Li Jiaying, He Rendong, Hsu Erh-Chi, Li Junxin
School of Nursing, Johns Hopkins University, 525 N Wolfe St, Baltimore, MD, 21205, United States, 1 4105022608.
School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, China (Hong Kong).
JMIR Aging. 2025 Mar 19;8:e67632. doi: 10.2196/67632.
Cognitive impairment in older adults reduces independence and raises health care costs but can be mitigated through stimulating activities. Based on network theory, intricate relationships within and between clusters of instrumental activities of daily living (IADLs) and cognitive domains suggest the existence of central IADLs and cognitive domains, as well as bridge IADLs. Modifying these can significantly enhance daily living activities and cognitive functions holistically.
This study aims to identify central IADLs (key activities within the IADL network), central cognitive domains (key domains within the cognitive network), and bridge IADLs (linking IADL and cognitive networks). These insights will inform targeted interventions to effectively improve IADL and cognitive well-being in older adults.
A cross-sectional analysis of adults aged 65 years and older in the United States focused on 5 IADLs and 6 cognitive domains from the National Health and Aging Trends Study (NHATS). Network analysis identified central and bridge variables. Nonparametric and case-dropping bootstrap methods checked network stability. Network comparison tests assessed sex differences with Benjamini-Hochberg adjustments.
Of the 2239 participants, 56.4% were female (n=976). We computed and tested 3 networks: IADL, cognition, and bridge-with correlation stability coefficients of 0.67, 0.75, and 0.44, respectively (all>0.25). Meal preparation was identified as the central IADL, with a centrality index of 3.87, which was significantly higher than that of other IADLs (all P<.05). Visual attention emerged as the central cognition domain, with a centrality index of 0.86, which was significantly higher than that of other cognition domains (all P<.05). Shopping was determined to be the bridge IADL, with a centrality index of 0.41, which was significantly higher than that of other IADLs (all P<.05). Notably, gender differences emerged in the IADL network, with stronger associations between laundry and meal preparation in females (1.69 vs males: 0.74; P=.001) and higher centrality in meal preparation among females (difference=1.99; P=.007).
While broad enhancements in all IADL and cognitive domains are beneficial, targeting meal preparation, visual attention, and shopping may leverage their within-network influence to yield a more pronounced improvement in holistic IADL, holistic cognition, and holistic cognition function through IADL interventions among older adults. Notably, meal preparation interventions may be less effective in males, requiring tailored approaches.
老年人的认知障碍会降低其独立性并增加医疗保健成本，但可通过刺激性活动得到缓解。基于网络理论，日常生活工具性活动（IADL）集群内部以及与认知领域之间的复杂关系表明存在核心IADL、认知领域以及桥梁IADL。对这些进行调整可从整体上显著增强日常生活活动和认知功能。
本研究旨在识别核心IADL（IADL网络中的关键活动）、核心认知领域（认知网络中的关键领域）以及桥梁IADL（连接IADL和认知网络）。这些见解将为有针对性的干预措施提供依据，以有效改善老年人的IADL和认知健康状况。
对美国65岁及以上成年人进行横断面分析，重点关注来自国家健康与老龄化趋势研究（NHATS）的5项IADL和6个认知领域。网络分析确定了核心变量和桥梁变量。非参数和删失法自抽样方法检验了网络稳定性。网络比较测试通过Benjamini-Hochberg校正评估性别差异。
在2239名参与者中，56.4%为女性（n = 976）。我们计算并测试了3个网络：IADL、认知和桥梁网络，其相关稳定性系数分别为0.67、0.75和0.44（均>0.25）。准备膳食被确定为核心IADL，中心性指数为3.87，显著高于其他IADL（所有P <.05）。视觉注意力成为核心认知领域，中心性指数为0.86，显著高于其他认知领域（所有P <.05）。购物被确定为桥梁IADL，中心性指数为0.41，显著高于其他IADL（所有P <.05）。值得注意的是，IADL网络中出现了性别差异，女性在洗衣和准备膳食之间的关联更强（1.69，男性为0.74；P = 0.001），女性在准备膳食方面的中心性更高（差异 = 1.99；P = 0.007）。
虽然所有IADL和认知领域的广泛改善都是有益的，但针对准备膳食、视觉注意力和购物进行干预，可能会利用它们在网络中的影响力，通过对老年人的IADL干预，在整体IADL、整体认知和整体认知功能方面产生更显著的改善。值得注意的是，准备膳食干预对男性可能效果较差，需要采取针对性的方法。
