Carrie A. Ciro, Michael P. Anderson, Linda A. Hershey, Calin I. Prodan, Margo B. Holm; Instrumental Activities of Daily Living Performance and Role Satisfaction in People With and Without Mild Cognitive Impairment: A Pilot Project. Am J Occup Ther 2015;69(3):6903270020. https://doi.org/10.5014/ajot.2014.015198
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© 2020 American Occupational Therapy Association
OBJECTIVE. We investigated differences in observed performance of instrumental activities of daily living (IADLs) and self-reported satisfaction with social role performance between people with amnestic mild cognitive impairment (a-MCI) and age- and gender-matched control participants.
METHOD. We measured observed performance of 14 IADLs using the Independence, Safety, and Adequacy domains of the Performance Assessment of Self-Care Skills (PASS) and the Patient-Reported Outcomes Measurement Information Systems (PROMIS) to examine satisfaction with social role performance.
RESULTS. Total PASS scores were significantly lower in participants with a-MCI (median = 40.6) than in control participants (median = 44.2; p = .006). Adequacy scores were also significantly lower. No significant differences were found between groups on the PROMIS measures.
CONCLUSION. IADL differences between groups were related more to errors in adequacy than to safety and independence. Occupational therapy practitioners can play a key role in the diagnosis and treatment of subtle IADL deficits in people with MCI.
Obtaining critical information from visual media (reading a mock newspaper article and answering questions)
Obtaining critical information from audio media (listening to a tape recording that simulates radio or television announcements and answering questions)
Performing home repairs (identifying why a flashlight does not work and problem solving that the battery is dead)
Paying two bills by check (using bill statements to write out checks accurately)
Balancing a checkbook ledger (adding a deposit and subtracting the two paid bills)
Mailing bills (addressing the envelopes and applying stamps)
Using a land line telephone (locating a number for a pharmacy in a phone book, dialing the number, and gathering information from the pharmacy about open hours)
Managing medication (sorting medications by time of delivery)
Shopping (purchasing precise items on a grocery list using real money)
Ascertaining home safety (visually finding safety errors such as a crumpled rug on the floor and problem solving how to fix them)
Using a stove (preparing a can of soup)
Using an oven (baking muffins)
Using sharps (cutting an apple into eight pieces).
0 indicates total assistance, high safety risk, or unacceptable performance in quality and process
1 indicates the need for physical assistance and verbal cues, need for supervision for safety, marginal compliance with standards for quality, or lack of precision in following steps
2 indicates lack of need for physical assistance to perform the task but need for occasional verbal cues or environmental supports to complete the task successfully, no physical assistance for safety, room for improvement on quality, or occasional lack of precision of effort in completing the task
3 indicates total independence with no cues needed to initiate and complete the task, safe completion of the task, or compliance with all quality and process standards.
Occupational therapy practitioners could advocate to be part of teams that provide diagnoses for people with emerging (MCI) and frank (dementia) cognitive disorders in older adults and can make specific contributions in the evaluation of occupational performance.
A performance-based ADL and IADL assessment such as the PASS may help occupational therapy practitioners both identify the specific underlying occupational performance dysfunction and direct treatment interventions to align with the performance deficit.
Our pilot results indicate that errors in adequacy, which includes quality and process of performance, are more likely to be problematic in people with a-MCI than safety and independence issues. Therefore, evidence-based assessments and treatments could build on clients’ strengths in independence and safety while seeking to compensate for errors in adequacy to facilitate maximal occupational performance.
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