A Qualitative Study of the Instrumental Activities of Daily Living for Mild Cognitive Impairment and Caregivers

PURPOSE: This study aimed to compare instrumental activities of daily living (IADL) difficulties in amnestic mild cognitive impairment (MCI) between the clients’ and their family caregivers’ perspectives through interview.

BACKGROUND: MCI is an intermediate status between normal cognitive function and dementia. MCI was defined as follows: The change of cognition was detectable for client and family members, but there was no impact on daily function. However, the definition of daily function was ambiguous. Recent research has suggested that people with MCI encounter various difficulties in advanced daily function, including IADLs and leisure. The result regarding the evaluation of the IADL function in MCI is still inconsistent. Therefore, the nature and extent of complex functional difficulties in this group is still to be discovered. Through qualitative research methods, individuals’ experience and culture may be investigated and the difficulty of daily life observed.

DESIGN: Qualitative research with semistructured interview of clients with MCI and their caregivers

PARTICIPANTS: Through purposive sampling, nine amnestic pairs of clients with MCI and their caregivers were included. The inclusion criteria were (1) >50 yr old, (2) diagnosed with MCI by neurological or psychiatric doctor, (3) independent in basic activities of daily living (ADLs), and (4) without dementia.

METHOD: The 9 pairs of clients with MCI and caregivers were referred by neurological doctor. The semistructured interview was conducted with open questions individually. This sampling was stopped after saturation of all obtained categories and when no new meaningful property was produced.

ANALYSIS: All interviews and observations were coded and analyzed based on directed content analysis. In the first stage, based on the general fields of ADL, the text was reviewed line by line and special parts of them that referred to a specific ADL. Then, those codes that were similar or had overlaps were revised to one refined specific code. In the final stage, the comparison of codes between the clients and caregivers was done.

RESULTS: Each session of the interview lasted between 30 and 70 min. The codes were finally refined to 37 codes in 10 fields of ADLs, such as hygiene, dressing, eating, medication, meal preparation, social interaction, outing, money management, housework, and leisure. In 18 of 37 codes, the specific difficulties of IADLs were complained about only by caregivers, such as the declining motivation and efficiency in doing leisure activities and housework. On the other hand, 5 codes that were pointed out only by clients showed that some ADL difficulties made clients with MCI stressful and nervous. Thus, they gradually lost motivation to learn or do something new.

DISCUSSION: In this study, the qualitative data from clients’ and caregivers’ perspectives were presented. Most IADL difficulties are in accord with the results of previous studies, despite the fact that these studies used quantitative research methods. However, this study enhances the previous studies’ findings by investigating the difference between clients’ and caregivers’ perspectives. Although the data reported by caregivers, as some questionnaires used before, provides professionals an overview of IADL difficulties, the clients’ perspective more precisely indicated the most difficult part in their daily living.

IMPACT STATEMENT: In general practice, occupational therapists evaluate IADL capacity through the questionnaire answered by caregivers. However, the results of this study highlight the importance of considering the perspective of clients with MCI. In the future, we need to emphasize the client-centered evaluation.