Abstract
As society has increased its reliance on technology, older individuals are at a disadvantage due to lack of experience and opportunities to engage with technological skills. In the current environment, many instrumental tasks such as management of personal finances and health management tasks such as managing insurance, scheduling appointments, and refilling prescriptions require the use of technology and the elimination of alternative strategies worsens these challenges. Despite cognitive decline and limited experience with technology, older individuals have demonstrated the ability to benefit from computer based cognitive and functional skills training and to develop mastery of everyday technology-based tasks such as ATM usage, internet banking, and on-line shopping. Of note, in previous studies an individual's benefits from training were not limited by current cognitive impairment. One of the primary predictors of access to technology is socioeconomic status. Correlated with socioeconomic factors are educational attainment, race, and immigration status. Many minority individuals have had historically limited access to education and the quality of education, indexed by achievement test scores, is commonly lower in areas with loer socioeconomic status. In this presentation, we examine Individual differences in racial and ethnic status, as well as educational attainment, achievement test scores, and baseline cognitive performance as predictors of baseline competence and training success in computerized skills training in a large scale remote training study. We hypothesized that educational attainment and baseline cognitive status would predict lower baseline performance on technology tasks, but that training gains would show a reduced correlation with these factors compared to baseline performance. Racial and ethnic status were not expected to correlate negatively with training gains, particularly after consideration cognitive status and academic achievement.
Older adults with normal cognition (n=72) or well-defined MCI (n = 92), ranging in age from 60-90, primarily female, racially and ethnically diverse, received fully remotely delivered computerized cognitive and functional skills training at 14 Community centers in New York City and Miami. Up to 12 weeks of training were delivered, with 2 hours total training per week, with six different technology-related functional skills trained. Half of the MCI participants also received computerized cognitive training. Training time for task completion and errors made on each task were the critical outcomes variables and each task was considered mastered after the participant performed the task with 1 or fewer errors.
There were 164 participants, of whom 82 (50%) self-reported Latinx ethnicity, 32(20%) reported being white non-Latinx, and 38 (23%) reported being black, with the other 7% reporting Asian or “other” as racial/ethnic status. Black participants had lower educational attainment, lower WRAT Scores, and lower MOCA scores compared to the other two groups. White and black participants had better baseline completion times for 3/6 tests compared to the Latinx participants, while for the other 3 white participants performed better than then other two groups. Composite training gains across all six tasks for the sample were 0.93 SD. Within the total sample, MOCA scores, years of education, and reading achievement were all significantly correlated with baseline completion times and training gains from baseline to final training session. Racial/ethnic status was associated with a significant difference in composite training gains, F=4.38, p=.014, with Black (d=.95) and Latinx (d=1.05) participants making relatively greater training gains than white participants (d= .64). MOCA scores manifested similar correlation with baseline performance and change scores in all three groups.
Minority status individuals performed more poorly on baseline assessments of technology-related everyday activities than white participants and Black participants also had more cognitive impairment and reduced educational attainment. However, training gains were greater for the participants with more baseline challenges and their gains with training were significantly greater than white participants. Thus, functional skills training, although moderated by baseline impairments, overcame baseline differences in performance It is quite possible that these baseline differences were associated with a history of reduced opportunities to learn critical technology-related skills and that when offered training, there was a reversal of baseline challenges leading to substantial gains in competence. Baseline competence in performance of training tasks does not seem to barrier in achieving competence.