Compensatory strategy use improves real-world functional performance in community dwelling older adults.

Abstract

Objective: Compensatory strategies such as assistive technology, external reminders, and environmental cues may help support instrumental activities of daily living (IADLs) and independence. However, functional ability is most often evaluated in clinical settings where everyday compensation cannot be readily observed. The present study used a novel, real-world evaluation of everyday activities (prospective memory, household chores, complex IADLs, and planning tasks) to examine the impact of compensation. Method: Fifty community dwelling older adults were recruited with cognitive status ranging from healthy to mildly impaired. Participants completed a battery of validated performancebased and cognitive tasks, an IADL questionnaire (also completed by an informant), and real-world activities carried out in their own homes. Results: The real-world evaluation demonstrated adequate interrater reliability (intraclass coefficient ϭ 0.92) and construct validity (r ϭ 0.55). Compensation improved real-world task outcome on prospective memory and household chores tasks. Further, cognition emerged as a moderator between compensation and prospective memory task outcome. Participants' ratings on an IADL questionnaire were related to real-world and performance-based functioning whereas informants' ratings were related to performance-based tasks and cognition. Conclusions: Our results suggest that proxy measures of functional ability (i.e., performance-based, cognitive, and IADL questionnaire measures) do not fully capture the complexity of real-world performance for nondemented community dwelling older adults. Compensation appeared to improve prospective memory performance, particularly for individuals with average to low average cognitive abilities. A difference in IADL questionnaire ratings suggest that participants may be better able to judge their real-world performance than informants.

Can Use of Digital Technologies by People with Dementia Improve Self-Management and Social Participation? A Systematic Review of Effect Studies

“…Of the 47 full texts that were read, only nine studies met all of our inclusion criteria [28][29][30][31][32][33][34][35][36]. Sixteen records were excluded because they were determined not to be reporting results from controlled interventional studies [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52]. Eight records were excluded because outcomes of the intervention were only measured in a laboratory environment [53][54][55][56][57][58][59][60].…”

Daily Assessment of Executive Functioning and Expressive Suppression Predict Daily Functioning among Community-Dwelling Older Adults

“…To address these limitations, a few studies have attempted to target real-world functioning. For example, one study presented participants with a list of tasks (e.g., making lunch, changing a light bulb, demonstrating their medication routine) to complete at home during a brief observation (less than 2 hours; Weakley & Schmitter-Edgecombe, 2019). Although this approach allows participants to complete tasks they would complete regardless of being in a study, the single observation period precludes measurement of daily variation or the capacity to spontaneously interleave study tasks with other daily routines.…”

A Mixed-Method Study on Strategies in Everyday Personal Goals among Community-Dwelling Older Adults

“…Because resources decline with age, compensation and selection strategies appear more important in maintaining personal goals and satisfying levels of functioning in older than in younger adults, whereas the reverse is true for optimization strategies [6]. Indeed, there is robust evidence that selection supports a major shift in motivational processes with increasing age [18] and that compensation is summoned for both physical and cognitive functioning when dealing with declining resources [4, 14, 15, 19].…”