Ecological Factors Influencing Decision-Making Among Middle-Aged and Older Adults: A Neurocognitive Approach

Introduction: Decision-making capacity (DMC) significantly influences the autonomy and well-being of middle-aged and older adults. While extensive research has addressed cognitive determinants of decision-making, less attention has been given to ecological factors, especially within non-Western contexts. This study aims to assess ecological influences (social environment, emotional states, stress levels) on decision-making competence among the older population in Pakistan, employing a neurocognitive approach to address gaps in culturally diverse research.

Methods: A quantitative cross-sectional study was conducted from September to October 2024, involving 100 adults aged ≥45 years from Rawalpindi and Islamabad. Participants completed a structured questionnaire incorporating demographic information, the Adult Decision-Making Competence (A-DMC) scale, the Satisfaction with Life Scale (SWLS), the Geriatric Depression Scale (GDS), and assessments of ecological and cognitive factors. Data was analyzed using IBM SPSS Version 26 (IBM Corp., Armonk, NY), employing descriptive statistics, correlations, independent sample t-tests, ANOVA, and regression analyses.

Results: Marital status and living arrangements significantly influenced social environment perceptions (p = 0.03), stress levels (p = 0.05), and cognitive engagement (p = 0.01). Married individuals reported better social environments and lower stress than single participants. Individuals living with family showed higher subjective well-being (M=19.61±4.53) compared to those living alone (M=17.33±7.09) or with friends (M=13.20±6.69; F=4.65, p<0.01). Age groups showed non-significant trends in decision-making scores, with seniors (65+ years) scoring lower (M=33.75±20.33) compared to pre-seniors (M=45.21±14.05) and middle-aged adults (M=44.35±13.33; p=0.06). Regression analysis indicated minimal predictive value of social environment, ecological context, and physical environment for decision-making competence (R²=0.014, p=0.711).

Conclusion: The findings underscore the significant roles of marital status and living contexts in shaping psychological well-being, social interactions, and stress in middle-aged and older adults. Decision-making appears less directly influenced by ecological contexts, indicating potential resilience due to life experience. Future research should employ longitudinal designs and broader samples to enhance understanding and generalizability.