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.

Danielle M Feger,Alden L Gross,Sherry L Willis,Michael Marsiske,George W Rebok,Cynthia Felix,Kelsey R Thomas

doi:10.3389/fneur.2020.550577

Abstract

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.

Highlights

Instrumental activities of daily living (IADLs) are complex daily tasks important for independent living
Difficulty performing housework was significantly more likely to occur before difficulty managing money [ratio range (0.88–3.86)], shopping [ratio range (1.27– 4.20)], and traveling [ratio range (1.43–8.00)], but less likely to become difficult before managing health care [ratio range (0.37–1.13)]
Difficulty managing money was less likely to occur before managing health care [ratio range (0.25–0.82)] or using the phone [ratio range (0.30–2.25)], while managing health care was more likely to become difficult before using the phone [ratio range (0.90–3.57)], shopping [ratio range (1.91–12.00)], or traveling [ratio range (3.00–13.50)]

Summary

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. It is unknown in what order IADLs become difficult. Difficulty in performing daily activities increases with age [1, 2] due to declining physical and cognitive functioning. IADLs encompass more complex tasks important for independent living (e.g., cooking, household chores, and handling money) [6], while ADLs are basic with more physical tasks of self-care necessary for independent living, and include functions such as bathing, dressing, and feeding [7]. Among community-dwelling older adults, patterns of progressive difficulty are varied [12, 13]

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