Instrumental activities of daily living among community-dwelling older adults: Discrepancies between self-report and performance are mediated by cognitive reserve

Abstract

The ability to engage in instrumental activities of daily living (IADLs) is known to rely on cognitive abilities, primarily executive functioning and memory. There is also evidence that good self-awareness, which facilitates the use of compensatory strategies, may prolong functionality and delay the diagnosis of dementia. However, little is known about the mechanisms that mediate self-awareness among healthy elderly. The present study examined the correlates of discrepancies between self-report and performance-based measures of IADLs in a sample of 75 community-dwelling elderly. The results indicate that even among independently living individuals, there is still variability in functionality (i.e., 35% of the sample made IADL performance errors) and self-awareness (i.e., 38% of the sample demonstrated a discrepancy between IADL self-report and performances). Better awareness of IADL weaknesses was associated with higher levels of cognitive reserve but, unexpectedly, lower levels of executive abilities. Additionally, consistent with prior research, better IADL performances were associated with better cognition.

Keywords:

• Activities of daily living
• Awareness
• Insight
• Elderly
• Cognitive reserve
• Executive functioning

The study was approved by the University of Utah institutional review board (IRB). The authors had no conflict of interest when conducting this research or reporting the results.

Notes

¹Non-right-handers were excluded from the study because of some evidence that they may differ somewhat from right-handers cognitively (Basso et al., 2006; Gunstad, Spitznagel, Luyster, Cohen, & Paul, 2007; Wright, Hardie, & Rodway, 2004).

²Health problems were assessed via a structured interview developed for this study.