Is There a Moderating Effect of Food-Related IADL on the Association between Cognitive Function and Nutrition Risk

Abstract

Grocery shopping and meal preparation are among the earliest instrumental activities of daily living (IADL) to decline in older adults experiencing cognitive loss. Dependence on these activities can impact their nutritional status. Prior research examines IADL as a global construct rather than focusing on specific areas of IADL dependence. This study examined the associations among cognitive function, food-related IADL difficulty, receipt of support, and nutrition risk, and assessed whether food-related IADL difficulty and receipt of support moderate the association between cognitive function and nutrition risk among community-dwelling older adults with subjective cognitive impairment (SCI). This was a secondary analysis of cross-sectional data from the SCREEN-14 validation study involving community-dwelling older adults with subjective cognitive impairment (n = 151; age ≥55 years). Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), nutrition risk using the Nutrition Risk Rating Score (NRRS), and food-related IADLs using measures of perceived difficulty or burden and support with grocery shopping and meal preparation. Descriptive statistics and chi-square tests were used to summarize participants' characteristics and to examine gender differences in food-related IADLs. Multivariable logistic and linear regression analyses were performed, adjusting for age, gender, and living situation, and interaction terms were used to test moderation effects. The sample had a mean age of 76.8 ± 9.1 years, and 63.4% were women. Lower MoCA scores was independently associated with higher nutrition risk (B = −0.130, SE = 0.025, 95% CI: −0.179 to −0.082, p < 0.001). Among the food-related IADLs examined, only grocery shopping difficulty was independently associated with higher nutrition risk (B = 1.269, SE = 0.291, 95% CI: 0.698 to 1.839, p < 0.001). In addition, lower MoCA scores was associated with greater odds of receiving meal preparation support (OR = 0.84, 95% CI: 0.76 to 0.91, p < 0.001) and grocery shopping support (OR = 0.75, 95% CI: 0.66 to 0.83, p < 0.001). However, food-related IADL difficulty or burden and receipt of support did not significantly moderate the association between cognitive function and nutrition risk (all p > 0.05), suggesting that cognitive function and food-related IADLs were independently associated with nutrition risk among community-dwelling older adults with SCI. Therefore, it was concluded that dementia on its own is associated with nutrition risk and this association cannot be explained by IADL difficulty or burden or support received for IADL. Geriatric nutrition assessments should also consider cognition of clients and how this could influence nutritional status through several mechanism beyond IADL impairment.