Jarred Gallegos, Julie Lutz, Emma Katz, and Barry Edelstein
The assessment of older adults is quite challenging in light of the many age-related physiological and metabolic changes, increased number of chronic diseases with potential psychiatric manifestations, the associated medications and their side effects, and the age-related changes in the presentation of common mental health problems and disorders. A biopsychosocial approach to assessment is particularly important for older adults due to the substantial interplay of biological, psychological, and social factors that collectively produce the clinical presentation faced by clinicians. An appreciation of age-related and non-normative changes in cognitive skills and sensory processes is particularly important both for planning the assessment process and the interpretation of findings. The assessment of older adults is unfortunately plagued by a paucity of age-appropriate assessment instruments, as most instruments have been developed with young adults. This paucity of age-appropriate assessment instruments is an impediment to reliable and valid assessment. Notwithstanding that caveat, comprehensive and valid assessment of older adults can be accomplished through an understanding of the interaction of age-related factors that influence the experience and presentation of psychiatric disorders, and an appreciation of the strengths and weaknesses of the assessment instruments that are used to achieve valid and reliable assessments.
Karen Z. H. Li, Halina Bruce, and Rachel Downey
Research on the interplay of cognition and mobility in old age is inherently multidisciplinary, informed by findings from life span developmental psychology, kinesiology, cognitive neuroscience, and rehabilitation sciences. Early observational work revealed strong connections between sensory and sensorimotor performance with measures of intellectual functioning. Subsequent work has revealed more specific links between measures of cognitive control and gait quality. Convergent evidence for the interdependence of cognition and mobility is seen in patient studies, wherein cognitive impairment is associated with increased frequency and risk of falling. Even in cross-sectional studies involving healthy young and older adults, the effects of aging on postural control and gait are commonly exacerbated when participants perform a motor task with a concurrent cognitive load. This motor-cognitive dual-task method assumes that cognitive and motor domains compete for common capacity, and that older adults recruit more cognitive capacity than young adults to support gait and posture.
Neuroimaging techniques such as magnetic resonance imaging (MRI) have revealed associations between measures of mobility (e.g., gait velocity and postural control) and measures of brain health (e.g., gray matter volumes, cortical thickness, white matter integrity, and functional connectivity). The brain regions most often associated with aging and mobility also appear to subserve high-level cognitive functions such as executive control, attention, and working memory (e.g., dorsolateral prefrontal cortex, anterior cingulate). Portable functional neuroimaging has allowed for the examination of neural functioning during real-time walking, often in conjunction with detailed spatiotemporal measures of gait. A more recent strategy that addresses the interdependence of cognitive and motor processes in old age is cognitive remediation. Cognitive training has yielded promising improvements in balance, walking, and overall mobility status in healthy older adults, and those with age-related neurodegenerative conditions such as Parkinson’s Disease.
Victoria M. Esses
Migration is the movement of people from one location to another, either within a country (internal migration between cities or regions) or between countries (international migration). Migration may be relatively voluntary (e.g., for employment opportunities) or involuntary (e.g., due to armed conflict, persecution, or natural disasters), and it may be temporary (e.g., migrant workers moving back and forth between source and receiving areas) or permanent (e.g., becoming a permanent resident in a new country). The term immigration refers specifically to international migration that is relatively permanent in nature. Immigrants are those individuals who have moved to a new country on a relatively permanent basis. Of importance, refugees are a particular type of immigrant, defined and protected by international law. They are individuals who have been formally recognized as having fled their country of residence because of a well-founded fear of persecution, armed conflict, violence, or war. Until they are recognized as such, these individuals are asylum seekers—individuals who have claimed refugee status and are waiting for that claim to be evaluated. Despite the relative permanence of immigration, advances in transportation and communication mean that immigrants are able to travel to, spend time in, and communicate on a regular basis with their country of origin. As a result, what has been termed transnationalism may result, with individuals holding strong ties with, and actively participating in, both the country of origin and the new receiving country.
Migration often results in two or more cultures coming into contact. This contact is especially likely for international migration where immigrants from one national group (the society of origin) come into contact with members of a different national group (the receiving society). Culture may include specific beliefs, attitudes, and customs, as well as values and behaviors. The term acculturation refers to the changes that may occur when individuals from different cultures come into contact, with possible changes in both immigrants and members of the receiving society. Psychological theory and research suggest that acculturation is bidimensional, with changes potentially taking place along two dimensions—one representing the maintenance or loss of the original culture and the other representing the adoption or rejection of the new culture. This bidimensionality is important because it suggests that acculturation is not linear from original culture to new culture, but instead that individuals may simultaneously participate in the new culture and maintain their original culture. The two cultures may be expressed at different times, in different contexts, or may merge to form cultural expressions that have aspects of both cultures. With voluntary and involuntary migration at historically high levels, understanding the drivers of migration and its consequences for migrants and those with whom they come into contact are essential for global cooperation and well-being.
Aidan Moran, Nick Sevdalis, and Lauren Wallace
At first glance, there are certain similarities between performance in surgery and that in competitive sports. Clearly, both require exceptional gross and fine motor ability and effective concentration skills, and both are routinely performed in dynamic environments, often under time constraints. On closer inspection, however, crucial differences emerge between these skilled domains. For example, surgery does not involve directly antagonistic opponents competing for victory. Nevertheless, analogies between surgery and sport have contributed to an upsurge of research interest in the psychological processes that underlie expertise in surgical performance. Of these processes, perhaps the most frequently investigated in recent years is that of motor imagery (MI) or the cognitive simulation skill that enables us to rehearse actions in our imagination without engaging in the physical movements involved. Research on motor imagery training (MIT; also called motor imagery practice, MIP) has important theoretical and practical implications. Specifically, at a theoretical level, hundreds of experimental studies in psychology have demonstrated the efficacy of MIT/MIP in improving skill learning and skilled performance in a variety of fields such as sport and music. The most widely accepted explanation of these effects comes from “simulation theory,” which postulates that executed and imagined actions share some common neural circuits and cognitive mechanisms. Put simply, imagining a skill activates some of the brain areas and neural circuits that are involved in its actual execution. Accordingly, systematic engagement in MI appears to “prime” the brain for optimal skilled performance. At the practical level, as surgical instruction has moved largely from an apprenticeship model (the so-called see one, do one, teach one approach) to one based on simulation technology and practice (e.g., the use of virtual reality equipment), there has been a corresponding growth of interest in the potential of cognitive training techniques (e.g., MIT/MIP) to improve and augment surgical skills and performance. Although these cognitive training techniques suffer both from certain conceptual confusion (e.g., with regard to the clarity of key terms) and inadequate empirical validation, they offer considerable promise in the quest for a cost-effective supplementary training tool in surgical education. Against this background, it is important for researchers and practitioners alike to explore the cognitive psychological factors (such as motor imagery) that underlie surgical skill learning and performance.