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Cited by 29Mindfulness and Compassion InterventionsAging and Gerontology ResearchReligion, Spirituality, and Psychology

Psychological flexibility in older adulthood: a scoping review.

Open access
Plys, Evan, Jacobs, M. Lindsey, Allen, Rebecca S., Arch, Joanna J.·2023·Aging & Mental Health
DOI 10.1080/13607863.2022.2036948PMC PMC9376200
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Abstract

Psychological flexibility/inflexibility (PF/PI) is a core component of the acceptance and commitment therapy (ACT) model, which is gaining more attention in the geropsychological literature. This scoping review examines the size and scope of the research on PF/PI in older adulthood related to age differences between older adult and younger samples, correlates relevant to psychological health, and changes with ACT. A systematic literature search was conducted using PubMed, CINAHL, and PsycINFO. Peer-reviewed articles available in English were included that: had a mean age ≥65 and a minimum age ≥60; and reported self-report measures of PF/PI. We categorized PF/PI into three domains: open, aware, and engaged. Forty-six articles were included. Most studies measured open or aware domains; few measured the engaged domain. Older adults evidenced greater awareness compared to younger adults (9 of 13 analyses were significant). Openness and awareness consistently yielded medium to large correlations with anxiety and depression. PF/PI did not relate with positive affect and inconsistently correlated with quality of life measures. Despite emerging trends, variability and limitations were evident in the literature. Specifically, measurement issues, lack of conceptual clarity, and the omission of values and behavioral measures require future attention.

Integrity signals

Registry

Crossref · 10.1080/13607863.2022.2036948

Cites

115 of 115 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

12 of 24 cited sources checked · 7 supported · 1 flagged · accuracy not yet measured

  • Findingcitation

    No study reported good internal consistency for the AAQ.

    “No study reported good internal consistency for the AAQ, as indicated by Cronbach α > .80 (Taber, 2018).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Taber, 2018 source

      In “Describing the Significance of Alpha,” Taber reports that researchers use Cronbach’s alpha as an indicator of internal consistency. But “Characterising Values of Cronbach’s Alpha” reports values labelled “good” as low as 0.71 and says there is no clear consensus on labels; the paper does not establish α > .80 as the cutoff for good internal consistency. It also does not report whether any AAQ study met that cutoff. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Findingcitation

    PF/PI research with older adults is characterized by heterogeneity and fragmentation in conceptual definitions, measurement approaches, and psychometric quality of several commonly used measures.

    “However, also consistent with the broader literature (Cherry et al., 2021), our findings suggest that PF/PI research with older adults is categorized by heterogeneity and fragmentation in regards to conceptual definitions, measurement approaches, and the psychometric quality of several commonly used measures.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Cherry et al., 2021 source
  • Findingcitation

    PF/PI correlates with mental health and global quality of life in older adulthood.

    “The current evidence suggests that older adults generally exhibit greater PF and lower PI compared to younger adults, and, consistent with the literature on younger adults (Kashdan & Rottenberg, 2010), PF/PI correlates with mental health and global QoL in older adulthood.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Kashdan & Rottenberg, 2010 source
  • Findingown data

    PF/PI correlations with quality of life measures were inconsistent.

    “PF/PI did not relate with positive affect and inconsistently correlated with quality of life measures.”
    • Also stated in: § Correlates of PF/PI Among Older Adults · plain
      “However, relationships between PF/PI and more specific measures of health-related QoL yielded inconsistent results.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Openness and awareness variables consistently had medium to large correlations with anxiety and depression.

    “Openness and awareness consistently yielded medium to large correlations with anxiety and depression.”
    • Also stated in: § Correlations with PF/PI Measures · plain
      “All studies that measured anxiety (n = 13) or depression (n = 12) reported statistically significant correlations (p < .05) with openness variables yielding medium or large effect sizes.”
    Quote in the paperSubstantial claim
  • May combine two claims. 26
  • Classified as probably not a substantial claim. 18
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingcitation

    All studies using the AAQ and one third of studies using the AAQ-II reported internal consistency below recommended cutoffs, with alphas as low as .57 and .51.

    “Specifically, all studies using the AAQ and one third of studies using the AAQ-II reported internal consistency below recommended cutoffs (i.e., Cronbach’s alpha > .80; Taber, 2018), with alphas as low as .57 and .51 respectively.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Taber, 2018 source

      The citation is attached to the proposed cutoff of Cronbach’s alpha > .80, not to the citing authors’ AAQ study counts. Taber’s Discussion instead describes .70 as a commonly used rule of thumb with limited grounds for adoption; “Characterising Values of Cronbach’s Alpha” says there is no clear consensus on how alpha values should be labelled. The paper does not endorse > .80 as a recommended cutoff. (LLM, conf=0.86)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The review followed PRISMA-ScR guidance.

    “This study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR; Tricco et al., 2018); see Appendix A.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Tricco et al., 2018 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    A protocol was developed before the review and preregistered with the Open Science Framework.

    “A protocol was developed a priori and pre-registered with Open Science Framework (Foster & Deardorff, 2017); see Plys et al. (2020).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Foster & Deardorff, 2017 source
    • cites Plys et al. (2020)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Mean sample ages ranged from 65-69, 70-74, 75-79, and 80+ years, with one study splitting young-old and old-old.

    “The mean age of study samples ranged from 65–69 (n = 13); 70–74 (n = 22); 75–79 (n = 6), and 80+ (n = 4) years; one study split the sample into young-old (i.e., < 75) and old-old (i.e., 75+; Borella et al., 2007).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Borella et al., 2007 source

      The Abstract (page unavailable) says the study included young-old and old-old adults, supporting the cited example of a split sample. Our copy does not give the stated cutoff of 75 years. The counts of studies in each mean-age range appear to describe the citing paper’s collection of studies, not a finding attributed to Borella et al. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Measurement issues may have contributed to the null findings on age differences in experiential avoidance.

    “However, it is possible that measurement issues contributed to these null findings (see Cherry et al., 2021; Rochefort et al., 2018; Tyndall et al., 2019).”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites Cherry et al., 2021 source

      Section 4.4 (p. 10) identifies validity problems with the AAQ-II, a measure designed to assess experiential avoidance, so the review supports the concern about measurement issues. It does not examine age differences or suggest that those issues contributed to the cited null findings. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites Rochefort et al., 2018 source
    • cites Tyndall et al., 2019 source

  • May combine two claims.

    Findingcitation

    Gould et al. reported reliable improvements on the AAQ-II for 24% of the sample and clinically reliable improvements for 14%.

    “Gould et al. (2021) noted reliable improvements on the AAQ-II for 24% of the sample and clinically reliable improvements for 14% of the sample based on the Reliable Change Index and Clinically Significant Change criteria.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Gould et al. (2021) source

  • May combine two claims.

    Interpretationreasoning

    The internal consistency findings suggest conceptual and statistical issues, including that the AAQ and AAQ-II may not measure a common factor among older adults or may not perform consistently in older adult samples.

    “These findings suggest a number of conceptual and statistical issues (see Taber, 2018; Tavakol & Dennick, 2011), including the possibility that the AAQ and AAQ-II do not measure a common factor among older adults or that, given the broad range of alpha scores (i.e., .51-.94), these measures do not perform consistently in older adult samples.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites Taber, 2018 source

      In “What Does Alpha Actually Measure?” and “Misuse of Alpha to Imply Unidimensionality” (page numbers unavailable), Taber cautions that alpha does not establish that items measure one common factor. “Examples of Alpha Cited in Measuring Affective Constructs” also says alpha depends on the sample tested. The paper does not assess the AAQ or AAQ-II, older-adult samples, or the cited .51–.94 range, so it supports the general cautions but not those instrument-specific possibilities. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites Tavakol & Dennick, 2011 source

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).

    Findingnone given

    Three of the four intervention studies delivered ACT for chronic pain.

    “Three of the four delivered an ACT intervention for chronic pain.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The review included 46 articles.

    “Forty-six articles were included.”
    • Also stated in: § Search Results · plain
      “Overall, 46 articles published between 2004–2021 were included in the final sample.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Older adults showed greater awareness than younger adults, with 9 of 13 analyses significant.

    “Older adults evidenced greater awareness compared to younger adults (9 of 13 analyses were significant).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The additional validity searches yielded 277 results and identified no new studies beyond the broader search.

    “These searches yielded 277 results; no new studies were identified beyond those identified in the broader search described above.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    After duplicates were removed, 1,237 titles and abstracts were screened.

    “After removing duplicates, 1,237 titles and abstracts were screened.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Updated searches yielded 115 articles, of which three were included.

    “Updated database searches in October 2021 yielded 115 articles; three were included.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Only one study examined engaged variables with anxiety and depression and found non-significant correlations.

    “Only one study investigated relationships with engaged variables and observed non-significant correlations with both anxiety and depression.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Sample sizes ranged from 19 to 212 for age comparison studies, 19 to 965 for correlational studies, and 10 to 60 for intervention studies.

    “Sample sizes ranged from 19 to 212 (n = 16; M = 71.0, SD = 45.3) for age comparison studies; 19 to 965 (n = 34; M = 193.9, SD = 212.8) for correlational studies; and 10 to 60 (n = 4; M = 40.0, SD = 22.2) for intervention studies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Eight studies reported cognitive abilities; seven had mean scores within normal limits, and one reported average scores consistent with mild cognitive impairment.

    “Eight studies reported data on study participants’ cognitive abilities; seven had mean scores within normal limits based on validated screens (e.g., Mini-Mental State Exam [MMSE]; Folstein et al., 1983). Only Guzmán et al. (2020) reported average scores consistent with mild cognitive impairment (Montreal Cognitive Assessment, Mean = 21.9, SD = 3.1).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Folstein et al., 1983

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Guzmán et al. (2020)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingreasoning

    Relatively few studies sampled older adults with physical or cognitive limitations, leaving a gap related to non-normative aging.

    “Relatively few studies sampled older adults with physical or cognitive limitations, leaving a gap in the PF/PI literature related to non-normative aging.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Included articles represented 14 countries, most commonly the United States, United Kingdom, and Spain.

    “The articles represented 14 different countries, with the United States (n = 16; 35%), United Kingdom (n = 7; 15%), and Spain (n = 6; 13%) being the most prevalent.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    All significant correlations were in the expected direction, with anxiety or depression positively related to PI and negatively related to PF.

    “All significant findings were in the expected direction (i.e., anxiety or depression positively related to PI and negatively related to PF).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Of the 46 articles, 16 reported age differences, 34 reported correlations, and four tested interventions; eight included multiple analysis types.

    “Of the included 46 articles, 16 reported data on age differences, 34 reported correlations, and four tested interventions; eight articles included multiple types of analyses.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    PF/PI measures yielded significant relationships with global quality of life, with higher PF and lower PI related to higher QoL.

    “PF/PI measures yielded significant relationships with global QoL measures (i.e., higher PF and lower PI related to higher QoL), which represent a broad overview of biopsychosocial health (Skevington et al., 2004).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Skevington et al., 2004 source

  • May combine two claims.

    Findingown data

    All 23 studies reporting race or ethnicity had majority non-Hispanic white samples, and 20 had more than 80% non-Hispanic white participants.

    “All of the 23 studies reporting data on race or ethnicity had majority non-Hispanic white samples; 20 studies included more than 80% non-Hispanic white participants.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The review identified only four studies that measured changes in PF/PI during ACT interventions, three targeting chronic pain.

    “The current review only identified four studies that measured changes in PF/PI processes during ACT interventions, three targeting ACT for chronic pain.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    Neither the Personalized Psychological Flexibility Index nor the MEAQ has been used with older adult samples.

    “However, to date, neither of these scales have been used with older adult samples.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Of 45 articles reporting gender, 41 (91%) had majority women samples.

    “All but one article reported participant gender (n = 45); 41 (91%) included majority women samples.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

    Findingown data

    The initial searches identified 1,788 articles.

    “A total of 1,788 articles were identified from initial databases and additional searches.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Four hundred twenty-five full texts were reviewed, and 381 (90%) were excluded.

    “Four hundred twenty-five full texts were reviewed and 381 (90%) were excluded based on criteria.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The authors performed an additional validity check by searching 26 common PF/PI measures.

    “we performed an additional validity check by searching 26 common measures of PF/PI (e.g., Multidimensional Experiential Avoidance Questionnaire [MEAQ]) that appear in the literature (see Ciarriochi & Bilich, 2020; Ong et al., 2019) combined with “older adult” using Google Scholar on December 16, 2020.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Ciarriochi & Bilich, 2020

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Ong et al., 2019 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The review adapted a standardized data extraction tool from the Joanna Briggs Institute.

    “The current study adapted a standardized data extraction tool from the Joanna Briggs Institute (Aromataris & Munn, 2020).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Aromataris & Munn, 2020

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The author team met multiple times to refine eligibility criteria and reach consensus on article inclusion.

    “The author team met multiple times to review and refine the eligibility criteria, as well as discuss and reach consensus on inclusion of specific articles.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Older adults generally exhibit greater PF and lower PI compared to younger adults.

    “The current evidence suggests that older adults generally exhibit greater PF and lower PI compared to younger adults, and, consistent with the literature on younger adults (Kashdan & Rottenberg, 2010), PF/PI correlates with mental health and global QoL in older adulthood.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    Only one author reviewed studies for inclusion, which increases risk of bias.

    “Second, only one author reviewed studies for inclusion, which increases risk of bias.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The review weighted studies similarly, and comparability across studies may be limited due to the lack of a study quality index.

    “Fourth, we weighted studies similarly to present an overview of the research landscape; however, comparability across studies may be limited due to the lack of a study quality index.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The findings suggest PF/PI may be linked to maladaptive processes and negative outcomes, but it is unclear whether it is linked with positive psychological processes and outcomes in older adulthood.

    “Our findings suggest that PF/PI may be linked to maladaptive processes and negative outcomes, but it is unclear whether PF/PI is linked with positive psychological processes and outcomes in older adulthood.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    A second author confirmed inclusion of articles for the final sample, and questionable studies were discussed by the broader author team until consensus.

    “That stated, a second author confirmed inclusion of articles for the final sample and any questionable studies were discussed by the broader author team until we reached consensus.”
    Quote in the paperNot a substantial claim
35 of 35

  • The paper relies on this without support.

    The empirical landscape of PF/PI studies in older adulthood had not yet been examined.

    “To our knowledge, the field has yet to examine the empirical landscape of PF/PI studies in the developmental context of older adulthood.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • A review has shown older patients to have a higher average psychological flexibility on other measures than on the AAQ-II.

    “Additionally, a review has shown older patients to have a higher average psychological flexibility on other measures than on the AAQ-II (37).”

    From Increasing psychological flexibility is associated with positive therapy outcomes following a transdiagnostic ACT treatment (2024) · cites this paper as [37]

    The Discussion section on age differences reports a general trend toward higher openness and awareness in older adults than in younger adults, while few studies found significant age differences using the AAQ or AAQ-II. It does not report that older patients had a higher average psychological-flexibility score on other measures than on the AAQ-II; that cross-measure comparison overstates the finding. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Increasing psychological flexibility reduces burden and depression, helping care partners manage losses related to dementia that are unchangeable or incurable.

    “Increasing psychological flexibility reduces burden and depression, helping care partners manage losses related to dementia that are unchangeable or incurable (Plys et al., 2023).”

    From Acceptance and Commitment Therapy Tele-Counselling Program With Care Partners of Persons Living With Dementia: A Pilot Feasibility RCT. (2026) · cites this paper as Plys et al., 2023

    The Results section, “Correlations with PF/PI Measures” (page unavailable), reports that greater psychological flexibility was associated with less depression in older adults. But the Discussion section, “Changes in PF/PI with ACT with Older Adults” (page unavailable), says the intervention evidence was insufficient to establish that flexibility can be increased; the copy does not establish a causal reduction in depression or burden, or address dementia care partners managing losses. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • ACT has shown to be a promising therapy method for the elderly.

    “On the other hand, ACT has shown to be a promising therapy method for the elderly (37).”

    From Increasing psychological flexibility is associated with positive therapy outcomes following a transdiagnostic ACT treatment (2024) · cites this paper as [37]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Search-flow counts imply 47 included articles, not 46

    Minor

    The full-text counts leave 44 articles (425 minus 381). Adding the three articles included from the updated search gives 47, whereas the stated final sample is 46.

1 of 1

Cites

Flagged first, then by citations

1 of the 116 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. *Alonso, M. A., López, A., Losada, A., & González, J. L. (2013). Acceptance and commitment therapy and selective optimization with compensation for older people with chronic pain: A pilot study. Behavioral Psychology/Psicología Conductual: Revista Internacional Clínica y de La Salud, 21(1), 59–79.
  2. 10.1080/08870446.2013 · DOI
  3. Plys E. Jacobs M. L. & Arch J. (2020). Psychological flexibility and psychological suffering in older adulthood: A scoping review. osf.io/58cbe

Cited by

Sorted by citations

Related

Authors
Plys, E., Jacobs, M. L., Allen, R. S., & Arch, J. J.
Affiliations
  • University of Colorado Anschutz (US)
  • University of Alabama (US)
  • University of Colorado Boulder (US)
Corresponding author
Plys, Evan
ORCID
Venue
Aging & Mental Health
Publisher
Informa UK Limited
Published
2022-02-15
Volume
27
Issue
3
Pages
453-465
ISSN
  • 1360-7863 (ISSN-L)
  • 1364-6915
DOI
10.1080/13607863.2022.2036948
PMC
PMC9376200
OpenAlex
W4212784172
Cited by
29
References
116
Citations by year
2026: 4 · 2025: 8 · 2024: 9 · 2023: 4 · 2022: 4
FWCI
1.04
Type
journal article
Language
en
Open access
Locations
  • Aging & Mental Health (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Health Resources and Services Administration (D4093336)
  • National Institute of Nursing Research (R01NR018479)
  • National Institute on Aging (5T32AG044296-07)
  • U.S. Department of Veterans Affairs (VA VISN 7 Research Development Award)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Aging and Gerontology Research
  • Social Sciences › Health › Religion, Spirituality, and Psychology
Keywords
psychological flexibility, psychological inflexibility, acceptance and commitment therapy, older adults, age differences, awareness, openness, engagement, anxiety, depression, positive affect, quality of life, psychology of aging
MeSH terms
Aged, Anxiety, Humans, Mental Health, Quality of Life, Acceptance and Commitment Therapy

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