Fostering Self-Management of Everyday Memory in Older Adults: A New Intervention Approach

Abstract

Traditional memory strategy training interventions improve older adults’ performance on tests of episodic memory, but have limited transfer to episodic memory tasks, let alone to everyday memory. We argue that an alternative approach is needed to assist older adults to compensate for age-related cognitive declines and to maintain functional capacity in their own natural ecologies. We outline a set of principles regarding how interventions can successfully train older adults to increase successful goal pursuit to reduce risks of everyday memory failures. We argue that training individuals to use metacognitive self-regulatory strategies to proactively manage formulation and pursuit of daily goals can compensate for age-related cognitive changes and increase the likelihood of goal attainment. We then describe an intervention approach that instantiates these principles in a multi-modal intervention that is unique in its three-phase approach: (1) individualized assessment of an individual’s current approaches to self-regulation; (2) training memory strategies, self-management skills, and new habits of mind in a group training context; and (3) a behavioral shaping period in which individuals receive coaching and feedback on their efforts to use trained procedures to improve everyday cognition. A recently completed study conducted an initial test of the intervention, with highly encouraging results. We advocate further efforts to replicate, extend, and fine-tune this type of intervention. The ultimate goal is to be able to deliver the intervention in a way that increases its potential reach, including to subpopulations of older adults at risk for everyday cognitive impairments.

Awareness of Performance on a Functional Cognitive Performance-Based Assessment Across the Adult Lifespan

“…The normative data on strategy use presented in this study support further research in metacognitive and strategy training programs centered around self-monitoring, and self-regulation, organizing, and keeping track of information during everyday complex tasks. Data presented here have the potential to inform healthy aging programs such as that reported by Levine et al (2007) and are consistent with the self-regulatory approach described by Hertzog et al (2021).…”

“…Cognitive training to remediate impaired executive functions is modestly successful within the context of the training activity but has less of an effect on far transfer, including to everyday functioning (Basak et al, 2020;Hertzog et al, 2021).…”

“…Metacognitive awareness, and strategy use, however, have been shown to be modifiable within older adults and transferable to different contexts (Dunlosky et al, 2003;Levine et al, 2007;Cavallini et al, 2010) and is the basis for a recent intervention approach to address the impact of memory deficits on daily life (Hertzog et al, 2021). Similarly, in cognitive rehabilitation with people with acquired brain injury, metacognitive strategy approaches have been emphasized (Jaywant et al, 2021;Toglia and Foster, 2021).…”

Metacognitive Scales: Assessing Metacognitive Knowledge in Older Adults Using Everyday Life Scenarios

“…This finding indicates that older adults have poor metacognitive knowledge that pertains to different aspects of memory, and thus poor insight into how memory works. Furthermore, if older adults are not able to discriminate between different aspects of memory, and thus between situations with different cognitive demands (it is one thing to retain a short amount of information for a few seconds, i.e., working memory, but another thing to remember next week’s doctor’s appointment, i.e., prospective memory), it is of no surprise that they do not effectively use encoding strategies [ 8 , 28 , 29 , 30 ]. Similarly, studies that have tested the effects of metacognitive trainings in the elderly have shown that they were able to use more efficiently mnemonic strategies and self-regulatory processes when they obtained a better understanding of how memory operates [ 29 , 31 ].…”

Using Online Self-Management Diaries for Qualitative Research

“…Diaries offer unique data collection opportunities for self-management both for research and clinical practice. Diaries are great tools for collecting data for research (Evald et al, 2020; Furness & Garrud, 2010; Hertzog et al, 2021), providing narrative everyday life events as a reflection tool or as a primary data collection tool with the purpose of analyzing data into meaningful categories (e.g., information about daily routine). Diaries can be used in clinical decision support (Van Woensel et al, 2015) and can also improve patients’ adherence (Shim & Hwang, 2016) and enhance self-efficacy (van Kruijssen et al, 2015).…”