Evolution of ToM abilities among older adults and the elder.

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Ledicia Iglesias, Miquel Àngel Pellicena, Jesús Valero-Garcia, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2878340/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Theory of Mind (ToM) is a construct of cognitive, social and affective skills that contributes to a better effectiveness of interpersonal relationships, as well as a better understanding of social scenarios. Its evolution throughout adulthood is being subject of extensive study. We have done a quasi-experimental design study with a healthy aging sample of 69 people ranging in age from 65 to 94. The purpose was to understand the evolution of ToM abilities in this group of age; to determine whether these abilities evolve equally and clarify which aspects influence this evolution. Results show a progressive decrease in the scores registered in the elders, mainly from the age of 79. But this decline is uneven, since 2nd order false belief tasks, that is, tasks with greater cognitive complexity, obtain worse results at an older age. On the other hand, findings indicate that the variable that has the most influence on ToM skills is social activity, followed by verbal reasoning. Likewise, in line with the most recent literature, age itself is not shown as a factor that justifies the decrease in mental abilities, but rather the individual social and cognitive changes associated with it. These results reinforce the link between social activity, mental performance and cognitive health, in such a way that social activity based on interpersonal relationships becomes a tool for the prevention of social isolation and cognitive deterioration associated with the most advanced stages of adulthood. Theory of mind social activity verbal reasoning aging prevention Figures Figure 1 Introduction Over the past few decades, a great deal of psychological research has been dedicated to the study of the complex construct called the theory of mind (ToM). ToM refers to a socio-cognitive skill that is needed if one is to understand the mental states of others and how they may differ from our own. This is what allows people to predict and explain others’ behavior, desires, intentions, beliefs and feelings (Premack and Woodruff 1978 ). In other words, it is a skill that makes it possible for people to function effectively in their interpersonal relations (Milligan et al. 2007 ; Hodges et al. 2011 ), and it allows them the flexibility to adapt to situations thanks to an understanding of complex social dynamics (McKinnon et al. 2007). This, in turn, helps reduce the risk of misunderstandings and miscommunication (Hughes and Leekam 2004 ). Currently, many researchers tend to reject the definition of ToM as a single, monolithic cognitive construct. Instead, they argue that ToM is made up of certain dimensions or components. For example, Lucariello et al. ( 2007 ) defined two distinct types of ToM. The first of them, interpersonal ToM, refers to the ability to understand the thoughts and emotions of others. The second type, intrapersonal ToM, allows a person to recognize and reflect upon his or her own mental states. Elsewhere, other authors have proposed an understanding of ToM as a complex construct affected by a number of factors, mainly falling into the affective or cognitive dimensions (Shamay-Tsoory and Aharon-Peretz 2007 ). These researchers have described cognitive ToM as the ability to make inferences about other people’s cognitive states, beliefs, thoughts, and intentions. Meanwhile, they have defined affective ToM as the ability to infer others’ feelings, affective states and emotions. It is true that there is a good deal of neuro-physiological and neuro-anatomical evidence to support these classifications of ToM. However, when researchers use instruments to test ToM skills, it is often unclear whether they are focusing on the cognitive or the affective dimension, because the two variants of ToM tend to be closely linked to one another. Given that ToM is a heterogeneous psychological construct, most tests designed to assess it consist of verbal tasks. These activities tend to include visual support and are narrated in the third person, and they require the listener to attribute mental states to characters within a defined setting. Often, people taking the tests are asked to identify social gaffes, to point out false beliefs, or to interpret ambiguous, ironic or sarcastic messages (Achim et al. 2013 ). These tests usually assess respondents based on open-ended questions that require them to be aware of the mental state of one or more characters in order to be able to explain or predict the behavior of one of these characters (see, for example, Happé 1994 ). There are a number of well-known ToM studies that examine this construct in childhood, but it has only been in the past decade that we have seen a proliferation of research aimed at analyzing ToM in adults, especially among people over 65 years of age. There is a certain degree of controversy as to the functioning of ToM in the aging process. Initially, Happé et al. ( 1998 ) implemented a series of narratives intended to test the abilities of people of different ages to detect false beliefs, persuasion and irony. This study did not find any differences between older and younger adults. Later, Maylor et al. ( 2002 ) replicated the study but divided the older participants into two different groups, one with a mean age of 67 and another with a mean age of 81. In this case, the results indicated a significant decline in the latter group. Other studies have also found significant differences as a function of age (Henry et al. 2013 ; Rosi et al. 2016 ; Pearlman-Avnion et al. 2018 ; Zhou et al. 2019 ). In short, there is a body of research that shows that older people often have difficulties in completing mentalization tasks, especially when they involve second-order false beliefs, an understanding of social gaffes, and non-literal language (Laisney et al. 2013 ; Poletti and Bonuccelli 2013 ; Moreau et al. 2015 , among others). A recent study by Ivern et al. (to be published) with a sample of 410 people (ranging from 18 to 92 years of age; M = 43; SD = 17.6) found that ToM skills tend to gradually decrease with age, especially when it comes to more cognitively complex tasks. Elsewhere, researchers have argued that the decline in ToM scores cannot strictly be attributed to aging itself, but rather to other general aspects that are associated with the aging process. For instance, Walsh et al. ( 2017 ), Pearlman-Avnion et al. ( 2018 ) and Clouston et al. (2019) have observed that aging tends to be accompanied not only by changes in cognitive abilities, but also by certain social and emotional transformations (including the loss of spouses and friends) that can affect older people’s social perceptions. According to this perspective, age-related changes in ToM are not linear, but instead are subject to the influence of individual aspects such as a person’s cognitive status (Charlton et al. 2009 ; Rosi, et al. 2016 ), sex (Russell et al. 2007 ), social functioning (Pezzuti et al. 2011 ; Radecki et al. 2019 ; López-Montilla et al. 2021 ) and education level (Lee et al. 2011 ; Pezzuti et al. 2011 ; López-Montilla et al. 2021 ). A more extreme version of this position is posed by Yıldırım et al. ( 2020 ), who argue that ToM remains intact in the context of healthy aging. There are a number of potential causes of this lack of consensus among researchers in the field. Firstly, a range of different testing instruments have been used, some more focused on affective aspects of social understanding and other aimed at cognitive aspects. Secondly, tests are administered in different formats, some visually and others verbally, and the contents of the tests can be either narrative or non-narrative. Thirdly, different studies have used samples with different age ranges. For example, studies that have not found differences in terms of age have tended to select a relatively younger age range (55–60 years old) to represent older adults, while studies that have found differences have focused on people from 65 to 67 years of age. Finally, the upper age limit for inclusion in studies has varied, with a maximum age of 83 in studies that did not find differences as a function of age and a maximum of 93 in studies that did find such differences. There is another factor, though, that is very common among adults over 65 years of age that has a great deal of influence on their social relations but that has received very little attention in the literature on ToM among older people. This factor is age-related hearing loss or presbycusis. Especially in its initial stages, this kind of hearing loss is often not perceived as a serious issue, and most older adults who experience it are not very aware of the problem, rendering it an underdiagnosed disorder (Valero-García and Vila-Rovira 2018 ). Despite this, presbycusis is considered the third most common chronic pathology among older people, and its prevalence is increasing (WHO 2021). The most immediate effects are on the comprehension of spoken language, but in the longer term the disorder can also affect a person’s mastery of language pragmatics and his or her social participation (Taljaard et al. 2016 ; Thomson et al. 2017 ; Curhan et al. 2019 ). In other words, in addition to potential problems with understanding what another person is saying, people can also face certain difficulties in recognizing the intentions of other speakers, as their ability to comprehend implicit or non-literal messages may have declined (Pearlman-Avnion et al. 2018 ; Goy et al. 2018 ). Thus, people with presbycusis are often prone to misunderstandings in their social relations, leading to maladjusted social behavior. One technological method of helping people with presbycusis to continue to communicate is the use of hearing aids, and there is a growing body of literature associating the use of these devices with improved social adaptation and quality of life (Amieva and Ouvrard 2020 ; Sarant et al. 2020 ). One recent study of ToM and presbycusis (Valero-Garcia et al. 2021 and 2022) found that older people who used hearing aids tended to display better mentalization skills than those who suffered from presbycusis and did not use these devices. This finding suggests that it would be beneficial to focus attention on the possible influence of untreated presbycusis on the mentalization abilities of older people. In light of the above, we believe more research is needed to shed light on how ToM abilities evolve among normally developing older people while taking into account the presence of presbycusis as a variable. Indeed, the lack of consideration of hearing loss may be one explanation for the inconclusive results described above. Study objective and hypotheses The aim of this study is to shed light on how the mentalization abilities of people over 65 years of age evolve in a context of healthy aging (meaning among people who do not suffer from neurodegenerative pathologies generally associated with aging). We will seek to answer the following research questions: In a healthy aging process, does the ability to complete mentalization tasks decrease with age? Are all the components of ToM equally affected by this decrease in mentalization skills, or are some more affected than others? 3.- What other sociodemographic factors might affect people’s performance on mentalization tasks? We pose the following hypotheses: [H 1 ] ToM skills decrease with age. [H 2 ] Results on narrative tests will be lower when the stories require an understanding of false beliefs, as this is a more cognitively complex component of ToM. [H 3 ] Age, poor cognitive functioning and worsening social relations all make large contributions to the decrease in the mentalization abilities of older people. Materials and method This study was approved in 2021 by the Research Ethics Committee of Universitat Ramon Llull in Barcelona. The study was carried out in accordance with the principles of the Helsinki Declaration and made use of the clinical method of data collection through semi-structured interviews and the administration of non-harmful tests. Participants Participation was voluntary and subject to informed consent. On a random basis, requests were sent to city-run leisure centers for older people [1] , a health and social center [2] , and a number of nursing homes [3] , all in the Barcelona metropolitan area. Participants were informed as to the objectives and the methodology of the study and voluntarily signed informed consent documents. The exclusion criteria were 1) a clinical history of another neurological disease, behavioral disorders or epilepsy, 2) a clinical history of psychiatric disorders, 3) cognitive deterioration 4) use of medications known to affect cognitive functioning. Materials and procedure The participants in the study were first interviewed in order to gather sociodemographic data. Then, the following tests were administered to them on an individual basis: 1/ Cognitive assessment .- An overall score of 7 points on the WAIS IV (Wechsler 2012) Vocabulary and Matrix Tests was established as the minimum to qualify to be included in the sample for the study, thus guaranteeing that participants would be able to understand the stories selected to assess their ToM. A total of 16 participants were excluded for this reason. This initial cognitive exploration also allowed us to become familiar with the cognitive capacity of the participants. 2/ ToM assessment .- In order to test the participants’ abilities to successfully complete mentalization or ToM tasks, they were administered a test consisting of eight oral stories, which was also used by Ivern et al. (to be published). The stories are designed to make it possible to infer the intentions, emotions and/or beliefs of their characters. They are aimed at assessing the following domains of ToM: sarcasm (two stories), first-order false beliefs (one story), second-order false beliefs (two stories), social abilities (two stories) and persuasion (one story). Each participant was told the stories orally, always in the same order. The stories were accompanied by text and by images that had been designed to illustrate them. After listening to each story, the participants were asked for their opinions about what they had just heard and read. Responses were considered correct when participants were able to identify the intentions underlying the comments made by the characters in the stories. Following Happé et al. (1998), the assessment criteria were as follows: two points for a correct reference to mentalization-related aspects of the characters in the story, one point for a partial or confusing reference to mentalization, and zero points for an incorrect answer. The overall score can range from 0 to 16 puntos. Additional instruments were administered to assess the following variables: 3/ Depression .- Some studies have found links between depression and a clear risk of cognitive decline, a reality that complicates depression research with the olders (Alexopoulos et al. 2005). Therefore, this study used the Geriatric Depression Scale (GDS) (Sheik and Yesavage 1983; cited in Martínez de la Iglesia et al. 2002) to gather mood-related data on participants. A minimum value of 20 points was established as an inclusion criterion. Not participants were excluded as a result of this test. 4/ Cognitive reserve .- The Cognitive Reserve Questionnaire (Rami et al. 2011) was administered in order to provide a reference that could subsequently be correlated with the results of the ToM tests. 5/ Social activity .- Data were gathered on the participants’ level of social activity via a semi-structured interview that was intended to gather information about their social participation (hobbies, friendships, leisure and degree of satisfaction). The questions were inspired by the interpersonal relations subscale of the FUMAT Quality of Life Scale (Verdugo et al. 2009). Participants’ degrees of social participation were classified as limited, moderate or extensive. 6/ Hearing assessment . – A pure-tone audiometry test was used to determine the auditory thresholds (between 0.5 y 8 kHz), following the methodology established by the ASHA (1978). Hearing loss was calculated according to criteria from BIAP (1997). In order to determine whether a person had presbycusis, the WHO (2021) criteria were adopted. The WHO defines this disorder as an acquired loss of hearing in both ears that exceeds 40 dB in the better of the two ears. In our sample, there were 57 people who had presbycusis and did not regularly (at least eight hours a day) use hearing aids. These people were excluded from the final sample. Statistical analysis The software package IBM SPSS Statistics, version 28.0.1 (IBM, Corp. 2021) was used to conduct descriptive and inferential data analyses. In terms of descriptive data, it is worth highlighting the characteristics of the population, as well as the mean values and standard deviations for the continuous variables and the percentages for the qualitative variables. The inferential analyses included the use of Student’s t-test to determine whether there were differences between the different age groups in the sample. Then, a linear regression model was used to examine the associations between the statistically significant independent variables and the overall ToM scores. The level of statistical significance was set at p < 0,05. [1] Casal d’avis de Lliçà d’Amunt and Esplai municipal de Sant Fruitós de Bages, both in Barcelona. [2] Clínica Sociosanitaria Ntra. Señora de la Guadalupe de Esplugues del Llobregat. [3] Centro Geriátrico Sanitas Altanova; Residencia Geriátrica Torrassa and Centro Residencial Rosben. Results The final sample was made up of 69 people (23 men and 46 women) ranging in age from 65 to 94 (M = 76.1; SD = 7.9). Table 1 illustrates how ToM evolves over time among older people. The results are divided into two groups: (A) Older adults (65–79 years old); (B) the elders (> 79 years old). The data indicate that there were no significant differences between the two groups in terms of education level or social activity. Meanwhile, Student’s t-test did indicate that there were statistically significant differences ( p < .05) between the age groups in cognitive reserve. There were also statistically significant differences in their results for the “violin” and “salesperson” story tests, as well as in their overall scores for ToM. Table 1 Sociodemographic data on the sample and overall results. Variables (Group A) 65–79 (n = 45) (Group B) > 79 (n = 24) Student’s t Cohen’s d Demographic characteristics Age Sex 71.2 (4.5) 15 Men/30 Women 85.2 (3.5) 8 Men/16 Women Education level 12 years % 38% 27% 35% 42% 29% 29% Social activity Limited Moderate Extensive 12% 18% 70% 17% 25% 58% Cognition Cognitive reserve VR LR 12.4 (4.8) 12.3 (3.2) 12.3 (3.2) 10.2 (5.1) 11,3 (3.0) 12.0 (3.4) 1.78 p = .040* .461 ToM Sarcasm Bank Confused father 1,6 (.68) 1.5 (.84) 1,5 (.65) 1.5 (.65) ToM False belief Violin (1st order) Prisoner (2nd order) Salesperson (2nd order) 1.9 (.14) 1.2 (.86) .96 (.90) 1.7 (.69) 1.2 (.77) .58 (.71) 1.88 p = .035* 1.87 p = .033* .638 .441 ToM Social abilities Curtains Teacher 1.8 (.45) 1.0 (.92) 1.5 (.65) .83 (.86) ToM Persuasion Kittens 1.7 (.52) 1.6 (.57) Sum of ToM stories 11.8 (.4) 10.4 (2.8) 1.80 p = .038* .431 * p < 0.05 Figure 1 is a graph that depicts the average scores for each story recorded by the two age groups. The stories are in order from highest to lowest average scores. As discussed above and depicted in Table 1 , in most cases there are no statistically significant differences between the groups. The easiest stories were those that were the least cognitively complex, while the stories involving more cognitive difficulty tended to result in a greater number of errors. These more difficult stories were usually those involving an understanding of second-order false beliefs (prisoner and salesperson). The “teacher” story is designed to test social skills, but its difficulty might reside in the need to detect absurdity. Table 2 shows the results of the various ToM story tests broken down by the domains that they measure: sarcasm, false beliefs and social skills. These results indicate that the only statistically significant differences between the group of older adults and the elders were in the stories measuring false beliefs ( t = 2.00; p > .05). Table 2 ToM stories by domain measured. (Group A) 65–79 (n = 45) (Group B) > 79 (n = 24) Student’s t-test Cohen’s d Sarcasm 3.08 (1.34) 3.04 (1.08) 0.14 ( p = .883) False beliefs 4.22 (1.55) 3.45 (1.41) 2.00 ( p < .05) 0.508 Social skills 2.80 (1.14) 2.41 (1.06) 1.36 ( p = .178) After the comparison of the mean scores of the two age groups and the analysis of statistically significant differences, calculations were carried out to determine the influence of various independent variables on the overall score for the ToM stories. A linear regression model was created, with the following treated as independent variables: age, social activity (SA), education, cognitive reserve (CR), logical reasoning (LR) and verbal reasoning (VR). Values near 1 on the tolerance index and lower than 2.0 on the VIF for the independent variables suggested the absence of multicollinearity, with the exceptions of the variables CT, LR and VR, all of which measure cognitive functioning. More specifically, the VIF values for these variables ranged from 2.1 to 2.7, slightly above the cut-off point of 2.0 recommended by Tabachnick and Fidell (2013). Neither the shape of the residual distributions, nor the comparison of the residual scatter plots with those provided by Tabachnick and Fidell (2013) for the set of independent variables as a whole, nor a separate examination of each independent variable indicated any problems in terms of the normality, linearity and homoscedasticity of residuals. The Durbin-Watson test value was 1.31 for the hierarchical regression analysis. This showed that there was no autocorrelation between the residuals. Finally, no cases were found with a standardized residual in excess of about |3.3|, indicating no outliers in the solution. The model obtained through the regression model yielded values of F (6) = 7.86 ( p < .001) and R 2 = .432. Table 3 shows the contribution of each of the variables to the resulting regression model. Table 3 Contribution of each variable to the overall ToM score. Age SA Education CR LR VR Partial correlation − .141 .427 − .045 − .024 − .072 .243 Thus, the variables that had the greatest influence on the overall ToM score were Social Activity (SA), followed (although with a significantly lower contribution) by Verbal Reasoning (VR). Age was also an influential variable, but to a much lesser extent, while education level and logical reasoning do not seem to have any influence on the results. A model was also created for the specific ToM stories measuring the false beliefs domain, in an attempt to explore which variables exert the greatest influence on the results of these specific tests. The explanatory model uses the same independent variables mentioned above with regard to the regression model for the overall ToM score. Here, the result was F (6) = 5.20 ( p < .001), and the model yielded a value of R 2 = .335. Table 4 shows the contributions of each variable to the regression model. Table 4 Contribution of each variable to the score for false beliefs. Age SA Education CR LR VR Partial correlation − .171 .312 .044 − .051 − .055 .217 Once again, the most relevant variables are social activity and verbal reasoning, meaning that these variables exert the largest influence on the results of the ToM story tests involving false beliefs. Discussion The main aim of this study was to investigate whether mentalization abilities tend to decline with age starting at the age of 65, and to explore the factors that may play a role in this decrease. The study’s first hypothesis was [H 1 ]: ToM abilities begin to decrease after the age of 65, and after that point they continue to decrease with age. The data in Table 1 partially corroborate this first hypothesis. Firstly, while there is an apparent age-related decrease in mentalization ability, the decrease seems to be gradual. The group of older adults performed slightly better on most of the tasks than their elder counterparts, with the exception of a few tests on which they recorded similar scores, specifically, Confused father and Prisoner . Typical aging tends to be linked to decreased cognitive performance, especially on tasks that require fast processing and transformation of information (Murman 2015 ; Yagi et al. 2020 ; Stieger and Lachman 2021 ). More specifically, imprecise executive functioning and a lack of working memory can gradually detract from people’s mentalization abilities as the age. Indeed, other recent studies of age groups ranging from 50 to 80 years old have shown, there is a correlation between working memory and the successful completion of mentalization tasks (Yıldırım et al, 2020 ). In our study, the cognitive results for the group of participants of over 79 years of age seem to confirm this tendency. In any case, additional research is needed to shed further light on the true impact of working memory on mentalization activities, especially among the elders. In connection with the above, it is worth underscoring that not all kinds of mentalization tasks seem to be equally affected by aging. This finding echoes the results of studies by Laisney et al. ( 2013 ), Poletti and Bonuccelli ( 2013 ) and Moreau et al. ( 2015 ). In this case, the stories that saw the biggest differences between the two age groups, Violin and Salesperson , were those that tested the understanding of false beliefs. It should also be noted that when the tests were being administered, the participants were not always able to go beyond the literal meaning of the stories in order to understand their “implicit messages.” This was clearly reflected in the difficulties some experienced in responding appropriately to the stories involving an understanding of sarcasm, such as Confused father , or of the absurd, such as Teacher . These stories seemed to cause confusion among some of the participants, which hindered their understanding and their ability to use mentalization to respond. We believe that this might explain, at least to a degree, why the elders group in the study recorded lower scores for mentalization skills, especially in some specific areas tested by certain stories. The second hypothesis was [H 2 ]: The scores for the group of the elders will be significantly lower for the stories testing the understanding of false beliefs, as this is a more cognitively complex aspect of ToM. The data confirm this hypothesis, in that only in this dimension were statistically significant differences between the two age groups found (see Table 2 ). Other studies in a similar vein that have compared older adults experiencing cognitive decline with healthy older adults have found that the ability to resolve first-order tasks tends to remain more intact than the ability to complete second-order tasks (Rossetto et al. 2020 ). The latter are more complex because they involve the activation of various cognitive processes. In order to complete these tasks, a person must first process immediate linguistic information, along with contextual information about the setting of the story. Secondly, he or she must be able to recall and apply knowledge about both the role played by the character in the story and its setting. This information is sometimes included only implicitly in the story, so the tasks require the person’s attention and the ability to access his or her store of memories and experiences, which are as varied as the individual’s own knowledge of the world. Once again, these findings echo those of earlier studies conducted with a healthy population, which have found that the factor with the greatest influence on the decrease in ToM is not so much aging in and of itself, but rather the cognitive status of the individual (Walsh et al. 2017 ; Pearlman-Avnion et al. 2018 ). While there is some evidence as to the relationship between cognitive status and the ability to complete mentalization tasks, researchers have yet to come to an agreement as to how to properly disentangle the cognitive processes involved and to identify those that play the greatest role. Doing so would help determine the varying degrees of complexity of different mentalization activities. Finally, the third hypothesis was [H 3 ]: Age, poor cognitive functioning and worsening social relations all make large contributions to the decrease in the mentalization abilities of older people. Indeed, we can conclude that these three factors influence the overall results on the story tests, as all of them displayed positive correlations with ToM scores. However, the model yielded by the calculations suggests that the cause of the gradual decline of mentalization skills is not age itself, but rather individual factors such as social activity and cognitive capacity, especially when it comes to verbal reasoning. The differences between the two age groups (Table 1 ) in education level and social activity do not reach the level of statistical significance, but the group of people over 79 did have more participants who had had less schooling and an overall lesser degree of social activity. These lower scores among the older group correspond to poorer performance on cognition tasks and on overall ToM. These results are consistent with the findings of other recent research into healthy aging. Indeed, studies have found that age-related life changes, such as retirement, deteriorating health and decreased social relations, are linked to a reduction in opportunities to engage in stimulating cognitive activities, a situation that can contribute to cognitive decline (Clouston et al. 2019; Lövdén et al. 2020 ; Stieger and Lachman 2021 ; Vélez-Coto et al. 2021 ). In light of the above, to promote healthy aging it would be desirable to encourage older people to socialize often, as social activities contribute to improvements in ToM skills (Cavallini et al. 2015 ; López-Montilla et al. 2021 ). In fact, researchers such as Lecce et al. ( 2015 ), Rossetto et al. ( 2020 ) and Livingston et al. ( 2020 ) go even further along these lines, maintaining that direct mentalization-based interventions aimed at healthy older people can be effective at preventing cognitive decline and dementia. The results of our study seem to help confirm the potential of such preventive measures. Therefore, our study adds to the existing body of literature that underlines the importance of prevention among the healthy population of older adults and the elders. Interventions aimed at improving ToM abilities would do well to target social and cognitive skills. Conversely, as Rosi et al. ( 2016 ) and Rosseto et al. (2020) have argued, mentalization activities can help prevent deterioration linked to age-related social and cognitive changes. This approach is likely to lead to improvements in the quality of life of older adults. Limitations and future research. It is important to interpret this study’s results while bearing in mind its limitations. One limitation is connected to the sample. The study included a small number of participants. With a larger sample, the results would have been more robust. We faced some obstacles in the recruitment of participants of over 79 years of age, as it can be difficult to find healthy aging people in this age group without any comorbidities. A second limitation of this study is connected to the variable of social activity. The intention was to collect information on the frequency of leisure, free time activities and interpersonal relationships. The analysis of these activities was quantitative, but our study did not take into account the qualitative information provided by the participants about their perception of how these social activities contributed to their wellbeing and life satisfaction. A closer examination of these factors would have shed more light on the construct or older people’s quality of life and its correlation with their ToM abilities. In fact, the FUMAT scale applied in this study features additional subscales designed to assess respondents’ quality of life more thoroughly, so by applying the full instrument it would be possible to gain a fuller picture. Thus, we believe that future studies should explore this aspect more deeply. A third limitation is rooted in the study’s methodology. Specifically, this study provides additional evidence of the challenges involved in selecting a tool to assess ToM skills. It is a complex construct that calls upon a number of cognitive and social abilities, and the difficulties associated in assessing and analyzing it are reflected in the wide range of complex mechanisms that have been used to do so by the scientific community. Thus, from the outset it was challenging to select stories that truly helped meet our objective. Among the stories chosen for this study, there was some uncertainty with regard to the story entitled Teacher . The narration was overly absurdist for some of the participants, and their answers reflected confusion, resulting in low scores for both groups. Perhaps the story could be reformulated, or perhaps it is not a very suitable story to measure ToM among older people. In any case, this issue is yet another consequence of the lack of consensus as to how to assess mentalization skills. Therefore, an additional implication of this study would be the need to select and adapt ToM assessment tools in order to validate and implement them. Conclusion This study sheds light on the evolution of ToM abilities among older adults, providing evidence of a gradual decrease in these skills after 79 years of age. Additionally, our study confirms that age does not act as a factor in and of itself, but that the social and cognitive changes linked to aging are what truly affect people’s ability to understand the world around them. Declarations All the authors are members of the Communication and Health Research Group (COMSAL) of the FPCEE Blanquerna, Universitat Ramon Llull from Barcelona (Spain). Conflict of interest The authors declare that this study was carried out in the absence of any commercial or financial relationships that might constitute conflicts of interest. Data availability statement All the data sets generated by this study are included in the article or in complementary materials. References Achim AM, Guitton M, Jackson PL, Boutin A, Monetta L (2013) On what ground do we mentalize? Characteristics of current tasks and sources of information that contribute to mentalizing judgments. Psychol Assess Mar;25(1):117-26. http://doi.org/10.1037/a0029137 Alexopoulos GS, Kiosses DN, Heo M, Murphy CF, Shanmugham B, Gunning-Dixon F (2005) Executive dysfunction and the course of geriatric depression. 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Martínez de la Iglesia J, Onís MC, Dueñas R, Albert C, Aguado C, Luque R (2002) Versión española del Cuestionario Yesavage abreviado para el despistaje de la depresión en mayores de 65 años: adaptación y validación. Medifam 12(10):620-630. Maylor EA, Moulson JM, Muncer AM, Taylor LA 2002 Does performance on theory of mind tasks decline in old age? Br J Psychol Nov;93(Pt 4):465-85. https://doi.org/10.1348/000712602761381358. Milligan K, Astington JW, Dack LA (2007) Language and theory of mind: meta-analysis of the relation between language ability and false-belief understanding. Child Dev Mar-Apr;78(2):622-46. https://doi.org/10.1111/j.1467-8624.2007.01018.x. Moreau N, Rauzy S, Bonnefoi B, Renié L, Martinez-Almoyna L, Viallet F, Champagne-Lavau M (2015) Different Patterns of Theory of Mind Impairment in Mild Cognitive Impairment. J Alzheimers Dis 45(2):581-97. https://doi.org/10.3233/JAD-143021. Murman DL (2015) The Impact of Age on Cognition. Semin Hear Aug;36(3):111-21. https://doi.org/10.1055/s-0035-1555115. OMS (2021) World report on hearing. World Health Organization, Geneva. Pearlman-Avnion S, Ron N, Ezekiel S (2018) Ageing and Theory of Mind Abilities: The Benefits of Social Interaction. Educ Gerontol 44:5-6, 368-377. http://doi.org/10.1080/03601277.2018.1480130 Pezzuti L, Longobardi E, Milletti K, Ovidi A (2011) A study about the theory of mind in primary and secondary aging. Life Span Disabil 14(1):31–44. Poletti M, Bonuccelli U. (2013) Alteration of affective Theory of Mind in amnestic mild cognitive impairment. J Neuropsychol Mar;7(1):121-31. http://doi.org/10.1111/j.1748-6653.2012.02040.x. Premack D, Woodruff G (1978) Does the chimpanzee have a theory of mind? Behav Brain Sci 1:515–526. http://dx.doi.org/10.1017/ S0140525X00076512 Radecki MA, Cox SR, MacPherson SE (2019) Theory of mind and psychosocial characteristics in older men. Psychol Aging Feb;34(1):145-151. http://doi.org/10.1037/pag0000324. Rami L, Valls-Pedret C, Bartrés-Faz D, Caprile C, Solé-Padullés C, Castellví M, Olives J, Bosch B, Molinuevo JL (2011) Cuestionario de reserva cognitiva. Valores obtenidos en población anciana sana y con enfermedad de Alzheimer. Rev Neurol 52(04):195-201 https://doi.org/10.33588/rn.5204.2010478 Rosi A, Cavallini E, Bottiroli S, Bianco F, Lecce S (2016) Promoting theory of mind in older adults: does age play a role? Aging Ment Health 20(1):22-8. https://doi.org/10.1080/13607863.2015.1049118 Rossetto F, Baglio F, Massaro D, Alberoni M, Nemni R, Marchetti A, Castelli I (2020) Social Cognition in Rehabilitation Context: Different Evolution of Affective and Cognitive Theory of Mind in Mild Cognitive Impairment. Behav Neurol Jan;4:5204927. https://doi.org/10.1155/2020/5204927 Russell T, Tchanturia K, Rahman Q, Schmidt U (2007) Sex differences in theory of mind: A male advantage on Happé's "cartoon" task. Cognition and Emotion 21(7):1554-1564. https://doi.org/10.1080/02699930601117096 Shamay-Tsoory SG, Aharon-Peretz J (2007) Dissociable prefrontal networks for cognitive and affective theory of mind: a lesion study. Oct 1;45(13):3054-67. https://doi.org/10.1016/j.neuropsychologia.2007.05.021 Sarant J, Harris D, Busby P, Maruff P, Schembri A, Lemke U, Launer S. (2020) The Effect of Hearing Aid Use on Cognition in Older Adults: Can We Delay Decline or Even Improve Cognitive Function? J Clin Med Jan 17;9(1):254. https://doi.org/10.3390/jcm9010254 Stieger M, Lachman ME (2021) Increases in Cognitive Activity Reduce Aging-Related Declines in Executive Functioning. Front Psychiatry Jul 29;12:708974. http://doi.org/10.3389/fpsyt.2021.708974 Taljaard DS, Olaithe M, Brennan-Jones CG, Eikelboom RH, Bucks RS (2016) The relationship between hearing impairment and cognitive function: a meta-analysis in adults. Clin Otolaryngol Dec;41(6):718-729. https://doi.org/10.1111/coa.12607 Thomson RS, Auduong P, Miller AT, Gurgel RK (2017) Hearing loss as a risk factor for dementia: A systematic review. Laryngoscope Investig Otolaryngol Mar 16;2(2):69-79. https://doi.org/10.1002/lio2.65 Valero-García J, Vila-Rovira JM (2018) Descriptive study on the prevalence of Presbycusis among a population in the industrial belt of Barcelona by exploring a random sample of Primary Healthcare Center users. Eur J Investig Health Psychol Educ 8(2):79-90. https://doi.org/10.30552/ejihpe.v8i2.246 Valero-García J, Iglesias L, Silvestre N (2023) Theory of Mind and its relation to presbycusis. A pilot study, Speech Lang Hearing 26(1):11-24. https://doi.org/10.1080/2050571X.2021.1927591 Valero-García J, Ivern I, Mumbardó C, Iglesias L, Vila-Rovira JM, Pellicena MA (2022) Presbiacusia y teoría de la mente. Estudio sobre las limitaciones de las personas con presbiacusia para comprender las intenciones de su interlocutor. Revista Fiapas 179:1-15. Vélez-Coto M, Andel R, Pérez-García M, Caracuel A (2021) Complexity of work with people: Associations with cognitive functioning and change after retirement. Psychol Aging Mar;36(2):143-157. https://doi.org/10.1037/pag0000584 Verdugo MA, Gómez LE, Arias B (2009) Evaluación de la calidad de vida en personas mayores: La Escala Fumat. Inico, Salamanca. Yagi A, Nouchi R, Murayama K, Sakaki M, Kawashima R (2020) The Role of Cognitive Control in Age-Related Changes in Well-Being. Front Aging Neurosci Jul 9;12:198. http://doi.org/10.3389/fnagi.2020.00198 Walsh K, Scharf T, Keating N (2017) Social exclusion of older persons: a scoping review and conceptual framework. Eur J Ageing 14(1). http://dx.doi.org 10.1007/s10433-016-0398-8 Wechsler D (2012) WAIS IV, escala de inteligencia de Wechsler para adultos. Pearson, Madrid. Westby C, Robinson L (2014) A developmental perspective for promoting Theory of Mind. Top Lang Disord 34(4):362–382. http://doi.org/10.1097/TLD.00000000000 00035 Yıldırım E, Soncu Büyükişcan E, Gürvit H (2020) Affective theory of mind in human aging: is there any relation with executive functioning? Neuropsychol Dev Cogn B Aging Neuropsychol Cogn Mar;27(2):207-219. https://doi.org/10.1080/13825585.2019.1602706 Zhou W, Mou Z, Hong Z, Gao F, Liu S, Zhang N (2019) Gaining or losing wisdom? Developmental trends in Theory of Mind in old age. Curr Psychol. https://doi.org/10.1007/s12144-019-00394-8 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2878340","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":197156845,"identity":"85ed927b-c8f5-4cf9-a556-8efd797c3ce1","order_by":0,"name":"Ledicia Iglesias","email":"data:image/png;base64,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","orcid":"","institution":"Ramon Llull University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Ledicia","middleName":"","lastName":"Iglesias","suffix":""},{"id":197156846,"identity":"f1302146-f2fb-4e02-a83f-3907b4d78bee","order_by":1,"name":"Miquel Àngel Pellicena","email":"","orcid":"","institution":"Ramon Llull University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Miquel","middleName":"Àngel","lastName":"Pellicena","suffix":""},{"id":197156847,"identity":"8c0d8ea9-caac-42b2-aa76-feb76cc0d461","order_by":2,"name":"Jesús Valero-Garcia","email":"","orcid":"","institution":"Ramon Llull University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jesús","middleName":"","lastName":"Valero-Garcia","suffix":""},{"id":197156848,"identity":"3fc212d6-1979-4e0b-8125-933c98f2b4af","order_by":3,"name":"Ignasi Ivern","email":"","orcid":"","institution":"Ramon Llull University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ignasi","middleName":"","lastName":"Ivern","suffix":""},{"id":197156849,"identity":"fcea3842-c989-4df5-8067-c26a2f70dbda","order_by":4,"name":"Josep Maria Vila-Rovira","email":"","orcid":"","institution":"Ramon Llull University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Josep","middleName":"Maria","lastName":"Vila-Rovira","suffix":""}],"badges":[],"createdAt":"2023-04-30 07:59:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2878340/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2878340/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":36652547,"identity":"f1199999-9298-4745-8ab4-8522efb15155","added_by":"auto","created_at":"2023-05-05 15:28:27","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":26366,"visible":true,"origin":"","legend":"\u003cp\u003eResults for the various ToM story tests, by age group\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-2878340/v1/1395d1ccaada1c518b17a159.png"},{"id":37004408,"identity":"e0927493-b085-4cb8-86cb-6748deace062","added_by":"auto","created_at":"2023-05-14 14:14:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":338903,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2878340/v1/3aeee2a5-8ed3-4f54-97ed-bbbf0f2270d4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evolution of ToM abilities among older adults and the elder.","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOver the past few decades, a great deal of psychological research has been dedicated to the study of the complex construct called the theory of mind (ToM). ToM refers to a socio-cognitive skill that is needed if one is to understand the mental states of others and how they may differ from our own. This is what allows people to predict and explain others\u0026rsquo; behavior, desires, intentions, beliefs and feelings (Premack and Woodruff \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e1978\u003c/span\u003e). In other words, it is a skill that makes it possible for people to function effectively in their interpersonal relations (Milligan et al. \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Hodges et al. \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2011\u003c/span\u003e), and it allows them the flexibility to adapt to situations thanks to an understanding of complex social dynamics (McKinnon et al. 2007). This, in turn, helps reduce the risk of misunderstandings and miscommunication (Hughes and Leekam \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2004\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCurrently, many researchers tend to reject the definition of ToM as a single, monolithic cognitive construct. Instead, they argue that ToM is made up of certain dimensions or components. For example, Lucariello et al. (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2007\u003c/span\u003e) defined two distinct types of ToM. The first of them, interpersonal ToM, refers to the ability to understand the thoughts and emotions of others. The second type, intrapersonal ToM, allows a person to recognize and reflect upon his or her own mental states. Elsewhere, other authors have proposed an understanding of ToM as a complex construct affected by a number of factors, mainly falling into the affective or cognitive dimensions (Shamay-Tsoory and Aharon-Peretz \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). These researchers have described cognitive ToM as the ability to make inferences about other people\u0026rsquo;s cognitive states, beliefs, thoughts, and intentions. Meanwhile, they have defined affective ToM as the ability to infer others\u0026rsquo; feelings, affective states and emotions. It is true that there is a good deal of neuro-physiological and neuro-anatomical evidence to support these classifications of ToM. However, when researchers use instruments to test ToM skills, it is often unclear whether they are focusing on the cognitive or the affective dimension, because the two variants of ToM tend to be closely linked to one another.\u003c/p\u003e \u003cp\u003eGiven that ToM is a heterogeneous psychological construct, most tests designed to assess it consist of verbal tasks. These activities tend to include visual support and are narrated in the third person, and they require the listener to attribute mental states to characters within a defined setting. Often, people taking the tests are asked to identify social gaffes, to point out false beliefs, or to interpret ambiguous, ironic or sarcastic messages (Achim et al. \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). These tests usually assess respondents based on open-ended questions that require them to be aware of the mental state of one or more characters in order to be able to explain or predict the behavior of one of these characters (see, for example, Happ\u0026eacute; \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e1994\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere are a number of well-known ToM studies that examine this construct in childhood, but it has only been in the past decade that we have seen a proliferation of research aimed at analyzing ToM in adults, especially among people over 65 years of age.\u003c/p\u003e \u003cp\u003eThere is a certain degree of controversy as to the functioning of ToM in the aging process. Initially, Happ\u0026eacute; et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e1998\u003c/span\u003e) implemented a series of narratives intended to test the abilities of people of different ages to detect false beliefs, persuasion and irony. This study did not find any differences between older and younger adults. Later, Maylor et al. (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2002\u003c/span\u003e) replicated the study but divided the older participants into two different groups, one with a mean age of 67 and another with a mean age of 81. In this case, the results indicated a significant decline in the latter group. Other studies have also found significant differences as a function of age (Henry et al. \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Rosi et al. \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Pearlman-Avnion et al. \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Zhou et al. \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). In short, there is a body of research that shows that older people often have difficulties in completing mentalization tasks, especially when they involve second-order false beliefs, an understanding of social gaffes, and non-literal language (Laisney et al. \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Poletti and Bonuccelli \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Moreau et al. \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2015\u003c/span\u003e, among others). A recent study by Ivern et al. (to be published) with a sample of 410 people (ranging from 18 to 92 years of age; M\u0026thinsp;=\u0026thinsp;43; SD\u0026thinsp;=\u0026thinsp;17.6) found that ToM skills tend to gradually decrease with age, especially when it comes to more cognitively complex tasks.\u003c/p\u003e \u003cp\u003eElsewhere, researchers have argued that the decline in ToM scores cannot strictly be attributed to aging itself, but rather to other general aspects that are associated with the aging process. For instance,\u003c/p\u003e \u003cp\u003eWalsh et al. (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), Pearlman-Avnion et al. (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) and Clouston et al. (2019) have observed that aging tends to be accompanied not only by changes in cognitive abilities, but also by certain social and emotional transformations (including the loss of spouses and friends) that can affect older people\u0026rsquo;s social perceptions. According to this perspective, age-related changes in ToM are not linear, but instead are subject to the influence of individual aspects such as a person\u0026rsquo;s cognitive status (Charlton et al. \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Rosi, et al. \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), sex (Russell et al. \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2007\u003c/span\u003e), social functioning (Pezzuti et al. \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Radecki et al. \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; L\u0026oacute;pez-Montilla et al. \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) and education level (Lee et al. \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Pezzuti et al. \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; L\u0026oacute;pez-Montilla et al. \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). A more extreme version of this position is posed by Yıldırım et al. (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), who argue that ToM remains intact in the context of healthy aging.\u003c/p\u003e \u003cp\u003eThere are a number of potential causes of this lack of consensus among researchers in the field. Firstly, a range of different testing instruments have been used, some more focused on affective aspects of social understanding and other aimed at cognitive aspects. Secondly, tests are administered in different formats, some visually and others verbally, and the contents of the tests can be either narrative or non-narrative. Thirdly, different studies have used samples with different age ranges. For example, studies that have not found differences in terms of age have tended to select a relatively younger age range (55\u0026ndash;60 years old) to represent older adults, while studies that have found differences have focused on people from 65 to 67 years of age. Finally, the upper age limit for inclusion in studies has varied, with a maximum age of 83 in studies that did not find differences as a function of age and a maximum of 93 in studies that did find such differences.\u003c/p\u003e \u003cp\u003eThere is another factor, though, that is very common among adults over 65 years of age that has a great deal of influence on their social relations but that has received very little attention in the literature on ToM among older people. This factor is age-related hearing loss or presbycusis. Especially in its initial stages, this kind of hearing loss is often not perceived as a serious issue, and most older adults who experience it are not very aware of the problem, rendering it an underdiagnosed disorder (Valero-Garc\u0026iacute;a and Vila-Rovira \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Despite this, presbycusis is considered the third most common chronic pathology among older people, and its prevalence is increasing (WHO 2021). The most immediate effects are on the comprehension of spoken language, but in the longer term the disorder can also affect a person\u0026rsquo;s mastery of language pragmatics and his or her social participation (Taljaard et al. \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Thomson et al. \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Curhan et al. \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). In other words, in addition to potential problems with understanding what another person is saying, people can also face certain difficulties in recognizing the intentions of other speakers, as their ability to comprehend implicit or non-literal messages may have declined (Pearlman-Avnion et al. \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Goy et al. \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Thus, people with presbycusis are often prone to misunderstandings in their social relations, leading to maladjusted social behavior.\u003c/p\u003e \u003cp\u003eOne technological method of helping people with presbycusis to continue to communicate is the use of hearing aids, and there is a growing body of literature associating the use of these devices with improved social adaptation and quality of life (Amieva and Ouvrard \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Sarant et al. \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). One recent study of ToM and presbycusis (Valero-Garcia et al. 2021 and 2022) found that older people who used hearing aids tended to display better mentalization skills than those who suffered from presbycusis and did not use these devices. This finding suggests that it would be beneficial to focus attention on the possible influence of untreated presbycusis on the mentalization abilities of older people.\u003c/p\u003e \u003cp\u003eIn light of the above, we believe more research is needed to shed light on how ToM abilities evolve among normally developing older people while taking into account the presence of presbycusis as a variable. Indeed, the lack of consideration of hearing loss may be one explanation for the inconclusive results described above.\u003c/p\u003e\n\u003ch3\u003eStudy objective and hypotheses\u003c/h3\u003e\n\u003cp\u003eThe aim of this study is to shed light on how the mentalization abilities of people over 65 years of age evolve in a context of healthy aging (meaning among people who do not suffer from neurodegenerative pathologies generally associated with aging). We will seek to answer the following research questions:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIn a healthy aging process, does the ability to complete mentalization tasks decrease with age?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAre all the components of ToM equally affected by this decrease in mentalization skills, or are some more affected than others? 3.- What other sociodemographic factors might affect people\u0026rsquo;s performance on mentalization tasks?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eWe pose the following hypotheses: [H\u003csub\u003e1\u003c/sub\u003e] ToM skills decrease with age. [H\u003csub\u003e2\u003c/sub\u003e] Results on narrative tests will be lower when the stories require an understanding of false beliefs, as this is a more cognitively complex component of ToM. [H\u003csub\u003e3\u003c/sub\u003e] Age, poor cognitive functioning and worsening social relations all make large contributions to the decrease in the mentalization abilities of older people.\u003c/p\u003e"},{"header":"Materials and method","content":"\u003cp\u003eThis study was approved in 2021 by the Research Ethics Committee of Universitat Ramon Llull in Barcelona. The study was carried out in accordance with the principles of the Helsinki Declaration and made use of the clinical method of data collection through semi-structured interviews and the administration of non-harmful tests.\u003c/p\u003e\n\u003ch2\u003eParticipants\u003c/h2\u003e\n\u003cp\u003eParticipation was voluntary and subject to informed consent. On a random basis, requests were sent to city-run leisure centers for older people\u003csup\u003e\u003csup\u003e[1]\u003c/sup\u003e\u003c/sup\u003e, a health and social center\u003csup\u003e\u003csup\u003e[2]\u003c/sup\u003e\u003c/sup\u003e, and a number of nursing homes\u003csup\u003e\u003csup\u003e[3]\u003c/sup\u003e\u003c/sup\u003e, all in the Barcelona metropolitan area. Participants were informed as to the objectives and the methodology of the study and voluntarily signed informed consent documents. The exclusion criteria were 1) a clinical history of another neurological disease, behavioral disorders or epilepsy, 2) a clinical history of psychiatric disorders, 3) cognitive deterioration 4) use of medications known to affect cognitive functioning.\u003c/p\u003e\n\n\u003ch2\u003eMaterials and procedure\u003c/h2\u003e\n\u003cp\u003eThe participants in the study were first interviewed in order to gather sociodemographic data. Then, the following tests were administered to them on an individual basis:\u003c/p\u003e\n\u003cp\u003e\u003cu\u003e1/ Cognitive assessment\u003c/u\u003e.-\u003c/p\u003e\n\u003cp\u003eAn overall score of 7 points on the WAIS IV (Wechsler 2012) Vocabulary and Matrix Tests was established as the minimum to qualify to be included in the sample for the study, thus guaranteeing that participants would be able to understand the stories selected to assess their ToM. A total of 16 participants were excluded for this reason. This initial cognitive exploration also allowed us to become familiar with the cognitive capacity of the participants.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003e2/ ToM assessment\u003c/u\u003e.-\u003c/p\u003e\n\u003cp\u003eIn order to test the participants\u0026rsquo; abilities to successfully complete mentalization or ToM tasks, they were administered a test consisting of eight oral stories, which was also used by Ivern et al. (to be published). The stories are designed to make it possible to infer the intentions, emotions and/or beliefs of their characters. They are aimed at assessing the following domains of ToM: sarcasm (two stories), first-order false beliefs (one story), second-order false beliefs (two stories), social abilities (two stories) and persuasion (one story). Each participant was told the stories orally, always in the same order. The stories were accompanied by text and by images that had been designed to illustrate them.\u003c/p\u003e\n\u003cp\u003eAfter listening to each story, the participants were asked for their opinions about what they had just heard and read. Responses were considered correct when participants were able to identify the intentions underlying the comments made by the characters in the stories.\u003c/p\u003e\n\u003cp\u003eFollowing Happ\u0026eacute; et al. (1998), the assessment criteria were as follows: two points for a correct reference to mentalization-related aspects of the characters in the story, one point for a partial or confusing reference to mentalization, and zero points for an incorrect answer. The overall score can range from 0 to 16 puntos. \u003c/p\u003e\n\u003cp\u003eAdditional instruments were administered to assess the following variables:\u003c/p\u003e\n\u003cp\u003e3/ \u003cu\u003eDepression\u003c/u\u003e.-\u003c/p\u003e\n\u003cp\u003eSome studies have found links between depression and a clear risk of cognitive decline, a reality that complicates depression research with the olders (Alexopoulos et al. 2005). Therefore, this study used the Geriatric Depression Scale (GDS) (Sheik and Yesavage 1983; cited in Mart\u0026iacute;nez de la Iglesia et al. 2002) to gather mood-related data on participants. A minimum value of 20 points was established as an inclusion criterion. Not participants were excluded as a result of this test.\u003c/p\u003e\n\u003cp\u003e4/ \u003cu\u003eCognitive reserve\u003c/u\u003e.-\u003c/p\u003e\n\u003cp\u003eThe Cognitive Reserve Questionnaire (Rami et al. 2011) was administered in order to provide a reference that could subsequently be correlated with the results of the ToM tests.\u003c/p\u003e\n\u003cp\u003e5/ \u003cu\u003eSocial activity\u003c/u\u003e.-\u003c/p\u003e\n\u003cp\u003eData were gathered on the participants\u0026rsquo; level of social activity via a semi-structured interview that was intended to gather information about their social participation (hobbies, friendships, leisure and degree of satisfaction). The questions were inspired by the interpersonal relations subscale of the FUMAT Quality of Life Scale (Verdugo et al. 2009). Participants\u0026rsquo; degrees of social participation were classified as limited, moderate or extensive.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003e6/ Hearing assessment\u003c/u\u003e. \u0026ndash; A pure-tone audiometry test was used to determine the auditory thresholds (between 0.5 y 8 kHz), following the methodology established by the ASHA (1978). Hearing loss was calculated according to criteria from BIAP (1997). In order to determine whether a person had presbycusis, the WHO (2021) criteria were adopted. The WHO defines this disorder as an acquired loss of hearing in both ears that exceeds 40 dB in the better of the two ears. In our sample, there were 57 people who had presbycusis and did not regularly (at least eight hours a day) use hearing aids. These people were excluded from the final sample.\u003c/p\u003e\n\n\u003ch2\u003eStatistical analysis\u003c/h2\u003e\n\u003cp\u003eThe software package IBM SPSS Statistics, version 28.0.1 (IBM, Corp. 2021) was used to conduct descriptive and inferential data analyses. In terms of descriptive data, it is worth highlighting the characteristics of the population, as well as the mean values and standard deviations for the continuous variables and the percentages for the qualitative variables. The inferential analyses included the use of Student\u0026rsquo;s t-test to determine whether there were differences between the different age groups in the sample. Then, a linear regression model was used to examine the associations between the statistically significant independent variables and the overall ToM scores. The level of statistical significance was set at \u003cem\u003ep\u003c/em\u003e\u0026lt; 0,05.\u003c/p\u003e\n\n \u003cp\u003e\u003csup\u003e\u003csup\u003e[1]\u003c/sup\u003e\u003c/sup\u003e Casal d\u0026rsquo;avis de Lli\u0026ccedil;\u0026agrave; d\u0026rsquo;Amunt and Esplai municipal de Sant Fruit\u0026oacute;s de Bages, both in Barcelona.\u003c/p\u003e\n\n\n \u003cp\u003e\u003csup\u003e\u003csup\u003e[2]\u003c/sup\u003e\u003c/sup\u003e Cl\u0026iacute;nica Sociosanitaria Ntra. Se\u0026ntilde;ora de la Guadalupe de Esplugues del Llobregat.\u003c/p\u003e\n\n\n \u003cp\u003e\u003csup\u003e\u003csup\u003e[3]\u003c/sup\u003e\u003c/sup\u003e Centro Geri\u0026aacute;trico Sanitas Altanova; Residencia Geri\u0026aacute;trica Torrassa and Centro Residencial Rosben.\u003c/p\u003e\n \n"},{"header":"Results","content":"\u003cp\u003eThe final sample was made up of 69 people (23 men and 46 women) ranging in age from 65 to 94 (M\u0026thinsp;=\u0026thinsp;76.1; SD\u0026thinsp;=\u0026thinsp;7.9). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates how ToM evolves over time among older people. The results are divided into two groups: (A) Older adults (65\u0026ndash;79 years old); (B) the elders (\u0026gt;\u0026thinsp;79 years old).\u003c/p\u003e \u003cp\u003eThe data indicate that there were no significant differences between the two groups in terms of education level or social activity. Meanwhile, Student\u0026rsquo;s t-test did indicate that there were statistically significant differences (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05) between the age groups in cognitive reserve. There were also statistically significant differences in their results for the \u0026ldquo;violin\u0026rdquo; and \u0026ldquo;salesperson\u0026rdquo; story tests, as well as in their overall scores for ToM.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic data on the sample and overall results.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Group A)\u003c/p\u003e \u003cp\u003e65\u0026ndash;79\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(Group B)\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;79\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eStudent\u0026rsquo;s t\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCohen\u0026rsquo;s d\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eDemographic characteristics\u003c/span\u003e\u003c/p\u003e \u003cp\u003eAge\u003c/p\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71.2 (4.5)\u003c/p\u003e \u003cp\u003e15 Men/30 Women\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85.2 (3.5)\u003c/p\u003e \u003cp\u003e8 Men/16 Women\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eEducation level\u003c/span\u003e\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;8 years %\u003c/p\u003e \u003cp\u003e8\u0026ndash;12 years %\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;12 years %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38%\u003c/p\u003e \u003cp\u003e27%\u003c/p\u003e \u003cp\u003e35%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42%\u003c/p\u003e \u003cp\u003e29%\u003c/p\u003e \u003cp\u003e29%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSocial activity\u003c/span\u003e\u003c/p\u003e \u003cp\u003eLimited\u003c/p\u003e \u003cp\u003eModerate\u003c/p\u003e \u003cp\u003eExtensive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003cp\u003e18%\u003c/p\u003e \u003cp\u003e70%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17%\u003c/p\u003e \u003cp\u003e25%\u003c/p\u003e \u003cp\u003e58%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCognition\u003c/span\u003e\u003c/p\u003e \u003cp\u003eCognitive reserve\u003c/p\u003e \u003cp\u003eVR\u003c/p\u003e \u003cp\u003eLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.4 (4.8)\u003c/p\u003e \u003cp\u003e12.3 (3.2)\u003c/p\u003e \u003cp\u003e12.3 (3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.2 (5.1)\u003c/p\u003e \u003cp\u003e11,3 (3.0)\u003c/p\u003e \u003cp\u003e12.0 (3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.78 \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.040*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.461\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eToM Sarcasm\u003c/span\u003e\u003c/p\u003e \u003cp\u003eBank\u003c/p\u003e \u003cp\u003eConfused father\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,6 (.68)\u003c/p\u003e \u003cp\u003e1.5 (.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,5 (.65)\u003c/p\u003e \u003cp\u003e1.5 (.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eToM False belief\u003c/span\u003e\u003c/p\u003e \u003cp\u003eViolin (1st order)\u003c/p\u003e \u003cp\u003ePrisoner (2nd order)\u003c/p\u003e \u003cp\u003eSalesperson (2nd order)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.9 (.14)\u003c/p\u003e \u003cp\u003e1.2 (.86)\u003c/p\u003e \u003cp\u003e.96 (.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.7 (.69)\u003c/p\u003e \u003cp\u003e1.2 (.77)\u003c/p\u003e \u003cp\u003e.58 (.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.88 \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.035*\u003c/p\u003e \u003cp\u003e1.87 \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.033*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.638\u003c/p\u003e \u003cp\u003e.441\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eToM Social abilities\u003c/span\u003e\u003c/p\u003e \u003cp\u003eCurtains\u003c/p\u003e \u003cp\u003eTeacher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.8 (.45)\u003c/p\u003e \u003cp\u003e1.0 (.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5 (.65)\u003c/p\u003e \u003cp\u003e.83 (.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eToM Persuasion\u003c/span\u003e\u003c/p\u003e \u003cp\u003eKittens\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.7 (.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.6 (.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSum of ToM stories\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.8 (.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.4 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.80 \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.038*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.431\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e* \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFigure 1 is a graph that depicts the average scores for each story recorded by the two age groups. The stories are in order from highest to lowest average scores. As discussed above and depicted in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, in most cases there are no statistically significant differences between the groups. The easiest stories were those that were the least cognitively complex, while the stories involving more cognitive difficulty tended to result in a greater number of errors. These more difficult stories were usually those involving an understanding of second-order false beliefs (prisoner and salesperson). The \u0026ldquo;teacher\u0026rdquo; story is designed to test social skills, but its difficulty might reside in the need to detect absurdity.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the results of the various ToM story tests broken down by the domains that they measure: sarcasm, false beliefs and social skills. These results indicate that the only statistically significant differences between the group of older adults and the elders were in the stories measuring false beliefs (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.00; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eToM stories by domain measured.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Group A)\u003c/p\u003e \u003cp\u003e65\u0026ndash;79\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(Group B)\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;79\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eStudent\u0026rsquo;s t-test\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCohen\u0026rsquo;s d\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSarcasm\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.08 (1.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.04 (1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.14 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.883)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFalse beliefs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.22 (1.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.45 (1.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.00 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.508\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocial skills\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.80 (1.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.41 (1.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.36 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.178)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAfter the comparison of the mean scores of the two age groups and the analysis of statistically significant differences, calculations were carried out to determine the influence of various independent variables on the overall score for the ToM stories. A linear regression model was created, with the following treated as independent variables: age, social activity (SA), education, cognitive reserve (CR), logical reasoning (LR) and verbal reasoning (VR). Values near 1 on the tolerance index and lower than 2.0 on the VIF for the independent variables suggested the absence of multicollinearity, with the exceptions of the variables CT, LR and VR, all of which measure cognitive functioning. More specifically, the VIF values for these variables ranged from 2.1 to 2.7, slightly above the cut-off point of 2.0 recommended by Tabachnick and Fidell (2013).\u003c/p\u003e \u003cp\u003eNeither the shape of the residual distributions, nor the comparison of the residual scatter plots with those provided by Tabachnick and Fidell (2013) for the set of independent variables as a whole, nor a separate examination of each independent variable indicated any problems in terms of the normality, linearity and homoscedasticity of residuals. The Durbin-Watson test value was 1.31 for the hierarchical regression analysis. This showed that there was no autocorrelation between the residuals. Finally, no cases were found with a standardized residual in excess of about |3.3|, indicating no outliers in the solution.\u003c/p\u003e \u003cp\u003eThe model obtained through the regression model yielded values of F\u003csub\u003e(6)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;7.86 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) and R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.432. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the contribution of each of the variables to the resulting regression model.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eContribution of each variable to the overall ToM score.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eVR\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePartial\u003c/p\u003e \u003cp\u003ecorrelation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.427\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.243\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e Thus, the variables that had the greatest influence on the overall ToM score were Social Activity (SA), followed (although with a significantly lower contribution) by Verbal Reasoning (VR). Age was also an influential variable, but to a much lesser extent, while education level and logical reasoning do not seem to have any influence on the results.\u003c/p\u003e \u003cp\u003eA model was also created for the specific ToM stories measuring the false beliefs domain, in an attempt to explore which variables exert the greatest influence on the results of these specific tests. The explanatory model uses the same independent variables mentioned above with regard to the regression model for the overall ToM score. Here, the result was F\u003csub\u003e(6)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;5.20 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), and the model yielded a value of R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.335. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the contributions of each variable to the regression model.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eContribution of each variable to the score for false beliefs.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eVR\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePartial\u003c/p\u003e \u003cp\u003ecorrelation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.312\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.055\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.217\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOnce again, the most relevant variables are social activity and verbal reasoning, meaning that these variables exert the largest influence on the results of the ToM story tests involving false beliefs.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe main aim of this study was to investigate whether mentalization abilities tend to decline with age starting at the age of 65, and to explore the factors that may play a role in this decrease.\u003c/p\u003e \u003cp\u003eThe study\u0026rsquo;s first hypothesis was [H\u003csub\u003e1\u003c/sub\u003e]: ToM abilities begin to decrease after the age of 65, and after that point they continue to decrease with age.\u003c/p\u003e \u003cp\u003eThe data in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e partially corroborate this first hypothesis. Firstly, while there is an apparent age-related decrease in mentalization ability, the decrease seems to be gradual. The group of older adults performed slightly better on most of the tasks than their elder counterparts, with the exception of a few tests on which they recorded similar scores, specifically, \u003cem\u003eConfused father\u003c/em\u003e and \u003cem\u003ePrisoner\u003c/em\u003e. Typical aging tends to be linked to decreased cognitive performance, especially on tasks that require fast processing and transformation of information (Murman \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Yagi et al. \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Stieger and Lachman \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). More specifically, imprecise executive functioning and a lack of working memory can gradually detract from people\u0026rsquo;s mentalization abilities as the age. Indeed, other recent studies of age groups ranging from 50 to 80 years old have shown, there is a correlation between working memory and the successful completion of mentalization tasks (Yıldırım et al, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). In our study, the cognitive results for the group of participants of over 79 years of age seem to confirm this tendency.\u003c/p\u003e \u003cp\u003eIn any case, additional research is needed to shed further light on the true impact of working memory on mentalization activities, especially among the elders.\u003c/p\u003e \u003cp\u003eIn connection with the above, it is worth underscoring that not all kinds of mentalization tasks seem to be equally affected by aging. This finding echoes the results of studies by Laisney et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), Poletti and Bonuccelli (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) and Moreau et al. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). In this case, the stories that saw the biggest differences between the two age groups, \u003cem\u003eViolin\u003c/em\u003e and \u003cem\u003eSalesperson\u003c/em\u003e, were those that tested the understanding of false beliefs.\u003c/p\u003e \u003cp\u003eIt should also be noted that when the tests were being administered, the participants were not always able to go beyond the literal meaning of the stories in order to understand their \u0026ldquo;implicit messages.\u0026rdquo; This was clearly reflected in the difficulties some experienced in responding appropriately to the stories involving an understanding of sarcasm, such as \u003cem\u003eConfused father\u003c/em\u003e, or of the absurd, such as \u003cem\u003eTeacher\u003c/em\u003e. These stories seemed to cause confusion among some of the participants, which hindered their understanding and their ability to use mentalization to respond. We believe that this might explain, at least to a degree, why the elders group in the study recorded lower scores for mentalization skills, especially in some specific areas tested by certain stories.\u003c/p\u003e \u003cp\u003eThe second hypothesis was [H\u003csub\u003e2\u003c/sub\u003e]: \u003cem\u003eThe scores for the group of the elders will be significantly lower for the stories testing the understanding of false beliefs, as this is a more cognitively complex aspect of ToM.\u003c/em\u003e The data confirm this hypothesis, in that only in this dimension were statistically significant differences between the two age groups found (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Other studies in a similar vein that have compared older adults experiencing cognitive decline with healthy older adults have found that the ability to resolve first-order tasks tends to remain more intact than the ability to complete second-order tasks (Rossetto et al. \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The latter are more complex because they involve the activation of various cognitive processes. In order to complete these tasks, a person must first process immediate linguistic information, along with contextual information about the setting of the story. Secondly, he or she must be able to recall and apply knowledge about both the role played by the character in the story and its setting. This information is sometimes included only implicitly in the story, so the tasks require the person\u0026rsquo;s attention and the ability to access his or her store of memories and experiences, which are as varied as the individual\u0026rsquo;s own knowledge of the world. Once again, these findings echo those of earlier studies conducted with a healthy population, which have found that the factor with the greatest influence on the decrease in ToM is not so much aging in and of itself, but rather the cognitive status of the individual (Walsh et al. \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Pearlman-Avnion et al. \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile there is some evidence as to the relationship between cognitive status and the ability to complete mentalization tasks, researchers have yet to come to an agreement as to how to properly disentangle the cognitive processes involved and to identify those that play the greatest role. Doing so would help determine the varying degrees of complexity of different mentalization activities.\u003c/p\u003e \u003cp\u003eFinally, the third hypothesis was [H\u003csub\u003e3\u003c/sub\u003e]: \u003cem\u003eAge, poor cognitive functioning and worsening social relations all make large contributions to the decrease in the mentalization abilities of older people.\u003c/em\u003e Indeed, we can conclude that these three factors influence the overall results on the story tests, as all of them displayed positive correlations with ToM scores. However, the model yielded by the calculations suggests that the cause of the gradual decline of mentalization skills is not age itself, but rather individual factors such as social activity and cognitive capacity, especially when it comes to verbal reasoning.\u003c/p\u003e \u003cp\u003eThe differences between the two age groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) in education level and social activity do not reach the level of statistical significance, but the group of people over 79 did have more participants who had had less schooling and an overall lesser degree of social activity. These lower scores among the older group correspond to poorer performance on cognition tasks and on overall ToM.\u003c/p\u003e \u003cp\u003eThese results are consistent with the findings of other recent research into healthy aging. Indeed, studies have found that age-related life changes, such as retirement, deteriorating health and decreased social relations, are linked to a reduction in opportunities to engage in stimulating cognitive activities, a situation that can contribute to cognitive decline (Clouston et al. 2019; L\u0026ouml;vd\u0026eacute;n et al. \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Stieger and Lachman \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; V\u0026eacute;lez-Coto et al. \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn light of the above, to promote healthy aging it would be desirable to encourage older people to socialize often, as social activities contribute to improvements in ToM skills (Cavallini et al. \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; L\u0026oacute;pez-Montilla et al. \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). In fact, researchers such as Lecce et al. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), Rossetto et al. (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) and Livingston et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) go even further along these lines, maintaining that direct mentalization-based interventions aimed at healthy older people can be effective at preventing cognitive decline and dementia. The results of our study seem to help confirm the potential of such preventive measures.\u003c/p\u003e \u003cp\u003eTherefore, our study adds to the existing body of literature that underlines the importance of prevention among the healthy population of older adults and the elders. Interventions aimed at improving ToM abilities would do well to target social and cognitive skills. Conversely, as Rosi et al. (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) and Rosseto et al. (2020) have argued, mentalization activities can help prevent deterioration linked to age-related social and cognitive changes. This approach is likely to lead to improvements in the quality of life of older adults.\u003c/p\u003e \u003cp\u003e \u003cb\u003eLimitations and future research.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIt is important to interpret this study\u0026rsquo;s results while bearing in mind its limitations.\u003c/p\u003e \u003cp\u003eOne limitation is connected to the sample. The study included a small number of participants. With a larger sample, the results would have been more robust. We faced some obstacles in the recruitment of participants of over 79 years of age, as it can be difficult to find healthy aging people in this age group without any comorbidities.\u003c/p\u003e \u003cp\u003eA second limitation of this study is connected to the variable of social activity. The intention was to collect information on the frequency of leisure, free time activities and interpersonal relationships. The analysis of these activities was quantitative, but our study did not take into account the qualitative information provided by the participants about their perception of how these social activities contributed to their wellbeing and life satisfaction. A closer examination of these factors would have shed more light on the construct or older people\u0026rsquo;s quality of life and its correlation with their ToM abilities. In fact, the FUMAT scale applied in this study features additional subscales designed to assess respondents\u0026rsquo; quality of life more thoroughly, so by applying the full instrument it would be possible to gain a fuller picture. Thus, we believe that future studies should explore this aspect more deeply.\u003c/p\u003e \u003cp\u003eA third limitation is rooted in the study\u0026rsquo;s methodology. Specifically, this study provides additional evidence of the challenges involved in selecting a tool to assess ToM skills. It is a complex construct that calls upon a number of cognitive and social abilities, and the difficulties associated in assessing and analyzing it are reflected in the wide range of complex mechanisms that have been used to do so by the scientific community. Thus, from the outset it was challenging to select stories that truly helped meet our objective. Among the stories chosen for this study, there was some uncertainty with regard to the story entitled \u003cem\u003eTeacher\u003c/em\u003e. The narration was overly absurdist for some of the participants, and their answers reflected confusion, resulting in low scores for both groups. Perhaps the story could be reformulated, or perhaps it is not a very suitable story to measure ToM among older people. In any case, this issue is yet another consequence of the lack of consensus as to how to assess mentalization skills. Therefore, an additional implication of this study would be the need to select and adapt ToM assessment tools in order to validate and implement them.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study sheds light on the evolution of ToM abilities among older adults, providing evidence of a gradual decrease in these skills after 79 years of age. Additionally, our study confirms that age does not act as a factor in and of itself, but that the social and cognitive changes linked to aging are what truly affect people\u0026rsquo;s ability to understand the world around them.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAll the authors are members of the Communication and Health Research Group \u003cem\u003e(COMSAL)\u003c/em\u003e of the FPCEE Blanquerna, Universitat Ramon Llull from Barcelona (Spain).\u003c/p\u003e\n\u003cp\u003eConflict of interest\u003c/p\u003e\n\u003cp\u003eThe authors declare that this study was carried out in the absence of any commercial or financial relationships that might constitute conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the data sets generated by this study are included in the article or in complementary materials.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAchim AM, Guitton M, Jackson PL, Boutin A, Monetta L (2013) On what ground do we mentalize? 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Eur J Ageing 14(1). http://dx.doi.org 10.1007/s10433-016-0398-8\u003c/li\u003e\n\u003cli\u003eWechsler D (2012) WAIS IV, escala de inteligencia de Wechsler para adultos. Pearson, Madrid.\u003c/li\u003e\n\u003cli\u003eWestby C, Robinson L (2014) A developmental perspective for promoting Theory of Mind. Top Lang Disord 34(4):362\u0026ndash;382. http://doi.org/10.1097/TLD.00000000000 00035\u003c/li\u003e\n\u003cli\u003eYıldırım E, Soncu B\u0026uuml;y\u0026uuml;kişcan E, G\u0026uuml;rvit H (2020) Affective theory of mind in human aging: is there any relation with executive functioning? Neuropsychol Dev Cogn B Aging Neuropsychol Cogn Mar;27(2):207-219. https://doi.org/10.1080/13825585.2019.1602706\u003c/li\u003e\n\u003cli\u003eZhou W, Mou Z, Hong Z, Gao F, Liu S, Zhang N (2019) Gaining or losing wisdom? Developmental trends in Theory of Mind in old age. Curr Psychol. https://doi.org/10.1007/s12144-019-00394-8\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Theory of mind, social activity, verbal reasoning, aging, prevention","lastPublishedDoi":"10.21203/rs.3.rs-2878340/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2878340/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eTheory of Mind (ToM) is a construct of cognitive, social and affective skills that contributes to a better effectiveness of interpersonal relationships, as well as a better understanding of social scenarios. Its evolution throughout adulthood is being subject of extensive study. We have done a quasi-experimental design study with a healthy aging sample of 69 people ranging in age from 65 to 94. The purpose was to understand the evolution of ToM abilities in this group of age; to determine whether these abilities evolve equally and clarify which aspects influence this evolution.\u003c/p\u003e \u003cp\u003eResults show a progressive decrease in the scores registered in the elders, mainly from the age of 79. But this decline is uneven, since 2nd order false belief tasks, that is, tasks with greater cognitive complexity, obtain worse results at an older age. On the other hand, findings indicate that the variable that has the most influence on ToM skills is social activity, followed by verbal reasoning. Likewise, in line with the most recent literature, age itself is not shown as a factor that justifies the decrease in mental abilities, but rather the individual social and cognitive changes associated with it.\u003c/p\u003e \u003cp\u003eThese results reinforce the link between social activity, mental performance and cognitive health, in such a way that social activity based on interpersonal relationships becomes a tool for the prevention of social isolation and cognitive deterioration associated with the most advanced stages of adulthood.\u003c/p\u003e","manuscriptTitle":"Evolution of ToM abilities among older adults and the elder.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-05-05 15:28:22","doi":"10.21203/rs.3.rs-2878340/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"41491e7b-cad0-4185-a6b3-8eeb60798b84","owner":[],"postedDate":"May 5th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-05-14T14:14:12+00:00","versionOfRecord":[],"versionCreatedAt":"2023-05-05 15:28:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2878340","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2878340","identity":"rs-2878340","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}