Subjective Memory Problems and Social Determinants of Health on Timed Instrumental Activities of Daily Living With Older Adults in the ACTIVE Study

Abstract

Objective

This study examines the longitudinal relationship between subjective memory problems (SMPs) and timed instrumental activity of daily living (IADL) performance while considering the effects of depressive symptoms and the moderating role of the social determinants of health (SDHs).

Methods

Data from 2622 older adults in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized control trial were analyzed longitudinally, spanning up to 10 years. SMPs and timed IADL performance were assessed at each wave. The SDHs were captured using validated factors incorporating US Census data and person-level data from the ACTIVE Study. Multilevel mixed models examined associations, adjusting for demographics and the effects of depressive symptoms.

Results

More SMPs at baseline were associated with slower timed IADL performance which rapidly became slower over time. Those older adults who experienced SMPs as they aged also experienced declines in timed IADL. These associations were influenced by socially determined health outcomes such as neighborhood and built environment, healthcare access and quality, and social and community context. Living in a better neighborhood and built environment and having access to quality healthcare weakened relationships over time between baseline SMPs and slower timed IADL performance. Better healthcare access and quality weakened the association of increases in SMPs with the slowing of timed IADL. Contrary to our prediction, living in a better social and community context, which fostered social engagement and decreased social isolation, strengthened relationships over time between baseline SMPs and slower timed IADL performance as well as the association of increases in SMPs with slower timed IADL performance over time.

Discussion

More SMPs at baseline were significantly related to slower rates of timed IADL performance over time, especially in older adults living in worse neighborhoods and built environments as well as areas with better social and community contexts. Increases in SMPs as one aged were also related to the slowing of timed IADL performance, especially in older adults living in areas with worse healthcare access and quality. Finally, our study found that higher scores on SMPs were related to slower timed IADL performance—independent of major confounds such as depressive symptoms.