Social Resources That Preserve Functional Independence After Memory Loss.

摘要

We used a large, diverse, longitudinal study of middle aged and older Americans to identify social factors that help individuals preserve functional independence in basic and instrumental ADLs as long as possible, even in the context of declining memory or severe memory impairment. We found strong associations between decreased cognitive functioning and incident ADL and IADL limitations. Physical activity may help to decrease the risk of ADL and IADL limitations even among those with cognitive impairment, while smoking and depression may increase the risk of incident ADL limitations among those with cognitive impairments. We also found that physical activity is associated with lower risk of future nursing home admission, another powerful indicator of functional independence. Although most family level variables were not associated with independence outcomes, being married and spouse's education and (less) depression predicted better functional outcomes. Finally, our results indicate that several features of neighborhood, including perceived safety, disorder, and cohesion predict IADL outcomes, in individuals with or without memory impairments. By managing conventional risk factors, it may be possible to stave off dependencies, maximize quality of life, and minimize caregiver burden.