Ethical Approval

Ethical approval for Study 2 was obtained simultaneously to ethical approval for Study 1 from DCU Ethics Committee (reference: DCUREC/2015/2016). As for Study 1, following the Call for Volunteers (see Appendix D) only individuals without a known history of dementia or other neurological or psychiatric conditions were permitted to take part in this study. The specific inclusion and exclusion criteria were identical to those adopted for Study 1 and these inclusion and exclusion criteria and their rationale are outlined in Chapter 3. Recruited participants were required to confirm that, to the best of their knowledge, they met the study inclusion criteria and did not suffer from any of the conditions detailed as exclusion criteria. The ethical consideration specific to this study are also described in detail in Chapter 3.

5.3.3 Study Materials

Participants in Study 2 were asked to complete the same survey that was administered to participants in Study 1. The survey included two standardised self-report measures, the PRMQ and the HADS, and questions pertaining to socio-demographics, health, and sleep, all of which are described in full detail in Chapter 3. In addition, participants were requested to complete a number of objective cognitive tests. These tests, the MMSE, Mini-Cog and GPCOG, are described in detail in the Measures section for

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Study 2 in Chapter 3. A standardised test of objective PM, the Cambridge Prospective Memory Test (CAMPROMPT; Wilson & Wilson, 2005) was also included in the test battery, and is also described in Chapter 3. In total, this evaluation generally lasted between 70 and 80 minutes.

5.3.4. Participants: Recruitment and Sample Characteristics

A convenience sample of 99 healthy participants aged 50 and over was recruited on a volunteer basis from the community, using the snowball technique as described in Chapter 3.

The face-to-face nature of the evaluation helped to avoid missing data that might have occurred more frequently in the absence of a researcher. Nonetheless, two participants from the final sample did not complete the full set of objective tests. In both these cases, the CAMPROMPT was not completed. One participant did not complete the CAMPROMPT as she became upset about her test performance on the previously administered cognitive tests. Therefore, a joint decision was made with the participant to terminate the evaluation and the participant was debriefed in line with the ethical protocol for the study. The other participant received telephone notice of a personal emergency that necessitated premature termination of the evaluation, leaving the CAMPROMPT uncompleted. These two cases were thus excluded, leaving a total of 97 participants available for subsequent analyses.

Table 5.1 presents summary demographic data for this sample (N=97). The mean age of this sample was 66.3 years, range 51 - 91 years. As can be seen from the table, there were 58 females (59.8%) and 39 males (40.2%) in the final sample.

Overall, 63.9% of the sample were married, 11.3% were single, 15.5% were widowed, 2.1% were separated, almost 2.1% were divorced, 4% were cohabiting and 0.2% were in a civil partnership.

In terms of education, 12.4% had a Third level Degree, 19.6% had completed their Leaving Certificate, 12.4% had a Post-Leaving Certificate qualification, 15.5% had a Higher Diploma, 5.2% had a master’s degree, 14.4% were educated to Inter-certificate/Junior Certificate level, 13.4% had completed Primary level education, 5.2% held a vocational training apprenticeship, and 2.1% had a PhD.

In terms of occupation, a high proportion described themselves as professionals (22.1%). In terms of occupational status, the next most common categories were Managers (20%), followed by Clerical Support Workers (18.9%), other occupations (18.9%), Services and Sales Workers (8.4%) and Technician or associated professional (8.4%). A smaller percentage self-identified as Craft and related trades occupations (1.1%) and Elementary occupation (2.1%).

Just over twice as many participants reported they drink alcohol (69.7%) than do not drink (30.3%).

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Table 5.1: Basic descriptive demographic data for the Study 2 sample

Variable N (%)

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Regarding information relating to sleep, the average number of hours of sleep obtained was 6.73 hours.

The distribution of the average number of hours of daily sleep reported by participants is depicted in Table 5.2 below. As can be seen from this table, the greatest proportion of participants (18.6%) self-reported obtaining 6 hours of sleep, on average, per night. This was followed by an average of 7.5 hours (17.5%), then 7 hours (14.4%). 13.4% of the sample reported obtaining the often recommended 8 hours of daily sleep. At the other end of the continuum, one participant (1%) reported obtaining as few as 3 hours of sleep, on average, daily, and another individual (1%) reported getting an average of 1.5 hours of sleep. Two participants (2.1%) reported an average of 4 hours daily sleep and six participants (6.2%) get an average of 5 hours daily sleep.

Table 5.2: Average number of hours of sleep per night reported by participants Average number of hours sleep per night Frequency Percent

3.0 1 1.0

3.5 1 1.0

4.0 2 2.1

5.0 6 6.2

5.5 10 10.3

6 18 18.6

6.5 8 8.2

7.0 14 14.4

7.5 17 17.5

8.0 13 13.4

8.5 2 2.1

9.0 3 3.1

9.5 2 2.1

A higher proportion of the sample reported no difficulty with falling asleep (78.4%), compared with those who did report such difficulty (21.6%). However, a higher proportion also self-reported waking up during the night (83.5% -v- 16.5% who did not). Finally, 41 participants (42.3%) self-reported waking earlier than intended, while for 56 (57.7%) participants, this was not a problem.

Regarding physical health of the sample, the prevalence and type of chronic health conditions self-reported in the sociodemographic questionnaire by participants is presented in Table 5.3. As the table highlights, the most commonly endorsed physical health condition was arthritis (23.7%), followed by breathing problems (16.5%) and diabetes (13.4%). The least commonly endorsed health conditions were ulcerative colitis (0%) followed by Crohn’s disease (1%) and hormonal problems (2%).

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Table 5.3: Prevalence and type of self-reported physical health conditions.

Physical Condition N (%)

Cardiovascular Disease (CVD) 7 (7.2)

Hormonal Problems 2 (2.1)

Breathing Problems 16 (16.5)

Gastric Problems 9 (9.3)

Diabetes 13 (13.4)

Chronic Pain 5 (5.2)

Arthritis 23 (23.7)

Ulcerative Colitis 0

Thyroiditis 8 (8.2)

Crohn’s Disease 1 (1.0)

Other physical condition 15 (15.5)

In total, 15 participants (15.5%) also endorsed the category “other condition”. While there was some overlap with conditions already specified and endorsed in the socio-demographic questionnaire, such

“other” conditions included (but were not limited to) cancer in remission, auto-immune disease, Fibromyalgia, tinnitus, osteopenia, osteoporosis, renal failure, ADHD, hernia, sciatica and conditions not perceived to warrant full clinical diagnosis, e.g. “a touch of diabetes.” High blood pressure was listed in this category by 5 participants, and other heart problems – mainly atrial fibrillation - were reported by 4 participants in the absence of self-reported diagnosed cardiovascular disease. A count of the prevalence of two or more self-reported chronic conditions in the sample was carried out, showing that 20 (20.6%) participants demonstrated multimorbidity. There was a significant difference in age between those with multimorbidity (M = 69.25, SD = 5.66) and those without (M = 65.32, SD = 7.386, unequal variances t(37.651) = 2.581, p (2-tailed) = .014 but the two groups did not differ in terms of education level X² (8) = 6.131, p = .693. Notably, there was no significant difference between those with multimorbidity and those without in terms of in the spread of HADS Anxiety scores, U = 693.00, p

= .490. Neither was there a significant difference between the groups in terms of HADS Depression scores; U = 641.50, p = .242.

Analyses of whether this subset of older participants with multimorbidity experienced significantly greater subjective and objective cognitive impairment than the participants without multimorbidity were also carried out and findings are reported later in this Chapter.

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As for Study 1, to help determine the extent to which the sample in Study 2 is representative of the general older Irish population, an attempt was made to draw comparisons between the sample characteristics in Study 2 and the sample characteristics in TILDA and the 2016 Irish Census.

The TILDA report following analysis of Wave 1 data reported that in the population aged 50 years and above in Ireland, 48% are men and 52% are women. In Study 2, this broad gender distribution was replicated, although there were slightly fewer males and more females in the present sample than is represented in the general Irish population: specifically, 40.2% of the Study 2 sample were males and 59.8% were females. While TILDA reported that the greater proportion of people aged 50 and over in Ireland are in the 50 to 64 years age group (58%), the present sample showed an opposite trend, with the greater proportion of participants in the sample aged above 64 years.

In the TILDA Wave 1 report, which ascertained marriage history, almost 10% of people aged 50 years and above have never been married, and men were more likely to never have been married than women (13% men; 7% women). As with Study 1, Study 2 obtained data on current marital status and so is not directly comparable. However, for the interested reader, 15.5% of participants were widowed, 12.2% of the sample were single, 2.1% were separated and 2.1% were divorced. Remaining participants were either currently married (63.9%), in a civil partnership (0.2%), or cohabiting (4.1%).

Regarding education, the TILDA study reported that most older adults in Ireland have achieved at least secondary education (62%). This compares to 72.6 % of older adults with at least secondary education in our Study 2 sample. Therefore, the present Study 2 sample, on average, has obtained slightly higher educational status than the general older population of Ireland.

Census 2016 data also highlighted that the more educated a person is the more likely they are to be married. However, amongst individuals aged between 55 and 64 years, those with either lower secondary or third level degree or higher qualification had a similar likelihood of getting married (71.3%

-v- 72.6%). The much smaller sample size in Study 2 (n= 97), combined with a very small number of participants with low and very high educational attainment makes meaningful comparison difficult.

Across the entire Study 2 sample aged 50 years and above, more females were separated (3.4%) and divorced (3.4%) than were males (0%). In the age group 65 years and over, 2.8% of females were separated while no males were separated, and 2.8% of females were divorced in contrast to no males.

The rates of divorce and separation in females were higher in the 50 – 64 age group than in those aged 65 and above. Overall, while Study 2 sample size is a much smaller convenience sample, these patterns corresponds broadly to the census data showing that the peak age for separation or divorce is 53 years and showing a trend of higher rates of separation and divorce in females than in males.

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As noted earlier, in terms of self-reported depression, the TILDA study, using the CES-D, found that 10%

of the population aged 50 years and above reported clinically significant depressive symptoms, with a further 18% reporting subthreshold levels of depression. Notably, none of the 97 participants in the Study 2 sample could be classified as clinically depressed and just 2 individuals (2.1%) could be classified as having mild or subthreshold depression. By comparison, using the Crawford et al., (2001) cut-off scores, just 1 individual would be classified as clinically depressed. Regarding anxiety, using Zigmond &

Snaith’s cut-offs, 1 participant could be classified as clinically anxious, while 10 (10.3%) could be regarded as having mild or subthreshold anxiety. Applying the cut-off used in Crawford et al. (2011), 5 (5.2%) of the sample would be classified as anxious.

As previously mentioned, according to the TILDA study, the most prevalent medical conditions among adults aged 50 years and older in Ireland were hypertension (38% at Wave 4), arthritis (39% at Wave 4) and pain (35% at Wave 4). This compares to the most prevalent prespecified physical health conditions self-selected in the Study 2 sample, which were arthritis (23.7%), followed by breathing problems (16.5%) and diabetes (13.4%).

Acknowledging that occupational groupings used in this study and those used in the Census are not identical, the current sample comprises a higher proportion of individuals with professional occupations than the general population, most likely reflecting the relatively high level of education in the sample.