Everyday problem solving and instrumental activities of daily living: support for domain specificity

Long-term functional disabilities in intensive care unit survivors: A prospective cohort study

BACKGROUND

Functional disabilities are common in intensive care unit (ICU) survivors and may affect their ability to live independently. Few previous studies have investigated long-term functional outcomes with health status before ICU admission (pre-ICU health), and they are limited to specific patient groups.

OBJECTIVES

The objective of this study was to investigate the prevalence of functional disabilities and examine pre-ICU health variables as possible predictive factors of functional disabilities 12 months after ICU admission in a mixed population of ICU survivors.

METHODS

This prospective cohort study was conducted in six ICUs in Norway. Data on pre-ICU health were collected as soon as possible after ICU admission using patients, proxies, and patient electronic health records and at 12 months after ICU admission. Self-reported functional status was assessed using the Katz Index of independence in personal activities of daily living (P-ADL) and the Lawton instrumental activities of daily living scale (I-ADL).

RESULTS

A total of 220 of 343 (64%) ICU survivors with data on pre-ICU health completed the questionnaires at 12 months and reported the following functional disabilities at 12 months: 31 patients (14.4%) reported P-ADL dependencies (new in 16 and persisting in 15), and 80 patients (36.4%) reported I-ADL dependencies (new in 41 and persisting in 39). In a multivariate analysis, worse baseline P-ADL and I-ADL scores were associated with dependencies in P-ADLs (odds ratio [OR]: 1.87; 95% confidence interval [CI]: 1.14-3.06) and I-ADLs (OR: 1.52; 95% CI: 1.03-2.23), respectively, at 12 months. Patients who were employed were less likely to report I-ADL dependencies at 12 months (OR: 0.34; 95% CI: 0.12-0.95).

CONCLUSION

In a subsample of ICU survivors, patients reported functional disabilities 12 months after ICU admission, which was significantly associated with their pre-ICU functional status. Early screening of pre-ICU functional status may help identify patients at risk of long-term functional disabilities. ICU survivors with pre-ICU functional disabilities may find it difficult to improve their functional status.

Memory performance mediates the relationship between depression and independence in instrumental activities of daily living among community-dwelling older adults: Evidence from the China Family Panel Study

Our objective was to examine the link between depression and independence in the instrumental activities of daily living (IADLs) and to explore the mediating role of memory performance through a cross-sectional analysis of a nationally representative sample of community-dwelling older adults in China. In total, 3730 respondents age ≥ 60 (51.7% males) from the 2020 survey of the China Family Panel Study (CFPS) constituted the study sample. Their depressive symptoms, memory performance, and independence in the IADLs were measured. Based on the descriptive statistics, bivariate correlation analysis and bootstrapping mediation analysis were conducted. As hypothesized, independence in the IADLs was negatively related to depression, while it was positively associated with memory performance. Moreover, after controlling for demographic factors, memory performance was demonstrated to be a partial mediator between depression and independence in the IADLs. These findings support the development of clinical interventions which prevent disability or maintain the physical functioning of older adults through alleviating depression and enhancing memory performance.

The brief case for everyday problems: a proposal of two brief alternate forms of the Everyday Problems Test

Everyday Problems Test (EPT; Willis and Marsiske, Manual for the everyday problems test, Pennsylvania State University, Pennsylvania, 1993) is an 84-item performance-based measure of older adults' everyday cognitive competencies in seven everyday domains (e.g., finance, reading prescription). Its length makes it disadvantageous in the typical time-constrained testing context. Due to the potential practice effects, it is also impractical for longitudinal and intervention studies which require repetitive testing. We have addressed these issues by adapting two brief forms of EPT, with 14 items each. The psychometric evaluation of these two versions was conducted on a sample of 157 cognitively healthy older adults. Both brief forms demonstrated good internal consistency, high inter-correlation, and have shown satisfactory concurrent criterion-related validity based on their correlations with socio-demographic and cognitive variables. Results indicate that the two proposed brief forms can be a valuable tool in assessing the everyday cognitive competence of healthy older adults either as a one-time screening instrument or as a pretest-posttest difference indicator of the intervention efficacy.

The Cultural Adaptation of the Everyday Problems Test-Greek Version: An Instrument to Examine Everyday Functioning

Assessing cognitive decline and everyday functioning (EvF) in older age is valuable in detecting age-related neurological disorders. In Greece, there is a lack of sensitive instruments that capture fluctuations in EvF among older persons who are cognitively healthy or have subtle cognitive impairments. The EPT 28-items test, a widely used paper-and-pencil EvF measure, was translated in Greek and adapted to the Greek culture in this study. A multi-step methodology using a sample of 139 older Greek persons was employed. The results indicate that the Greek version of the EPT 28-items (i.e., the EPT-G) was well adapted, representing everyday tasks in Greece within a good range of task difficulty. The psychometric properties of the EPT-G replicate those of the original instrument, capturing EvF fluctuations among older persons with mild cognitive impairments. It was concluded that the EPT-G is a useful measure of EvF among Greek older persons.

Self-reported activities of daily living, health and quality of life among older adults in South Africa and Uganda: a cross sectional study

BACKGROUND

Difficulties in performing the activities of daily living (ADL) are common among middle-aged and older adults. Inability to perform the basic tasks as well as increased healthcare expenditure and dependence on care can have debilitating effects on health and quality of life. The objective of this study was to examine the relationship between self-reported difficulty in activities of daily living (ADL), health and quality of life among community-dwelling, older population in South Africa and Uganda.

METHODS

We analyzed cross-sectional data on 1495 men and women from South Africa (n = 514) and Uganda (n = 981) which were extracted from the SAGE Well-Being of Older People Study (WOPS 2011-13). Outcome variables were self-reported health and quality of life (QoL). Difficulty in ADL was assessed by self-reported answers on 12 different questions covering various physical and cognitive aspects. The association between self-reported health and quality of life with ADL difficulties was calculated by using multivariable logistic regression models.

RESULTS

Overall percentage of good health and good quality of life was 40.4% and 20%, respectively. The percentage of respondents who had 1-3, 3-6, > 6 ADL difficulties were 42.4%7, 30.97% and 14.85%, respectively. In South Africa, having > 6 ADL difficulties was associated with lower odds of good health among men [Odds ratio = 0.331, 95%CI = 0.245,0.448] and quality of life among men [Odds ratio = 0.609, 95%CI = 0.424,0.874] and women [Odds ratio = 0.129, 95%CI = 0.0697,0.240]. In Uganda, having > 6 ADL difficulties was associated lower odds of good health [Odds ratio = 0.364, 95%CI = 0.159,0.835] and quality of life [Odds ratio = 0.584, 95%CI = 0.357,0.954].

CONCLUSION

This study concludes that difficulty in ADL has a significant negative association with health and quality of life among community-dwelling older population (> 50 years) in South Africa and Uganda. The sex differences support previous findings on differential health outcomes among men and women, and underline the importance of designing sex-specific health intervention programs.

Problem-solving in technology-rich environments and cancer screening in later life

Routine cancer screening is widely recognized as an effective preventive strategy to reduce cancer mortality - the second leading cause of death in the US. However, cancer screening requires a complex array of tasks such as seeking up-to-date guidelines, making appointments, planning hospital visits, and communicating with health care professionals. Importantly, modern health care largely relies on technology to disseminate the latest information and administer the system. Yet, little is known about the technology-related skills that are relevant to regular cancer screening. This study examined the association between problem-solving skills in the technology-rich environment and cancer screening in later life. Using 2012/2014 Program for International Assessment of Adult Competencies data, binary logistic regressions with survey weights were used to estimate the association between problem-solving skills in the technology-rich environment and four cancer screening behaviors among the corresponding target populations aged between 45 and 74 years old (n = 1374 for cervical screening; n = 1373 for breast screening; n = 1166 for prostate screening; n = 2563 for colon screening). Results showed that greater problem-solving skills in the technology-rich environment scores (0-500 points) were significantly and positively associated with prostate cancer screening (odds ratio = 1.005, P < 0.05) among men, but not with colon (men and women) or cervical or breast (women) cancer screenings. Improvement in problem-solving skills in the technology-rich environment may promote specific cancer screening behaviors. Our findings inform future policy discussions and interventions that seek to improve cancer screening among a vulnerable section of older populations.

Age-specific changes in cognitive function

Currently, the number of cases of pathological aging of the central nervous system, represented by a violation of cognitive functions, is increasing. But there is a social request to prolong the physical and mental activity of older people. The study of the dynamics of cognitive aging is timely and relevant. The article contains a report on a cohore non-repeating study of higher brain functions at various age periods. 148 people involved. Their age is 27 -74 years. They are right handed. We applied the screening neuropsychological method. Statistical data processing was performed using SPSS Statistics 17.0 (Mann-Whitney U-test). The dynamic heterogeneity of the cognitive profile during aging was revealed. The deterioration in the performance of the graphomotor test was the most age-specific. In older study participants, a decrease in the visual gnosis test correlated with a decrease in non-verbal intelligence. The decrease in executive functions correlated with the growth of neurodynamic disorders in elderly study participants. The results obtained are useful for differentiating normative and pathological aging of the central nervous system.

Improving Everyday Functioning in the Old-Old with Working Memory Training

OBJECTIVE

The aim of this study was to assess gains related to working memory (WM) training, in the short and long term (9 months after the training), in abilities required in everyday life, and in cognitive measures in old-old adults (aged ≥ 75 years).

METHODS

Thirty-two community-dwelling older adults (aged 75-85 years) were randomly assigned to a training or an active control group. In addition to testing for any specific gains in a WM task similar to the one used in the training (criterion task), we sought transfer effects to: 1) abilities involved in everyday life using objective performance-based tasks (the Everyday Problem Test [EPT] and the Timed Instrumental Activities of Daily Living [TIADL] scale; 2) tasks demanding the comprehension and recall of spatial information and pairing names with faces; and 3) a measure of inhibitory control, that is, recall errors (intrusion errors).

RESULTS

Only the trained group showed specific gains in the criterion task, and in the TIADL in the short term. At follow-up, the trained group maintained gains in the criterion task, and showed transfer effects to everyday problem-solving (in the EPT), and in constructing spatial representations of an environment. The trained group also improved in a cognitive inhibition measure (intrusion errors) at follow-up. No such improvements were seen in the active control group.

CONCLUSION

WM training may be a valid way to help old-old adults preserve at least some abilities related to everyday functioning.

The Impact of a Community-Based Food Education Program on Nutrition-Related Knowledge in Middle-Aged and Older Patients with Type 2 Diabetes: Results of a Pilot Randomized Controlled Trial

The purpose of this study was to evaluate the impact of a community-based food education program on nutrition-related knowledge in middle-aged and older patients with type 2 diabetes (T2D). Participants (n = 36; 65.9 ± 6.0 years old) were recruited in primary health care to a 9-month community-based lifestyle intervention program for patients with T2D and randomly assigned to an exercise program (control group; n = 16) or an exercise program plus a food education program (experimental group; n = 20). Nutrition-related knowledge was assessed through a modified version of the General Nutrition Knowledge Questionnaire. The increase in total nutrition-related knowledge score and sources of nutrients area score was significantly higher in the experimental group compared to the control group. No significant changes in nutrition-related knowledge were found between groups in dietary recommendations and diet-disease relationship areas, although improvements were observed. This community-based food education program, with the use of easy to implement strategies (short-duration lectures and dual-task problem solving activities during exercise), had a positive and encouraging impact on nutrition-related knowledge in middle-aged and older patients with T2D.

Is Episodic Future Thinking Important for Instrumental Activities of Daily Living? A Study in Neurological Patients and Healthy Older Adults

OBJECTIVE

Episodic future thinking is the ability to mentally project oneself into the future. This construct has been explored extensively in cognitive neuroscience and may be relevant for adaptive functioning. However, it has not been determined whether the measurement of episodic future thinking might be valuable in a clinical neuropsychological setting. The current study investigated (1) the relationship between episodic future thinking and instrumental activities of daily living (IADLs); and (2) whether episodic future thinking is related to IADLs over and above standard measures of cognition.

METHOD

Sixty-one older adults with heterogeneous neurological conditions and 41 healthy older adults completed a future thinking task (the adapted Autobiographical Interview), a performance-based measure of instrumental activities of daily living (the Independent Living Scales), and standard clinical measures of memory and executive functioning.

RESULTS

Episodic future thinking significantly predicted IADLs after accounting for age, education, gender, and depression (increase in R2 = .050, p = .010). Episodic future thinking significantly predicted IADLs over and above executive functioning (increase in R2 = .025, p = .030), but was not predictive of IADLs over and above memory (p = .157).

CONCLUSIONS

This study suggests that episodic future thinking is significantly associated with IADLs, beyond what can be accounted for by executive functioning. However, episodic future thinking did not predict IADLs over and above memory. Overall, there is limited evidence for the clinical utility of episodic future thinking. The findings suggest that an episodic future thinking task does not provide enough valuable information about IADLs to justify its inclusion in a clinical neuropsychological setting.

Problem Solving in Technology-Rich Environments and Self-Rated Health Among Adults in the U.S.: An Analysis of the Program for the International Assessment of Adult Competencies

Problem-solving skills in the context of technologically complex modern societies have become increasingly important to health management in later life. This study is designed to investigate the associations between problem-solving skills in technology-rich environments (PSTRE) and health, and to explore whether age differences exist. Using data from the 2012/2014 Program for the International Assessment of Adult Competencies (PIAAC), we used logistic regression to examine the relationship between PSTRE and self-reported health among a representative sample of American adults aged 35 years and older (N = 3,260). Overall, greater PSTRE (odds ratio [OR] = 1.012, p < .001) was significantly associated with better self-rated health even after adjusting for the sociodemographic characteristics. Yet, PSTRE was only partially predictive of health in some age groups. Our findings highlight the potential of PSTRE to reduce health disparities among middle-aged and older adults living in modern technology and information-rich societies.

Problem solving skills and deficits among homeless veterans with serious mental illness

Few interventions train homeless consumers in housing-related independent living skills. To inform the development of such interventions for the Department of Veterans Affairs' Supported Housing consumers with serious mental illness, we examined these consumers' problem-solving skills and deficits. We performed semistructured interviews and cognitive tests with 20 consumers who retained housing for ≥1 year ("stayers") and 20 consumers who lost housing in <1 year ("exiters"). Salient types of problems were identified in the qualitative data; we categorized problem-solving approaches by complexity level and identified differences in problem-solving complexity by consumers' housing outcomes. Instrumental (e.g., money management), interpersonal, and health-related problems were prominent in consumers' narratives. Cognition was poor among stayers and exiters. Problem-solving approaches were highly relevant to day-to-day functioning in supported housing. There was a trend toward greater problem-solving complexity in stayers versus exiters. These data explore potential challenges faced in supported housing and help inform the development of a Veterans Affairs-based housing-focused skills training intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Intervention Program to Improve Executive Functions and Enhance Planning Abilities of Patients With Mild Neurocognitive Disorder

PURPOSE

The aim of this study was to examine the effects of an intervention program to improve executive functions and enhance the planning abilities of patients with mild neurocognitive disorder.

DESIGN

A pilot intervention study.

METHODS

Ten inpatients performed an intervention program based on Lezak's conceptual model that teaches task-specific routines. The program consisted of six training sessions presented over a 2-week period. Neuropsychological assessments were performed pre- and postintervention.

FINDINGS

The postintervention scores of the Behavioral Assessment of Dysexecutive Syndrome Total Profile and two subtests were significantly higher than the preintervention scores. The instrumental Activities of Daily Living Scale and the Visual Analog Scale were significantly improved.

CONCLUSION

This intervention program leads to improvement in the executive function of planning ability and promotes independence and self-confidence in patients with mild neurocognitive disorder.

CLINICAL RELEVANCE

Clinicians should consider the program in terms of improving the executive dysfunction, and the process of planning and the process of actual practice are important.

Performance-based everyday functional competence measures across the adult lifespan: the role of cognitive abilities

BACKGROUND

The effects of age on the ability to manage everyday functioning, crucial to ensure a healthy aging process, have been rarely examined and when, self-report measures have been used. The aim of the present study was to examine age effects across the adult lifespan in everyday functioning with two performance-based measures: the Everyday Problems Test (EPT), and the Timed Instrumental Activities of Daily Living (TIADL) tasks. The role of some crucial cognitive abilities, i.e. working memory (WM), processing speed, reasoning, vocabulary, and text comprehension in the EPT and the TIADL were also assessed to see whether or not they have a similar influence (and to what extent) in accounting for age-related effects in these two performance-based measures.

METHOD

Two hundred and seventy-six healthy participants, from 40 to 89 years of age were presented with the EPT, the TIADL, as well as WM, processing speed, reasoning, text comprehension, and vocabulary tasks.

RESULTS

Path models indicated an indirect effect of age and education on the EPT, which was mediated by all the cognitive variables considered, with WM and reasoning being the strongest predictors of performance. An indirect quadratic effect of age, but not of education, was found on the TIADL score, and an accelerated decline in processing speed mediated the relationship between age and the TIADL score.

CONCLUSION

This study revealed age-related effects in performance-based measures, which are mediated by different cognitive abilities depending on the measure considered. The findings highlight the importance of assessing everyday functioning even in healthy older adults.

Cognitive Predictors of Everyday Problem Solving across the Lifespan

BACKGROUND

An important aspect of successful aging is maintaining the ability to solve everyday problems encountered in daily life. The limited evidence today suggests that everyday problem solving ability increases from young adulthood to middle age, but decreases in older age.

OBJECTIVES

The present study examined age differences in the relative contributions of fluid and crystallized abilities to solving problems on the Everyday Problems Test (EPT). We hypothesized that due to diminishing fluid resources available with advanced age, crystallized knowledge would become increasingly important in predicting everyday problem solving with greater age.

METHOD

Two hundred and twenty-one healthy adults from the Dallas Lifespan Brain Study, aged 24-93 years, completed a cognitive battery that included measures of fluid ability (i.e., processing speed, working memory, inductive reasoning) and crystallized ability (i.e., multiple measures of vocabulary). These measures were used to predict performance on EPT.

RESULTS

Everyday problem solving showed an increase in performance from young to early middle age, with performance beginning to decrease at about age of 50 years. As hypothesized, fluid ability was the primary predictor of performance on everyday problem solving for young adults, but with increasing age, crystallized ability became the dominant predictor.

CONCLUSION

This study provides evidence that everyday problem solving ability differs with age, and, more importantly, that the processes underlying it differ with age as well. The findings indicate that older adults increasingly rely on knowledge to support everyday problem solving, whereas young adults rely almost exclusively on fluid intelligence.

Translation and validation of Chinese version of the problems in everyday living (PEDL) test in patients with mild cognitive impairment

BACKGROUND

Cognitive impairment places older adults at increased risk of functional decline, injuries, and hospitalization. Assessments to determine whether older persons are still capable of meeting the cognitive challenges of everyday living are crucial to ensure their safe and independent living in the community. The present study aims to translate and validate the Chinese version of the Problems in Everyday Living (PEDL) test for use in Chinese population with mild cognitive impairment (MCI).

METHODS

The cultural relevancy and content validity of the Chinese version of PEDL (C-PEDL) was evaluated by a seven-member expert panel. Forty patients with MCI and 40 cognitively healthy participants were recruited to examine the psychometric properties of C-PEDL.

RESULTS

Significant differences in the C-PEDL scores were found between the patients with MCI and the cognitively healthy controls in both educated (F = 9.96, p = 0.003) and illiterate (F = 10.43, p = 0.004) populations. The C-PEDL had excellent test-retest and inter-rater reliabilities, with intraclass correlation coefficient at 0.95 and 0.99 respectively. The internal consistency of C-PEDL was acceptable with Chronbach's α at 0.69. The C-PEDL had moderate correlation with the Mini-Mental State Examination (r = 0.45, p = 0.004) and the Category Verbal Fluency Test (r = 0.40, p = 0.012), and a moderate negative Spearman's correlation with the Global Deteriorating Scale (r = -0.42, p = 0.007).

CONCLUSIONS

The C-PEDL is a valid and reliable test for assessing the everyday problem-solving ability in Chinese older population with MCI.