TY  - JOUR
AU  - Li, Jiaying
AU  - He, Rendong
AU  - Hsu, Erh-Chi
AU  - Li, Junxin
PY  - 2025
DA  - 2025/3/19
TI  - Network Analysis of Key Instrumental Activities of Daily Living and Cognitive Domains for Targeted Intervention in US Older Adults Without Dementia: Cross-Sectional Study
JO  - JMIR Aging
SP  - e67632
VL  - 8
KW  - cognition function
KW  - older adults
KW  - intervention targets
KW  - elder
KW  - elderly
KW  - cognitive impairment
KW  - stimulating activity
KW  - instrumental activities of daily living
KW  - IADL
KW  - daily living activity
KW  - cognitive domain
KW  - non-demented
KW  - cognitive network
KW  - holistic cognition
KW  - holistic cognition function
KW  - network comparison
KW  - central variables
KW  - bridge variables
KW  - network analysis
AB  - Background: Cognitive impairment in older adults reduces independence and raises health care costs but can be mitigated through stimulating activities. Based on network theory, intricate relationships within and between clusters of instrumental activities of daily living (IADLs) and cognitive domains suggest the existence of central IADLs and cognitive domains, as well as bridge IADLs. Modifying these can significantly enhance daily living activities and cognitive functions holistically. Objective: This study aims to identify central IADLs (key activities within the IADL network), central cognitive domains (key domains within the cognitive network), and bridge IADLs (linking IADL and cognitive networks). These insights will inform targeted interventions to effectively improve IADL and cognitive well-being in older adults. Methods: A cross-sectional analysis of adults aged 65 years and older in the United States focused on 5 IADLs and 6 cognitive domains from the National Health and Aging Trends Study (NHATS). Network analysis identified central and bridge variables. Nonparametric and case-dropping bootstrap methods checked network stability. Network comparison tests assessed sex differences with Benjamini-Hochberg adjustments. Results: Of the 2239 participants, 56.4% were female (n=976). We computed and tested 3 networks: IADL, cognition, and bridge-with correlation stability coefficients of 0.67, 0.75, and 0.44, respectively (all>0.25). Meal preparation was identified as the central IADL, with a centrality index of 3.87, which was significantly higher than that of other IADLs (all P<.05). Visual attention emerged as the central cognition domain, with a centrality index of 0.86, which was significantly higher than that of other cognition domains (all P<.05). Shopping was determined to be the bridge IADL, with a centrality index of 0.41, which was significantly higher than that of other IADLs (all P<.05). Notably, gender differences emerged in the IADL network, with stronger associations between laundry and meal preparation in females (1.69 vs males: 0.74; P=.001) and higher centrality in meal preparation among females (difference=1.99; P=.007). Conclusions: While broad enhancements in all IADL and cognitive domains are beneficial, targeting meal preparation, visual attention, and shopping may leverage their within-network influence to yield a more pronounced improvement in holistic IADL, holistic cognition, and holistic cognition function through IADL interventions among older adults. Notably, meal preparation interventions may be less effective in males, requiring tailored approaches. 
SN  - 2561-7605
UR  - https://aging.jmir.org/2025/1/e67632
UR  - https://doi.org/10.2196/67632
DO  - 10.2196/67632
ID  - info:doi/10.2196/67632
ER  -