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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

Being busy is not automatically harmful. This study suggests that day-to-day swings in busyness are especially linked to everyday-functioning errors among older adults with weaker executive functioning, while consistently high busyness can affect task completion more broadly.

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

Being busy is not automatically harmful. This study suggests that day-to-day swings in busyness are especially linked to everyday-functioning errors among older adults with weaker executive functioning, while consistently high busyness can affect task completion more broadly.

Cognitively healthy older adults with mild executive-function weaknesses are vulnerable to the negative impacts of life complexity, or daily busyness, when performing instrumental activities of daily living. Past research assessed life complexity at only one timepoint, so it did not capture daily fluctuations.

This study therefore examined whether variability in daily busyness would be more detrimental than its level, and whether executive functioning assessed at home would moderate busyness's impact on everyday tasks. Fifty-two community-dwelling older adults aged sixty to ninety-five completed daily everyday-task measures, executive-function measures, and busyness measures independently at home for eighteen days.

The reported pattern was specific: among participants with mild executive-function weaknesses, high variability in busyness was associated with fewer tasks completed correctly; across all participants, high daily busyness was associated with fewer tasks completed on time.

The Contextually Valid Executive Assessment model proposes that everyday-task performance is determined by an interplay between cognition and quantifiable contextual factors. In this model, executive functioning can act as both a mediator and a moderator, so context and cognition are considered together when predicting everyday functioning.

The study asked whether daily busyness, defined here as a person's reported sense of busyness relative to a typical day, would predict daily everyday-task performance beyond daily executive functioning. A second goal was to test whether overall executive functioning, averaged across eighteen days, would moderate the impact of busyness on daily functioning.

Participants completed everyday-task measures at home over eighteen days, along with daily ecological momentary assessments of executive functioning and busyness. The DAILIES tasks resembled typical instrumental activities of daily living and were completed six days a week for three weeks.

The tasks covered bill paying and finances, internet information lookup, password management, shopping and errands, hypothetical daily-life problems, and communication. Participants provided evidence within time frames that varied by day, and scoring captured both timeliness and accuracy.

The sum across all eighteen tasks was the DAILIES outcome reflecting home-based everyday-task performance. Because no tasks were repeated, the study found no practice effects across the eighteen days. Participants reported daily busyness in an evening survey, answering how busy they had been compared with their typical day.

They used a slider from zero, meaning not busy at all, to one hundred, meaning much more busy than usual. The mean and standard deviation of responses across eighteen days represented average busyness and variability in busyness, called Busy-Mean and Busy-SD.

Table one summarizes the sample and the study’s dependent and independent variables for fifty-two participants, with GDS available for forty-nine. Participants averaged 69.33 years of age and 16.87 years of education; average DRS-2 SS was 11.60, and average EMA-EF was .00 with an SD of .78.

The DAILIES accuracy mean was 40.25 out of its observed range from 28.00 to 47.00, providing important context for interpreting daily functioning outcomes. Table 3 reports zero-order correlations for fifty-two participants, linking DAILIES and EMA-EF with busyness measures and sample characteristics.

Age and sex were correlated with Busy-SD, at minus .448 and .435, respectively, while education correlated with DAILIES at .273. Notably, weekly hours spent at work were not correlated with either Busy-Mean or Busy-SD, helping distinguish reported work time from broader daily busyness patterns.

Table 4 presents two hierarchical regressions predicting DAILIES scores in fifty-two participants. After age, education, and sex, adding EMA-EF increased explained variance to .245, with a change in R squared of .176 and p equal to .002; adding Busy-Mean contributed a further .069, with p equal to .037.

Busy-SD contributed only .001 in that sequence, with p equal to .790, while reversing the order produced the same final R squared of .315 and confirmed a .069 contribution from Busy-Mean. Ecological momentary assessment executive functioning and Busy-Mean continued to emerge as unique predictors in both analyses.

Executive functioning did not moderate Busy-Mean, but it did moderate Busy-SD. This moderation effect added about ten percent of variance, bringing the full model to forty-two percent of variance in DAILIES scores. For participants with lower executive-function scores, corresponding to the bottom fifteen point three eight percent of the sample, DAILIES performance decreased significantly as variability in busyness increased.

A second significant region appeared among participants with higher executive-function scores, but it was difficult to interpret because the subgroup had a narrow range of busyness variability and the result was driven by only two individuals. Table five reports two general linear regressions predicting DAILIES scores in fifty-two participants.

EMA-EF and Busy-Mean were unique predictors in both models; the EMA-EF by Busy-SD interaction was also significant in Model two, with a coefficient of two point two nine nine and p less than .001? Wait, table shows p equals .008. Model two explained .418 of the variance, compared with .352 in Model one, supporting the authors’ prediction that variability in busyness moderates the association between executive functioning and daily living skills.

Taken together, the results suggest that high variability in busyness interferes with completing tasks correctly, but only for participants with lower executive-function levels. The complementary finding is that high levels of busyness were linked to broader task-completion problems.

The study examined average busyness, variability in daily busyness, everyday-task performance at home over eighteen days, and whether average executive functioning moderated busyness's association with functioning. Among participants with poorer average daily executive functioning, 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 completed and fewer tasks completed on time. The interaction between life complexity, operationalized here as variability in busyness, and executive functioning accounted for a similar amount of variance in functioning as in the prior study: sixteen percent in the present study versus fifteen percent in the prior study.

The findings provide additional support for the part of the Contextually Valid Executive Assessment model proposing that executive functioning interacts with contextual factors when predicting everyday-task performance. In this sample, that model contributed an additional sixteen percent of variance in everyday-task accuracy beyond traditional executive-function measures.

The model shows promise as a clinically applicable tool, but more work is needed to characterize the relationships precisely and to develop, standardize, and norm instruments for quantifying contextual factors. The primary limitation was the modest sample size, which limited power and may have resulted in Type One error in some analyses.

The possible high-executive-function moderation pattern was driven by only two participants, so it is difficult to interpret. A replication with a larger sample is therefore needed. The central takeaway is that everyday functioning depends on both executive functioning and context: variability in busyness was linked to accuracy problems for people with weaker executive functioning, while high busyness was linked to completing fewer tasks or completing them late.

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