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It’s complicated: Executive functioning moderates impacts of daily busyness on everyday functioning in community-dwelling older adults

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Yana Suchy, Michelle Gereau Mora, Libby A. DesRuisseaux, Stacey L. Brothers

A busy day can make almost anyone late. But for some older adults, the bigger danger may be how sharply life swings from quiet one day to chaotic the next.

Abstract

Objective: Research shows that cognitively healthy older adults with mild executive function (EF) weaknesses are vulnerable to the negative impacts of life complexity (or daily busyness) when performing instrumental activities of daily living (IADLs). However, past research assessed life complexity only at one timepoint, not capturing daily fluctuations. Importantly, fluctuations in busyness can themselves have deleterious impacts on functioning. This study extended past research by examining whether (1) variability in daily busyness would be more detrimental than level of busyness to performance of IADLs, and (2) EF assessed at home would moderate deleterious impact of busyness on IADLs. Method: Fifty-two community-dwelling older adults aged 60 to 95 completed daily IADL tasks and daily measures of EF and busyness via ecological momentary assessment, independently at home for 18 days. Results: (1) In a subset of participants with mild EF weaknesses, high variability in busyness across days was associated with fewer tasks completed correctly; and (2) across all participants (regardless of EF), high levels of daily busyness were associated with fewer tasks completed on time. Conclusions: Findings indicate that high variability in daily busyness, potentially reflecting a lack of daily routine, was associated with IADL errors among cognitively healthy older adults with mild EF weaknesses. Additionally, consistently high levels of busyness were associated with failures to complete tasks, or failures to complete them on time, regardless of EF. These results further support the Contextually Valid Executive Assessment (ConVExA) model, which posits that EF and contextual factors interact to predict functional outcomes.

Transcript

A busy day can make almost anyone late. But for some older adults, the bigger danger may be how sharply life swings from quiet one day to chaotic the next. Everyday independence depends on ordinary tasks: handling money, finding information, managing errands, and keeping commitments.

Older adults with mild weaknesses in executive function are vulnerable to the negative impacts of daily busyness while doing these tasks. Earlier research looked at life complexity at only one timepoint, so it missed daily fluctuations. This study asked whether variability in daily busyness could be more harmful than simply having a high average level of busyness.

The study also asked whether executive function could change the impact of busyness. In the home setting, older adults completed daily tasks and daily measures of executive function and busyness. The key distinction is between how busy life usually is and how much it changes from day to day.

A person can have a busy schedule, but a schedule that repeatedly jumps between calm and overloaded may be harder to manage. The study tested whether variability in daily busyness, rather than its average level, would be more detrimental to daily instrumental activities of daily living beyond daily executive function.

The goal was also to test whether daily measures taken at home had implications similar to measures taken in an office. Older adults completed everyday tasks at home along with daily measures of executive function and busyness. The everyday tasks resembled typical activities of independent living.

They involved paying bills, looking up information, managing passwords, shopping and errands, solving daily problems, and communicating. The tasks also changed their demands from day to day. People had to provide evidence that a task was finished within time windows that varied, much as a doctor’s office may be reachable only during certain hours.

Performance included both accuracy and timeliness: whether a task was completed, whether it was completed at the right time, and how accurately it was done. The tasks were not repeated, so practice effects were not seen across the days.

On survey evenings, participants compared that day’s busyness with their own typical day and reported it on a numerical scale. Because people differ in how busy they consider themselves relative to others, within-person comparisons were considered more valid for assessing daily busyness.

Those reports provided two separate clues: the average level of busyness and the amount of day-to-day variability. The study specifically expected deviations from routine to be more harmful than overall busyness. The results separated these two kinds of busyness.

Executive function and average busyness each predicted everyday task performance, but executive function changed the effect of variability in busyness, not the effect of average busyness. For people with weaker executive function, performance decreased as day-to-day variability in busyness increased.

High variability in busyness was associated with lower everyday task performance, but only among participants with weaker executive function. The overall pattern was two-part. Among people with poorer average daily executive-function performance, high day-to-day variability in busyness was associated with fewer tasks completed correctly.

Across all participants, high levels of daily busyness were associated with fewer tasks being completed, or with fewer tasks being completed on time. So constant pressure and unpredictable pressure were linked to different kinds of difficulty.

Together, the findings support the idea that executive function interacts with circumstances when predicting everyday performance. The interaction added information beyond traditional executive-function measures in explaining task accuracy. That does not yet make this a clinical tool.

More work is needed to describe these relationships precisely and to develop better ways to measure the circumstances surrounding daily life. But the practical possibility is important: people with intermediate scores might not struggle all the time.

They might be at risk of lapses under particular circumstances, allowing recommendations to focus on the situations most likely to cause trouble. The study suggests that everyday functioning depends on both a person’s planning ability and the rhythm of daily life.

More stable routines may help protect people who are especially vulnerable to disruption.

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