July 2007
418
The Psychologist Vol 20 No 7
R EMEMBERING is not simply amatter of freezing particular piecesof information in our minds so that
we can return to them at a later date, like a
series of photographs. The brain actually
filters out most of what it receives; memory
is a reconstructive process, the creation of a
coherent framework for the information
available to our senses.
There are various memory processes
which help us achieve this goal – one is the
ability to put things into a semantic context
if we intend to create an appropriate
framework for them. This ability has been
described as a capacity to ‘gist’ (Gallo,
2006). It is a crucial element in healthy
memory, but there is controversy about its
condition in people who suffer from
amnesic disorders, such as Alzheimer’s.
One method of examining gist memory
is through false memories. As their name
suggests, these are inaccurate memories or
memories of events that never actually
occurred (Schacter, 1995). There is
evidence that even healthy individuals
regularly acquire false memories, both
experimental (Loftus, 1991) and through
some extremely striking real-life cases
(Clifasefi et al., in press). One such
example is the ‘Satanic ritual abuse’ panic
that affected certain areas of America in the
1980s. During this time, numerous adults
claimed to have recovered memories of
being sexually and physically abused as
children, and many of the accused received
long jail sentences. However, a lot of these
memories were the result of a highly
controversial psychological therapy called
‘recovered memory therapy’, which used
various techniques to ‘recover’ repressed
memories from patients. This type of
therapy has since been heavily criticised,
and it is now suggested that the memories
of child abuse were actually implanted
rather than recovered. As a result, many of
the jail sentences were overturned and many
of the therapists responsible were sued.
It is perhaps counterintuitive that false
memories can exist in a healthy mind, but
if we look at them in the context of
memory as a reconstructive process, and
particularly in relation to the ability to gist,
it becomes more understandable. Since the
ultimate goal of memory, in this view, is to
make sense of our experience rather than to
remember it exactly as it occurred, it would
be reasonable for our memory to endorse
inaccurate or false interpretations of events,
if these interpretations would assist us in
making sense of our experience. In
addition, it is likely that these false
memories would be semantically related to
the experience itself, since they exist to
make sense of it, and hence their
occurrence might well be linked with the
ability to gist effectively.
This process has been demonstrated in a
series of experiments that asked healthy
participants to study semantically related
word lists, which converged on certain
target words, sometimes called related
lures. For example, one list from an
experimental paradigm called the DRM
(Roediger & McDermott, 1995) contains
the words hot, snow, warm, winter, ice,
wet, frigid, chilly, heat, weather, freeze, air,
shiver, arctic and frost, but not the related
lure cold. Participants then completed a
recall or recognition phase, and the results
showed that people consistently produced
or recognised the related lures that were
not actually on the original lists.
These experiments using related word
lists have been modified and extended to
study patterns of false recognition across
different groups. For instance, it has been
found that younger adults recognise fewer
related lures than older adults (Balota et
al., 1999; Norman & Schacter, 1997;
Schacter et al., 1997). In one way this
result might seem surprising, as it could
imply that old adults have a better gist
memory than young adults, but further
experiments reveal this is not the case
(Dehon & Bredart, 2004). It appears
instead that younger adults simply have a
better item-specific memory and use this to
exclude some of the related lures that our
gist might endorse (Balota et al., 1999;
Budson et al., 2000; Kensinger & Schacter,
1999).
When false recognitions are studied in
people suffering from memory disorders
such as Alzheimer’s disease (AD), the
results are quite striking. Given that their
memory for specific items is so poor, we
might expect AD patients to show a
substantial increase in the number of
related lures they falsely recognise.
However, the results indicate the complete
opposite – they falsely recognise even
fewer related lures than healthy young
adults (Schacter et al., 1996; Budson et al.,
2000, 2001).
A large body of literature explains this
result by inferring that AD patients have an
impaired gist memory (Budson et al., 2000,
2001, 2006; Gallo et al., 2006; Schacter et
al., 1996). This certainly seems like a
rational explanation, but there may be
another way of looking at the results that
would lead to a different conclusion. It
could be that in order to gist, we need a
certain amount of information to gist from.
Whilst it may not have been tested, it
seems common sense that we would get a
clearer gist from a list of 20 related items
than we would from a list of two. Hence an
JACK NISSAN, winner in the undergraduate category of
our Student Writer Competition, on surprising findings
surrounding the memory of people with Alzheimer’s.
Getting the gist
Judges’ report
This was the ninth annual Student Writer Competition, sponsored by The Psychologist, the Research
Board and the Professional Practice Board.The number of entries was disappointing this year, particularly
from postgraduates; however, we think we have still ended up with worthy winners.
Articles were rated blind on quality of writing; clarity of argument; and accessibility, relevance and
interest for The Psychologist’s audience.We thought that both winners showed originality in choice of
topic and approach, that would be likely to engage our wide-ranging audience.
The winners get an expenses-paid trip to the Society’s London Lectures or Annual Conference.We
look forward to all your entries next year.
Jon Sutton (Editor,The Psychologist)
Paul Redford (Chair, Psychologist Policy Committee)

increased item-specific memory, whilst
being able to oppose gist memory in one
sense, might at the same time enhance it,
since the more items one has available, the
better the gisting resources.
An experiment in which the entire
study-test procedure was repeated across
five trials (Budson et al., 2000) found that
false recognition in AD patients actually
increased over trials, in sharp contrast with
young adults, whose false recognition
decreased (due to an improved memory for
specific items), and old adults whose false
recognition remained fairly stable. While
the authors explain this result in terms of
an impaired gist memory in the AD
patients that improves with repetition, it
could instead be that their impaired item-
specific memory improves, which in turn
enables their intact gist memory to come
into play. However, unlike healthy adults,
they may still be unable to remember
enough specific items to suppress the gist
representations now available to them.
There is some evidence that supports
this theory, notably from studies conducted
by Balota and colleagues (Balota et al.,
1999; Watson et al., 2001) which analyse
the number of false recognitions of related
lures with respect to the number of true
recognitions of studied items. They
matched AD patients who performed well
on true recognition of studied words with
healthy older adults who performed poorly
on this measure, and found that under these
conditions AD patients did not produce
fewer false recognitions than older adults.
Since true recognition of studied items can
be seen as a measure of item-specific
memory, this seems to imply that the
reduced number of false recognitions
commonly found in AD patients is more a
result of their poor item-specific memory
than of a damaged gist memory.
Some support for this theory also comes
from the literature on semantic memory in
AD. There is a debate over whether AD
damages semantic memory itself (e.g.
Gollan et al., 2006) or whether it damages
other functions which interfere with the
access to semantic memory (Balota et al.,
1999; Watson et al., 2001). In a similar
way, the false recognition results of
amnesic patients could imply either
damage to their gist memory itself or an
inability to access it, perhaps due to the
poor item-specific memory caused by the
amnesia.
Another observation that questions the
assumption that gist memory is damaged in
AD patients is that this reduction in false
recognitions has been found in patients
suffering a variety of amnesias and
amnesic syndromes, in addition to those
suffering from AD. Examples include
Korsakoff’s syndrome (Schacter et al.,
1996), semantic dementia (Simons et al.,
2005), frontal lobe and medial temporal
lobe lesions (Verfaellie et al., 2004), and
mixed etiologies including anoxia and
encephalitis (Verfaellie et al., 2002). These
disorders all affect different areas of the
brain, so it seems unlikely that they would
all damage the same function. However, it
is more feasible that gist memory, as a
particular memory function, could be
accessed in various ways, and thus it seems
likely that each disorder prevents access to
this function in some way as opposed to
damaging it directly.
It would seem, then, that the study of
false recognitions does not provide
adequate evidence of an impaired gist
memory in AD patients. We need to rule
out the possibility that it is the deficit in
item-specific memory which is causing the
apparent lack of gisting, as opposed to
damage to the actual gist memory itself. It
is still possible that AD patients do get the
gist, and therefore that it might be possible
to help them gain a better understanding of
their environment, even though they
struggle to remember specific items. Using
Balota’s theory as a basis, finding ways to
bypass item-specific memory might offer a
useful direction for future clinical research
in AD.
■ Jack Nissan is an undergraduate at the
University of Edinburgh. E-mail:
s0341936@sms.ed.ac.uk.
Balota, D.A., Cortese, M.J., Duchek, J.M.
et al. (1999).Veridical and false
memories in healthy older adults
and in dementia of the Alzheimer’s
type. Cognitive Neuropsychology, 16,
361–384.
Budson,A.E., Daffner, K.R., Desikan, R.
& Schacter, D.L. (2000).When false
recognition is unopposed by true
recognition: Gist-based memory
distortion in Alzheimer’s disease.
Neuropsychology, 14, 277–287.
Budson,A.E., Desikan, R., Daffner, K.R.
& Schacter, D.L. (2001). Perceptual
false recognition in Alzheimer’s
disease. Neuropsychology, 15,
230–243.
Budson,A.E.,Todman, R.W. & Schacter,
D.L. (2006). Gist memory in
Alzheimer’s disease.
Neuropsychology, 20, 113–122.
Clifasefi, S.L., Maryanne Garry, M. &
Loftus, E. (in press). Setting the
record (or video camera) straight
on memory. In S. Della Sala (Ed.)
Tall tales about the mind and the
brain. Oxford: Oxford University
Press.
Dehon, H. & Bredart, S. (2004). False
memories. Psychology and aging, 19,
191–197.
Gallo, D.A. (2006). Associative illusions of
memory. New York: Psychology
Press.
Gallo, D.A., Shahid, K.R., Olson, M.A. et
al. (2006). Overdependence on
degraded gist memory in
Alzheimer’s disease.
Neuropsychology, 20, 625–632.
Gollan,T.H., Salmon, D.P. & Paxton, J.L.
(2006).Word association in early
Alzheimer’s disease. Brain and
Language, 99, 289–303.
Kensinger, E.A. & Schacter, D.L. (1999).
When true memories suppress
false memories: Effects of aging.
Cognitive Neuropsychology, 16,
399–415.
Loftus, E.F. (1991). Made in memory. In
G.H. Bower (Ed.) The psychology of
learning and motivation:Advances in
research and theory,Vol. 27
(pp.187–215). San Diego, CA:
Academic Press.
Norman, K. & Schacter, D.L. (1997).
False recognition in younger and
older adults. Memory & Cognition,
25, 838–848.
Roediger, H.L. & McDermott, K.B.
(1995). Creating false memories:
Remembering words not
presented in lists. Journal of
Experimental Psychology: Learning,
Memory, and Cognition, 21,
803–814.
Schacter, D.L. (1995). Memory distortion.
Cambridge, MA: Harvard
University Press.
Schacter, D.L.,Verfaellie, M. & Pradere,
D. (1996).The neuropsychology of
memory illusions. Journal of
Memory and Language, 35,
319–334.
Schacter, D.L., Koutstaal,W. & Norman,
K.A. (1997). False memories and
aging. Trends in Cognitive Sciences, 1,
229–236.
Simons, J.S.,Verfaellie, M., Hodges, J.R. et
al. (2005). Failing to get the gist.
Neuropsychology, 19, 353–361.
Verfaellie, M., Schacter, D.L. & Cook,
S.P. (2002).The effect of retrieval
instructions on false recognition:
Exploring the nature of the gist
memory impairment in amnesia.
Neuropsychologia, 40, 2360–2368.
Verfaellie, M., Rapcsak, S.Z., Keane,
M.M. & Alexander, M.P. (2004).
Elevated false recognition in
patients with frontal lobe damage
is neither a general nor a unitary
phenomenon. Neuropsychology, 18,
94–103.
Watson, M.J, Balota, D.A. & Sergent-
Marshall, S.D. (2001). Semantic,
phonological, and hybrid veridical
and false memories in healthy
older adults and in individuals with
dementia of the Alzheimer Type.
Neuropsychology, 15, 254–267.
July 2007
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www.thepsychologist.org.uk
Student competition
WEBLINKS
A short version of the DRM:
www.msnbc.com/onair/nbc/nightlynews/memory
A similar false recognition memory test:
tinyurl.com/2mmt8f
British False Memory Society: www.bfms.org.uk
Description of general memory processes (including
gist memory): tinyurl.com/2kybkc
References

July 2007
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The Psychologist Vol 20 No 7
Student competition
ON 24 November 2004, Nana, mywife’s grandmother, fell over inher front garden. She was picking
up litter when her neighbour called to her,
and when she turned to answer she found
herself lying half across her drive and half
across her lawn. She couldn’t walk on her
right leg, and later found out in the accident
and emergency department that she had
fractured her right knee.
The fracture meant not only two weeks
in hospital, but also an operation to insert a
metal plate into her knee, with her leg in a
cast for three weeks. She can now walk, but
she initially needed a commode and a
stairlift fitted in her home.
Nana is aged 76 and is not alone in
having this traumatic experience. In 1999,
UK accident and emergency departments
had to deal with almost 650,000 instances
of people over 60 having similar
experiences, of which over 200,000 resulted
in hospital admissions. The economic cost
of treating older people who have fallen is
estimated at almost £1 billion (Scuffham et
al., 2003).
Beyond this economic cost and the
medical implications of fractures and
treatment, older people can develop a fear
of falling that leads them to unnecessarily
restrict their lifestyle and diminish their
quality of life (Howland et al., 1993). For
instance, Nana is able to walk without a
stick, but uses it because it makes her feel
safer: ‘It’s nerves more or less…without the
stick I could trip over a matchstick.’
Preventing falls
Contrary to popular belief, falls are not an
inevitable part of ageing. Falls can be
prevented, especially with balance training
(Gardner et al., 2000). This is some form of
physical activity that improves balance,
coordination, and lower-leg muscle
strength, such as walking, jogging, playing
tennis, or tai chi
For an older person to accept that they
could benefit from receiving falls-
prevention advice, they must first accept
that they are at risk of a fall. The problem
with accepting that they are at risk of a fall
is the stigma attached to being labelled ‘a
faller’. A faller is someone who is old, frail,
dependent, and usually living in a
residential home (Health Education Board
for Scotland, 2001). In their study, the
Health Education Board for Scotland
concluded that ‘health education campaigns
to prevent “falls in older people” are
unlikely to succeed’ (2001, p.44).
It is likely this stigma of falls has
contributed to the fact that many older
people are not readily taking up falls-
prevention advice. Falls clinics led by
consultant physicians see an average of only
five older people a week – representing
just 3 per cent of fallers in the average-
sized primary care trust (Royal College of
Physicians, 2006). Studies that include
balance training in their interventions have
reported participation rates as low as 10 per
cent (Day et al., 2002).
What can falls-prevention
interventionists do? They want to prevent
falls, but to do this they need older people
to talk about it. It is like falls-prevention
interventionists are playing the board game
Taboo, where the objective is to describe a
word without mentioning it or five
associated words/phrases. Is there a way
out of this game? Recent research suggests
there is.
Not what you say but how you
say it
It appears that older people are willing to
discuss falls prevention when it is part of
advice that stresses the benefits of balance
training. Lucy Yardley and colleagues at the
A balancing act?
SAMUEL R. NYMAN, winner in the postgraduate
category, on ways of preventing falls in older people
without creating a stigma.
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University of Southampton, along with
Chris Todd at the University of
Manchester, conducted a survey with over
700 older people (Yardley et al., 2007),
seeking their views on different versions of
balance-training advice. One version
contained advice stressing their risk of falls
and the need to prevent them to avoid
broken bones. They found that when
comparing the version containing advice
stressing the risk of falls to versions that
only discussed the benefits of balance
training, mentioning falls did not produce
a fear of falling or make older people reject
the advice.
Why, then, did the Health Education
Board of Scotland find that older people do
not want to talk about falls? Yardley and
colleagues measured the link between older
people’s intention to perform balance
training and other measures. They found
that the older people who wanted to take
up balance training were more likely to
believe that the advice was suitable for
someone like themselves; that other people
think they should do it; and that balance
training would be enjoyable, improve their
ability to do daily tasks, and not be
harmful. In contrast, intention to undertake
balance training was not linked with
perceived falls risk, fear of the
consequences of falls, or having health
conditions that increased their falls risk.
Taken together, it’s not what you say in
falls prevention, it’s how you say it. Trying
to get older people to see themselves at risk
of a fall does not work. However,
presenting positive advice that is suitable
for them should encourage older people to
do balance training to prevent falls. You
can talk to older people about falls once
you’ve stressed the benefits of balance
training. Falls prevention can be a
secondary benefit to meeting new people
and taking up a new hobby, which are
more of an incentive for older people to
take up physical activities (Stead et al.,
1997). To illustrate, I will turn to a recent
study to show how falls-prevention advice
can be successfully communicated to older
people.
A tailored approach
We developed an online intervention to
encourage older people to take up balance
training for the prevention of falls (Yardley
& Nyman, in press). The intervention uses
tailoring, a technique that makes the advice
more personally relevant to the individual.
This is achieved by taking the individual’s
answers to questions and using them to
match the advice to the individual’s needs
and preferences (Kreuter et al., 2000).
We invited 16 older people into one of
our laboratories and asked them to
comment on our balance-training website,
www.balancetraining.org.uk (Nyman &
Yardley, 2006). The participants provided
comments whilst accessing the website,
and gave general feedback at the end.
The participants found the website to
be usable – older people with minimal
experience in using computers could use
the website: ‘It was quick and easy to use
because it was kept simple’ (64-year-old
woman). Comments were generally
positive: ‘I would say it’s very very good,
extremely good, because I think there’s a
lot of practical information on there which
could benefit a lot of people’ (64-year-old
man).
Perhaps the response was positive for
two reasons. First, we did not focus on falls
or falls risk, but on the benefits of balance
training. Second, the tailoring made the
advice more relevant to the older person:
they had control over what balance training
advice they selected, enabling them to
select advice on the activities they wanted
to know about and decide which activities
to start.
Conclusion
Older people frequently fall and the results
can be traumatic. Falls can be prevented,
but current uptake to interventions can be
low. Means of increasing motivation such
as balance training websites may help
bridge the gap between the older person
and the intervention. They can do so
because ‘falls’ is not a taboo: it’s not what
you say but how you say it.
Falls-prevention advice that is positive
and relevant can include a discussion on
falls, and can be effective in encouraging
older people to prevent falls. People like
Nana will then be able to be independent
for longer, and enjoy more life in her years
as well as more years in her life.
■ Samuel R. Nyman is a postgraduate at
the University of Southampton. E-mail:
sam.nyman@soton.ac.uk.
Day, L., Fildes, B., Gordon, I. et al.
(2002). Randomised factorial trial
of falls prevention among older
people living in their own homes.
British Medical Journal, 325, 128–131.
Gardner, M.M., Robertson, M.G. &
Campbell,A.J. (2000). Exercise in
preventing falls and fall related
injuries in older people:A review
of randomised controlled trials.
British Journal of Sports Medicine,
34, 7–17.
Health Education Board for Scotland
(2001). The construction of the risks
of falling in older people: Lay and
professional perspectives. Edinburgh:
Author.
Howland, J., Peterson, E.W., Levin,W.C.
& Fried, L. (1993). Fear of falling
among the community-dwelling
elderly. Journal of Aging and Health,
5, 229–243.
Kreuter, M.W., Farrell, D., Olevitch, L. &
Brennan, L. (2000). Tailoring health
messages: Customizing communication
with computer technology. Mahwah,
NJ: Lawrence Erlbaum.
Nyman, S.R. & Yardley, L. (2006). The
acceptability of a balance training
website:A qualitative study. Poster
presented at the British
Psychological Society Division of
Health Psychology Conference,
University of Essex.
Royal College of Physicians (2006).
National audit of the organisation of
services for falls and bone health for
older people. London:Author. [See
tinyurl.com/22jd2s]
Scuffham, P., Chaplin, S. & Legood, R.
(2003). Incidence and costs of
unintentional falls in older people
in the United Kingdom. Journal of
Epidemiology and Community
Health, 57, 740–744.
Stead, M.,Wimbush, E., Eadie, D. & Teer,
P. (1997).A qualitative study of
older people’s perceptions of
ageing and exercise:The
implications for health promotion.
Health Education Journal, 56, 3–16.
Yardley, L., Donovan-Hall, M., Francis, K.
& Todd, C. J. (2007).Attitudes and
beliefs that predict older people's
intention to undertake strength
and balance training. Journal of
Gerontology: Psychological Sciences,
62B, 119–125.
Yardley, L. & Nyman, S.R. (in press).
Internet provision of tailored
advice on falls prevention activities
for older people:A randomized
controlled evaluation. Health
Promotion International. Advance
online access:
http://heapro.oxfordjournals.org/cg
i/content/abstract/
dam007?ijkey=ZRT3xez4NIwa3Zp
&keytype=ref
References
July 2007
421
www.thepsychologist.org.uk
Student competition
WEBLINKS
Our balance training website:
www.balancetraining.org.uk
Prevention of Falls Network Europe (ProFaNE):
www.profane.eu.org
Help the Aged: www.helptheaged.org.uk
Advice to ‘Stay active! Stay independent! Stay on
your feet!’: www.stayactive.qut.edu.au
Later life training: www.laterlifetraining.co.uk
Extend – Movement to music for the over 60s and
less able people: www.extend.org.uk
Active Independent Ageing: www.falls-chutes.com