NRSA Fellowship for Geiger: Testing a Values-Based Approach to Healthcare Decision-Making in Older Adults

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 socioemotional 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 decision-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 in 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.