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Cognitive function is associated with risk aversion in community-based older persons
Patricia A Boyle, Lei Yu, Aron S Buchman, David I Laibson, David A Bennett
BMC Geriatrics , 2011, DOI: 10.1186/1471-2318-11-53
Abstract: Using data from 369 community-dwelling older persons without dementia from the Rush Memory and Aging Project, an ongoing longitudinal epidemiologic study of aging, we examined the correlates of risk aversion and tested the hypothesis that cognition is negatively associated with risk aversion. Global cognition and five specific cognitive abilities were measured via detailed cognitive testing, and risk aversion was measured using standard behavioral economics questions in which participants were asked to choose between a certain monetary payment ($15) versus a gamble in which they could gain more than $15 or gain nothing; potential gamble gains ranged from $21.79 to $151.19 with the gain amounts varied randomly over questions. We first examined the bivariate associations of age, education, sex, income and cognition with risk aversion. Next, we examined the associations between cognition and risk aversion via mixed models adjusted for age, sex, education, and income. Finally, we conducted sensitivity analyses to ensure that our results were not driven by persons with preclinical cognitive impairment.In bivariate analyses, sex, education, income and global cognition were associated with risk aversion. However, in a mixed effect model, only sex (estimate = -1.49, standard error (SE) = 0.39, p < 0.001) and global cognitive function (estimate = -1.05, standard error (SE) = 0.34, p < 0.003) were significantly inversely associated with risk aversion. Thus, a lower level of global cognitive function and female sex were associated with greater risk aversion. Moreover, performance on four out of the five cognitive domains was negatively related to risk aversion (i.e., semantic memory, episodic memory, working memory, and perceptual speed); performance on visuospatial abilities was not.A lower level of cognitive ability and female sex are associated with greater risk aversion in advanced age.Compelling economics, behavioral economics, and neuroeconomics studies have shown that r
Poor Decision Making Is a Consequence of Cognitive Decline among Older Persons without Alzheimer’s Disease or Mild Cognitive Impairment  [PDF]
Patricia A. Boyle, Lei Yu, Robert S. Wilson, Keith Gamble, Aron S. Buchman, David A. Bennett
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0043647
Abstract: Objective Decision making is an important determinant of health and well-being across the lifespan but is critical in aging, when many influential decisions are made just as cognitive function declines. Increasing evidence suggests that older adults, even those without dementia, often make poor decisions and are selectively vulnerable to scams. To date, however, the factors associated with poor decision making in old age are unknown. The objective of this study was to test the hypothesis that poor decision making is a consequence of cognitive decline among older persons without Alzheimer’s disease or mild cognitive impairment. Methods Participants were 420 non-demented persons from the Memory and Aging Project, a longitudinal, clinical-pathologic cohort study of aging in the Chicago metropolitan area. All underwent repeated cognitive evaluations and subsequently completed assessments of decision making and susceptibility to scams. Decision making was measured using 12 items from a previously established performance-based measure and a self-report measure of susceptibility to scams. Results Cognitive function data were collected over an average of 5.5 years prior to the decision making assessment. Regression analyses were used to examine whether the prior rate of cognitive decline predicted the level of decision making and susceptibility to scams; analyses controlled for age, sex, education, and starting level of cognition. Among 420 persons without dementia, more rapid cognitive decline predicted poorer decision making and increased susceptibility to scams (p’s<0.001). Further, the relations between cognitive decline, decision making and scams persisted in analyses restricted to persons without any cognitive impairment (i.e., no dementia or even mild cognitive impairment). Conclusions Poor decision making is a consequence of cognitive decline among older persons without Alzheimer’s disease or mild cognitive impairment, those widely considered “cognitively healthy.” These findings suggest that even very subtle age-related changes in cognition have detrimental effects on judgment.
The Role of Risk Aversion in Non-Conscious Decision Making  [PDF]
Shuo Wang,Ian Krajbich,Ralph Adolphs,Naotsugu Tsuchiya
Frontiers in Psychology , 2012, DOI: 10.3389/fpsyg.2012.00050
Abstract: To what extent can people choose advantageously without knowing why they are making those choices? This hotly debated question has capitalized on the Iowa Gambling Task (IGT), in which people often learn to choose advantageously without appearing to know why. However, because the IGT is unconstrained in many respects, this finding remains debated and other interpretations are possible (e.g., risk aversion, ambiguity aversion, limits of working memory, or insensitivity to reward/punishment can explain the finding of the IGT). Here we devised an improved variant of the IGT in which the deck-payoff contingency switches after subjects repeatedly choose from a good deck, offering the statistical power of repeated within-subject measures based on learning the reward contingencies associated with each deck. We found that participants exhibited low confidence in their choices, as probed with post-decision wagering, despite high accuracy in selecting advantageous decks in the task, which is putative evidence for non-conscious decision making. However, such a behavioral dissociation could also be explained by risk aversion, a tendency to avoid risky decisions under uncertainty. By explicitly measuring risk aversion for each individual, we predicted subjects’ post-decision wagering using Bayesian modeling. We found that risk aversion indeed does play a role, but that it did not explain the entire effect. Moreover, independently measured risk aversion was uncorrelated with risk aversion exhibited during our version of the IGT, raising the possibility that the latter risk aversion may be non-conscious. Our findings support the idea that people can make optimal choices without being fully aware of the basis of their decision. We suggest that non-conscious decision making may be mediated by emotional feelings of risk that are based on mechanisms distinct from those that support cognitive assessment of risk.
On The Correlated Impact Of The Factors Of Risk Aversion On Decision-Making
Journal of Knowledge Management, Economics and Information Technology , 2011,
Abstract: Risk aversion is among the most advertised and complex factors influencing a decision, but it is itself subject to an intricate complex of both objective and subjective factors. The present paper set out to investigate some of the factors that would have appeared obvious in influencing attitudes towards risk, such as value of options, probability of options, level of information (specifically onprobability) and position of the respondent relative to the outcome of the risk (loss or gain). For this purpose we devised a survey testing each of these elements and allowing for interpretation of their interdependence. After analyzing hypothetical situations, we also investigated how these were reflected in self-assessment and real-life behavior. What we found is that, although these factors do play their intuitive role in fundamenting decisions in contexts of risk, they are ill correlated to one another and may themselves notbe coherent across different contexts.
Differences in risk aversion between young and older adults
Albert SM, Duffy J
Neuroscience and Neuroeconomics , 2012, DOI: http://dx.doi.org/10.2147/NAN.S27184
Abstract: ences in risk aversion between young and older adults Original Research (2780) Total Article Views Authors: Albert SM, Duffy J Published Date February 2012 Volume 2012:1 Pages 3 - 9 DOI: http://dx.doi.org/10.2147/NAN.S27184 Received: 10 October 2011 Accepted: 11 January 2012 Published: 15 February 2012 Steven M Albert1, John Duffy2 1Department of Behavioral and Community Health Sciences, 2Department of Economics, University of Pittsburgh, Pittsburgh, PA, USA Abstract: Research on decision-making strategies among younger and older adults suggests that older adults may be more risk averse than younger people in the case of potential losses. These results mostly come from experimental studies involving gambling paradigms. Since these paradigms involve substantial demands on memory and learning, differences in risk aversion or other features of decision making attributed to age may in fact reflect age-related declines in cognitive abilities. In the current study, older and younger adults completed a simpler, paired lottery choice task used in the experimental economics literature to elicit risk aversion. A similar approach was used to elicit participants' discount rates. The older adult group was more risk averse than the younger (P < 0.05) and had a higher discount rate (15.6%–21.0% versus 10.3%–15.5%, P < 0.01), indicating lower expected utility from future income. Risk aversion and implied discount rates were weakly correlated. It may be valuable to investigate developmental changes in neural correlates of decision making across the lifespan.
Exploring disadvantageous inequality aversion in children: How cost and discrepancy influence decision-making  [PDF]
Amanda Williams,Chris Moore
Frontiers in Psychology , 2014, DOI: 10.3389/fpsyg.2014.01088
Abstract: This research examined disadvantageous inequality aversion in 4- and 6-year-old children. Using the resource allocation paradigm, we explored how inequality aversion was influenced by whether a cost was associated with the equitable choice. We also investigated whether preferences for equality differed depending on whether the inequitable choice presented a small or large discrepancy between the payoff of the participant and their partner. The results demonstrated that cost plays a large role in decision-making, as children preferred equality more when there was no cost associated with it compared to when there was a cost. Interestingly, the effect of cost also affected discrepancy, with children more likely to choose equality when the discrepancy was large as opposed to small, in cost trials but not in no cost trials. Finally, the effect of discrepancy also interacted with age, with older children being more sensitive to the discrepancy between themselves and their partner Together, these results suggest that children’s behaviour is not indiscriminately guided by a generalized aversion to inequality or established fairness norms. Alternate motives for inequality aversion are discussed.
Older Patients’ Involvement in Shared Decision-Making—A Systematic Review  [PDF]
Anne Lise Holm, Astrid Karin Berland, Elisabeth Severinsson
Open Journal of Nursing (OJN) , 2016, DOI: 10.4236/ojn.2016.63018
Abstract: Shared decision-making has been described as allowing patients to gain more control over their life situation and feel less helpless. The aim of this systematic review was to describe the involvement of older patients in shared decision-making in community settings. In accordance with the systematic review method, a total of 2468 abstracts were read, after which nine quantitative studies were included. A qualitative thematic analysis was performed and two themes emerged; increased understanding of self-management and a desire to strengthen one’s position in relationship with professionals, both of which were essential for empowering older patients to participate in shared decision-making. Older patients’ shared decision-making was seen as a struggle to maintain their autonomy in different areas of everyday life. Emotional and psychological problems made their position more difficult. In order to empower them in relationships with healthcare professionals, older patients require more knowledge (self-efficacy) and information about their illness, which could strengthen their position in the decision-making process. They also need a greater awareness of decisional conflicts that may arise. Age, gender and health status influence older patients’ chance of being respected and taken seriously in relationship with professionals.
Living with Uncertainty: Older Persons’ Lived Experience of Making Independent Decisions over Time  [PDF]
Agneta Breitholtz,Ingrid Snellman,Ingegerd Fagerberg
Nursing Research and Practice , 2013, DOI: 10.1155/2013/403717
Abstract: The aim of the study was to illuminate the meaning of older persons’ independent decision making concerning their daily care. Autonomy when in care is highly valued in the western world. However, research shows that autonomy can give rise to problematic issues. The complexity of independence and dependence for older people when living at home with help has also been highlighted. In Sweden, older people are increasingly expected to live at home with help from municipal home care services, and study into this aspect of care is limited. This study is a part of an ongoing project and has a qualitative life world perspective. Audiotaped narrative interviews were conducted and analysed using a phenomenological hermeneutic method. Findings revealed a main theme: “living with uncertainty as to how to relate one’s own independence and dependence with regard to oneself, and others.” This involves a constant process of relating to one’s independence controlled by others or oneself, and adjusting one’s independence and dependence with regard to oneself and others. The conclusion is that professional carers need to acknowledge the changing vulnerability of dependent older persons over time. The implication is a relational approach to autonomy beyond the traditional individualistic approach. 1. Introduction The care of the old, with an increasing population over 60 years old, presents a challenge worldwide [1]. In Sweden municipalities are responsible for the care of the old, and older people are now increasingly expected to live at home aided by municipal home help services. As a consequence older people’s care needs have increased as well as the workload for professional carers [2]. Older people apply for support, and the help available includes laundry, cleaning, shopping, personal care, meals, and emergency alarms. Care managers assess their needs according to the Social Service Act, which requires that people’s right to self-determination and integrity should be respected [3]. Autonomy when in care is highly valued in the western world and involves people’s right to make their own choices without involving others [4–6]. Nevertheless, in the care of the old this individualistic approach to autonomy is problematic due to their dependence on others in their everyday lives [4, 7–9]. However, Sandman [6] argues that it is important to recognize that people value their autonomy differently. Further, it is therefore important to distinguish between different aspects of autonomy, that is, self-determination, freedom, desire fulfilment, and independence. The most central
How do persons with dementia participate in decision making related to health and daily care? A multi-case study  [cached]
Smebye Kari,Kirkevold Marit,Engedal Knut
BMC Health Services Research , 2012, DOI: 10.1186/1472-6963-12-241
Abstract: Background Many countries have passed laws giving patients the right to participate in decisions about health care. People with dementia cannot be assumed to be incapable of making decisions on their diagnosis alone as they may have retained cognitive abilities. The purpose of this study was to gain a better understanding of how persons with dementia participated in making decisions about health care and how their family carers and professional caregivers influenced decision making. Methods This Norwegian study had a qualitative multi-case design. The triad in each of the ten cases consisted of the person with dementia, the family carer and the professional caregiver, in all 30 participants. Inclusion criteria for the persons with dementia were: (1) 67 years or older (2) diagnosed with dementia (3) Clinical Dementia Rating score 2, moderate dementia; (3) able to communicate verbally. The family carers and professional caregivers were then asked to participate. A semi-structured interview guide was used in interviews with family carers and professional caregivers. Field notes were written after participant observation of interactions between persons with dementia and professional caregivers during morning care or activities at a day centre. How the professional caregivers facilitated decision making was the focus of the observations that varied in length from 30 to 90 minutes. The data were analyzed using framework analysis combined with a hermeneutical interpretive approach. Results Professional caregivers based their assessment of mental competence on experience and not on standardized tests. Persons with dementia demonstrated variability in how they participated in decision making. Pseudo-autonomous decision making and delegating decision making were new categories that emerged. Autonomous decision making did occur but shared decision making was the most typical pattern. Reduced mental capacity, lack of available choices or not being given the opportunity to participate led to non-involvement. Not all decisions were based on logic; personal values and relationships were also considered. Conclusions Persons with moderate dementia demonstrated variability in how they participated in decision making. Optimal involvement was facilitated by positioning them as capable of influencing decisions, assessing decision-specific competence, clarifying values and understanding the significance of relationships and context.
Loss Aversion: A Comparison of Investment Decision Making Between Individual Investors and Pension Funds in Brazil
Luiz Augusto Martits,William Eid Junior
Revista Brasileira de Finan?as , 2009,
Abstract: This article compares the application of a loss aversion utility function with a traditional Von Neumann-Morgenstern utility function aiming to test whether the first form of utility could better replicate the actual behavior of Brazilian investors concerning the choice of optimum investment portfolio. The results generated by both functions, in terms of stock market participation in the optimum investment portfolio, are compared with real aggregate data from two types of Brazilian investors (pension funds and individual investors). The analysis indicates that: i) the traditional utility function should be rejected as an adequate model to replicate Brazilian individual investors behavior in the stock market; and ii) Brazilian individual investors behavior are better replicated by a loss aversion utility function.
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