Association Between Executive Dysfunction and Instrumental Activities of Daily Living: Racial and Ethnic Differences Among Community-Dwelling Older Adults in the Southeastern US.

Objective: Examining cultural differences in assessment of cognitive/functional disability among older Americans is needed. This analysis examined associations between day-to-day function, measured by activities of daily living (ADL), and cognition, measured by CLOX scores, among older African American (AA) and non-Hispanic White (nHW) community-dwelling women and men.

Methods: Design- Cross-sectional.

Setting: Homes of community-dwelling older adults. Participants- 893 Medicare beneficiaries >65 living in west-central Alabama, without diagnoses of dementia, who were participants in the University of Alabama at Birmingham (UAB) Study of Aging, and who had complete data. Measurements- Physical function was assessed by self-reported ADL difficulty; cognitive function by CLOX, a clock drawing-task. Multivariable, linear regression models were used to examine associations within race/sex specific groups.

Results: After controlling for socio-demographic factors and comorbidities, CLOX1 scores were inversely and significantly correlated with ADL for AA men (β = -0.205, P = 0.003). CLOX2 scores were similarly associated with ADL and IADL for the total group (β = -0.118, P = 0.001, and β = -0.180, P < 0.001, respectively); for ADL, significant associations were seen for AA men and nHW women (β = -0.203, P = 0.004, and β = -0.139, P = 0.02, respectively) and, for IADL, in AA women and men (β = -0.156, P = 0.03, and β = -0.24, P < 0.001, respectively).

Conclusion: While African American women reported the highest difficulty with ADLs and IADLs among all race/sex groups, CLOX1 scores were correlated with ADL for AA men only. CLOX1 may have limitations to identify functional disability for older AA women. [Word Count = 234].