When it comes to dangerous behavior, the elderly and adolescents have much in common.
Mary Cazzell, the first graduate of the College of Nursing's B.S.N. to Ph.D. program in 2009, discovered this while studying adolescent risk taking for her dissertation. Her conversations with recent graduate Kathryn Daniel fueled the finding.
Risk-taking behaviors are controlled by the prefrontal cortex of the brain, which does not mature until the mid-20s. This area of the brain also deteriorates with aging.
Dr. Daniel is a nurse practitioner who specializes in geriatric patients, and both she and Dr. Cazzell are now nursing faculty members.
"Kathryn saw parallel behaviors between teens and many of her elderly patients," Cazzell says, behaviors like binge drinking, driving under the influence, and having unprotected sex. "The highest number of new reported AIDS cases are among the heterosexual elderly."
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For her dissertation, Cazzell used two recently developed tools to measure the propensity of adolescents to take risks. In the Balloon Analog Risk Task, developed at the University of Maryland, subjects use a computer mouse to click a pump that inflates a balloon on the screen. Each pump of the balloon with no explosion places money into a reserve. The objective is to get the largest amount of money while avoiding explosions.
Should subjects pop their balloons, they lose the money and another balloon appears. At any time during play, subjects can click "collect money" and transfer the amount from a temporary bank account to a safe, permanent account.
The other tool was the Tower of Hanoi mathematical puzzle. Previous studies compared substance-involved adolescents with a control group of youth on their Tower of Hanoi performance. There were significantly different error patterns in the two groups, with the substance involved making more moves and spending less time per move.
After Cazzell's study with the adolescents was complete, Daniel entered the picture as principal investigator on a study to determine if the two tools would be effective in assessing subjects over 65.
"We know that many of the elderly have a problem with impulsivity and risk-taking behaviors," Daniel says. "We were looking for a tool that could identify those with that proclivity, before they have a problem."
Associate Dean of Nursing Research Carolyn Cason played a pivotal role in designing the study. For example, the length of the Tower of Hanoi test was problematic.
"We knew we could not get an over-65 group to sit still for 22 separate problems," Cason says. "I provided the psychometric guidance on how many problems and which ones to include with the older group."
As data collection neared completion, a pattern emerged: Risk taking can be accurately predicted in the elderly, just as with adolescents.