Instalando funcionalidades extras

An anonymous survey (see Appendix F) that included two standardised self-report measures and several other questions was administered in online and hardcopy format and obtained the following information:

• Self-reported memory failures – using the Prospective and Retrospective Memory Questionnaire (PRMQ; Smith et al., 2000).

o As noted in Chapter 2, the PRMQ is a self-report measure of prospective (PM) and retrospective (RM) memory failures in everyday life. It is the only self-report instrument assessing both PM and RM memory. The instrument consists of 16 items;

half of these refer to PM failures (e.g. How often do you: “decide to do something in a

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few minutes time and then forget to do it?”) and half refer to RM failures (e.g. How often do you: “fail to recognise a place you have visited before?”). The questions are categorised further into event-based/time-based and short-term/long-term memory tasks, with two questions in each of the eight categories (PM/RM x event-based/time-based x short-term/long-term).

The participant is asked to answer each of the 16 questions by rating the frequency with which they make the described error, e.g. How often do you: “decide to do something in a few minutes’ time and then forget to do it?” Choice of response is in a Likert format, as follows; “very often” (score = 5), “quite often” (score = 4),

“sometimes” (score = 3), “rarely” (score = 2), “never” (score = 1). Thus, across the 16 items (i.e. PRMQ Total), the minimum raw score is 16 while the maximum raw score is 80, with higher raw scores representing poorer self-reported memory. On each of the two subscales (PM and RM), the minimum raw score is 8 while the maximum raw score is 40, with higher scores again representing poorer self-reported memory. In total, the PRMQ takes less than 10 minutes to complete.

Crawford et al. (2003) established normative data for the PRMQ using 551 healthy participants aged 17 to 94 from the UK general community. Factor analyses of the PRMQ has generally found agreement for a tripartite factor structure consisting of a general memory factor which all items load on, and two orthogonal factors of PM and RM (Crawford et al., 2003; Ronnlund et al., 2008). Crawford et al. found good reliability estimates using Cronbach’s alpha, of .89 for the PRMQ Total Scale, .84 for the PRMQ PM Scale and .80 for the PRMQ RM scale, and they calculated mean scores and standard deviations for each of the scales. Age and sex were not found to be significantly associated with performance on the PRMQ.

Typically, raw scores on the PRMQ scales are converted to T-scores. Here, raw scores are ‘reflected’ such that when converted to T-scores (mean = 50, standard deviation = 10), higher scores now represent better memory (i.e. fewer self-reported memory failures).

A copy of the PRMQ is available for free download from a webpage hosted by the University of Edinburgh, on condition that it is used for the purpose of not-for-profit research and that the authors of the original article are cited in resulting publications;

see www.psy.ed.ac.uk/psy_research/PRMQ_authorisation.php

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• Mood state - using the self-report Hospital Anxiety and Depression Scale (HADS; Zigmond &

Snaith, 1982).

o The HADS is one of the most widely used instruments for the assessment of anxiety and depression in older adults (Roberts, Fletcher & Merrick, 2014).

It was originally developed to identify “caseness” (possible and probable) of anxiety and depression among patients in non-psychiatric wards (Zigmond and Snaith, 1983).

Since then, its use has been extended to outpatient and community settings (Dunbar et al., 2000; Caci et al., 2003). The HADS is reported to be well-accepted (Hermann, 1997) and easy to use. It contains 14 items, divided into two subscales measuring either anxiety (HADA) or depression (HADD). It requires the self-assessment of symptoms of anxiety and depression over the preceding week, rated on a 4-point Likert scale. There is a maximum score of 21 on each subscale, and higher scores correspond to higher disease severity (Johnston, Pollard & Hennessy, 2000). It may be particularly suited to the detection of mood disturbance in the elderly because the measure does not contain any physical indicators of psychological distress that might lead to confounding of depression with somatic disorders (Hermann, 1997; Bjelland, Dahl, Haug &

Neckelmann (2002). The “floor-effect” often seen with assessment of depression in non-psychiatric individuals is also avoided because items measuring severe psychopathology are also omitted. The HADS has good reported psychometric properties, with moderate to high internal consistency (Cronbach’s alpha coefficients of 0.73 - 0.85; Helvik, Engedal, Skancke & Selbaek (2011) and good test-retest reliability over an average three-week period for the anxiety (0.89), depression (0.86) and total scales (0.91; Spinhoven et al., 1997).

The research team holds a site license for use of this questionnaire.

• Sociodemographic Data

o This aspect of the survey contained questions on participant demographics (age, gender, occupation, education), health status, alcohol use, sleep duration and sleep difficulties. The rationale for inclusion of each of these variables in the sociodemographic questionnaire derives from a review of the literature summarised in Chapter 2.

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o Data related to both age and gender were obtained because of the possible link between these variables and cognitive performance.

o To address the possible effects of education on PRMQ and other test scores in an older Irish population, years of education, as well as highest level of education obtained, were included. Bands for education level were taken from the Irish Census of Population (www.cso.ie).

o Data were also obtained in relation to occupation. The data collection format used to capture current or past occupation in this study differed from the free-text format used in the National Census. Here, a categorical format was chosen to facilitate easier analysis and cross-national comparison. Occupational categories used in this study were previously utilised in the European IN-MINDD (Innovative Midlife INtervetion for Dementia Deterrence) study (www.inmindd.eu). These categories were used in the In-MINDD study for the purpose of cross-national comparison. For the present research project, these predetermined categories of occupation were considered more manageable and interpretable from an analytic perspective than the free text format utilised, for example, in the Irish Census.

• Health related data (physical health conditions, alcohol drinking status)

o The physical conditions assessed in the present study are in harmony with those assessed by cohort studies of aging that demonstrated an association with objective frailty, and are not dissimilar to the somatic symptoms and chronic disease assessed via self-report in other population-based studies that also investigated subjective memory, such as The Irish Longitudinal Study of Aging (TILDA; Barrett et al., 2011), the Kungsholmen Project in Swededn (Frisioni et al., 2000) and the Amsterdam Longitudinal Study of Aging (LASA; Comijs et al., 2002).

o Physical health conditions self-assessed in the present study were chosen based on their prevalence in older people and on their potential or evidenced association with subjective or objective cognitive problems and physical frailty. The health conditions included for specific mention in the survey were:

▪ Cardiovascular Disease

▪ Hormonal problems

▪ Breathing problems

▪ Diabetes

▪ Chronic pain

▪ Arthritis

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▪ Conditions arising from dysfunction of the Enteric Nervous System (ENS):

Gastric problems, Ulcerative Colitis, Crohn’s Disease and Thyroiditis

Participants also had space and opportunity to record any other physical conditions that they felt were noteworthy but that were not included in the list on the sociodemographic questionnaire. For all physical health conditions, participants were asked to record how long, in years and months, they have experienced the condition.

Participants were also asked about alcohol consumption. Here, all participants were required to respond Yes or No to the question as to whether they drink alcohol. Since alcohol problems may be unrecognised or under-reported, those participants who drink alcohol were also asked to respond Yes or No to the question of whether they ever felt they needed a drink (“eye opener”) first thing in the morning. This question was used as a screening question for alcohol misuse and was taken from the CAGE questionnaire (Ewing, 1984) which is a popular self-report measure of alcohol use problems, developed originally to identify the hidden alcoholic in hospital settings (Magruder-Habib, Durand & Frey, 1991). It is commonly used as a screen for alcohol use disorder in the primary care setting (Volk, Cantor, Steinbauer & Cass, 1997). Use of all four CAGE questions in TILDA resulted in the identification of a higher percentage of alcohol misuse cases in the older Irish population than would be detected based purely on the basis of a formal diagnoses of alcohol use disorders (Cronin, O’Regan & Kenny, 2011). The specific question selected for use in this study reflects the most salient of the four CAGE questions in terms of alcohol use problems.

• Sleep data

o In relation to sleep, participants were asked questions pertaining to difficulties falling asleep (“Do you generally find it difficult to fall asleep?”), difficulties staying asleep (“Do you ever wake up during the night?”), and problems with waking earlier than intended (“Do you wake up earlier than intended?”). Participants responding Yes to any of these questions were asked to indicate when the particular sleep problem began (“Less than 1 month ago; 1 – 2 months ago; 3 – 6 months ago; 7 – 12 months ago; 1 – 2 years ago; 3 – 5 years ago; 6 – 10 years ago; 11 or more years ago”) and how often the sleep problem occurred (7 nights per week; 4 – 6 nights per week; 2 – 3 nights per week; 1 night per week). They were also asked to indicate self-perceived reason(s) for the particular sleep problem (i.e. anxiety, diet, caffeine, pain, physical condition,

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inactivity or other reason(s)). If participants indicated “other reason(s)” they were asked to specify the reason(s).

o Participants were also asked how many hours, on average, they slept per night. As with the preceding sleep questions, participants were then asked to indicate when this began to be the average number of hours slept per night, how often this was the number of hours slept per night, and to indicate the self-perceived reason for this being the average number of hours slept per night (an extra response choice to this question in addition to the response choices outlined as per the preceding sleep questions was

“This is the amount of sleep my body needs to feel rested”).

The choice of sleep questions was informed by studies in the literature that have reported that poor sleepers subjectively experience longer sleep latencies, frequent nocturnal awakenings or waking during the night, less total sleep time, more difficulty initiating and maintaining sleep, as well as excessive daytime sleepiness (Lugaresi, Cirignotta, Zucconi, Mondini, Luigi Lenzi & Coccagna, 1983;

Morin & Gramling, 1989; Bilwise, 1992). An epidemiological, cross-sectional, study of Dutch community-dwelling older adults assessed participants on quality of sleep, sleep latency (length of time to sleep), night time awakenings (sleep maintenance) and excessive daytime sleepiness (which, arguably, may manifest in napping behaviours) as well as time spent in bed (which may approximate, though not map exactly, hours of sleep) (Middelkoop, Smilde-van den Doel, Neven, Kamphuisen &

Springer, 1996). Together, the designs and findings of these studies were taken into consideration to guide the inclusion of the sleep questions in the sociodemographic questionnaire used in Study 1 and Study 2.