Bidirectional relationship between cognitive function and loss hierarchy of activities of daily living among older adults with disabilities in urban China: a cross-lagged analysis

OBJECTIVES: The present study aimed to determine the bidirectional relationship between cognitive function and the loss hierarchy of activities of daily living (ADL) among older adults in China. DESIGN: Data were derived from the Longitudinal Study on Family Caregivers for Frail Older Adults Aged 75 or Above in Shanghai (2010–2013). SETTING: Community-dwelling older adults and their primary caregivers were invited to participate in this research. PARTICIPANTS: The inclusion criteria for the older adults were as follows: (a) have a Shanghai urban household registration status, (b) be 75 years old or older, (c) have no fewer than two limitations in ADLs or equivalent, and (d) have one primary caregiver aged 18 years or older. 469 older adults cared by their spouses or children were included in the final analytical sample of this research. PRIMARY AND SECONDARY OUTCOME MEASURES: Cognitive function was assessed using the Chinese version of the Short Portable Mental Status Questionnaire and ADLs were measured by self-reports of having difficulty or needing help with basic daily activities. RESULTS: Cognitive function in 2010 was a significant predictor of intermediate loss of ADLs in 2013 (β=−0.13, p<0.05) and late loss of ADLs in 2013 (β=−0.17, p<0.01). The loss hierarchy of ADLs among older adults was not shown to be significant as a risk factor of cognitive function in 2013. CONCLUSIONS: Practitioners are encouraged to adopt the ADL loss hierarchy as a supplementary needs assessment tool to make the social service delivery process more effective, economical and tailored. Cognitive function change monitoring programmes and services providing education on nutrition and encouraging social participation of older individuals were also helpful in promoting the quality of life of the older adults.