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Peer-reviewedCC BY-NCHong Kong journal of occupational therapy : HKJOT

Performance-Based Versus Informant-Reported IADL in Dementia: A Person-Environment-Occupation Perspective for Occupational Therapy Outcome Selection.

  • Hui-Mei Chen1,2
  • Hung-Chia Huang1
  • Chun-Wei Chang1
  • Hsiu-Fen Lin3,4
  • Cheng-Sheng Chen5,6
6 affiliations
  1. 1Department of Occupational Therapy, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.
  2. 2Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
  3. 3Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
  4. 4Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
  5. 5Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
  6. 6Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Abstract

Selecting an instrumental activities of daily living (IADL) outcome is important in occupational therapy intervention for older adults with dementia. Inspired by the Person-Environment-Occupation (PEO) framework, this study compared older adults with AD and non-AD dementia on performance-based and informant-reported IADL outcomes and examined correlates by group. Eighty older adults with mild-to-moderate dementia (49 AD; 31 non-AD: 17 vascular dementia, 14 dementia with Lewy bodies) and 30 controls were recruited in Taiwan. Cognition, physical performance, neuropsychiatric symptoms, and caregiver distress were assessed with the Montreal Cognitive Assessment (MoCA), modified Physical Performance Test, and Neuropsychiatric Inventory. IADL was measured using Taiwan Performance-based IADL (TPIADL) and the Disability Assessment for Dementia-IADL (DAD-IADL). ANCOVA was used to compare groups, hierarchical regression was used to examine correlates, and Pearson correlations was used to examine within-group TPIADL-DAD-IADL associations. AD and non-AD participants had comparable cognitive, physical, and neuropsychiatric profiles. Non-AD participants had poorer DAD-IADL scores (p = .019), whereas TPIADL did not differ (p = .256). TPIADL and DAD-IADL were correlated in AD (r = -.697, p < .001) and non-AD dementia (r = -.374, p = .038). MoCA was the only consistent correlate of TPIADL (β = -.66 to -.87). For DAD-IADL, MoCA was the primary correlate in AD (β = .57), whereas hyperactivity (β = .59) and caregiver distress (β = -.58; ΔR2 = .287) were identified in non-AD. Performance-based and informant-reported IADL measures may provide complementary information about occupational performance in older adults with dementia. Their associations may be interpreted within the PEO framework as reflecting person-related and contextual influences.

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Cite

BibTeXRIS
BibTeX
@article{chen2026performancebased,
  title = {{Performance-Based Versus Informant-Reported IADL in Dementia: A Person-Environment-Occupation Perspective for Occupational Therapy Outcome Selection.}},
  author = {Hui-Mei Chen and Hung-Chia Huang and Chun-Wei Chang and Hsiu-Fen Lin and Cheng-Sheng Chen},
  journal = {Hong Kong journal of occupational therapy : HKJOT},
  year = {2026},
  month = nov,
  doi = {10.1177/15691861261504474},
  url = {https://europepmc.org/article/MED/42996456},
  note = {CC BY-NC},
}
RIS
TY  - JOUR
TI  - Performance-Based Versus Informant-Reported IADL in Dementia: A Person-Environment-Occupation Perspective for Occupational Therapy Outcome Selection.
AU  - Hui-Mei Chen
AU  - Hung-Chia Huang
AU  - Chun-Wei Chang
AU  - Hsiu-Fen Lin
AU  - Cheng-Sheng Chen
PY  - 2026
DA  - 2026/11/04
JO  - Hong Kong journal of occupational therapy : HKJOT
DO  - 10.1177/15691861261504474
UR  - https://europepmc.org/article/MED/42996456
AB  - Selecting an instrumental activities of daily living (IADL) outcome is important in occupational therapy intervention for older adults with dementia. Inspired by the Person-Environment-Occupation (PEO) framework, this study compared older adults with AD and non-AD dementia on performance-based and informant-reported IADL outcomes and examined correlates by group. Eighty older adults with mild-to-moderate dementia (49 AD; 31 non-AD: 17 vascular dementia, 14 dementia with Lewy bodies) and 30 controls were recruited in Taiwan. Cognition, physical performance, neuropsychiatric symptoms, and caregiver distress were assessed with the Montreal Cognitive Assessment (MoCA), modified Physical Performance Test, and Neuropsychiatric Inventory. IADL was measured using Taiwan Performance-based IADL (TPIADL) and the Disability Assessment for Dementia-IADL (DAD-IADL). ANCOVA was used to compare groups, hierarchical regression was used to examine correlates, and Pearson correlations was used to examine within-group TPIADL-DAD-IADL associations. AD and non-AD participants had comparable cognitive, physical, and neuropsychiatric profiles. Non-AD participants had poorer DAD-IADL scores (p = .019), whereas TPIADL did not differ (p = .256). TPIADL and DAD-IADL were correlated in AD (r = -.697, p < .001) and non-AD dementia (r = -.374, p = .038). MoCA was the only consistent correlate of TPIADL (β = -.66 to -.87). For DAD-IADL, MoCA was the primary correlate in AD (β = .57), whereas hyperactivity (β = .59) and caregiver distress (β = -.58; ΔR2 = .287) were identified in non-AD. Performance-based and informant-reported IADL measures may provide complementary information about occupational performance in older adults with dementia. Their associations may be interpreted within the PEO framework as reflecting person-related and contextual influences.
SN  - 1569-1861
SN  - 1876-4398
ER  -