Network-based identification of central ADL and IADL items in older adults living alone

The proportion of older adults living alone is rapidly increasing in Korea, making this population vulnerable to physical, psychological and social health problems. Functional decline in activities of daily living (ADL) and instrumental activities of daily living (IADL) is particularly pronounced among those living alone. This study applied network analysis to identify the structural relationships and central ADL/IADL items in older adults living alone.

We utilised the data from the 2022 Korean Longitudinal Study of Aging. Participants were 1,006 community-dwelling older adults aged ≥ 65 years living alone. ADL (seven items) and IADL (ten items) were coded dichotomously (0 = independent, 1 = required help). Network analysis was performed using IsingFit and qgraph in Rand centrality indices (strength, closeness and betweenness) were estimated. Network stability was evaluated using 1,000 bootstrap case-dropping subsets.

Among the participants, 8.55% required help with at least one ADL item, and 20.68% required at least one IADL item. 'Using means of transportation' demonstrated the highest strength centrality, followed by 'going in and out of bathroom, cleaning after urinating or defecating, then getting dressed', 'preparing hot meals' and 'bathing or showering'.

The findings of this study highlight central ADL and IADL items within the functional network of older adults living alone. These results provide insights into the interrelationships among functional abilities and may guide future research on strategies to support or prevent functional decline in this population.