Perceiving, interpreting and responding to changes in hand function among older adults with mild cognitive impairment: a common-sense model-informed qualitative study.

BACKGROUND: Older adults with mild cognitive impairment (MCI) may exhibit selective differences in hand function, including complex manual dexterity, movement speed, rhythm, and performance variability, even while basic independence remains largely preserved. However, existing research has relied predominantly on objective measures, and little is known about how older adults notice, interpret, and respond to these changes in everyday life. Guided by the Common-Sense Model of Self-Regulation (CSM), this study explored the subjective experiences and everyday meanings of changes in hand function among community-dwelling older adults with MCI.

METHODS: A descriptive qualitative study was conducted. Nineteen community-dwelling older adults with MCI were recruited from three communities in Nanjing, China. Semi-structured interviews were conducted and analyzed using directed content analysis informed by the CSM. The study followed the COREQ checklist.

RESULTS: Seven themes were identified and mapped to the relevant CSM domains: (1) identity-changes becoming visible through disruption in familiar activities; (2) timeline-gradual changes absorbed into everyday adaptation; (3) cause-aging as a normalizing explanation for changes in hand function; (4) consequences-consequences emerging through functional participation and self-identity; (5) control and coping-self-adjustment, support seeking, and limited pathways for action; (6) coherence-hand-cognition links interpreted through experiential knowledge; and (7) emotional representations-normalization, loss, and determination. Together, these themes described variation in how participants recognized changes in hand function, understood their causes and consequences, related them to cognition, and responded emotionally and behaviorally.

DISCUSSION: Everyday activities both made subtle changes in hand function visible and gave them practical meaning. Aging provided a familiar causal explanation, but this explanation was not always integrated into a coherent understanding of the nature, possible cognitive relevance, and controllability of these changes. Accounts of concrete coping more often linked valued activities with feasible strategies and available support. These findings suggest that noticing change, making sense of it, and knowing how to respond are interrelated yet distinguishable components of self-regulation and may inform activity- and goal-oriented approaches to assessment and care planning.