participants could use a computer to access comparative information about the fuel economy, comfort, maintenance cost, safety record, styling, purchase price, and resale value of various automobiles. Overall, the two age groups took approximately the same amount of time to reach a final decision about which car to purchase. However, the older retirees viewed fewer pieces of information about the cars, although they spent more time on each one than the young adults did. In short, prior to making a decision, the older retirees did not consider all of the possible alternatives to the extent that the young adults did, which would indicate that they were less cautious.

In sum, it is important to distinguish between reaction time and decision-making. Rather than being overly cautious when faced with choosing between several alternatives that require thoughtful consideration, older adults sometimes review less information than younger adults do. They often make decisions, even when those decisions are far from trivial, without methodically considering all the information that is available. In some cases they seem to be in more of a hurry to make a decision – they reach a decision more quickly than do younger adults. Therefore, it is not warranted to assume that, as decision-makers, older adults are more cautious than young adults.