Testing a Values-Based Approach to Healthcare Decision-Making in Older Adults

 描述(申请人提供)：本建议的目的是在情绪调节、衰老和医疗保健决策等交叉领域提供研究培训。尽管身体和认知功能自然下降，但老年人保持良好的情绪调节能力，导致情绪健康和弹性。这种现象可以部分地用社会-情绪选择性理论(SST)来解释，该理论认为，当时间被认为是有限的资源时，情绪幸福就成为首要任务。尽管这种积极效应维持着情绪健康，但它可能会扰乱信息 与医疗保健决策相关的处理。与年轻人相比，老年人对医生的要求更少，不太可能征求第二意见，更快做出决定，并更多地关注积极的医疗信息。虽然这些策略实现了情感幸福的目标，但它们不允许做出完全知情的决策。研究表明，当老年人准备好减少他们的情感关注度或增加他们收集的信息量时，这些SST效应是可塑性的，并暂时可逆。然而，老年人通常不会收集大量信息，因为它不支持当下的情绪健康；相反，它会减少积极的情绪，并可能降低情绪调节所需的自我调节能力。该提案的研究部分将调查一种基于个人价值观的策略，以减少与医疗决策相关的信息处理的积极影响。在阅读威胁健康的信息时，写关于个人价值观的文章会增加积极的情绪，抵消自我调节的疲劳，并减少防御性。以价值观为基础的干预措施已被广泛研究，但很少应用于老年人。这项研究将整合两个广泛的研究领域(衰老、情绪和决策，以及价值观在决策中的作用)，这两个领域在改善人的一生中的决策方面有很大的希望。在老龄化和基于价值观的研究方面的授课和体验式培训将包括(1)与肯塔基大学桑德斯·布朗老龄教员中心的定期会议，(2)涵盖老龄化、决策和高级统计学的课程作业，(3)强化统计培训计划，(4)与老龄化和决策领域的领导人进行访问学者培训。为了促进专业发展，拟议的活动包括：(1)出席多个国家会议并提出研究报告；(2)利用R01资助的社区居住老年人纵向数据库，提出更多的研究问题。最后，将非常重视道德培训，包括(1)针对老年人的道德研究课程，(2)以美国国立卫生研究院负责任的研究行为准则为基础的课程，以及(3)定期与顾问会面，讨论道德问题。这项提议提供了广泛的培训，以建立致力于开发新的情绪调节干预措施的研究生涯，以改善老年人的生活。

 DESCRIPTION (provided by applicant): The purpose of this proposal is to provide research training in the intersecting fields of emotion regulation, aging, and decision-making in healthcare. Despite natural declines in physical and cognitive function, older adults maintain good emotion regulation abilities, leading to emotional wellbeing and resilience. This phenomenon can partially be explained by socio-emotional selectivity theory (SST), which posits that when time is perceived as a limited resource, emotional wellbeing becomes a top priority. Although this positivity effect maintains emotional wellbeing, it may disrupt information processing related to healthcare decision-making. Older adults request less information from their doctors, are less likely to ask for a second opinion, make their decisions more quickly, and devote more attention to positive medical information, compared with younger adults. Although these strategies fulfill goals of emotional wellbeing, they do not allow for fully informed decisio-making. Research has shown these SST effects are malleable and temporarily reversible when older adults are primed to reduce their emotional focus or increase the amount of information they gather. However, older adults do not normally gather extensive information because it does not support present-moment emotional wellbeing; instead, it reduces positive affect and may reduce self-regulatory capacities required for emotion regulation. The research component of this proposal will investigate a personal values-based strategy for reducing the positivity effect n information processing related to healthcare decision-making. Writing about personal values increases positive affect, counteracts self-regulatory fatigue, and reduces defensiveness while reading threatening health information. Values-based interventions have been extensively studied but rarely applied to older adults. This study will integrate two broad areas of research (aging, emotion and decision- making and the role of values in decision-making) that has great promise in improving decision-making across the lifespan. Didactic and experiential training in aging and values-based research will include (1) regular meetings with University of Kentucky Sanders Brown Center for Aging faculty members, (2) coursework covering aging, decision-making, and advanced statistics, (3) intensive statistics training program, (4) visiting scholar training with leaders in the field of aging and decision-making. In order to foster professional development, proposed activities include (1) attending and presenting research at multiple national conferences and (2) pursuing additional research questions with access to an R01-funded longitudinal dataset of community-dwelling older adults. Finally, a substantial emphasis will be placed on ethical training including (1) a course on ethical research with older adults, (2 a course based on NIH guidelines for Responsible Conduct of Research, and (3) regular meetings with advisors to discuss ethical issues. This proposal provides extensive training to build a research career devoted to the development of novel emotion regulation interventions that enhance the lives of older adults.