No abstract

Background Clinical decision-making (CDM) is an important competency for young doctors especially under complex and uncertain conditions in geriatric emergency medicine (GEM). However, research in this field is characterized by vague conceptualizations of CDM. To evolve and evaluate evidence-based knowledge of CDM, it is important to identify different definitions and their operationalizations in studies on GEM. Objective A scoping review of empirical articles was conducted to provide an overview of the documented evidence of findings and conceptualizations of CDM in GEM. Methods A detailed search for empirical studies focusing on CDM in a GEM setting was conducted in PubMed, ProQuest, Scopus, EMBASE and Web of Science. In total, 52 publications were included in the analysis, utilizing a data extraction sheet, following the PRISMA guidelines. Reported outcomes were summarized. Results Four themes of operationalization of CDM emerged: CDM as dispositional decisions, CDM as cognition, CDM as a model, and CDM as clinical judgement. Study results and conclusions naturally differed according to how CDM was conceptualized. Thus, frailty-heuristics lead to biases in treatment of geriatric patients and the complexity of this patient group was seen as a challenge for young physicians engaging in CDM. Conclusions This scoping review summarizes how different studies in GEM use the term CDM. It provides an analysis of findings in GEM and call for more stringent definitions of CDM in future research, so that it might lead to better clinical practice.

Several theories of emotional development in adulthood provide the rationale for anticipating enhanced emotion regulation effectiveness (i.e., successful, goal-consistent regulation of emotions) with age. However, the existing empirical evidence is ambiguous. The aims of the present systematic review and meta-analysis were to investigate age-group differences in instructed emotion regulation effectiveness, and to explore whether age-group differences in instructed emotion regulation effectiveness vary according to person factors (i.e., age gap between age groups, gender distribution), the specific strategy (i.e., type of emotion regulation strategy), and situational factors (i.e., intensity and type of emotion to-be-regulated, emotion regulation goal, experimental context). PsycINFO and PubMed were searched for studies assessing age-group differences in instructed emotion regulation effectiveness in physically healthy adults. The literature search yielded 18 relevant studies conducted in laboratories (n = 1,366) and no relevant studies conducted in naturalistic settings. The meta-analyses indicated no statistically significant overall age-group differences (g = −0.01, p = .878). A statistically significant small effect favoring older adults was identified in a subgroup meta-analysis of studies assessing attentional focusing (g = −0.22, p = .027), while no other statistically significant results were identified. Together, these findings, albeit limited to a laboratory setting, indicate that instructed emotion regulation effectiveness remains largely stable in adulthood. The findings are discussed with reference to theoretical work emphasizing age-related changes in motivation (e.g., Socioemotional Selectivity Theory) and resources (e.g., Strength and Vulnerability Integration model). Limitations include the small number of studies and the limited generalizability of the findings.

Background: According to the notion of maturational dualism, the link between mind and body weakens with age and this weakening has important consequences for emotional experiences. Specifically, it is hypothesized that age-related decline in interoceptive awareness and physiological reactivity reduce the ability to use bodily states to guide judgments about emotions. If this hypothesis is valid, then age may moderate the association between explicit measures (based on consciously accessible mental representations of affect) and implicit measures (based on unconscious affective processes such physiological activation) of affective reactivity. Purpose: To investigate whether age moderates the association between explicit and implicit measures of negative affective reactivity. Methods: A sample of 275 participants (age range=20-78) viewed 25 pictures validated to induce negative emotions. Participants filled in the PANAS assessing explicit affect and the IPANAT assessing implicit affect before and after viewing the pictures. Emotional reactivity was operationalized as residualized gain scores derived from regressions of baseline affect on affect following picture viewing. Results: Age moderated the association between implicit negative affective reactivity and explicit negative affective reactivity (B=60). Discussion: The results showed a reduced association between explicit and implicit negative affective reactivity with age. This finding is consistent with the notion of maturational dualism and may indicate that older adults use affective processes that are not represented consciously (e.g., physiological activation) less than young adults when judging their emotional state.

Background Clinical decision-making (CDM) is an important competency for young doctors especially under complex and uncertain conditions in geriatric emergency medicine (GEM). However, research in this field is characterized by a vague conceptualization of CDM. To evolve and evaluate evidence-based knowledge of CDM, it is important to identify different definitions and their operationalisations in studies on GEM. Objective A scoping review of empirical articles was conducted to provide an overview of the documented evidence of findings and conceptualizations of CDM in GEM. Methods A detailed search for empirical studies focusing on CDM in a GEM setting was conducted in PubMed, ProQuest, Scopus, EMBASE and Web of Science. In total, 52 publications were included in the analysis, utilizing a data extraction sheet, following the PRISMA guidelines. Reported outcomes were summarized. Results Four themes of operationalization of CDM emerged: CDM as dispositional decisions, CDM as cognition, CDM as a model, and CDM as clinical judgement. Study results and conclusions naturally differed according to how CDM was conceptualized. Thus, frailty-heuristics lead to biases in treatment of geriatric patients and the complexity of this patient group was seen as a challenge for young physicians engaging in CDM. Conclusions This scoping review summarizes how different studies in GEM use the term CDM. It provides an analysis of findings in GEM and call for more stringent definitions of CDM in future research, so that it might lead to better clinical practice.