Individual Instrumental Activities Of Daily Living Research Articles

The Prevalence and Trends of Instrumental Activities of Daily Living Impairments in the United States from 2008-2018.

Instrumental activities of daily living (IADL) are neuropsychological-driven tasks that are linked to cognitive dysfunction. Examining population-based IADL deficits may reveal insights for the presence of these impairments in the United States. This investigation sought to evaluate the prevalence and trends of IADL impairments in Americans. A secondary analysis of data from the 2006-2018 waves of the Health and Retirement Study was conducted. The overall unweighted analytic sample included 29,764 Americans aged≥50 years. Respondents indicated their ability to perform six IADLs: manage money, manage medications, use a telephone, prepare hot meals, shop for groceries, and use a map. Persons reporting difficulty or an inability to complete an individual IADL were considered as having a task-specific impairment. Similarly, those indicating difficulty or an inability to perform any IADL were classified as having an IADL impairment. Sample weights were utilized to generate nationally-representative estimates. Having an impairment in using a map (2018 wave: 15.7% (95% confidence interval (CI): 15.0-16.4) had the highest prevalence in individual IADLs regardless of wave examined. The overall prevalence of IADL impairments declined during the study period (p < 0.001) to 25.4% (CI: 24.5-26.2) in the 2018 wave. Older Americans and women had a consistently higher prevalence of IADL impairments compared to middle-aged Americans and men, respectively. The prevalence of IADL impairments was also highest among Hispanics and non-Hispanic Blacks. IADL impairments have declined over time. Continued surveillance of IADLs may help inform cognitive screening, identify subpopulations at risk of impairment, and guide relevant policy.

Older Adults' Resilience Against Impact of Lifestyle Changes During the COVID-19 Pandemic.

Background:Older adults were expected to experience a decline in physical activities and an increase in social isolation during the COVID-19 pandemic.Methods:We investigated the changes in living conditions of 508 older adults (79.70 years ± 0.88) before (from July to December 2019) and during (in August 2020) the pandemic. We compared the mean score for the same individual instrumental activities of daily living (IADL), frequency of going out, exercise, and social interaction at two-time points. We also examined the influence of living arrangement (living alone or not) on the frequency of exercise and social interaction.Results:The frequency of going out decreased during the pandemic (in 2020); however, there was no significant change in IADL. The frequency of exercise and social interaction increased irrespective of the living arrangement. The frequency of exercise increased more in those living alone.Conclusions:Although older adults refrained from going out, they compensated for the risks of inactivity in daily life by increasing or maintaining their frequency of exercise and social interactions. The view that “older adults have a poor ability to accommodate the lifestyle changes during the COVID-19 pandemic” may be a stereotypical assumption.

A-200 Which Domains of Neuropsychological Functioning are Most Strongly Related to Impairment in Instrumental Activities of Daily Living?

Abstract Objective The current study investigated relationships between neuropsychological test findings and instrumental activities of daily living (IADLs) in a mixed sample of Mild and Major Neurocognitive Disorder (NCD). Method Archival data from a memory disorder clinic were analyzed. Patients (n = 68, mean age = 72.3, mean education = 13.2 years, 26.5% Mild NCD, 73.5% Major NCD) minimally completed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Delis-Kaplan Executive Function System (D-KEFS). Information on IADLs was obtained from family members via the Functional Activities Questionnaire (FAQ). Spearman correlations were calculated between individual IADLs from the FAQ, total FAQ ratings, RBANS index scores, and a composite executive functioning score (average scaled score on DKEFS Trail Making, Verbal Fluency, and Tower). Results Executive functioning was the only cognitive domain that significantly correlated (p &amp;lt; .05) with total FAQ ratings. However, all cognitive domains except language significantly correlated with individual IADLs. Tracking current events correlated with immediate memory, while financial management correlated with delayed memory. Attending to, understanding, and discussing TV, books, and magazines correlated with executive functioning and immediate and delayed memory. Remembering events correlated with attention and executive functioning. Shopping alone correlated with immediate memory, attention, and executive functioning, while operating basic kitchen appliances correlated with visuospatial skills, attention, and executive functioning. Traveling also correlated with visuospatial skills and executive functioning. Conclusions Executive functioning was the only domain associated with overall daily functioning; however, all domains except language corresponded with individual IADLs. Current findings highlight the utility of neuropsychological test findings in understanding the nuances of deficits in daily functioning.

Impairments in Individual Autonomous Living Tasks and Time to Self-Care Disability in Middle-Aged and Older Adults

ObjectivesImpairments in specific tasks that are necessary for independent living may identify future self-care limitations, and the use of time-varying covariates can better capture the fluidity in functional capacity trajectories over time. The purpose of this study was to determine the associations between individual instrumental activities of daily living (IADL) impairments and time to activities of daily living (ADL) disability for middle-aged and older adults in the United States. DesignLongitudinal panel. SettingDetailed interviews that included physical, biological, and psychosocial measures were completed in person. The core interview was typically completed over the telephone. ParticipantsA nationally representative sample of 15,336 adults aged at least 50 years from the 2006 wave of the Health and Retirement Study was followed for 8 years. MeasuresAbility to perform IADL and ADL were self-reported at each wave. Separate covariate-adjusted Cox models were used to examine the time-varying associations between individual IADL impairments and time to ADL disability. ResultsThe presence of each IADL impairment was associated with a higher hazard ratio for an ADL disability for the following functions: 2.52 [95% confidence interval (CI) 2.35, 2.70] for grocery shopping, 1.91 (CI 1.77, 2.06) for preparing hot meals, 1.55 (CI 1.37, 1.76) for taking medications, 1.48 (CI 1.36, 1.61) for managing money, 1.41 (CI 1.27, 1.57) for using a telephone, and 1.38 (CI 1.29, 1.48) for using a map. Conclusions/ImplicationsOur findings provide insights into the disabling process by revealing how impairments in each IADL are differentially associated with time to ADL disability. Interventions aiming to retain function during aging should be informed by fluctuations in IADL performance and how specific IADL impairments may exacerbate functional capacity declines more so than others.

Trajectories of Limitations in Instrumental Activities of Daily Living in Frail Older Adults With Vision, Hearing, or Dual Sensory Loss.

This study investigated the trajectories of decline in individual instrumental activities of daily living (IADL) with aging and the effect of hearing loss, vision loss, or dual sensory loss on these trajectories in community-living frail older persons. This longitudinal population-based study was conducted in 9,319 community-living frail Dutch persons aged 60 years and older. Self-reported hearing loss, vision loss, or dual sensory loss and nine IADL were assessed in 15 studies of the Dutch National Care for the Elderly Program (The Older Persons and Informal Caregivers Survey Minimum Dataset). Probabilities of limitations in IADL, odds ratios (per 5 years) for binary, and rate ratios (per 5 years) for score outcomes were calculated using mixed logistic and negative binomial models with age as the underlying timescale, stratified by sensory loss, and corrected for confounders. At baseline, the number of IADL limitations was higher in dual sensory loss (2.00 [interquartile range 1.00-4.00]) and vision loss (2.00 [interquartile range 1.00-4.00]) compared to no sensory loss (1.00 [interquartile range 0.00-2.00]) or hearing loss (1.00 [interquartile range 0.00-3.00]). Trajectories of individual IADL showed an increase in limitations in all IADL with age. Household tasks, traveling, shopping, preparing a meal, and walking showed the most rapid decline. Handling finances, traveling, and walking followed a different pattern of decline based on sensory loss status. The age effect on limitations in IADL appears to be similar across all types of sensory loss, with the exception of handling finances, traveling, and walking. At baseline, persons with self-reported sensory loss had higher levels of self-reported functional limitations. Trajectories depict a decline in IADL competence with age.

Decreased Handgrip Strength is Associated With Impairments in Each Autonomous Living Task for Aging Adults in the United States.

The primary purpose of this study was to determine the time-varying associations between decreased handgrip strength (HGS) and individual instrumental activities of daily living (IADL) impairments for a nationally-representative sample of aging adults in the United States. Longitudinal-Panel. Detailed interviews were completed in person and core interviews were typically completed over the telephone. A total of 15,336 participants aged at least 50 years who participated in the 2006 wave of the Health and Retirement Study were followed biennially for 8-years. A hand-held dynamometer assessed HGS and performance in IADLs were self-reported. Every 5-kilogram decrease in HGS was associated with an increased odds ratio for the following IADL impairments: 1.11 (95% confidence interval (CI): 1.09, 1.13) for using a map, 1.10 (CI: 1.07, 1.12) for grocery shopping, 1.09 (CI: 1.05, 1.14) for taking medications, 1.07 (CI: 1.05, 1.09) for preparing hot meals, 1.06 (CI: 1.04, 1.08) for managing money, and 1.05 (CI: 1.02, 1.09) for using a telephone. Decreased HGS was associated with each IADL impairment, and slightly different associations were observed in individual IADL tasks for aging adults in the United States. Our findings suggest that decreased HGS, which is reflective of reduced function of the neuromuscular system, is associated with diminished performance in autonomous living tasks during aging. Losses in HGS may lead to the development of an IADL impairment. Therefore, health-care providers working with aging adults should utilize measures of HGS as a screening tool for identifying future deficits in neuromuscular functioning. Interventions designed to preserve IADLs in aging adults should also include measures of HGS for detecting early changes in IADL capacity, and intervening at the onset of HGS declines may help aging adults retain their ability to live autonomously.

DECLINE IN INSTRUMENTAL ACTIVITIES OF DAILY LIVING IS MORE MARKED IN BEHAVIOURAL VARIANT FRONTOTEMPORAL DEMENTIA THAN IN ALZHEIMER’S DISEASE

Different subtypes of dementia show different levels of impairment in everyday functioning. However, there has been little focus on the decline of individual daily activities over time, and how these might vary between subtypes of dementia. The objective of this study was to assess and compare the trajectories of decline of 10 individual instrumental activities of daily living (IADLs) (bills; taxes; shopping; hobbies; using kitchen appliances; preparing a meal; keeping track of current events; paying attention; remembering appointments; travelling) between behavioural variant frontotemporal dementia (bvFTD) and Alzheimer's disease (AD). This study included data from the Uniform Data Set of the National Alzheimer's Coordinating Center (NACC), which collects annual data on demographics, neuropsychological testing, clinical diagnosis, and assessments such the Functional Assessment Questionnaire (FAQ). The dataset was locked in November 2012, and data were extracted up to that occasion. There were a maximum of eight data points for each patient. Independent t-tests were used to assess variations in everyday functioning between dementia types at baseline. Linear mixed effect modelling was performed to explore the longitudinal functional decline between dementia subtypes. The model included random intercepts for subject IDs to account for any correlation between the repeated measures within subjects. In total, data from 3351 patients (306 bvFTD and 3045 AD) were analysed. At baseline, bvFTD patients were impaired to a greater degree with bills (mean difference, d=0.8, p<0.001), taxes (d=0.8, p<0.001), shopping (d=0.6, p<0.001), hobbies (d=0.7, p<0.001), using kitchen appliances (d=0.5, p<0.001), meal preparation (d=0.7, p<0.001), current events (d=0.4, p<0.01), paying attention (d=0.6, p<0.001), and travel (d=0.6, p<0.01) compared to AD patients. BvFTD patients were more impaired on the total FAQ (mean=20.1, standard deviation, sd=10.4) than AD patients (mean=15.2, sd=12.0). Longitudinally, analysing all time points together using linear mixed model, bvFTD patients had lower scores than AD patients on everyday activities (coeff.=-3.95, 95% CI:2.45–5.44, p<0.001). Findings from this study can have important implications for clinical practice in aiding the management of different dementia subtypes, by understanding in depth how different IADLs deteriorate throughout the disease across different types of dementia.

Hierarchical Decline of the Initiative and Performance of Complex Activities of Daily Living in Dementia.

While basic activities of daily living hierarchically decline in dementia, little is known about the decline of individual instrumental activities of daily living (IADLs). The objective of this study was to assess initiative and performance deficits in IADLs in dementia. A total of 581 carers completed the revised Interview for Deterioration in Daily Living Activities in Dementia 2 to rate their relative's everyday functioning. Initiating and performing IADLs deteriorated hierarchically, while people with dementia were consistently most impaired in initiating using the computer and managing finances. Initiating preparing a cold or hot meal and managing finances were more impaired than their performance, whereas performing maintaining an active social life for example were more impaired than their initiative. Findings can help identify the severity of dementia by understanding deficits in initiative and performance. This study has implications for the development of targeted interventions depending on the stage of dementia.

The newly revised interview for deteriorations in daily living activities in dementia (R-IDDD2): distinguishing initiative from performance at assessment.

Minimal evidence exists on the detailed deficits in complex instrumental activities of daily living (IADLs) in mild dementia. The aim of this study was twofold, to validate a revised questionnaire focusing measuring the initiative and performance of IADLs in mild dementia and to explore the relationship between individual IADLs and patient and carer well-being. A total of 183 carers of people with mild dementia completed a further modified Revised Interview for Deterioration in Daily Living Activities 2 (R-IDDD2), which comprised new activities such as computer use, as well as sub-activities on the performance scale. Carers also completed questionnaires assessing patient quality of life (QoL-AD), carer quality of life (AC-QoL), and burden (GHQ-12). Persons with dementia were significantly poorer initiating than performing cleaning, doing repair work, and preparing a hot or cold meal, whereas being poorer at performing dressing and following current affairs. Using the computer, preparing a hot meal, finance, and medication management were most impaired, whereas more basic activities of dressing, washing oneself, brushing hair or teeth, and preparing a hot drink were most preserved. Poor initiative and performance on nearly all activities were significantly related to reduced carer and patient well-being. The R-IDDD2 offers a platform to comprehensively assess everyday functioning. Deteriorations in initiative and performance need to be targeted separately in interventions, as the former requires effective triggering and the latter structured training and support. Most activities were significantly associated with well-being, particularly patient quality of life so that improving any activity should improve well-being.

Synthesizing complex data on functional decline in older people using partial least squares (PLS) analysis.

Declining capacity to function safely and independently in the community is a manifestation of ageing. Multiple measures are used to define and predict functional decline. This paper explores the use of partial least squares (PLS) analysis to understand the interaction between overtime measures of functional decline. Comprehensive information was captured on individuals aged 65+ who presented at a large metropolitan Australian hospital Emergency Department (ED) for a complaint, which did not result in a hospital admission. They were followed-up by telephone 1 and 3 months, post-ED discharge. Information was collected each time on home situations (living alone, using community services, using a gait aid and having a formal carer), recent falls, hospitalizations and instrumental activities of daily living (IADLs). PLS analysis was applied to identify overtime relationships between measures. Valid information was provided by 147 individuals at all three time points. The eight individual IADL items clustered clearly around physical, mental or combined mental and physical IADLs. These clusters were strongly related to increased use of community supports, gait aid and carer, and living alone. The relationship was less convincingly for hospitalizations, and falls were not explained well. PLS analysis offers a novel and comprehensive way of analysing complex health data, which allows sense to be made of relationships over a 3-month period. This analysis provides a better understanding of declining function over time, than could be provided by current health modelling methods.

An investigation into which individual instrumental activities of daily living are affected by a home visiting nurse intervention

to our knowledge no research has investigated the effect of home visiting nurse (HVN) interventions on individual instrumental activities of daily living (IADL). to investigate the effects of an HVN intervention on the difficulty or dependence in six individual IADLs. a secondary analysis of a randomised controlled study comparing an HVN intervention (n = 237) with usual care (n = 262) at 22 months after study entry. home care linked to primary care. a total of 499 Medicare patients needing or receiving help with at least three IADLs or two ADLs, who had recent significant health-care use. the intervention consisted of monthly home visits by trained nursing staff. Unadjusted and adjusted (binary and multinomial logistic regression) analyses were performed. unadjusted analyses found less difficulty or dependence for the HVN group for meal preparation, telephone use, shopping and ordinary housework, and more difficulty or dependence for medication management. After adjustment, in addition to an effect through health-care services use, the HVN group had less difficulty or dependence for meal preparation and shopping and more difficulty or dependence for medication management. an HVN intervention had mixed results for individual IADLs. The negative effect on medication management questions the validity of a total IADL score as an outcome measure, and implies that other medication management measures should be considered for outcome evaluation. Future research is needed to confirm and better understand these findings.

Mild Cognitive Deficits and Everyday Functioning Among Older Adults in the Community: The Monongahela-Youghiogheny Healthy Aging Team Study

: A key component of successful aging is the ability to independently perform instrumental activities of daily living (IADL). We examined the ability to perform multiple IADL tasks in relation to mild cognitive impairment (MCI) defined on purely neuropsychological grounds. : Cross-sectional study. : Population-based cohort in southwestern Pennsylvania. : One thousand seven hundred thirty-seven community-dwelling adults age 65 years and older. : Classification of MCI based on performance with reference to norms in the cognitive domains of memory, language, attention, executive, and visuospatial functions. The ability to perform seven IADL tasks (traveling, shopping, preparing meals, doing housework, taking medications, handling personal finances, and using the telephone) as assessed by the Older Americans Resources and Services scale. : Those with cognitively defined MCI were more likely to be dependent in at least one IADL task, as well as in each individual IADL task, than cognitively normal participants. Better memory and executive functioning were associated with lower odds of IADL dependence in MCI. Across the subtypes of MCI, those with the multiple-domain amnestic subtype were most likely to be dependent in all IADL tasks, with better executive functioning associated with lower risk of dependence in select IADL tasks in this group. : Mild impairment in cognition is associated with difficulty performing IADL tasks at the population level. Understanding these associations may help improve prediction of the outcomes of MCI. It may also allow appropriate targeting of cognitive interventions in MCI to potentially help preserve functional independence.

Predictors of functional recovery for hip fractured elders during 12 months following hospital discharge: a prospective study on a Taiwanese sample.

To examine the longitudinal changes in overall and individual physical activities of daily living (PADLs) and instrumental activities of daily living (IADLs), at 1, 3, 6, and 12 months after hospital discharge in elderly subjects, 110 hip fractured elders (mean+/-SD age, 79.4+/-7.5; 60.9% females) were enrolled in a prospective study. At 12 months following hospital discharge, 56.1% subjects had recovered their overall PADLs, 37.9% had recovered their overall IADLs, and 74.2% could walk independently or with the aide of a cane. When analyzed by generalized estimating equations (GEE), for individual PADL, bathing and climbing stairs had consistently improved at every time point throughout the 1-year follow-up period, while transferring, toileting, and walking ability only improved significantly in the first 3 months after discharge. For individual IADL, the proportion of recovery for mobility appeared to increase significantly during the first 6 months post-discharge, and the remaining IADLs appeared to be stable. These results indicated that the recovery rate is varied for performance of different activities according to the complexity and the involvement of the lower extremities. We also found that less concomitant diseases, and a shorter hospital stay could predict a better recovery trend of overall and of most individual PADLs. These findings may be applicable to other countries with Chinese populations, and could provide a reference for health care providers to develop specific interventions for Chinese hip fractured elders.

Cross-cultural Ranking of IADL Skills

Although causal theories of aging differ considerably across disciplines, the common denominator in published papers on the health and function of the aged is to be found in the methods section. The instrumental activities of daily living (IADL), used to determine the independence of the aged living in the community, are utilized both at a clinical and population level. While there has been a cross-disciplinary need for a scale to measure sub-populations, many scholars have been reticent to use the existing IADL items across geographical backgrounds. The results of this study, which surveys 236 physicians from 11 different cultures on the importance of individual IADL items, suggests the IADL may be useful as a universal measure of function.