4
Socioemotional Influences on Decision Making: The Challenge of Choice

The publication of Milton Friedman’s Free to Choose in 1980 (Friedman and Friedman, 1980) represented a high-water mark in positive public attitudes toward choice. By contrasting the constraints of socialism with the expanse of choices available in the unregulated free-market system he advocated, Friedman’s book served as a kind of manifesto for the idea that more choice is always better. Little more than 20 years later, a new arrival on bookstore shelves is giving voice to what seems to be a widespread reappraisal of this faith in the benefits of choice. In The Paradox of Choice, Barry Schwartz (2004) argues that Americans are confronted by an ever-increasing proliferation of decisions they wish they didn’t have to make, to the point that they have become shackled by what Schwartz calls a “tyranny of choice.”

Schwartz provides few details about how the extent or burden of choice differs across age groups, perhaps because he had little research to draw on in reaching any conclusions on the matter. It seems likely, however, that many older Americans would agree with the message of the book. Indeed, although the burden of choice affects Americans of all ages, it likely affects older Americans differently. Today’s elderly came of age in a world with fewer choices in their everyday lives. Electricity was provided by a centralized utility source, pensions were selected by employers, and health care plans were fixed. Today, consumers young and old must choose among different providers of electricity, gas, and, in some municipalities, even water. Employers often offer an assortment of health insurance options that differ in terms of out-of-pocket costs, procedures covered, cost caps, and



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When I’m 64 4 Socioemotional Influences on Decision Making: The Challenge of Choice The publication of Milton Friedman’s Free to Choose in 1980 (Friedman and Friedman, 1980) represented a high-water mark in positive public attitudes toward choice. By contrasting the constraints of socialism with the expanse of choices available in the unregulated free-market system he advocated, Friedman’s book served as a kind of manifesto for the idea that more choice is always better. Little more than 20 years later, a new arrival on bookstore shelves is giving voice to what seems to be a widespread reappraisal of this faith in the benefits of choice. In The Paradox of Choice, Barry Schwartz (2004) argues that Americans are confronted by an ever-increasing proliferation of decisions they wish they didn’t have to make, to the point that they have become shackled by what Schwartz calls a “tyranny of choice.” Schwartz provides few details about how the extent or burden of choice differs across age groups, perhaps because he had little research to draw on in reaching any conclusions on the matter. It seems likely, however, that many older Americans would agree with the message of the book. Indeed, although the burden of choice affects Americans of all ages, it likely affects older Americans differently. Today’s elderly came of age in a world with fewer choices in their everyday lives. Electricity was provided by a centralized utility source, pensions were selected by employers, and health care plans were fixed. Today, consumers young and old must choose among different providers of electricity, gas, and, in some municipalities, even water. Employers often offer an assortment of health insurance options that differ in terms of out-of-pocket costs, procedures covered, cost caps, and

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When I’m 64 co-payments. There are also new options, and hence greater need for decision making, when it comes to television, Internet, and cellular phone services: all of these can take alternate forms—analog or digital, land lines or satellite—and come in complicated packages differing in cost, speed, coverage, and so on. To the extent that they use such services, but are less savvy than younger people with new technologies, these choices are likely to pose special challenges for older adults. In addition, many older adults are compromised in the cognitive domains necessary to process new information and make decisions based on that information. Ironically, even programs designed specifically for older people, like Medicare, are becoming increasingly complicated in terms of the decisions required by participants. New proposals for private Medicare substitutes and add-ons, while offering some advantages, undermine the simplicity that was once one of Medicare’s strong points. The recent introduction of 73 different versions of Medicare drug cards underscores the problem. And the surprisingly low number of people who have signed up for these cards suggests that the choice problem may be overwhelming (Lind, 2004). Moreover, those who become sick (as, of course, the elderly do disproportionately) may face a whole new set of decisions that patients were previously rarely expected to make—between alternative drugs, procedures, doctors, and hospitals. Older Americans not only face many new choices themselves, at a time of life when some cognitive abilities may be in decline, but also experience the brunt of the consequences of many choices made earlier in life. In future generations these consequences may be even more significant. Decisions about geographical relocations may influence closeness to family in the decades when family support is critical. Decisions about whether and when to have children will influence financial stability and social status in old age. Perhaps nowhere, however, are the effects of early decisions more evident than for retirement savings. The most complicated and significant set of new choices results from the widespread shift from defined benefit to defined contribution retirement plans. Defined contribution plans give employees much more control over how much money to put aside and how to invest it, and inevitably result in much greater variability in retirement incomes. Proposed changes in the Social Security system would bring even more choices to workers and additional variability in retirement incomes. More than ever, older Americans’ standard of living in retirement will depend on choices they made when they were working—choices that most economists agree are far from optimal and have led to severely suboptimal levels of retirement saving for the population as a whole. Unless significant changes occur, it is very likely that large numbers of older Americans will be facing difficult choices of how much to spend from what is likely to be a

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When I’m 64 much reduced income from retirement savings and Social Security, while at the same time facing potentially catastrophic costs of health care and assisted living. CAPABILITIES FOR DECIDING Individuals The overall burden of choice depends not only on the number and nature of choices one has to make, but also on the capabilities one brings to making those decisions. As Mara Mather summarizes (in this volume), significant declines in mental capabilities are believed to play an essential role in rational decision making. However, very little empirical research has explicitly examined changes in decision-making processes and competencies as a function of age, gender, or level of physical or cognitive ability. Most of the limited research that has been done focuses on the ways in which cognitive decline impairs decision processes (e.g., Finucane et al., 2002; Peters, Finucane, MacGregor, and Slovic, 2000; Slovic, Finucane, Peters, and MacGregor, 2002). Findings from empirical examinations of older peoples’ performance are generally discouraging. For example, Hibbard et al. (2001) presented a sample of Americans with information commonly given to people selecting a health insurance plan and assessed comprehension in terms of respondents’ abilities to accurately interpret and report back information about the different plans. Not only were older respondents significantly more likely to make errors than the younger group (25 and 9 percent, respectively), but error rates continued to increase as a function of age within the elderly sample. By age 80, the error rate was 41 percent, and differences in competence as a function of education that were present in the younger subset of the elderly sample had disappeared. Other research, however, qualifies this rather bleak picture of decision making by the elderly. As noted above, the strategies people use to make judgments and decisions in everyday life draw on an array of mental processes that span a continuum from the intuitive (or emotional) to analytic or deliberative (Hammond et al., 1987; Kahneman, 2003), and aging seems to affect intuitive and deliberative aspects of the decision process quite differently. While active, effortful, information processing declines with age (National Research Council, 2000, pp. 38-39; Park, Nisbett, and Hedden, 1999), automatic, intuitive processing tends to remain stable or even to improve with age (Isaacowitz, Charles, and Carstensen, 2000). Even performance on tests of basic cognitive processes known to decline with age, such as memory and attention, is enhanced when stimuli are emotional (Charles, Mather, and Carstensen, 2003; Denburg, Buchanan, Tranel, and Adolphs, 2003; Mather and Carstensen, 2003; Mather et al., 2004). Posi-

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When I’m 64 tive stimuli are remembered especially well (Charles et al., 2003). And in contrast to studies that ask participants to digest information about health care plans, studies of social problem solving, which are more likely to draw on emotional and intuitive processes, find more flexible performance by adults ages 45-75 than by those between 14 and 35 (Blanchard-Fields, Janke, and Camp, 1995). Moreover, whether they are consciously aware of such changes or not, older decision makers do tend to rely on the types of intuitive, emotional processes that they excel at, at least in relative terms. Adaptive decision making in old age seems to involve a shift toward a more intuitive form of decision making that relies less heavily on effortful strategies and instead on affective heuristics (Slovic et al., 2002). Of course, although attention to emotion may aid decision making in some ways, it can harm decision making in others. For example, there are likely to be times where reliance on “gut” feelings and past experiences may place older people at heightened disadvantage, such as when a decision feels familiar but is actually quite different from decisions made in the past. At first glance, it may appear that older people who are relying on gut feelings may be especially vulnerable to marketers or con artists who are adept at manipulating positive feelings and creating trust when it is unwarranted. Moreover, given evidence that older people are especially motivated to maintain social harmony, they may be more easily persuaded by providers of deceptive information (Chen and Blanchard-Fields, 2000). Yet it is not necessarily the case that older people’s increased reliance on emotion puts them at greater risk of being deceived; emotional acumen could lead to greater resistance to persuasion in older adults (see Pasupathi, 1999). One study has shown that older adults’ accumulated experience in social interactions enhances their ability to discriminate lies in situations of deception (Bond, Thompson, and Malloy, 2005). Overall, it is clear that there are important age differences in decision making; the nature and the extent of those differences are important topics for research. It is well established that intense emotion in younger adults can interfere with systematic deliberation and lead to impulsive, myopic, and often self-destructive choices (Baumeister, Stillwell, and Heatherton, 1994; Loewenstein, 1996). The importance of understanding the ways in which decisions are affected by strong emotions in older people is compounded by the fact that old age often presents decisions at times of high emotional strain, such as when a spouse becomes sick or dies or disability demands relocation to new living accommodations. Decisions about health care may be particularly susceptible to the influence of emotions because they often involve emotionally charged tradeoffs (Löckenhoff and Carstensen, 2004). Furthermore, one’s perception of self and others and the type of health care decisions to be made, as well as whether an individual is cared for by family

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When I’m 64 or placed in a nursing home, are all affected by a person’s gender; socioeconomic status; and racial, cultural, and ethnic identity. Research on decision making in younger adults highlights the central role of emotion in the decision process, and research on emotion and motivation suggests some intriguing changes with age, yet there has been almost no research examining the implications of such changes for decision making among the elderly. Several aspects of decision-making processes are especially important to understanding potential changes over the life course. Before delving into these specifics, however, a note on methodology is in order. Some of the most exciting new directions in decision research and in social psychology involve new types of measures (see paper by the committee on “Measuring Psychological Mechanisms”; also Schwarz, Krosnick et al., Hartel and Buckner, all in this volume). For example, measures of implicit attitudes are revealing that people have values and beliefs and automatic tendencies to draw connections between things that they are often unaware of but that can nonetheless exert a powerful influence on decision making (Greenwald and Banaji, 1995; McConnell and Leibold, 2001). Neuroscience methods, most notably functional magnetic resonance imaging (fMRI) have produced a wide range of new insights about both aging and decision making, albeit little on the intersection of these topics (see Adolphs, 2003). Finally, new large-scale field experiments have revolutionized the field of decision making and the closely allied field of behavioral economics, demonstrating that policies inspired by decision research can improve decision making and welfare at the aggregate level (see, e.g., Thaler and Bernartzi, 2004). Meta-Awareness In many domains, what one knows about one’s own capabilities is as important as the capabilities themselves. The vastly different effects of alcohol and marijuana on driving illustrate the point: although both drugs impair driving and judgment, alcohol makes one feel more competent and aggressive, which encourages one to drive fast, while marijuana makes one feel less competent and causes one to drive more slowly (Hall, Room, and Bondy, 1999). As a result, alcohol is a much larger contributor to accidents and fatalities, even after controlling for differences in use of the two drugs. When studied, metacognition has been viewed as a cognitive process; yet the social and emotional consequences of self-awareness surely play an important role in the views that people hold of their abilities. The case of driving, for example, is directly relevant to the elderly, who often experience impairments in their driving skills. Whether older people continue to drive, and if so, how far and fast they drive, depends not only on their

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When I’m 64 actual driving skills, but also on self-perceptions of their cognitive, sensory, and physical abilities. Because of the link of driving to independence, a decision to stop driving is emotionally charged. Older people may be motivated to minimize their impairments in order to stave off dependence on others. Indeed, there is some evidence that older people show considerable self-awareness about their driving abilities and modify their driving accordingly to reduce risks (Ball, Owsley, Stalvey, Roenker, and Graves, 1998). Clearly, older people with forms of dementia, developmental disabilities, or other types of cognitive impairment may not have such meta-awareness. There are many other domains in which self-insight might matter for the elderly. For example, working memory has been shown to decline significantly with age. If the elderly are aware of such declines, they may take steps to deal with them, such as using mnemonics or relying more heavily on written information (see, e.g., Schwarz, in this volume). Compliance with drug regimens is another good illustration of the importance of the meta-understanding of one’s own cognitive and decision processes. Studies have found that older people actually do better than middle-aged people at adhering to drug regimens (see, e.g., Park et al., 1999). And, while part of the explanation may be motivational, the main cause seems to be the recognition by older people of their own memory limitations, which motivates them to make use of such compliance aids as pill dispensers that signal when it is time to take a pill. In fact, there is a large literature on metacognitive functioning in older adults; it is a valuable basis for research on its implications for changes in decision making with age. LONG-RANGE PLANNING AND DECISION MAKING Long-term planning and decision making is an area of research in which there has been a great deal of convergence in findings from psychologists—including social psychologists—and economists. Research coming from both fields documents a common pattern of behavior: a tendency for people to place disproportionate weight on costs and benefits that are immediate, but to treat delayed costs and benefits in a much more evenhanded fashion. For example, someone might choose a $50 dinner immediately over a $70 dinner a week later, but would almost surely state the reverse preference if the delay on both dinners were increased by a year. However, in apparent contradiction to this common pattern, in many situations people—even those who have trouble with dieting and saving or who procrastinate—express a strong preference for sequences of outcomes that improve over time, as if they care more about later than about earlier outcomes. Putting these two sets of findings together, it appears that people want things to improve over time, but often behave in a fashion that ensures exactly the opposite result. For example, surveys have shown that

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When I’m 64 many people want to save more and plan to save more, but when faced by temptations, they often incur high levels of debt, including high-interest credit card debt (Angeletos, Laibson, Repetto, Tobacman, and Weinberg, 2003; Bernheim, Skinner, and Weinberg, 2001; Caplin, 2003; Laibson, Repetto, and Tobacman, 1998). As people live longer, long-range planning becomes increasingly important, as does the ability to implement such plans. Normative models of intertemporal choice (decisions between outcomes occurring at different points in time) assume that there are strong individual differences—that someone who is impulsive in one domain of behavior will also tend to be impulsive in other domains. Yet research shows that people are very inconsistent in their attitude toward the future, in some cases behaving as if present gratifications were all that mattered and in other cases appearing to care more about the future than the present. Indeed, it was research on intertemporal choice by the social psychologist Walter Mischel (1996) that first led him to recognize the importance of situational factors in human behavior, an insight that revolutionized social psychology for decades. Although Mischel emphasized the role played by cognitive self-control strategies in what he termed “delay of gratification”—in a wonderful example, that a child could successfully wait to get a chocolate bar instead of taking an immediately available marshmallow if she cognitively transformed the marshmallow into little white clouds—modern research has revealed a multiplicity of cognitive and motivational mechanisms, any one of which, alone, appears to be capable of producing radical variation in people’s weighting of present and future. Different mechanisms, or mixtures of mechanisms, are invoked in different situations, producing striking variability in people’s tradeoffs of immediate and delayed costs and benefits. Different decision contexts, for example, evoke different “choice heuristics”—rules of thumb that people use to help them make decisions (Frederick, Loewenstein, and O’Donoghue, 2003). For example, when presented with a simple choice between two sequences, one improving (e.g., a mediocre restaurant dinner one weekend followed by a superb dinner the following weekend) and the other deteriorating (the same dinners but in reverse order), most people prefer the improving sequence. However, if asked to price the two sequences, most people value the declining sequence more highly, apparently because asking about money evokes considerations of net present value. Emotions also play an important role in intertemporal decisions. There is considerable support for the idea that intertemporal decisions result from the interaction between two types of neural systems: “hot” affective systems that are inherently short-sighted and “cold” deliberative systems that are more even-handed when it comes to present and future (Loewenstein, 1996; McClure et al., 2004; Metcalfe and Mischel, 1999; Thaler and

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When I’m 64 Shefrin, 1981). These two systems often reinforce each other, as when the feeling of hunger reminds the deliberative system that it is time to eat. But in some cases they come into conflict, as when the sight of an available snack produces an affective urge to eat but reminds the deliberative system that one is on a diet, producing problems of, and in some cases failures of, self-control. Fluctuations in the intensity of affect can produce erratic, inconsistent patterns of behavior, with short-sighted decisions in situations characterized by intense affect, but much more far-sighted decisions when decision-makers are in affectively neutral states. MULTIPARTY DECISION MAKING Although most decision research focuses on individuals, much decision making in fact occurs in social contexts. For example, couples often make decisions jointly (such as where to live), sometimes tacitly coordinate on decision making (as when the husband buys a fancy car and the wife lives extra frugally to compensate), and sometimes provide each other with advice. There is intriguing evidence that for certain tasks, such as retrieving memories about a vacation, older adults benefit more than younger adults from collaboration with their spouses (Dixon and Gould, 1998). However, it is also well documented that couples commonly make decisions about survivor benefits that turn out to be disastrous for the survivor, putting widows especially at a disadvantage (International Longevity Center, 2003). The topic of collaborative decision making remains largely unstudied. The interpersonal context may be especially important for older people, but the effects of such age-dependent changes remain poorly understood. The smaller social networks of older people may reduce access to potential advisers and advocates, especially for elderly people who are geographically isolated from family members. This is also an area in which culture, race, and ethnicity exert particularly strong effects because of their influence on the relationship of self to the group, particularly the relationship of self to the family. There are references to this topic in the caregiving literature, but it has not been well studied (e.g., Miner, 1995; Smerglia, Deimling, and Schaefer, 2001). Family cohesion and responsiveness vary significantly on the basis of culture, race, and ethnicity, and the relative effects of these differences in family cohesion are important to understanding decision making and aging. Family cohesion may have quite different effects: with high family cohesion, resources within the family network may be efficiently mobilized to address the care needs; or strong family cohesion may create family discord because of varying opinions about care and responsibility. Because many members of minority cultural, racial, and ethnic populations live longer

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When I’m 64 with physical limitations and have smaller pools of financial resources, reliance on families to provide care in later life is prevalent. Understanding the effects of family cohesion among these groups will become increasingly important as more and more families become responsible for care. Affective Forecasting There has been a recent proliferation in research examining affective forecasting—the ability to predict future feelings (Gilbert, Driver-Linn, and Wilson, 2002; Kahneman, 1994; Loewenstein and Frederick, 1997; Loewenstein and Schkade, 1999; Mellers and McGraw, 2001; Wilson and Gilbert, 2003). Most recently, researchers have measured both predicted and experienced affective responses in an effort to identify and explain inaccuracies in affective forecasting. Virtually all of the studies examining different aspects of affective forecasting, however, have involved young or, in some cases, middle-aged adult samples. And with the exception of quite a large body of research on affective forecasting involving changes in health conditions, most studies have focused on the types of events that are especially important to young and middle-aged adults, such as romantic break-ups or professional setbacks. Even when it comes to health, however, there has been virtually no systematic research on affective forecasting by older people. The research on affective forecasting suggests that individuals are generally accurate in making predictions about the valence (positive or negative) of future emotional experiences (Wilson and Gilbert, 2003) and about the specific discrete emotion they will experience (Robinson and Clore, 2001). However, these results must be qualified by other findings that suggest that people have overly simplistic, schema-driven perceptions of the emotional responses to events when thinking about the distant as opposed to near future (Liberman, Sagristano, and Trope, 2002). Furthermore, research suggests that for events that elicit a more complex blend of emotions, individuals may not be as good at predicting the specific mixture of emotions they will experience (Wilson and Gilbert, 2003). Overall, though, people are relatively accurate in identifying specific future emotions. In contrast, individuals are not accurate at predicting the intensity and duration of their emotional experiences (Baron, 1992; Coughlan and Connoly, 2001; Mellers and McGraw, 2001; Wilson and Gilbert, 2003). Individuals tend to overestimate the enduring effect that future events will have on their emotional well-being. Measurement of this bias has typically used self-report scales and behavioral forecasting measures. This bias is important because evidence suggests that social behaviors and decisions are influenced by affective forecasts. Recent research has focused on the mechanisms that account for this

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When I’m 64 bias. Sources of affective forecasting errors include misconstruing the nature of the future event; focusing on features of the situation that are of little consequence to a person’s emotional experience (Schkade and Kahneman, 1998); memory errors in recalling past emotional experiences (Loewenstein and Frederick, 1997); faulty theories as to what caused an affective state; and failures to correct for unique influences on forecasts. Finally, when they are attempting to forecast their future emotional experiences, people do not account for a variety of processes that ultimately attenuate intense emotional states (e.g., homeostatic processes or defensive processes that diminish the physiological effect) (Gilbert, Lieberman, Morewedge, and Wilson, 2004). Gilbert and colleagues argue that this is the most important source of affective forecasting errors. In other words, people do not take into account the fact that they will ultimately transform events psychologically to regulate their affect. This transformation happens in two different ways. First, individuals underestimate how rapidly they will make sense of a novel and positive event and thus overestimate the duration of positive emotional reactions. Second, when predicting how they will respond to negative events, people fail to anticipate the degree to which their psychological immune systems will speed up their recovery. Both transformational processes seem to be largely automatic and nonconscious. For example, studies show that people who forecasted their emotional reactions underestimated the degree to which they would rationalize a failure to achieve an outcome by blaming an unfair component of the situation or questioning the validity of the feedback (Gilbert, Pinel, Wilson, Blumberg, and Wheatley, 1998). Social psychologists are puzzled by the fact that people do not seem to readily learn from experience that they are equipped with powerful transformational abilities that facilitate recovery from an initial emotional state. A life-span developmental perspective may offer new ways to address this question. Risk Aversion Contrary to the stereotype of old people as frightened and risk avoiding, empirical studies have not revealed systematic changes in risk taking with age, beyond those that can be accounted for simply on the basis of changing physical capabilities. And the prevalence of casino gambling among the elderly points to at least one domain in which they contradict the stereotype. How does risk taking relate to age? Are older people generally more or less risk averse than younger people, or are there domain-specific differences? Not surprisingly, there are reasons to think that risk taking might increase with age and reasons to think otherwise. On one side, as one ages, there are fewer years over which to average or correct mistakes. If one

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When I’m 64 invests in stocks in one’s 30s, and the market crashes, you still have several decades to make up your losses prior to retiring. Losing one’s “nest egg” in one’s later years is likely to be far more consequential. Indeed, many investment advisers recommend a progressive shift toward a safer mix of assets as people age. On the other side, the types of emotional changes that have been shown to occur with age might increase risk taking. There is substantial research supporting the idea that risk aversion is driven by negative emotions, such as fear and anxiety (see, e.g., Loewenstein et al., 2001; Loewenstein and Schkade, 1999). Since negative emotions have been shown to decrease with age, it would be natural to expect risk avoidance to decrease in tandem, especially social risk taking. Older people are notoriously less concerned about how they appear to others. To the extent that social risk aversion is driven by the fear of creating a negative impression, it would be expected to decline with age. There is relatively little research in this area. Limited findings do suggest that older adults perform well at maximizing gains in gambling tasks (Shiv et al., 2005; Stout, Rodawalt, and Siemers, 2001). However, this research does not address the possibility that different strategies (e.g., loss aversion versus an emphasis on gains) may change as a function of age. Along these lines, other researchers have shown that types of strategy vary as a function of the content of the decision. For example, people use different strategies for socially relevant decisions involving moral issues and personal immediacy (use of social schemas, emotion focus, story construction) than for decisions about stock investments (use of numerical calculations) (Rettinger and Hastie, 2001). Regrets The emotion of regret plays a critical role in decision making. It serves as an affective signal, albeit one with a great deal of noise, that previous choices may have been wrong. Not surprisingly, there has been quite a bit of research on the role of regret in decision making. Most of this research focuses on the role of anticipatory regret, shifting one away from choices that have the potential to engender regret (e.g., Bell, 1982, 1985; Larrick and Boles, 1995; Loomes and Sugden, 1982, 1986; Mellers, Schwartz, Ho, and Ritov, 1997; Mellers, Schwartz, and Ritov, 1999). Yet there has been no research on whether the avoidance of regret plays a more or less prominent role in decision making as a function of age. There is some evidence that older people remember their choices more positively than do younger people (Mather and Johnson, 2003). Still, the irreversibility of many decisions made in old age make anticipated regret quite salient. Gilovich and Medvec (1995) have examined the temporal pattern of

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When I’m 64 regret. Their research shows that, at least in younger adults, when looking back on the recent past there is a general tendency to regret acts of commission (things one wishes one hadn’t done); in contrast, when looking back at the distant past there is a tendency to regret acts of omission (things one didn’t do that one wishes one had). No research has examined the types of decisions that people regret, or end up feeling good about, late in life. This topic is important, because understanding what types of decisions people do and do not regret in old age might provide a rough guide to the types of mistakes that older people commonly make. Do people who move to assisted living or semi-independent facilities tend to regret the decision? Do people who choose a medical plan or a new physician regret the decision? An investigation of regrets in older age might help to improve decision making not only among the elderly, but also among younger adults who have to make decisions that will affect them later in life. END-OF-LIFE CARE Some of the most important practical issues for decision research involve end-of-life care. A very large fraction of total national expenditures on health are incurred in the last 6 months of people’s lives. This is not necessarily a mistake: older people tend to be sick and naturally draw on health care resources before they die. However, this fact has raised questions about whether the money is being put to the best use. More importantly, costly health care is often intrusive and degrading and may not be what people want. While the public places great value on “quality of death” (Bryce, Angus, and Loewenstein, 2003)—most people would prefer to die at home, surrounded by family—most people end up dying in hospitals or other sterile environments. End-of-life decision making often entails great complications, involving many relatives who may hold different opinions and intense and complex emotions, both on the part of the patients and their relatives. Research by Peter Ditto and his colleagues (Fagerlin, Ditto, Danks, and Houts, 2001; Fagerlin, Ditto, Hawkins, Schneider, and Smucker, 2002) shows that patient surrogates often make decisions that are contrary to the wishes of the patient and that advanced directives and living wills barely improve the situation. Moreover, physicians may face financial incentives and fear of malpractice suits that could encourage them to promote tests and services that may not be in the patients’ interest. With such a rich mix of complexity, affect, and conflicts of interest, it should come as no surprise that surviving family members often end up feeling deeply dissatisfied with the end-of-life care that their decedent relatives received (Addington-Hall, Lay, Altmann, and McCarthy, 1995; Teno et al., 2004). More research is clearly

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When I’m 64 needed to understand what factors may lead to misguided decisions that result in excessively costly and degrading health interventions for people who are, even with such interventions, almost certain to die. CONCLUSION For better or for worse, aging Americans are being faced with more choice in life, from daily purchases to retirement spending to health care. Even decisions about the dying process are being placed increasingly in the hands of individuals. Yet very little is known about decision making by older people and even less about the effects on that decision making of their gender and socioeconomic status or of their life-long identification with a racial, cultural, or ethnic group. The existing literature on decision making and aging is small, and most of it focuses on the ways that cognitive decline may degrade decision competence. Moreover, as in the broader field of decision research, the conceptual approach adapted in most research is one in which decisions are viewed as “rational” processes that entail the weighing of pros and cons about different options and the selection of the option with the most advantages. An emerging approach to decision research, however, suggests that emotional responses to options play a central role in the decision process. Given that emotional functioning appears to be relatively spared from age-related decline, emotional aspects of the decision process are especially important to understand. The area is particularly promising because it may point to aspects of the decision process in which older adults perform relatively well, such as using intuitions in domains in which they are highly experienced. The research proposed in this chapter promises to shed light not only on the decision-making processes of the elderly, but on decision making more broadly. Multiparty decision making, regret, and risk aversion are aspects of decision making at all ages, and gaining a better understanding of how they operate in the elderly will inevitably shed light on the decision making of younger groups, as well as contributing to more information for today’s elderly population. Even end-of-life decisions can be relevant for younger people, who may also face life-threatening health problems. We know that studying people with brain abnormalities can shed light on decision making. So, studying the relationship between changes in brain physiology and decision making over the life span should provide additional evidence on both decision making and its neural underpinnings. For example, since the time of Phineas Gage, the prefrontal cortex has been thought to be the seat of self-control (Damasio, 1994), yet we know that this area deteriorates with age. Why, then, are older people not generally characterized by a loss of self-control? One possibility is that the subregions of the prefrontal cortex that decline with age are different from those

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When I’m 64 associated with self-control. Another possibility is that the urgency of emotions and physical drives, such as hunger and sex, also decline, perhaps even more rapidly than self-control resources. Understanding why self-control is generally maintained with declining prefrontal cortex function could help us understand the ongoing mystery of self-control. As the population grows older, the decisions older people make will affect not only their own lives, but also the lives of their families, and public policies and societal functioning as well. Research on social and emotional aspects of decision making and on the intersection of emotional and cognitive processes is particularly promising because the marriage of these areas is likely to yield considerable progress in a relatively short period of time.