Learning and Recall of Medical Treatment-Related Information in Older Adults Using the Differential Outcomes Procedure

Abstract

It has recently been reported that the differential outcomes procedure (DOP) might be one of the therapeutical techniques focused at promoting autonomy in the elderly to deal with their medical issues. Molina et al. (2015) found that a group of healthy young adults improved their learning and long-term retention of six disorder/pill associations when each relationship to be learned was associated with a particular reinforcer (the differential outcomes condition) compared to when they were randomly administered (the non-differential outcomes condition). In the present study, we extend these findings to older adults who usually show difficulties to remember to take their medications as prescribed. Participants were asked to learn the association between three pills and the specific time at the day when they had to take each medication. Two memory tests were also performed 1 h and 1 week after completing the training phase. Results showed a faster learning of the task and long-term retention of the previously learned associations (pill/time of day) when differential outcomes were used. Furthermore, the older adults’ performance in the learning and memory phases did not differ from that of the younger adults in the DOP condition. These findings demonstrate that this procedure can help elderly people to ameliorate not only their learning, but also their long-term memory difficulties, suggesting the potential for the DOP to promote adherence to treatment in this population.

Enhanced learning and retention of medical information in Alzheimer’s disease after differential outcomes training

“…Memory tests were conducted 1 hour and 1 week after the learning training sessions. On the basis of the results observed by Molina et al [30] and Plaza et al [31], as well as those of other studies that have shown long-term memory improvements under the DOP (e.g., [28,32,33]), we hypothesized that patients with AD will show improved learning and long-term retention of the learned associations when they are trained with the DOP compared to when they are trained with the NOP.…”

“…The results indicated that, compared to the standard or non-differential outcomes procedure (the NOP), when each to-be-learned association was reinforced with a unique outcome (the DOP), participants showed higher percentage of correct responses, needed fewer trials to learn the associations, and demonstrated greater long-term retention of the information that was previously learned. In a recent follow-up study, Plaza, Molina, Fuentes, and Estévez [31] demonstrated that healthy older adults also benefited from the DOP when the to-be-learned association was between a particular pill and the time of the day the participants had to take it according to a prescribed schedule. The benefits of the DOP extended also to performance in a recognition memory test that took place one week later.…”

“…medicines (two pills) with the time of day (morning and night) they should be taken (see [31]). Outcomes consisted of two reinforcers (e.g., a pair of gloves and a keychain) that could be administered under the DOP (a unique outcome followed each determined pill/time of day association) or under the NOP (each outcome could be administered after each pill/time of the day association in a random manner).…”

Does the implicit outcomes expectancies shape learning and memory processes?

“…With an alpha = .05 and power = .80, the analysis revealed that thirty-six participants were required to detect a small-medium effect size (d=0.44). The effect size expected is based on previous studies concerning to the DOP in healthy adults (e.g., Plaza et al, 2018). Participants were tested individually in quiet rooms with identical sound and lighting conditions.…”

“…Previous studies have demonstrated that the DOP is effective in optimizing discriminative learning and visuospatial recognition memory in healthy people (e.g., Easton, 2004;Esteban, Vivas, Fuentes, & Estévez, 2015;Estévez et al, 2007;López-Crespo, Plaza, Fuentes, & Estévez, 2009;Martínez, Estévez, Fuentes, & Overmier, 2009;Miller, Waugh, & Chambers, 2002;Mok & Overmier, 2007;Molina, Plaza, Fuentes, & Estévez, 2015;Plaza, Estévez, López-Crespo, & Fuentes, 2011;Plaza, Molina, Fuentes, & Estévez, 2018). The DOP also helps to improve the same cognitive processes in populations with neurocognitive deficits (e.g., Carmona, Vivas, & Estévez, 2019;Esteban, Plaza, López-Crespo, Vivas, & Estévez, 2014;Estévez, Fuentes, Overmier, & González, 2003;Hochhalter, Sweeney, Bakke, Holub, & Overmier, 2000;Joseph, Overmier, & Thompson, 1997;Martínez et al, 2012;Plaza, López-Crespo, Antúnez, Fuentes, & Estévez, 2012).…”