The Performance of Instrumental Activities of Daily Living in Mild Cognitive Impairment: Combining Qualitative and Quantitative Research Methods
Date Issued
2015
Date
2015
Author(s)
Wen, Meng-Hsuan
Abstract
Background and aim: Recent research suggests that people with mild cognitive impairment (MCI) encounter various difficulties in advanced daily function, including instrumental activities of daily living (IADL) and leisure (included in IADL in this study). IADL assessments were seldom developed specifically for MCI. Its application and clinical interpretations of the results can be problematic. Results from various IADL assessments for MCI often showed inconsistent results. In addition, IADL participation shows great individual variations, the fixed items in quantitative assessments often fail to yield a realistic representation of these variations. Qualitative research method can explore the individuals’ experiences from their perspectives and is not limited by the fixed items of the quantitative assessments, and therefore, help to achieve a more thorough understanding of their IADL difficulties. This study used a mixed method approach. The goals are to investigate various perspectives of IADL performance of persons with MCI and clarify the underlying properties measured by different IADL evaluation. Methods: Nine pairs of persons with amnestic MCI and their caregivers were recruited by purposive sampling. Methodological triangulation by using both qualitative and quantitative methods was conducted to increase the quality of data. The quantitative method evaluated participants’ function with a self-reported questionnaire (The Disability Assessment for Dementia, DAD) and a performance-based measure (UCSD Performance-Based Skills Assessment -Brief, UPSA-B). Each participant completed individual in-depth interviews, which were recorded and transcribed verbatim. Qualitative content analysis of the interview transcripts and evaluation results were used to systematically investigate the IADL performance. DAD items were used as the initial coding system for the analysis. Qualitative and quantitative results of the assessments were juxtaposed and triangulated with each other. Result: The results of DAD evaluation showed that some persons with MCI could not perform IADL independently, such as finance, meal preparation, telephoning, outing, transportation, medication, and leisure. However, these tasks were often scored as NA (not applicable) by the scoring system indicated in the manuals as the client did not need to execute this task , and NAs would be excluded from the caculation of total score.. Some stated that the persons with MCI did not participate in certain IADL because their inability to independently complete the tasks. However, caregiver’s influences on how certain IADL was done affected the reliability. For certain tasks, the persons with MCI demonstrated significant difficulties during UPSA-B, even with a perfect score on DAD. The participants with MCI were observed to not understand the instructions immediately, need to take longer time to finish a task, to solve the problem by trial and error, et al. Qualitative interviews allowed the caregivers and the persons with MCI to systematically reflect upon their IADL experiences with declining cognitive ability, its influence on their IADL performance, emotional responses, and coping strategies. The juxtapositions of results from questionnaires, performance-based measures, and interviews showed an inconsistent picture of a person’s IADL state due to the different perspectives of IADL performance obtained from various data resources. Conclusion: The results from different methods could supplement each other and provide a more comprehensive understanding of the cognitive impairment, its consequences in everyday life, and emotional and adaptive strategies of people with MCI. But in clinical practice, it is impractical to conduct all above methods for ADL assessment. We need an evaluation tool that is tailored to the unique features of IADL decline in MCI population, with good psychometric properties, and being sensitive to detect the functional change.
Subjects
mild cognitive impairment
pre-dementia
instrumental activities of daily living
mixed method
Type
thesis
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