2026 ECNP Congress

PS03-3182

Executive function and functional independence as predictors of quality of life in community-dwelling older adults

Alfredo Minervino — R. Costa, M.E. Araújo, I. Ferreira, C. Minervino · Federal University of Paraiba, Department of Psychiatry, Joao Pessoa, Brazil

2026 ECNP Congress

Introduction

Cognitive ageing is a complex process that may impact autonomy and subjective well-being in older adults [1]. Throughout this process, the executive functions (EF) play an important role as superior cognitive abilities recruited to perform instrumental activities of daily living (IADL), which may influence the self-perception of quality of life (QoL) in older adults. Although the literature examines the relationship between EF and IADL, there are lacunae in the understanding of the role of EF interactions with contextual covariates [2] [3] [4]. This study aimed to analyze the EF, IADL and QoL controlled by covariates such as age, education and depressive symptoms in community-dwelling older adults within the predictors of QoL and the moderating role of the EF in the relationship between QoL and IADL.

Methods

In this cross-sectional study, 124 healthy community-dwelling older adults (60–92 years; 76.7% female; M=69.36, SD=7.34) were recruited. Participants were assessed with the following instruments: Pfeffer Functional Activities Questionnaire (PFAQ) for IADL; World Health Organization Quality of Life-BREF (WHOQOL-BREF) for QoL; Five-Digit Test and Digits Reverse (EF); Geriatric Depression Scale (depressive symptoms); and the Pittsburgh Sleep Quality Index (sleep quality). Data were analyzed using hierarchical multiple linear regression, moderation analysis (PROCESS macro)[4], and Structural Equation Modeling (SEM).

Results

Multiple regression analysis revealed that depressive symptoms (β = -0.319, p < 0.05) and sleep quality (β = -0.196, p < 0.05) were the only significant predictors of quality of life. EF were not direct predictors of quality of life, but demonstrated a moderating role with a marginally significant interaction effect in the relationship between QoL and IADL (β = -0.8457, p = 0.0561). The SEM showed the negative influence of depression on QoL (-0.50) and the direct relationship between EF and IADL (-0.21).

Conclusions

There is a relationship between EF, IADL, and QoL. However, the role of EF proved more relevant as a moderator of the impact of QoL on IADL, and not as a direct predictor. Furthermore, contextual factors, such as pain and sleep quality, negatively influenced cognitive and functional outcomes was also confirmed. Within SEM, the components of EF are interrelated and associated with performance in IADL. However, they did not show a direct and significant relationship with QoL. Depression emerges as the main negative predictor variable of QoL, impacting all domains (i.e., physical, psychological, health, and environment) and also acting as a mediator in the relationship between executive functioning and functional autonomy. Therefore, the results showed that QoL was strongly determined by affective and contextual factors, especially depressive symptoms and sleep quality. In this sense, the role of EF as a moderator was more relevant to the impact of QoL on IADL. Additionally, the presence of chronic pain and depressive symptoms can limit autonomy and reduce life satisfaction in older adults. These findings may be fundamental for considering multidimensional interventions that address both cognitive and mood aspects and contextual factors to promote healthy and functional aging.

References

  1. Castro-Costa, E., Lima-Costa, M. F., Bof de Andrade, F., Souza-Junior, P. R. B., & Ferri, C. P. (2018). Cognitive function among older adults: ELSI-Brazil results. Revista de Saúde Pública, 52(Suppl 2), 4s. https://doi.org/10.11606/S1518-8787.2018052000629
  2. Suchy Y. (2020). Introduction to special issue: Contextually valid assessment of executive functions in the era of personalized medicine. The Clinical neuropsychologist, 34(4), 613–618. https://doi.org/10.1080/13854046.2020.1748827
  3. Benincá, I. L., Gattuso, M., Butti, S., Caccia, D., & Morganti, F. (2024). Emotional status, motor dysfunction, and cognitive functioning as predictors of quality of life in physically engaged community-dwelling older adults: A structural equation modeling approach. International Journal of Environmental Research and Public Health, 21, 1469. https://doi.org/10.3390/ijerph21111469
  4. Gattuso, M., Butti, S., Benincá, I. L., Greco, A., Di Trani, M., & Morganti, F. (2024). A structural equation model for understanding the relationship between cognitive reserve, autonomy, depression and quality of life in aging. International Journal of Environmental Research and Public Health, 21(9), 1117. https://doi.org/10.3390/ijerph21091117