Edelweiss Applied Science and Technology ISSN: 2576-8484 Vol. 9, No. 4, 736-745 2025 Publisher: Learning Gate DOI: 10.55214/25768484.v9i4.6062 © 2025 by the author; licensee Learning Gate © 2025 by the author; licensee Learning Gate History: Received: 31 January 2025; Revised: 31 March 2025; Accepted: 4 April 2025; Published: 8 April 2025 * Correspondence: jyleena@joongbu.ac.kr The mediating effect of information and communication technology utilization on cognitive function and activities of daily living in eldery with cognitive decline Jee Young Lee1* 1Department of Nursing, Joongbu University, Republic of Korea; jyleena@joongbu.ac.kr (J.Y.L.). Abstract: This study aimed to identify the mediating effect of information and communication technology (ICT) utilization on cognitive function and activities of daily living (ADL) / instrumental activities of daily living (IADL) in Korean elderly individuals with cognitive decline. A total of 2,448 individuals aged 65 and older with cognitive decline were selected as study subjects from the original dataset of the 2023 National Survey on the Status of the Elderly. The data were analyzed using SPSS/WIN 25.0 with a complex sample analysis method. Frequency and descriptive statistics, partial correlation analysis, general linear model analysis, and Sobel's test were performed. The results showed a negative correlation between cognitive function and ADL/IADL, and a positive correlation between cognitive function and ICT utilization. ICT utilization was shown to be negatively correlated with ADL/IADL. Results also indicated that ICT utilization partially mediates the relationship between cognitive function and ADL/IADL. These findings suggest that using ICT can be a preventive factor in reducing the ability to perform daily activities that can be attributed to cognitive decline. This implies that we should consider strategies to strengthen the use of ICT that affect the maintenance and improvement of daily life performance for older adults with cognitive decline. Keywords: Activities of daily living, Aged, Cognition, Information technology, Instrumental activities of daily living. 1. Introduction As the world's population ages, it is estimated that the number of people aged 60 and over will increase to 1.4 billion by 2030, representing one-sixth of the world's population World [1]. This rapid increase of elderly population is considered a major risk factor for the increase in the incidence of dementia [2]. This is a global phenomenon, and the incidence of dementia is increasing every year in Korea as the older population grows. In 2023, the elderly population aged 65 and above in Korea reached 9.462 million, representing 18.5% in the total population, and the prevalence of dementia reached 9.25% and that of mild cognitive impairment (MCI) reached 28.42%. Estimated number of dementia patients reaching 1 million and number of people diagnosed with MCI reaching 3 million by 2026 [3]. Dementia is described as a marked deterioration in cognitive function in more than one cognitive dimension compared to former performance, which significantly impairs the ability to perform independent daily activities. MCI is a decline but not a loss of cognitive function, and ability to carry out daily activities and social roles are maintained [4]. MCI is a transitional phase from normal aging to dementia. While symptoms may stabilize or improve over time, many older adults with MCI progress to dementia more quickly than normal adults [5]. This suggests that more effective and preventive interventions at the stage of mild cognitive decline are important to decrease the incidence of dementia in older adults. https://orcid.org/0000-0001-8527-4374 737 Edelweiss Applied Science and Technology ISSN: 2576-8484 Vol. 9, No. 4: 736-745, 2025 DOI: 10.55214/25768484.v9i4.6062 © 2025 by the author; licensee Learning Gate The cognitive decline of the elderly begins as subjective complaints of memory problems, which over time can lead to a decline in daily life, increased dependence on care, a decline in quality of life, and social isolation [6]. Maintaining the performance of activities of daily living is necessary for healthy aging and independent old age. Decreased performance of daily activities due to cognitive decline is recognized as an important challenge for the elderly and their caregivers. Unlike activities of daily living (ADL), which are basic physical functions of the elderly, instrumental activities of daily living (IADL) are more complicated socio-economic activities. IADL is generally known to be more susceptible to subtle deterioration associated with cognitive decline, as it requires not only cognitive and motor skills but also social skills and complex neuropsychological processing [7]. Previous studies on the cognitive function and ADL in the elderly have shown that there is a highly relevant interrelationship between cognitive function and ADL/IADL [8, 9]. In addition, ADL/IADL disability is related to gender, age, and the level of education., social participation, and quality of life [10] and has been reported to be associated with physiological factors like physical dysfunction and frailty, as well as psychological factors like depression and cognitive dysfunction [11]. The decline in cognitive function in old age is closely related to the decline in ADL/IADL and is a risk factor that negatively affects not only mental health but also overall daily activities and quality of life. Therefore, research is needed to explore important protective factors that can mediate the relationship between cognitive decline in old age and the ability to conduct ADL/household chores. Recently, proactive utilization in information and communication technology (ICT) has been proposed as an efficient way to mitigate the negative effects of cognitive decline due to aging [12]. The use of information technology can be used in the home of the elderly or anywhere the elderly are, which can help overcome the mobility problems of elderly people with cognitive decline [13]. Mutual social participation has an effective role for improving the cognitive function and daily life performance of the elderly [14] so the use of ICT such as computers, smartphones, mobile devices, and personal digital devices is recommended to enhance the functioning of cognition in elderly [15]. In home-based clinical assessments, the more computer use, the higher the cognitive function in older people [16] and the more information technology used, the higher the level of cognitive function [17]. Results of these studies suggest using ICT helps in promoting cognitive function in the elderly and that it may act as a positive mediator between cognitive function and the performance of everyday activities. The use of various information technology devices by the elderly allows them to acquire information, communicate with others, and participate in social relationships [10]. The use of smartphones and computers has a favorable effect on the executive function and the speed of cognitive processing of older adults [17] suggesting that the use of various information technologies can be used as an intervention to improve the function of cognition and daily living performance in eldery [18]. In particular, the daily use of information technology at home can serve as a cost-effective and pragmatic approach to the sustainability of cognitive interventions. The purpose of this study is to determine whether the association between cognitive function and daily performance in elderly with cognitive decline is influenced by the utilization of ICT. By verifying whether the daily use of ICT can be a protective factor against the decline in daily life performance due to cognitive decline, it will provide useful basic data to inhancing the quality of life in elderly. 2. Methods 2.1. Research Design This study was implemented as a secondary analysis to assess the mediating effect of ICT utilization between cognitive function and ADL/IADL in elderly people with cognitive decline using the 2023 National Survey on the Status of the Elderly. 2.2. Research Data The primary data comes from the 2023 National Survey on the Status of the Elderly, a triennial statutory survey performed by the Korea Institute for Health and Social Affairs (KIHASA: IRB 2023- 738 Edelweiss Applied Science and Technology ISSN: 2576-8484 Vol. 9, No. 4: 736-745, 2025 DOI: 10.55214/25768484.v9i4.6062 © 2025 by the author; licensee Learning Gate 078), was used. The survey was conducted from September 4 to November 12, 2023, among people aged 65 and older in general households across the country. Of the total 10,078 subjects in the original data, 7,503 subjects classified as having normal cognitive function and 127 proxy respondents were excluded, leaving a total of 2,448 subjects in the analysis. 2.3. Instruments 2.3.1. Characteristics of the Subjects The general characteristics of the subjects were gender, age, marital status, education level, residence, work status, and family type. The age variable was grouped into "over 65 and under 75," "over 75 and under 85," and "over 85." The marital status was divided into '' not having a spouse'' and ''having a spouse.'' The level of education was further classified into " no school attendance," " Elementary school graduate," "middle school graduate," "high school graduate," and " college graduate or higher. Residence was categorized as " city " and " countryside,"and work status was classified into “working” and “not working.” and the family type was reclassified into “living alone,” “elderly couple,” and “living with family.” 2.3.2. Cognitive Function The Korean Mini-Mental State Examination2nd Edition (K-MMSE-2) was used to assess the function of cognition. This test is almost identical to the existing K-MMSE, but it provides more information for the screening of MCI by increasing the discriminability of the items that are related to language comprehension [19]. The test consists of 27 questions in the following areas: memory registration (3 items), memory recall (3 items), temporal memory (5 items), spatial memory (5 items), attention and calculation (5 items), language comprehension and command performance (5 items), and drawing (1 item). If the answer to each question is correct, it is scored as 1 point, and if it is incorrect, it is scored as 0 point. The two questions in the language comprehension and command performance areas are subdivided into 1 to 2 points or 1 to 3 points for correct answers. Scores on this test run from 0 to 30, with higher scores denoting superior cognitive functioning. If the score is below a certain level based on the converted score (T-score) adjusted for age and education level, it is determined as “cognitive decline.”. Pearson correlations for test-retest reliability of this instrument ranged from .54 to .63, and Cohen's weighted kappas for inter-rater reliability ranged from .87 to 1.00 [20]. The study's reliability was determined to be Cronbach's α=.89. 2.3.3. Activities of Daily Living (ADL) / Instrumental Activities of Daily Living (IADL) The subject's ability to conduct daily activities were assessed using the Korean version of the ADL/IADL [21]. The ADL includes seven items: washing and brushing teeth, dressing, bathing or showering, eating prepared food, rising and going outside, using the restroom, and regulating bowel and bladder movements. These are the basic things an older person needs to live independently. For each question, a score is given for complete independence (1 point), partial assistance (2 points), and complete assistance (3 points). Scores range from 7 to 21, and the lower the scores, the more independent. The study's reliability was determined to be Cronbach's α=.90. In addition, IADL are scored as complete independence (1 point), partial assistance (2 points), or complete assistance (3 points) for seven questions: personal care, housekeeping, meal preparation, laundry, taking medications, managing money, and walking short distances. Purchasing items, making and answering phone calls, and the three questions on going out with transportation are scored as follows: complete independence (1 point), partial assistance (2 points), substantial assistance (3 points), and complete assistance (4 points). Scores range from 10 to 33, and the lower the scores, the more independent. The study's reliability was determined to be Cronbach's α=.94. 739 Edelweiss Applied Science and Technology ISSN: 2576-8484 Vol. 9, No. 4: 736-745, 2025 DOI: 10.55214/25768484.v9i4.6062 © 2025 by the author; licensee Learning Gate 2.3.4. Information and Communication Technology (ICT) Utilization The extent to which the subject’s utilized ICT was gauged according to the number of ICT-using activities they engaged in. Activities included sending and receiving messages, searching and retrieving lots of information, taking pictures or videos, playing games, listening to music and streaming videos, using social networking services, e-commerce, financial activities, finding and installing applications, and ordering from kiosks. For each of the 13 areas, one point was awarded for answering “yes” using ICT and services. Scores run from 0 to 13, with higher scores indicating a more advanced ability to use ICT. 2.4. Ethical Consideration The use of original data from the 2023 National Survey on the Status of the Elderly was approved by the Korea Institute for Health and Social Affairs (KIHASA). Additionally, this study was conducted with the approval for exemption of the deliberation by the Institutional Review Board of J University (JIRB-2024110501-01-241216). 2.5. Data Analysis The collected data were processed using the IBM SPSS/WIN 25.0 program as follows. Given the original data's nature as a stratified cluster sample, a complex sample analysis method was used, and all statistical values except frequency were expressed as weighted values. Frequency and descriptive statistics were used to determine the general characteristics of the subjects and the study variables. Frequency analysis presented the frequency without weighting and the percentage with weighting, and descriptive statistics presented the weighted mean and standard deviation. To test the differences in the study variables according to the characteristics of the subjects, the means were compared using general linear model analysis. In addition, to test the mediating effect of ICT utilization between cognitive function and ADL/IADL, Baron & Kenny's three-step analysis was conducted, and in each step, general linear model analysis was used. The Sobel test was performed to verify the significance of the mediating effect. 3. Results 3.1. Characteristics of the Subjects The general characteristics of the subjects of this study, elderly people with cognitive decline, are presented in Table 1. A total of 60.1% of the subjects were women, while 39.9% were men. and the mean age of the subjects was 74.69±0.18, with the largest number of subjects aged 65 or older and under 75 years old, accounting for 54.9%. Of the subjects, 44.4% responded had no spouse, 15.1% had not attended school, 28.2% had graduated from elementary school, and 32.2% had graduated from high school. In addition, 69.6% lived in urban areas and 65.8% did not work. In terms of family type, 37.1% of the elderly live alone, 52.1% live with elderly spouse, and 10.8% live with their families. 740 Edelweiss Applied Science and Technology ISSN: 2576-8484 Vol. 9, No. 4: 736-745, 2025 DOI: 10.55214/25768484.v9i4.6062 © 2025 by the author; licensee Learning Gate Table 1. General chacteristics of the subjects (N = 2,448). Characteristics Categories N (%)† Gender Men 813 (39.9) Women 1,635 (60.1) Age (year) 65-74 1,320 (54.9) 75-84 912 (34.0) ≥ 85 216 (11.2) Marital status Not having a spouse 1,127 (44.4) Having a spouse 1,321 (55.6) Level of education No school attending 462 (15.1) Elementary school graduate 725 (28.2) Middle school graduate 440 (19.1) High school graduate 709 (32.2) College graduate or higher 112 (5.4) Residence City 1,606 (69.6) Countryside 842 (30.4) Work status Working 850 (34.2) Not Working 1,598 (65.8) Type of family Living alone 950 (37.1) Elderly couples 1,229 (52.1) Living with family 269 (10.8) Note: †N (%): unweighted frequency (weighted %). 3.2. Differences in Cognitive Function and ADL/IADL by Characteristics of the Subjects The differences in cognitive function and ADL/IADL by the characteristics of the subjects are presented in Table 2. Cognitive function showed significant differences depending on the age of the subject (F=63.08, p<.001), level of education (F=76.99, p<.001), residence (t=7.52, p<.001), and working status (t=4.45, p<.001). In the post-analysis, the cognitive function of the 85 years and older group and the group had not attended school was significantly lower than other groups. ADL showed significant differences depending on the gender of the subject (t=2.03, p=.042), age (F=14.98, p<.001), level of education (F=3.44, p=.009), work status (t=-7.73, p<.001), and family type (F=3.32, p=.021). For men who are elderly and do not work, the ADL score is significantly higher, indicating that they are more dependent on help in their daily lives. The results of the post-analysis show that the ADL score is significantly higher for 85years and older group, the group of people with no academic qualifications and those who have only completed elementary school, and the group living with their families than for other groups, indicating that they require a lot of help in their basic daily lives. In addition, the IADL also showed significant differences depending on the gender of the subject (t=2.30, p=.022), age (F=29.49, p<.001), level of education (F=3.75, p=.005), working status (t=-9.52, p<.001), and There were significant differences depending on the family type (F=6.20, p<.001). In the case of older men and do not work, the IADL score was significantly higher, indicating that they are highly dependent on help in their instrumental daily lives. post-hoc analyses indicated that the group of subjects aged 85 years and over and the group living with family members had significantly higher IADL scores than the other groups, indicating that they require a lot of help in instrumental daily life that requires social skills as well as cognitive and motor performance. 741 Edelweiss Applied Science and Technology ISSN: 2576-8484 Vol. 9, No. 4: 736-745, 2025 DOI: 10.55214/25768484.v9i4.6062 © 2025 by the author; licensee Learning Gate Table 2. Differences in Cognitive Function and ADL/IADL by chacteristics of the subjects (N = 2,448). Chacteristics Cognitive Function ADL IADL M±SE t /F(p)‡ M±SE t /F(p)‡ M±SE t /F(p)‡ Gender Men 18.90±0.26 0.94 (.349) 7.60±0.09 2.03 (.042) 12.26±0.25 2.30 (.022) Women 18.65±0.25 7.46±0.08 11.91±0.24 Age (year) 65-74 a 20.46±0.21 63.08 (<.001) a,b>c 7.14±0.05 14.98 (<.001) a,be 12.55±0.28 3.75 (.005) Elementary school b 18.59±0.22 7.65±0.11 11.95±0.25 Middle school c 18.98±0.25 7.50±0.11 12.08±0.28 High school d 18.49±0.40 7.42±0.09 11.68±0.24 ≥ College e 22.07±0.31 7.35±0.11 12.14±0.48 Residence City 20.18±0.23 7.52 (<.001) 7.58±0.09 1.33 (.185) 12.12±0.25 0.49 (.625) Countryside 17.37±0.33 7.48±0.09 12.04±0.25 Work status Working 19.36±0.26 4.45 (<.001) 7.36±0.08 -7.73 (<.001) 11.54±0.23 -9.52 (<.001) Not Working 18.20±0.24 7.70±0.08 12.62±0.25 Type of family Living alone a 18.78±0.32 2.41 (.066) 7.34±0.15 3.32 (.021) a