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‘Use it or lose it’ Researcher studies thinking and reasoning skills in older adults By Steve Infanti
Dr. Sherry L. Willis, professor of human development at Penn State, is leading the Penn State research team participating in the national cooperative trial for the Advanced Cognitive Training for Independent and Vital Elderly Project. In these photos, adults from Lewistown, Huntingdon, Mount Union, Altoona, and Tyrone are learning how to maintain their cognitive skills as they age during training sessions conducted by Penn State researchers.	“Use it or lose it” is a popular saying when it comes to physical exercise. Researchers from the Gerontology Center at Penn State are testing to see if the same holds true for thinking and remembering in older adults.   A research team led by Dr. Sherry L. Willis, professor of human development in the Department of Human Development and Family Studies in the College of Health and Human Development, is teaching older adults how to maintain their cognitive skills as they age.   “They’re learning to use strategies to help them maintain their mental abilities, ” explained Willis, a nationally recognized authority on intellectual development in older adults.   Willis and her research associate, Dr. Jeannie McKenzie, are leading the Penn State portion of a major national cooperative trial that examines the cognitive skills of older individuals. It’s known as the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Project.   One aspect of this study is the determination of whether training sessions designed to improve memory, concentration and problem-solving skills in senior citizens will help them to continue to live independently and perform daily tasks such as managing finances, taking medications and driving.   “If these problems are effective, it is hoped that the need for formal care and hospitalization, as well as substantial loss of independence in the nation’s older population will be delayed or reduced,” Willis said.   The concept for the project has been under development for some time. During the 1970s and 1980s, Willis conducted pilot studies of brief educational training in memory improvement or abstract reasoning, for example, to see if training might offset some of the normal declines generally seen as people reach their mid-60s.   “When elderly people find that their minds are not as sharp as they once were, they may not be suffering from inevitable biological decline. It may just be that they have let their mental skills get rusty,” she said.   Her past research projects contributed greatly to the funding for the ACTIVE Project. This multisite study is receiving five years of funding from the National Institute on Aging and the National Institute of Nursing Research, which are institutes within the National Institutes of Health. The project involves identical educational training at Johns Hopkins University, the University of Alabama at Birmingham, Indiana University, Wayne State University in Detroit and the Hebrew Rehabilitation Center for the Aged in Boston.   “This is an important age group to study,” Willis said. “Average life expectancy has increased dramatically in this century.”   In 1900, the average life expectancy was 49 years of age. Today, it is in the 70s, depending on gender and ethnicity. Thus, the age structure of our society is shifting from a pyramid with the largest proportion of individuals in childhood and young age to a rectangular distribution or even an inverted pyramid, with more and more of the population in middle and latter adulthood.   “This will become critical as the baby boomers enter old age by 2020. The number of people in the workforce contributing to Social Security and Medicare benefits will shrink, while the proportion of elders receiving those benefits increases,” Willis said.   This study showcases the college’s mission of promoting well-being across the life span. The Gerontology Center has researched the processes and consequences of aging for more than 25 years. Willis has been doing cognitive intervention studies since the mid-1970s.   “It is critical that our society keep the current and future elderly living independently and capable of carrying out the types of activities required for living independent for as long as possible. This is essential if you consider the shifting age distribution. The desire to live independently is one of the foremost concerns of the elderly, ” she said.   The Penn State ACTIVE Project is being conducted in cooperation with the PACE Program—Pharmaceutical Assistance Contract for the Elderly—of the Pennsylvania Department of Aging. The researchers are working with 480 PACE cardholders in Lewistown, Huntingdon, Mount Union, Altoona and Tyrone.   “These are rural-dwelling, at-risk elderly over 65 years of age,” Willis said. She noted that the fastest growing segment of our population today is those over 85 years of age. This is the segment most likely to be in poor health, to suffer from some type of dementia and to live alone.   “Elderly are at risk today not only due to normal age-related decline in abilities, but also because of differences in education and technological literacy,” she said.   The average educational level of elders today is 12 years of education or less, while the level of education for the adult population in general is some postsecondary education. Most elderly today are not computer literate and thus are disadvantaged in this increasingly computerized age.   The ACTIVE Project’s training involves a series of 10 one-hour training sessions to improve memory, abstract reasoning or concentration. And training leaders show participants how the strategies they learn might apply to “real world” tasks. Memory training, for example, includes working with lists of words or texts. Participants discover techniques like “chunking, ” as well as using mental imagery to help recall individual words or items.   Willis noted that such techniques allow people to remember extraordinarily long lists of words. In each kind of training, the focus is on basic abilities that are related to the kinds of activities that the elderly need to do in their daily lives.   “The reasoning skills are important for tasks that most people take for granted, such as figuring out the maximum dosage for cough syrup,” McKenzie said.   The ACTIVE Project just passed the halfway mark of its five-year term, and results are expected in 2001.   In the meantime, the participants are undergoing a series of 10 training sessions on helpful strategies for improving memory, concentration and problem-solving. The thinking skills of the participants are being measured during the training and at eight, 16 and 24 months following the training.   Willis and McKenzie hope the project combats stereotypes about aging and demonstrates that elderly people can indeed learn and improve their learning strategies.   “Future generations of elderly will be better educated and computer literate, but the rate of knowledge and technological change is increasing so rapidly that lifelong learning is becoming a real necessity,” Willis said. “Being a mental couch potato is no longer viable in our rapidly changing society.” An outreach program of the College of Health and Human Development