Incident Instrumental Activities of Daily Living Difficulty in Older Adults: Which Comes First? Findings From the Advanced Cognitive Training for Independent and Vital Elderly Study

Frontiers in Neurology

Michael Marsiske²  Alden L. Gross³  Danielle M. Feger³  Cynthia Felix⁴  George W. Rebok⁵  Sherry L. Willis⁶  Kelsey R. Thomas⁷ 

[1] Center on Aging and Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States;Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, FL, United States;Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States;Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States;Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States;Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States;Department of Psychiatry, University of California San Diego School of Health Sciences, La Jolla, CA, United States;Veterans Affairs San Diego Healthcare System, San Diego, CA, United States;

关键词: IADLs;    older adults;    activites of daily living;    MEPSUM;    cognitive training;   

DOI  :  10.3389/fneur.2020.550577

来源: DOAJ

【 摘 要 】

Introduction: Instrumental activities of daily living (IADLs) are complex daily tasks important for independent living. Many older adults experience difficulty with IADLs as their physical and/or cognitive function begins to decline. However, it is unknown in what order IADLs become difficult.Methods: Participants from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study who were free of IADL difficulty at baseline (N = 1,277) were followed up to 10 years until first reported IADL difficulty. A total of 19 IADL tasks were grouped into seven task categories. A discrete-time multiple-event process survival mixture model (MEPSUM) was used to generate hazard estimates of incident IADL difficulty in seven groups from ages 65 to 80. Hazard estimates were compared in the three intervention groups (memory, inductive reasoning, and speed of information processing) vs. the no-contact control group.Results: A total of 887 (69.5%) participants reported incident difficulty in at least one IADL task category. Compared to individuals who remained free of IADL difficulty, those who reported incident difficulty were more likely to be older, female, and have lower Short Form 36 general health scores. The IADL task categories to first become difficult were housework, managing health care, and phone use. There were no differences by intervention group in the hazard estimates of incident IADL difficulty.Conclusion: Managing health care and phone use are more cognitively demanding IADLs, and individuals who experience difficulty in these tasks first may be more likely to experience cognitive decline. Recognizing early difficulty in managing health care may allow for implementation of compensation strategies to minimize unintentional medication misuse, increased adverse medical events, and unnecessary hospitalization. Training of a specific cognitive domain may not influence ordering of IADL difficulty because IADL tasks require proficiency in, and integration of, multiple cognitive domains.

【 授权许可】

Unknown