What causes relative difficulties with technology and non‐technology based activities of daily living in those with ADRD?

Abstract

AbstractBackgroundDigital skills are critical to performing a host of instrumental activities of daily living (iADLs) in the 21st century. For example, financial management activities increasingly rely on managing accounts online, social interactions are frequently mediated by technologies like text messaging and social media, and critical health and commerce activities occur via tech enabled platforms. Despite the ever increasing importance of technology related iADLs to real world functioning, there are concerns that the digital divide may disproportionately impact those with ADRD making the modern technological environment more difficult to navigate. The current study explored two broad questions: 1) how do relative difficulties with tech iADLs relate to demographic factors and diagnostic staging?, and 2) what cognitive difficulties predict relative difficulties technology versus traditional iADL performance?MethodCare‐partners of 135 older adults (mean age 75.3 years (sd = 7.9); 10.5% with no cognitive disorder diagnosis, 37.0% with mild cognitive impairment; 51.1% with dementia) referred to a comprehensive interprofessional memory clinic for neuropsychological evaluations completed both the Functional Activities Questionnaire (as a measure of traditional ADL performance) as well as a series of 11 technology based iADL items (i.e. remembering passwords, managing online accounts, etc). In addition, clinic patients completed a battery of neuropsychological measures.ResultWhile decreasing performance in both traditional and technology iADLs were noted with the transition from MCI to dementia, diagnostic stage (Figure 1), age, and verbal memory performance did not predict disproportionately greater difficulties with tech iADLs relative to overall iADL performance. However, lower education (B = ‐1.77; p = .003; Figure 2), and more difficulties with cognitive set shifting (B = 1.03; p = .0116; Figure 3) predicted greater relative difficulties with tech iADLs.ConclusionIn our current sample, relative difficulties with technology related iADLs was associated with greater executive dysfunction and less educational attainment. These factors may identify individuals with ADRD at particular risk for having difficulties navigating an ever more technologically enriched environment. Implications for helping those with ADRD cross the digital divide, clinical assessment, and technology based interventions for ADRD are discussed.