Overcoming age-based stereotypes to optimize cognitive performance in older adults : a systematic review of methodology and existing evidence

Abstract

Background and Objectives: Age-based stereotype threat (ABST) poses serious risks for the cognitive screening of older adults. This review aimed to identify and critically appraise the methodology and existing evidence of studies investigating the use of threat-removal (TR) strategies to overcome the effects of ABST on the cognitive performance of older adults. The types of strategies, their effectiveness in optimizing cognitive performance, and factors influencing their effectiveness were examined. Research Design and Methods: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PsycINFO, PubMed, Embase, Web of Science, and Scopus were searched from January 1, 1995 to November 6, 2019. Two authors independently assessed article eligibility and appraised methodological quality of eligible articles using an adaptation of the Strengthening the Reporting of Observational studies in Epidemiology guidelines. Narrative synthesis was used to summarize results. Results: Thirty articles, reporting on 36 studies, were eligible and included. Overall, evidence for the effectiveness of TR was mixed and varied according to the explicitness of strategies and comparison conditions used. Studies examining blatant TR strategies, and those using a combination of blatant and subtle TR strategies, provided limited support for their effectiveness in overcoming ABST. However, studies evaluating subtle TR strategies provided preliminary support for their effectiveness in overcoming ABST. Discussion and Implications: Existing studies provide limited evidence regarding the effectiveness of TR strategies in overcoming ABST due to methodological limitations. Recommendations are made for the design of future studies to differentiate the benefits of TR strategies from the detrimental effects of ABST, thus potentially informing their use in clinical practice.