Functional status, life-space mobility, and quality of life: a longitudinal mediation analysis

Relationships between life-space mobility, physical function, and empowerment in patients with chronic obstructive pulmonary disease

[Purpose] This study aimed to elucidate the relationship between the Life-Space Assessment measure, which conceptualizes physical activity in terms of life-space, and indicators of empowerment, and physical function, in stable patients with chronic obstructive pulmonary disease. [Participants and Methods] This was a cross-sectional study. The participants were 25 stable outpatients with chronic obstructive pulmonary disease (22 males, mean age 75.6 ± 6.1 years). Measurements included the Life-Space Assessment; the Empowerment Scale for the Elderly; respiratory function; grip strength; weight-adjusted knee extension strength; and a six-minute walk test. Pearson's correlation coefficient and a multivariate analysis were used to examine the relationship between the Life-Space Assessment and each indicator, with the significance level set at 5%. [Results] The Life-Space Assessment score (83.4 ± 23.7 points) correlated with the percentage forced vital capacity and the six-minute walk distance. However, the Life-Space Assessment demonstrated no association with the Empowerment Scale for the Elderly (38.3 ± 7.0 points). [Conclusion]The results of this study suggest that physical function correlates with scores on the Life-Space Assessment in patients with stable chronic obstructive pulmonary disease.

Systemic inflammation in midlife is associated with late-life functional limitations

Systemic inflammation generally coexists with functional limitations that seriously affect quality of life. This study aimed to investigate the association between systemic inflammation in midlife and the risk of functional limitations in late-life. A total of 10,044 participants with an average age of 53.9 ± 5.7 years at baseline were included in a cohort study. At the last follow-up, the prevalence of impaired activities of daily living (ADLs), instrumental activities of daily living (IADLs), and lower extremity function (LEF) was 14.7%, 21.6%, and 50.3%, respectively. The values of four inflammatory biomarkers were used to calculate the inflammation composite score. Compared with the participants in the lowest quartile of the inflammation composite score (Q1), those in the highest quartile (Q4) exhibited an odds ratio (OR) of 1.589 and a 95% confidence interval (CI) of 1.335-1.892 for impaired ADLs, an OR of 1.426 and a 95% CI of 1.228-1.657 for impaired IADLs, and an OR of 1.728 and a 95% CI of 1.526-1.957 for impaired LEF. The association between systemic inflammation and functional limitations was partly mediated by cardiac and brain function. The present study provides evidence that systemic inflammation in midlife is associated with a higher risk of late-life functional limitations. Protecting vital organ functions in midlife may have a positive impact on reducing the risk of future functional limitations.Trial registration: www.clinicaltrials.gov ; Unique identifier: NCT00005131.

Life-Space Mobility: Normative Values From a National Cohort of U.S. Older Adults

BACKGROUND

Life-space mobility, which measures the distance, frequency, and independence achieved as individuals move through their community, is one of the most important contributors to healthy aging. The University of Alabama at Birmingham Life-Space Assessment (LSA) is the most commonly used measure of life-space mobility in older adults, yet U.S. national norms for LSA have not previously been reported. This study reports such norms based on age and sex among community-dwelling older adults.

METHODS

A cross-sectional analysis using data from the national REasons for Geographic and Racial Disparities in Stroke cohort study. LSA data were available for 10 118 Black and White participants over age 50, which were grouped by age (in 5-year increments) and sex, weighted for the U.S. national population. Correlations were calculated between LSA and measures of functional and cognitive impairment and physical performance.

RESULTS

The weighted mean LSA ranged from 102.9 for 50-54-year-old males to 69.5 for males aged 85 and older, and from 102.1 for 50-54-year-old females to 60.1 for females aged 85 and older. LSA was strongly correlated with measures of timed walking, activities of daily living, cognition, depressive symptoms, and quality of life (all p < .001).

CONCLUSIONS

We report U.S. national norms for LSA among community-dwelling Black and White older adults. These norms can serve as a reference tool for determining if clinical and research samples have greater or lesser life-space mobility than typical older adults in the United States for their age and sex.

Restricted life-space mobility impacts physical but not mental quality of life in older cancer survivors

BACKGROUND

Older cancer survivors often value quality of life (QOL) over survival. Life-space mobility (LSM), defined as the individual's spatial geographic mobility range, is an important QOL indicator in older adults with chronic illnesses; however, this relationship is unexplored in older cancer survivors.

METHODS

We examined the longitudinal associations and causal relationships between LSM and QOL in 153 older cancer survivors (≥65 years) from the University of Alabama at Birmingham (UAB) Study of Aging. LSM was assessed using the UAB Life-Space Assessment-Composite score (LSA-C), and QOL was assessed by the SF-12 Mental Component Score (MCS12) and Physical Component Score (PCS12) at 0 (study entry), 6, 18, 36, 54, and 72 months. We examined the causal relationship between LSM and QOL using a cross-lagged panel model (CLPM).

RESULTS

The cohort (n = 153) was 76 years old on average and predominantly White (58%), female (58%), and married (55%). Longitudinal analyses found LSM decreased over time (p < 0.0001), and this decrease was associated with decreased QOL (PCS12, p < 0.0001, MCS12, p < 0.0001). In the CLPM causal analysis, lower LSM resulted in worse PCS12 (p < 0.001), but not worse MSC12.

CONCLUSIONS

Restricted LSM resulted in worse physical QOL over 72 months in a sample of 153 older cancer survivors. Developing and evaluating interventions to preserve greater LSM could be a promising approach to improving QOL.

Bidirectional Association Between Multimorbidity and Frailty and the Role of Depression in Older Europeans

BACKGROUND

Although previous studies have reported an association between multimorbidity and frailty, its direction and mechanism remain unclear. This study aimed to investigate the direction of this association, as well as the role of depression among older Europeans.

METHODS

We used a cross-lagged panel design to evaluate the temporal relationship between multimorbidity and frailty and the role of depression. Multimorbidity status was assessed by the self-reporting of 14 chronic diseases. Frailty was assessed based on the frailty phenotype. The European-Depression Scale (EURO-D) was used to assess depression.

RESULTS

There was a bidirectional relationship between frailty and multimorbidity. More severe multimorbidity predicted greater frailty (β = 0.159; p < .001) and vice versa (β = 0.107; p < .001). All paths from multimorbidity to frailty were stronger than the paths from frailty to multimorbidity (b1-a1: β = 0.051; p < .001). Likewise, early multimorbidity change was a significant predictive factor for late frailty change (β = 0.064; p < .001) and vice versa (β = 0.048; p < .001). Depression in Wave 5 (T5) mediated the association between frailty in Wave 4 (T4) and multimorbidity in Wave 6 (T6; indirect effect: β = 0.004; bootstrap 95% confidence interval: 0.003, 0.006).

CONCLUSIONS

A positive, bidirectional association was observed between multimorbidity and frailty. Depression may be a potential cause of an increased risk of multimorbidity later in life in frail older adults. Early monitoring of frailty and depression may slow the progression of multimorbidity, thereby interrupting the vicious cycle.

Multidimensional interventions to increase life-space mobility in older adults ranging from nursing home residents to community-dwelling: a systematic scoping review

BACKGROUND

Life-space mobility (LSM) is an important aspect of older adults' real-life mobility. Studies have shown that restricted LSM is a risk factor for many adverse outcomes such as low quality of life and mortality. Therefore, an increasing number of interventions aim to enhance LSM. However, the intervention approaches differ in terms of their type/content, duration, targeted populations, but also in terms of their outcome measures and assessment tools. Especially the latter impairs the comparability of studies with otherwise similar interventional approaches and thus also the interpretation of their results. Therefore, this systematic scoping review aims to provide an overview of the intervention components, assessment tools, and effectiveness of studies aiming to improve LSM in older adults.

METHODS

A systematic literature search was carried out in PubMed and Web of Science. We considered studies in older adults of any design that included an intervention approach and at least one outcome of LSM.

RESULTS

27 studies were included in the review. These studies analyzed healthy community-dwelling as well as frail older adults in need of care or rehabilitation and nursing home residents with a mean age between 64 and 89. The percentage of female participants ranged from 3 to 100%. The types of interventions were of the following: physical, counseling, multidimensional, miscellaneous. Multidimensional interventions consisting of physical interventions plus any of the following or a combination of counseling/education/motivation/information appear to be most effective in increasing LSM. Older adults with mobility impairments were more responsive to these multidimensional interventions compared to healthy older adults. Most of the studies used the questionnaire-based Life-Space Assessment to quantify LSM.

CONCLUSIONS

This systematic scoping review provides a comprehensive overview of a heterogenous stock of literature investigating LSM-related interventions in older adults. Future meta-analyses are needed to provide a quantitative evaluation of the effectiveness of LSM interventions and recommendations.

The Longitudinal Association Between Frailty, Cognition, and Quality of Life in Older Europeans

OBJECTIVES

Evidence on the association between frailty and quality of life (QoL) is mostly limited to cross-sectional studies. Thus, the temporal order and potential mechanisms of this association are largely unknown. Our study examines both the directionality of this association and the role of cognition in this association in longitudinal data.

METHODS

Cross-lagged panel models were employed to examine the temporal relationship between frailty and QoL, as well as cognition's role among 19,649 older adults in Europe. Frailty, QoL, and cognition were assessed using the health deficit index, CASP-12, and 3 standard cognitive tests, respectively.

RESULTS

We observed a bidirectional association between frailty and QoL and their dynamics. High initial levels of frailty predicted poorer QoL later and vice versa (β = -0.151 and -0.052, p < .001). The early change in frailty predicted the late change in QoL, and vice versa (β = -0.093 and -0.061, p < .001). Frailty or its early change drives this interrelationship. Cognition at Wave 5 partially mediated frailty's effect at Wave 4 on QoL at Wave 6 (indirect effect: β = -0.005, 95% confidence interval = -0.006, -0.004).

DISCUSSION

Our findings supported that early prevention of frailty and its risk factors may have more influential protective effects on later physical and mental health, as well as the need for ongoing screening for mental health in aging population. Also, the maintenance of good cognitive performance may help interrupt this possible vicious cycle linking frailty and QoL decline.

Comparison of healthspan-related indicators between adults with and without HIV infection aged 18-59 in the United States: a secondary analysis of NAHNES 1999-March 2020

BACKGROUND

As persons with HIV (PWH) live longer they may experience a heightened burden of poor health. However, few studies have characterized the multi-dimentional health of PWH. Thus, we aimed to identify the extent and pattern of health disparities, both within HIV infection status and across age (or sex) specific groups.

METHODS

We used cross-sectional data from the US National Health and Nutrition Examination Survey, 1999-March 2020. The adjusted prevalence of six healthspan-related indicators-physical frailty, activities of daily living (ADL) disability, mobility disability, depression, multimorbidity, and all-cause death-was evaluated. Logistic regression and Cox proportional hazards analyses were used to investigate associations between HIV status and healthspan-related indicators, with adjustment for individual-level demographic characteristics and risk behaviors.

RESULTS

The analytic sample consisted of 33 200 adults (170 (0.51%) were PWH) aged 18-59 years in the United States. The mean (interquartile range) age was 35.1 (25.0-44.0) years, and 49.4% were male. PWH had higher adjusted prevalences for all of the 6 healthspan-related indicators, as compared to those without HIV, ranged from 17.4% (95% CI: 17.4%, 17.5%) vs. 2.7% (95%CI: 2.7%, 2.7%) for all-cause mortality, to 84.3% (95% CI: 84.0%, 84.5%) vs. 69.8% (95%CI: 69.7%, 69.8%) for mobility disability. While the prevalence difference was largest in ADL disability (23.4% (95% CI: 23.2%, 23.7%); P < 0.001), and least in multimorbidity (6.9% (95% CI: 6.8%, 7.0%); P < 0.001). Generally, the differences in prevalence by HIV status were greater in 50-59 years group than those in 18-29 group. Males with HIV suffered higher prevalence of depression and multimorbidity, while females with HIV were more vulnerable to functional limitation and disabilities. HIV infection was associated with higher odds for 3 of the 6 healthspan-related indicators after fully adjusted, such as physical frailty and depression. Sensitivity analyses did not change the health differences between adults with and without HIV infection.

CONCLUSIONS

In a large sample of U.S. community-dwelling adults, by identifying the extent and pattern of health disparities, we characterized the multi-dimentional health of PWHs, providing important public health implications for public policy that aims to improve health of persons with HIV and further reduce these disparities.

Life-space mobility and post-hospitalization outcomes among older Mexican American Medicare beneficiaries

BACKGROUND

Older adults with limited mobility are at an increased risk of adverse health outcomes, an outcome inadequately investigated in older Mexican Americans. We explored whether pre-admission life-space mobility predicts post-hospitalization outcomes among hospitalized Mexican American Medicare beneficiaries.

METHODS

Life-space mobility, using the Life-Space Assessment (LSA), was analyzed using quartiles and 5-point intervals. Using the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE) Waves 7 and 8 data linked to Medicare claims data, 426 older Mexican Americans with at least 2 months of Medicare coverage who were hospitalized within 2 years of completing the LSA were included. Logistic and Cox Proportional regression analyses estimated the association of pre-admission LSA with post-hospitalization outcomes.

RESULTS

Prior to hospitalization, 85.4% reported limited life-space mobility. Most patients (n = 322, 75.6%) were hospitalized for medical reasons. About 65% were discharged to the community. Pre-admission LSA scores were not associated with community discharge (Odds Ratio [OR] = 1.02, 0.95-1.10). Higher pre-admission LSA scores were associated with 30-day readmission (OR = 1.11, 1.01-1.22). Patients in the highest pre-admission LSA quartile (i.e., greatest life-space mobility) were less likely to die within 2 years after hospital discharge (OR = 0.61, 0.39-0.97) compared to those with lower pre-admission LSA scores.

CONCLUSIONS

Among older Mexican American Medicare beneficiaries, greater pre-admission LSA scores were associated with an increased risk of 30-day readmission and a decreased risk of mortality within 2 years following hospitalization. Future work should further investigate the relationship between LSA and post-hospitalization outcomes in a larger sample of Mexican American older adults.

Predictors of life-space mobility in patients with fracture 3 months after discharge from convalescent rehabilitation ward: a prospective longitudinal study

[Purpose] To identify predictors of life-space mobility in patients with fracture three months after discharge from convalescent rehabilitation ward. [Participants and Methods] This is a prospective longitudinal study that included patients aged 65 or older with a fracture who were scheduled for discharge home from the convalescent rehabilitation ward. Baseline measurements included sociodemographic variables (age, gender, and disease), the Falls Efficacy Scale-International, maximum walking speed, the Timed Up & Go test, the Berg Balance Scale, the modified Elderly Mobility Scale, the Functional Independence Measure, the revised version of Hasegawa's Dementia Scale, and the Vitality Index up to two weeks before discharge. As a follow-up, the life-space assessment was measured three months after discharge. In the statistical analysis, multiple linear and logistic regression analyses were performed with the life-space assessment score and the life-space level of "places outside your town" as dependent variables. [Results] The Falls Efficacy Scale-International, the modified Elderly Mobility Scale, age, and gender were selected as predictors in the multiple linear regression analysis, whereas in the multiple logistic regression analysis, the Falls Efficacy Scale-International, age, and gender were selected as predictors. [Conclusion] Our study emphasized the importance of fall-related self-efficacy and motor function for life-space mobility. The findings of this study suggest that when considering post-discharge living, therapists should conduct an appropriate assessment and adequate planning.

Patterns of participation restriction among older adults at risk of falls and relationship with intrinsic capacity: A latent cluster analysis

Introduction

The concept of participation restriction was first described by the World Health Organization in 2001 as a component of The International Classification of Functioning, Disability and Health Framework. Both falls and fear of falling (FOF) are associated with social isolation, depression, anxiety, poor quality of life and cognitive impairment resulting in participation restriction. Life-space mobility (LSM) is an important indicator for participation restriction which depends on multiple inter-related factors. We aimed to determine participation patterns using latent cluster analysis (LCA) in older adults at risk of falls, its relationship with intrinsic capacity (IC) and its risk prediction.

Methods

Cross-sectional study of 154 community dwelling older adults ≥ 60 years with falls or risk of falls was conducted. Questionnaires were administered on demographics, hearing, LSM, frailty (FRAIL scale), anorexia of aging (SNAQ), cognition (Montreal Cognitive Assessment, MoCA), FOF (Falls Efficacy Scale-International), physical function, and assessment for handgrip strength (HGS), gait speed, 5-times sit to stand (STS), vision and times-up-and-go (TUG) were performed. Six IC domains (vision and hearing, cognition, nutrition, mobility and depression) were measured.

Results

Three pattern of participation cluster were identified, high (n = 63, 40.9%), moderate (n = 83, 53.9%) and low (n = 8, 33 5.2%). Individuals in the high participation cluster were significantly younger, had higher LSM scores and lower FES-I scores, more robust, fewer ADL and IADL limitations, lower prevalence of low HGS, higher gait speed and shorter TUG. In the fully adjusted model compared to the high participation cluster, moderate participation was significantly associated with low MoCA scores (OR 4.2, 95% CI 1.7-10.4, p = 0.02), poor STS (OR 7.1, 95% CI 3.0-17.0, p < 0.001) whereas low participation was associated with anorexia of aging (OR 9.9, 95% CI 1.6-60.9, p = 0.014), poor STS (OR 19.1, 95% CI 2.0-187.5, p = 0.011) and hearing impairment (OR 9.8, 95% CI 1.4-70.8, p = 0.024). Participants with 3 out of 6 IC decline had a probability of greater than 80% to belong to the low/moderate participation class.

Discussion

Physical function, cognition, hearing and nutrition were significantly associated with low and/or moderate participation class. Future studies are needed to evaluate improvement in participation of those with falls or at risk for falls through restoration of IC.

Life-space, frailty, and health-related quality of life

INTRODUCTION

Life-space and frailty are closely linked to health-related quality of life and understanding their inter-relationship could indicate potential intervention targets for improving quality of life. We set out to examine the relationship between frailty and life-space and their relative impact on quality of life measures.

METHODS

Using cross-sectional data from a population-representative cohort of people aged ≥ 70 years, we assessed quality of life with the EuroQol Health Index tool (5-levels) (EQ-5D-5L). We also undertook a life-space assessment and derived a frailty index. Linear regression models estimated EQ-5D-5L scores (dependent variable) using life-space assessment, frailty index and interactions between them. All models were adjusted by age, sex, lifestyle, and social care factors.

RESULTS

A higher EQ-5D Index was associated with higher life-space (0.02 per life-space assessment score, 95%CI: 0.01 to 0.03, p < 0.01) and decreasing frailty (-0.1 per SD, 95%CI: -0.1 to -0.1, p < 0.01). There was evidence of an interaction between life-space and frailty, where the steepest gradient for life-space and EQ-5D was in those with the highest frailty (interaction term = 0.02 per SD of frailty, 95%CI: 0.01 to 0.03, p < 0.01).

CONCLUSION

Individuals with the highest frailty were twice as likely to have higher quality of life in association with a larger life-space. Interventions designed to improve quality of life in frail older people could focus on increasing a person's life-space.

Differences in Characteristics between Older Adults Meeting Criteria for Sarcopenia and Possible Sarcopenia: From Research to Primary Care

Identification of possible sarcopenia, which is a simple assessment of sarcopenia, has been proposed for the earlier detection of sarcopenia in primary care settings; however, there are no studies comparing the differences in characteristics of older adults with possible sarcopenia or sarcopenia. This study aimed to compare the characteristics of “possible sarcopenia” in real-world primary care and “sarcopenia” in research settings. A total of 2129 older adults were enrolled from the Korean Frailty and Aging Cohort Study. Possible sarcopenia and sarcopenia were defined using Asian Working Group for Sarcopenia 2019; the possible sarcopenia for real-world primary care was defined by a combination of case findings using low calf circumference or the SARC-F questionnaire and 5-times chair stand test, without considering the measurement of handgrip strength. The prevalence of possible sarcopenia was higher in women than in men; however, that of sarcopenia was higher in men than in women (all, p < 0.001). Older men and women with possible sarcopenia had a lower education level, longer time taken for the Timed Up and Go test, more severe mobility limitation, lower scores on the EuroQol-5 dimension and 12-item short-form survey for physical health, and more cognitive dysfunction than those with sarcopenia did (all, p < 0.05). In conclusion, the participants with possible sarcopenia differed from those with sarcopenia in some characteristics. Identifying differences in characteristics may be helpful to screening and earlier diagnosis of sarcopenia in real-world primary care, as well as in research, which can lay the foundations for personalized lifestyle intervention in diet and exercise.

Longer Residence in the United States is Associated With More Physical Function Limitations in African Immigrant Older Adults

Acculturation and racial discrimination have been independently associated with physical function limitations in immigrant and United States (U.S.)-born populations. This study examined the relationships among acculturation, racial discrimination, and physical function limitations in N = 165 African immigrant older adults using multiple linear regression. The mean age was 62 years (SD = 8 years), and 61% were female. Older adults who resided in the United States for 10 years or more had more physical function limitations compared with those who resided here for less than 10 years (b = -2.62, 95% confidence interval [CI] = [-5.01, -0.23]). Compared to lower discrimination, those with high discrimination had more physical function limitations (b = -2.51, 95% CI = [-4.91, -0.17]), but this was no longer significant after controlling for length of residence and acculturation strategy. Residing in the United States for more than 10 years is associated with poorer physical function. Longitudinal studies with large, diverse samples of African immigrants are needed to confirm these associations.

Effect of life-space mobility on subjective well-being in aged home-based rehabilitation users with different levels of independence in activities of daily living

[Purpose] The relationship between quality of life and life-space mobility in community-dwelling older adults has recently been reported. The present study aimed to elucidate this relationship in home-based rehabilitation users with limited life-space mobility and loss of independence in activities of daily living. [Participants and Methods] The study population comprised 33 home-based rehabilitation users. The participants were expected to have a wide range of the level of independence in activities of daily living; therefore, they were categorized into three groups according to the Barthel Index score: independent (95–100 points), moderately disabled (90–65 points), and severely disabled (60–0 points) groups. We examined the relationships among the Philadelphia Geriatric Center Morale Scale, Life-Space Assessment, and Barthel Index scores and age. [Results] We detected a strong positive correlation between the Philadelphia Geriatric Center Morale Scale and Life-Space Assessment scores in the independent group; however, no significant correlations were observed in the moderately and severely disabled groups. [Conclusion] Our findings suggest a relationship between subjective well-being and life-space mobility in home-based rehabilitation users who are mostly independent in activities of daily living. However, owing to the small sample size and characteristics of the scales used in this study, further studies are warranted to verify these results.

Prevalence of functional limitations among foreign and US-born Black older adults: 2010-2016 National Health Interview Surveys

OBJECTIVE

To determine whether the prevalence of functional limitations in United States (US) born differs from that of foreign-born Black older adults.

DESIGN

We performed a cross-sectional analysis of data from 14,438 US-born and 1583 foreign-born Black older adults (≥50 years) in the 2010-2016 National Health Interview Surveys (NHIS). Functional limitations were defined by upper and lower extremity limitations, and global functional limitations. Generalized linear modeling using a Poisson distribution and logarithmic link function was used to compare the predicted probabilities of functional limitations in both groups.

RESULTS

The mean age (SE) of US-born Blacks was 63.56 (0.12) years and foreign-born Blacks was 62.06 (0.32). The majority (92%) of foreign-born Blacks had resided in the US for ≥10 years. US-born older adults were more likely to have upper (46% vs. 29%, p < .001) and lower (61% vs. 40%, p < .001) extremity limitations than foreign-born Blacks. The prevalence of lower extremity limitations was 22% less in foreign-born Blacks compared to US-born Blacks after adjusting for sociodemographic and health profiles (Prevalence Ratio [PR]: 0.78, 95% CI:0.73-0.84). The adjusted prevalence of upper extremity limitations in foreign-born Blacks was 27% (PR: 0.73, 95% CI: [0.68-0.79]), compared to US-born Black older adults. And that of global functional limitations was 22% less (PR: 0.78, 95% CI [0.73-0.83]) in foreign-born compared to US-born Blacks.

CONCLUSION

Compared to their US-born counterparts, foreign-born Black older adults had a markedly lower prevalence of upper and lower extremity functional limitations. Future comparative studies should examine reasons for this apparent health advantage among foreign-born adults to inform social and medical interventions to prevent functional decline in Black older adults in the US.

Predicting Autonomous Shuttle Acceptance in Older Drivers Based on Technology Readiness/Use/Barriers, Life Space, Driving Habits, and Cognition

Shared autonomous vehicle services (i. e., automated shuttles, AS) are being deployed globally and may improve older adults (>65 years old) mobility, independence, and participation in the community. However, AS must be user friendly and provide safety benefits if older drivers are to accept and adopt this technology. Current potential barriers to their acceptance of AS include a lack of trust in the systems and hesitation to adopt emerging technology. Technology readiness, perceived ease of use, perceived barriers, and intention to use the technology, are particularly important constructs to consider in older adults' acceptance and adoption practices of AS. Likewise, person factors, i.e., age, life space mobility, driving habits, and cognition predict driving safety among older drivers. However, we are not sure if and how these factors may also predict older adults' intention to use the AS. In the current study, we examined responses from 104 older drivers (M _age = 74.3, SD _age = 5.9) who completed the Automated Vehicle User Perception Survey (AVUPS) before and after riding in an on-road automated shuttle (EasyMile EZ10). The study participants also provided information through the Technology Readiness Index, Technology Acceptance Measure, Life Space Questionnaire, Driving Habits Questionnaire, Trail-making Test Part A and Part B (TMT A and TMT B). Older drivers' age, cognitive scores (i.e., TMT B), driving habits (i.e., crashes and/or citations, exposure, and difficulty of driving) and life space (i.e., how far older adults venture from their primary dwelling) were entered into four models to predict their acceptance of AVs-operationalized according to the subscales (i.e., intention to use, perceived barriers, and well-being) and the total acceptance score of the AVUPS. Next, a partial least squares structural equation model (PLS-SEM) elucidated the relationships between, technology readiness, perceived ease of use, barriers to AV acceptance, life space, crashes and/or citations, driving exposure, driving difficulty, cognition, and intention to use AS. The regression models indicated that neither age nor cognition (TMT B) significantly predicted older drivers' perceptions of AVs; but their self-reported driving difficulty (p = 0.019) predicted their intention to use AVs: R ² = 6.18%, F (2,101) = 4.554, p = 0.040. Therefore, intention to use was the dependent variable in the subsequent PLS-SEM. Findings from the PLS-SEM (R ² = 0.467) indicated the only statistically significant predictors of intention to use were technology readiness (β = 0.247, CI = 0.087-0.411) and barriers to AV acceptance (β = -0.504, CI = 0.285-0.692). These novel findings provide evidence suggesting that technology readiness and barriers must be better understood if older drivers are to accept and adopt AS.

Are Mobile Persons With Parkinson Disease Necessarily More Active?

BACKGROUND AND PURPOSE

Walking activity in persons with Parkinson disease (PD) is important for preventing functional decline. The contribution of walking activity to home and community mobility in PD is poorly understood.

METHODS

Cross-sectional baseline data (N = 69) were analyzed from a randomized controlled PD trial. The Life-Space Assessment (LSA) quantified the extent, frequency, and independence across 5 expanding levels of home and community mobility, producing individual subscores and a total score. Two additional summed scores were used to represent mobility within (Levels 1-3) and beyond (Levels 4-5) neighborhood limits. An accelerometer measured walking activity for 7 days. Regression and correlation analyses evaluated relationships between daily steps and mobility scores. Mann-Whitney U tests secondarily compared differences in mobility scores between the active and sedentary groups.

RESULTS

Walking activity contributed significantly to the summed Level 1-3 score (β = 0.001, P = 0.004) but not to the summed Level 4-5 (β = 0.001, P = 0.33) or total (β = 0.002, P = 0.07) scores. Walking activity was significantly related to Level 1 (ρ = 0.336, P = 0.005), Level 2 (ρ = 0.307, P = 0.010), and Level 3 (ρ = 0.314, P = 0.009) subscores. Only the summed Level 1-3 score (P = 0.030) was significantly different between the active and sedentary groups.

DISCUSSION AND CONCLUSIONS

Persons with PD who demonstrated greater mobility beyond the neighborhood were not necessarily more active; walking activity contributed more so to home and neighborhood mobility. Compared with LSA total score, the Level 1-3 summed score may be a more useful participation-level measure for assessing the impact of changes in walking activity.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A349).

Objectively measured sleep and physical function: Associations in low-income older adults with disabilities

OBJECTIVE

Late-life sleep health has been tied to physical function, but little is known about these associations among socially disadvantaged populations.

DESIGN

We determined cross-sectional associations of sleep with physical function in low-income, predominantly Black older adults with disabilities.

PARTICIPANTS

One hundred thirty-six older adults (mean age 76.0 years, 83.8% women, 82.4% Black).

MEASUREMENTS

Primary predictors were actigraphic total sleep time (TST), wake after sleep onset (WASO), and subjective sleep complaints. Outcomes were objective physical performance (Short Physical Performance Battery (SPPB)) and participant-reported difficulties in basic and instrumental activities of daily living (ADLs and IADLs).

RESULTS

In regression models adjusted for potential confounders, both longer TST and greater WASO were associated with lower SPPB scores and increased IADL difficulty. Participants with a mean TST in the longest (>7.5 hours) vs. intermediate (6.3-7.5 hours) tertile had 27% higher odds of additional IADL difficulty (incident rate ratio = 1.27, 95% confidence interval [CI] 1.03, 1.58). Each additional 10 minutes of WASO was associated with 0.13 point lower SPPB scores (B = -0.13, 95% CI -0.25, -0.01) and increased IADL difficulty (B = 0.02, 95% CI 0.0003, 0.04). Sex moderated the associations of WASO with IADL and ADL difficulties: associations were stronger for males. Subjective sleep complaints were not statistically significantly associated with function.

CONCLUSIONS

Among disabled, low-income, mostly Black older adults, objective measures of long sleep and greater WASO are associated with poorer physical function. Effect sizes for the associations were modest; however, findings may have important implications given the significant consequences of decreased function on quality of life and caregiving demands.

The Association of Mobility Determinants and Life Space Among Older Adults

BACKGROUND

It is important to understand the factors associated with life space mobility so that mobility disability can be prevented/treated. The purpose of this study was to identify the association between mobility determinants and life space among older adults.

METHODS

This study was a cross-sectional analysis of 249 community-dwelling older adults (mean age=77.4 years, 65.5% female, 88% white) who were recruited for a randomized, controlled, clinical intervention trial. Associations between cognitive, physical, psychosocial, financial, and environmental mobility determinants and the Life Space Assessment (LSA) at baseline were determined using Spearman's correlation coefficients and one-way analysis of variance. Multivariate analysis was performed using multivariable linear regression models.

RESULTS

The mean LSA score for the sample was 75.3 (SD=17.8). Personal factors (age, gender, education, comorbidities), cognitive (Trail Making Test A and B), physical (gait speed, lower extremity power, Six Minute Walk Test, Figure of 8 Walk Test, tandem stance, energy cost of walking, and Late Life Function and Disability Function Scale), psychosocial (Modified Gait Efficacy Scale), and financial (neighborhood socio-economic status) domains of mobility were significantly associated with LSA score. In the final regression model, age (β=-0.43), lower extremity power (β=0.03), gait efficacy (β=0.19), and energy cost of walking (β=-57.41) were associated with life space (R 2=0.238).

CONCLUSIONS

Younger age, greater lower extremity power, more confidence in walking, and lower energy cost of walking were associated with greater life space. Clinicians treating individuals with mobility disability should consider personal, physical, and psychosocial factors assessing barriers to life space mobility.

A timed activity protocol to address sleep-wake disorders in home dwelling persons living with dementia: the healthy patterns clinical trial

BACKGROUND

Sleep-wake disorders occur in most persons living with dementia and include late afternoon or evening agitation, irregular sleep-wake rhythms such as daytime hypersomnia, frequent night awakenings, and poor sleep efficiency. Sleep-wake disorders pose a great burden to family caregivers, and are the principal causes of distress, poor quality of life, and institutionalization. Regulating the sleep-wake cycle through the use of light and activity has been shown to alter core clock processes and suggests that a combination of cognitive, physical, and sensory-based activities, delivered at strategic times, may be an effective mechanism through which to reduce sleep-wake disorders.

METHODS

A definitive Phase III efficacy trial of the Healthy Patterns intervention, a home-based activity intervention designed to improve sleep-wake disorders and quality of life, is being conducted using a randomized two-group parallel design of 200 people living with dementia and their caregivers (dyads). Specific components of this one-month, home-based intervention involve 4 in-home visits and includes: 1) assessing individuals' functional status and interests; 2) educating caregivers on environmental cues to promote activity and sleep; and 3) training caregivers in using timed morning, afternoon, and evening activities based on circadian needs across the day. The patient focused outcomes of interest are quality of life, measures of sleep assessed by objective and subjective indicators including actigraphy, subjective sleep quality, and the presence of neuropsychiatric symptoms. Caregiver outcomes of interest are quality of life, burden, confidence using activities, and sleep disruption. Salivary measures of cortisol and melatonin are collected to assess potential intervention mechanisms.

DISCUSSION

The results from the ongoing study will provide fundamental new knowledge regarding the effects of timing activity participation based on diurnal needs and the mechanisms underlying timed interventions which can lead to a structured, replicable treatment protocol for use with this growing population of persons living with dementia.

CLINICAL TRIAL REGISTRATION

Clinicaltrials.gov # NCT03682185 at https://clinicaltrials.gov/ ; Date of clinical trial registration: 24 September 2018.

Life-space constriction in aging adults

BACKGROUND

Early indicators of declining function and frailty, such as life-space constriction (LSC), are important in identifying those at risk for frailty.

PURPOSE

Examine factors associated with LSC and the influence on function and frailty.

METHODS

A cross-sectional, descriptive study was conducted using a convenience sample of community dwelling persons 55 and older living in the South.

RESULTS

Most participants (N = 72) were female (69%; n = 50) and half were White (53.5%; n = 38). Individual factors including challenges (age-related physiological changes, disease burden, mental health limitations) and buoy (assistive devices, and other compensatory strategies) explained 22% variance in self-reported frailty (F = 3.099 (6, 65); p = .01). LSC explained 34% variance in function (F = 3.805 (8, 59); p = .001) when environmental supports (family ties, and social network) and challenges (area deprivation, built environment, and social disorganization) and individual factors were controlled for. Number of assistive devices was the only significant predictor of frailty.

Association Between Kinesiophobia and Life Space Among Community-Dwelling Older People with Chronic Musculoskeletal Pain

OBJECTIVE

Kinesiophobia (i.e., fear of movement caused by pain) is increasingly acknowledged as a determinant of disuse among patients with chronic musculoskeletal pain. Kinesiophobia may affect life space-a crucial indicator of an active lifestyle among older people. This study aimed to investigate the previously unexamined association between kinesiophobia and life space among community-dwelling older people with chronic musculoskeletal pain.

DESIGN

Cross-sectional study.

SETTING

Community.

SUBJECTS

We analyzed data from 194 community-dwelling older people (age ≥65 years, mean age = 75.7 years, 71.6% women) with chronic musculoskeletal pain.

METHODS

Kinesiophobia, life space, and pain severity were assessed using the Tampa Scale for Kinesiophobia, Life Space Assessment, and Brief Pain Inventory. Linear regression models were applied to analyze the associations between kinesiophobia and life space, and pain severity and life space.

RESULTS

In our sample, the prevalence rates for chronic musculoskeletal pain were 10.82% (N = 21) for neck, 55.15% (N = 107) for lower back, 25.26% (N = 49) for shoulder, and 50.00% (N = 97) for knee. The results suggest that higher kinesiophobia is associated with smaller life space (adjusted beta = -0.91, 95% CI = -1.43 to -0.45, P < 0.001), even after adjustment for age, gender, years of education, pain severity, and presence of comorbidity. On the contrary, no significant association between pain severity and life space was observed (adjusted beta = -0.61, 95% CI = -2.92 to 1.72, P = 0.624).

CONCLUSIONS

Our findings suggest that kinesiophobia plays an important role in the determination of life space among older people with chronic musculoskeletal pain.

Life-Space Mobility in the Elderly: Current Perspectives

Life-space mobility (LSM) is a concept for assessing patterns of functional mobility over time. LSM is gaining traction in the research of geriatric population health. Several instruments have been developed to measure LSM, such as the University of Alabama at Birmingham Life-Space Assessment (LSA) or the Nursing Home Life-Space Diameter instrument. There has been exponential growth in the use of instruments measuring LSM in studies of older adults since the concept was introduced in 1985. In response to the increased volume of publications with clinical applicability to those working in geriatric health or conducting population-based research in older adults, we conducted a narrative review: a) to provide a summary of the articles that have assessed validation of the University of Alabama at Birmingham LSA instrument, the most widely used instrument to assess LSM in older adults; and b) to provide a summary of the research articles that have examined LSM as independent or outcome variable. Studies for this review were obtained with an organized search format and were included if they were published in the past 20 years, written in English, published in peer-reviewed literature, and included LSM as an independent or outcome variable. Seventy-nine articles were identified: 36 that employed a cross-sectional design and 22 that employed a longitudinal/prospective design to examine LSM as outcome variable; 17 longitudinal/prospective design articles that examined LSM as primary independent variable; 3 review articles; and 1 systematic review. Areas of research included physical function, cognitive function, sensory impairment, mental health, falls, frailty, comorbidities, healthcare use, mortality, and social/environmental factors. These studies showed that LSM instruments can accurately predict morbidity, mortality, and healthcare use.

Working conditions mediate the association between social class and physical function in older age in Sweden: a prospective cohort study

Background

Global demographics are changing as societies all over the world are aging. This puts focus on maintaining functional ability and independence into older age. Individuals from lower social classes are at greater risk of developing limitations in physical function later in life. In this study, we investigated the mediating role of working conditions in the association between occupation-based social class and physical function measured as self-reported mobility limitations and objectively measured physical impairment in older age.

Methods

Two Swedish surveys, linked at the individual level, were used (n = 676–814 depending on the outcome). Follow-up time was 20–24 years. Multiple logistic regression analyses were performed with adjustments for age, sex, level of education, mobility, and health problems at baseline. This was followed by analyses of the size of the mediating effect of working conditions.

Results

Working conditions seem to mediate 35–74% of the association between social class and physical impairment in older age. The pattern of mediation was primarily driven by passive jobs, i.e., low psychological demands and low control, among blue-collar workers. Working conditions did not mediate the association between social class and self-reported mobility limitations in older age.

Conclusions

The results of this study indicate that working conditions are important in combating the social gradient in healthy aging, contributing to the evidence regarding the magnitude of impact exerted by both the physical and psychosocial work environment separately and in conjunction.

Long-term digital device-enabled monitoring of functional status: Implications for management of persons with Alzheimer's disease

INTRODUCTION

Informal caregiving is an essential element of health-care delivery. Little data describes how caregivers structure care recipients' lives and impact their functional status.

METHODS

We performed observational studies of community dwelling persons with dementia (PWD) to measure functional status by simultaneous assessment of physical activity (PA) and lifespace (LS). We present data from two caregiver/care-recipient dyads representing higher and average degrees of caregiver involvement.

RESULTS

We acquired >42,800 (subject 1); >41,300 (subject 2) PA data points and >154,500 (subject 1); >119,700 (subject 2) LS data points over 15 months of near continuous observation. PA and LS patterns provided insights into the caregiver's role in structuring the PWD's day-to-day function and change in function over time.

DISCUSSION

We show that device-enabled functional monitoring (FM) can successfully gather and display data at resolutions required for dementia care studies. Objective quantification of individual caregiver/care-recipient dyads provides opportunities to implement patient-centered care.

Activities of Daily Living and Life-Space Mobility in Older Adults with Chronic Obstructive Pulmonary Disease

Purpose

The aim of this study was to investigate whether limitation during the performance of activities of daily living (ADL) was associated with life-space mobility in older people with chronic obstructive pulmonary disease (COPD), and to generate a regression model for life-space mobility score.

Patients and Methods

This cross-sectional study with a convenience sample included older people (aged ≥60 years old) with COPD. We assessed participants’ lung function (spirometry), life-space mobility (University of Alabama at Birmingham Study of Aging Life-Space Assessment questionnaire), severity of dyspnea (Modified Dyspnea Index) and limitation during the performance of ADL (London Chest Activity of Daily Living). We used Pearson’s correlation to investigate the associations between the measures, and multiple linear regression to detect which of the measures influenced life-space mobility. Statistical significance was set at 5%.

Results

Fifty participants completed all the assessments (29 females [58%]; mean ± SD age of 67 ± 6 years old, FEV₁ 47 ± 29% of predicted, and body mass index 22.5 ± 11.6 kg/m²). Their mean scores for life-space mobility and for limitation during the performance of ADL were 49.7 ± 27.2 and 16.46 ± 9.74, respectively. We found a strong inverse correlation between limitation during the performance of ADL and life-space mobility (r = −0.57, p = <0.01) as well as between severity of dyspnea and life-space mobility (r= 0.86, p= <0.01). Both sex and limitation during the performance of ADL were considered as independent factors associated to life-space mobility (R²= 0.56).

Conclusion

In this study, limitations during the performance of ADL and dyspnea had a strong correlation with life-space mobility in older adults with COPD. Also, alongside sex, the limitation during the performance of ADL is an independent factor associated with life-space mobility in a regression model.

Longitudinal Stress-Buffering Effects of Social Integration for Late-Life Functional Health

Stress can negatively affect multiple aspects of health, including functional health, among older adults, who are likely to face unique, age-related stressful experiences. Previous research has addressed the protective effects of social relations (i.e., social ties, social participation, and social integration) for physical and mental health outcomes, yet few studies have examined functional health. This study aimed to investigate the longitudinal stress-buffering effects of social integration on late-life functional health. Using three-wave data from 399 older adults (aged older than 60 years), two-level hierarchical linear modeling analysis was conducted and the results indicated that in addition to its main effect on functional (activity of daily living) limitations, social integration moderated the negative effect of stress on the longitudinal trajectory of functional limitations. The findings suggest important directions of future research to identify the mechanisms of such buffering effects over time and develop effective interventions to enhance late-life functional health while promoting social integration.

Fear of Falling Predicts Incidence of Functional Disability 2 Years Later: A Perspective From an International Cohort Study

Objective

To study the extent to which fear of falling (FOF) is associated with the onset of functional disability over a 2-year period in older adults using self-reported and performance-based measures.

Methods

In 2012, 1,601 participants (aged 65-74 years) were recruited from four sites: Kingston and Saint-Hyacinthe, Canada; Manizales, Colombia; and Natal, Brazil. They were re-assessed in 2014. We quantified FOF using the Fall Efficacy Scale-International (FES-I; range: 16-64). Functional disability measures were (i) self-reported incident mobility disability, defined as difficulty climbing a flight of stairs or walking 400 m and (ii) incident poor physical performance, defined as a score <9 on the Short Physical Performance Battery. In the Poisson regression analysis, we included only those participants without functional disability at baseline to calculate incident risk ratios in 2014.

Results

1,355 participants completed the 2014 assessment, of which 917 and 1,078 had no mobility disability and poor physical performance at baseline, respectively. In 2014, 131 (14.3%), and 166 (15.4%) participants reported incident mobility disability and poor physical performance, respectively. After adjusting for age, sex, socioeconomic, and health covariates, a one-point increase in FES-I at baseline was significantly associated with a 4% increase in the risk of reporting incident mobility disability (95% CI: 1.02-1.05) and a 3% increase in the risk of developing poor physical performance at follow up in the overall sample (95%CI: 1.01-1.05).

Conclusions

FOF is associated with a higher risk of incident mobility disability and poor physical performance in a cohort of older adults. It is increasingly important to study FOF's effect on functional disability and to take necessary measures to prevent the transition to end-stage disability.

Psychosocial working conditions across working life may predict late-life physical function: a follow-up cohort study

BACKGROUND

Increasing life expectancy has made understanding the mechanisms underlying late-life health and function more important. We set out to investigate whether trajectories of change in psychosocial working conditions are associated with late-life physical function.

METHODS

Two Swedish surveys, linked at the individual level, were used (n = 803). A psychosocial job exposure matrix was used to measure psychosocial working conditions during people's first occupation, as well as their occupation every five years thereafter until baseline in 1991. Physical function was measured in 2014. Random effects growth curve models were used to calculate intraindividual trajectories of working conditions. Predictors of physical function were assessed with ordered logistic regression.

RESULTS

A more active job at baseline was associated with increased odds of late-life physical function (OR 1.15, CI 1.01-1.32). Higher baseline job strain was associated with decreased odds of late-life physical function (OR 0.75, CI 0.59-0.96). A high initial level followed by an upward trajectory of job strain throughout working life was associated with decreased odds of late-life physical function (OR 0.32, CI 0.17-0.58).

CONCLUSIONS

Promoting a healthier workplace by reducing chronic stress and inducing intellectual stimulation, control, and personal growth may contribute to better late-life physical function.

Validation of a Modified Life-Space Assessment in Multimorbid Older Persons With Cognitive Impairment

BACKGROUND AND OBJECTIVES

To investigate the validity, reliability, sensitivity to change, and feasibility of a modified University of Alabama at Birmingham Study of Aging Life-Space Assessment (UAB-LSA) in older persons with cognitive impairment (CI).

RESEARCH DESIGN AND METHODS

The UAB-LSA was modified for use in persons with CI Life-Space Assessment for Persons with Cognitive Impairment (LSA-CI). Measurement properties of the LSA-CI were investigated using data of 118 multimorbid older participants with CI [mean age (SD): 82.3 (6.0) years, mean Mini-Mental State Examination score: 23.3 (2.4) points] from a randomized controlled trial (RCT) to improve motor performance and physical activity. Construct validity was asessed by Spearman's rank (rs) and point-biseral correlations (rpb) with age, gender, motor, and cognitive status, psychosocial factors, and sensor-derived (outdoor) physical activity variables. Test-retest reliability was analyzed using intra-class correlation coefficients (ICCs). Sensitivity to change was determined by standardized response means (SRMs) calculated for the RCT intervention group.

RESULTS

The LSA-CI demonstrated moderate to high construct validity, with significant correlations of the LSA-CI scores with (outdoor) physical activity (rs = .23-.63), motor status (rs = .27-.56), fear of falling-related psychosocial variables (rs = |.24-.44|), and demographic characteristics (rpb = |.27-.32|). Test-retest reliability was good to excellent (ICC = .65-.91). Sensitivity to change was excellent for the LSA-CI composite score (SRM = .80) and small to moderate for the LSA-CI subscores (SRM = .35-.60). A completion rate of 100% and a mean completion time of 4.1 min) documented good feasibility.

DISCUSSION AND IMPLICATIONS

The LSA-CI represents a valid, reliable, sensitive, and feasible interview-based life-space assessment tool in multimorbid older persons with CI.

Associations of Usual Pace and Complex Task Gait Speeds With Incident Mobility Disability

BACKGROUND/OBJECTIVES

To assess whether gait speed under complex conditions predicts long-term risk for mobility disability as well as or better than usual-pace gait speed.

DESIGN

Longitudinal cohort study.

SETTING/PARTICIPANTS

Subsample of Health Aging and Body Composition study with follow-up from 2002 to 2003 to 2010 to 2011, including 337 community-dwelling adults (mean age = 78.5 years, 50.7% female, 26.1% black).

MEASUREMENTS

Associations of gait speed measured under usual-pace, fast-pace, dual-task, and narrow-path conditions with mobility disability, defined by any self-reported difficulty walking ¼ mile assessed annually, were tested by Cox proportional hazard models adjusted for demographic and health characteristics. Models were fitted for each walking condition, and R² statistics were used to compare predictive value across models. Models were repeated for persistent mobility disability, defined as at least two consecutive years of mobility disability.

RESULTS

Mobility disability occurred in 204 (60.5%) participants over the 8-year follow-up. There was a lower hazard of developing mobility disability with faster gait speed under all conditions. Hazard ratios, confidence intervals, and R² of gait speed predicting mobility disability were similar across all four walking conditions (R² range = 0.22-0.27), but were strongest for dual-task gait speed (hazard ratio [95% confidence interval], R² of fully adjusted models = 0.81 [0.75-0.88], 0.27). Results were comparable for persistent mobility disability (R² range = 0.26-0.28).

CONCLUSION

Slower gait speed under both usual-pace and complex conditions may be a clinical indicator of future risk of mobility disability. These results support the call for increased use of gait speed measures in routine geriatric care. J Am Geriatr Soc 67:2072-2076, 2019.

Older Adult Lifespace Varies by Driving Status and Residential Population Density

Individual- and environmental-level factors may explain differential trajectories in lifespace mobility in older adults. The current study tested whether driving status was associated with lifespace, whether lifespace change varied by driving status, and whether residential context moderated the relationship between driving status and lifespace. Participants were older adults ages 65 to 94 (mean = 73.6 + 5.9) enrolled in the Advanced Cognitive Training for Independent and Vital Elderly Study (N = 2,792). Lifespace and driving status were assessed at baseline and first, second, third, and fifth annual follow-up visits. Residential population density was measured as the population density for participants' enrollment site counties. Two sites were categorized as low density (< 600 per square mile) and four sites were categorized as high density (> 1,200 per square mile). Multilevel longitudinal models tested relationships between driving status, residential population density, and lifespace over five years. After controlling for potential confounders, results indicated that non-drivers had smaller mean lifespace than drivers across five years. Rates of lifespace declines did not differ between drivers and non-drivers. Non-drivers at baseline residing in low population density areas had smaller lifespace than non-drivers in high population density areas and all drivers regardless of population density. The findings suggest that residential context plays a role in older adults' travel behaviors and choices. Further research is needed to understand what residential characteristics support or hinder lifespace maintenance for older adult non-drivers, such as availability and usability of transportation and walkability.

Disparities in the Prevalence and Correlates of Disability in Older Immigrants in the USA: a Systematic Review of the Literature

BACKGROUND

Disability in older adults leads to poor quality of life, is costly for the health system, and is a risk for mortality. Little is known about disability in older immigrants to the USA.

OBJECTIVE

To synthesize the evidence on the prevalence and factors associated with disability in older adult immigrants.

METHODS

We conducted searches in PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus. Disability was defined as difficulty in performing basic or instrumental activities of daily living. Older adult was defined as 65 years and older. Immigrant status was defined as someone born outside of the USA.

RESULTS

Eighteen articles met the inclusion criteria. Seven studied Hispanic/Latino immigrants, six studied Asian immigrants, four studied diverse older immigrant samples, and one studied European immigrants. Prevalence of disability ranged from 2 to 49% in Asians and 3 to 58.1% in Hispanic/Latinos. In a diverse sample of immigrants, the prevalence of disability was 19.3%. Correlates of disability included female gender, low income, limited education, single status, migration in late adulthood, obesity, arthritis, and diabetes. Factors protective against disability in older adult immigrants were acculturation, migrating at a younger age, exercise, alcohol intake, and church attendance.

CONCLUSION

Disability prevalence was generally lower in Asian immigrants compared to Hispanic/Latino immigrants. Identification of the precise rates and factors associated with disability in older immigrants can inform health interventions for this population.

Effect of a Biobehavioral Environmental Approach on Disability Among Low-Income Older Adults: A Randomized Clinical Trial

IMPORTANCE

Disability among older adults is a strong predictor of health outcomes, health service use, and health care costs. Few interventions have reduced disability among older adults.

OBJECTIVE

To determine whether a 10-session, home-based, multidisciplinary program reduces disability.

DESIGN, SETTING, AND PARTICIPANTS

In this randomized clinical trial of 300 low-income community-dwelling adults with a disability in Baltimore, Maryland, between March 18, 2012, and April 29, 2016, 65 years or older, cognitively intact, and with self-reported difficulty with 1 or more activities of daily living (ADLs) or 2 or more instrumental ADLs (IADLs), participants were interviewed in their home at baseline, 5 months (end point), and 12 months (follow-up) by trained research assistants who were masked to the group allocation. Participants were randomized to either the intervention (CAPABLE) group (n = 152) or the attention control group (n = 148) through a computer-based assignment scheme, stratified by sex in randomized blocks. Intention-to-treat analysis was used to assess the intervention. Data were analyzed from September 2017 through August 2018.

INTERVENTIONS

The CAPABLE group received up to 10 home visits over 5 months by occupational therapists, registered nurses, and home modifiers to address self-identified functional goals by enhancing individual capacity and the home environment. The control group received 10 social home visits by a research assistant.

MAIN OUTCOMES AND MEASURES

Disability with ADLs or IADLs at 5 months. Each ADL and IADL task was self-scored from 0 to 2 according to whether in the previous month the person did not have difficulty and did not need help (0), did not need help but had difficulty (1), or needed help regardless of difficulty (2). The overall score ranged from 0 to 16 points.

RESULTS

Of the 300 people randomized to either the CAPABLE group (n = 152) or the control group (n = 148), 133 of the CAPABLE participants (87.5%) were women with a mean (SD) age of 75.7 (7.6) years; 126 (82.9%) self-identified as black. Of the controls, 129 (87.2%) were women with a mean (SD) age of 75.4 (7.4) years; 133 (89.9%) self-identified as black. CAPABLE participation resulted in 30% reduction in ADL disability scores at 5 months (relative risk [RR], 0.70; 95% CI, 0.54-0.93; P = .01) vs control participation. CAPABLE participation resulted in a statistically nonsignificant 17% reduction in IADL disability scores (RR, 0.83; 95% CI, 0.65-1.06; P = .13) vs control participation. Participants in the CAPABLE group vs those in the control group were more likely to report that the program made their life easier (82.3% vs 43.1%; P < .001), helped them take care of themselves (79.8% vs 35.5%; P < .001), and helped them gain confidence in managing daily challenges (79.9% vs 37.7%; P < .001).

CONCLUSIONS AND RELEVANCE

Low-income community-dwelling older adults who received the CAPABLE intervention experienced substantial decrease in disability; disability may be modifiable through addressing both the person and the environment.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT01576133.

The effect of body mass index, lower extremity performance, and use of a private car on incident life-space restriction: a two-year follow-up study

Background

The purpose of the study was to explore the single and combined contributions of body mass index (BMI) and lower extremity performance as modifiable physical factors, and the influence of use of a private car as an environmental factor on prevalent and incident life-space restriction in community-dwelling older people.

Methods

Community-dwelling people aged 75–90 years (n = 823) participated in the Life-Space Mobility in Old Age (LISPE) two-year follow-up study. Participants who reported that the largest life-space area they had attained, without aid from any device or another person, was the neighborhood or less were considered to have life-space restriction. Incident life-space restriction was the endpoint of Cox’s proportional hazard model. BMI, lower extremity performance (Short Physical Performance Battery, SPPB), and use of a private car were predictors.

Results

At baseline, people who had both obesity (BMI ≥30.0) and impaired lower extremity performance (SPPB 0–9) had a higher prevalence of life-space restriction (prevalence ratio 3.6, 95% confidence interval, CI, 2.0–6.3) compared to those with normal weight (BMI 23.0–24.9) and intact physical performance (SPPB 10–12). The 581 people without life-space restriction at the baseline contributed 1033 person-years during the two-year follow-up. Incident life-space restrictions were reported by 28.3% participants. A higher hazard ratio (HR) for incident life-space restriction was observed in subjects having both obesity and impaired lower extremity performance (HR 3.6, 95% CI, 1.7–7.4), impaired lower extremity performance only (HR 1.9, 95% CI 0.9–4.1), and obesity only (HR 1.8, 95% CI, 0.9–3.5) compared to those with normal weight and intact performance. Private car passengers (HR 2.0, 95% CI, 1.3–3.0) compared to car drivers had a higher risk of life-space restriction. All models were adjusted for age, sex, chronic diseases, and education.

Conclusions

Older people with impaired lower extremity performance have an increased risk of incident life-space restriction especially if combined with obesity. Also, not driving a car renders older people vulnerable to life-space restriction.

Life-Space mobility and clinical outcomes in COPD

Background

Social isolation is a common experience in patients with COPD but is not captured by existing patient-reported outcomes, and its association with clinical outcomes is unknown.

Methods

We prospectively enrolled adults with stable COPD who completed the University of Alabama at Birmingham Life Space Assessment (LSA) (range: 0–120, restricted Life-Space mobility: ≤60 and a marker of social isolation in older adults); six-minute walk test (6MWT), and the University of California at San Diego Shortness of Breath Questionnaire, COPD Assessment Test, and Hospital Anxiety and Depression Scale. The occurrence of severe exacerbations (emergency room visit or hospitalization) was recorded by review of the electronic record up to 1 year after enrollment. We determined associations between Life-Space mobility and clinical outcomes using regression analyses.

Results

Fifty subjects had a mean ± SD %-predicted FEV₁ of 42.9±15.5, and 23 (46%) had restricted Life-Space mobility. After adjusting for age, gender, %-predicted FEV₁, comorbidity count, inhaled corticosteroid/long-acting beta₂-agonist use, and prior cardiopulmonary rehabilitation, subjects with restricted Life-Space had an increased risk for severe exacerbations (adjusted incidence rate ratio 4.65, 95% CI 1.19–18.23, P=0.03). LSA scores were associated with 6MWD (R=0.50, P<0.001), dyspnea (R=−0.58, P<0.001), quality of life (R=−0.34, P=0.02), and depressive symptoms (R=−0.39, P=0.005).

Conclusion

Restricted Life-Space mobility predicts severe exacerbations and is associated with reduced exercise tolerance, more severe dyspnea, reduced quality of life, and greater depressive symptoms.

Recruiting Older Adults With Functional Difficulties Into a Community-Based Research Study: Approaches and Costs

The CAPABLE (Community Aging in Place, Advancing Better Living for Elders) trial in Baltimore City tested whether an interdisciplinary team of occupational therapists, nurses, and handymen reduces disability and health expenditures in community-dwelling older adults with functional difficulties. This study describes methods and associated costs of recruiting 300 low-income, cognitively intact, older adults with functional difficulties into this study. Sources of participant enrollment included direct mailings (35%), government program referrals (19%), community-based organizations (16%), ambassador referrals (15%), and media (4%). Fifty six (30%) of 187 older adults referred through government organizations were enrolled, while 49 (7.6%) of 648 referred from community-based organizations were enrolled. Total recruitment costs were US$81,453.12. Costs per participant for mailings, media, ambassadors, and community-based organizations were respectively US$745.10, US$256.82, US$22.28, and US$1.00. Direct mailings yielded the most participants but was the most costly method per participant. Ambassadors were least expensive and may offer a low-cost addition to community outreach for recruitment of older adults into research.

Trajectories of Community Mobility Recovery After Hospitalization in Older Adults

OBJECTIVES

To identify trajectories of recovery of community mobility in acutely ill older adults using the University of Alabama at Birmingham Life-Space Assessment (LSA).

DESIGN

Prospective observation cohort study.

SETTING

Central Alabama, Birmingham Veterans Affairs Medical Center.

PARTICIPANTS

Community-dwelling adults aged 65 and older hospitalized for nonsurgical medical reasons (N=173).

MEASUREMENTS

We determined LSA scores for the month before and monthly for 6 months after hospitalization (composite scores ranging from 0-120, with 120 reflecting completely unrestricted mobility).

RESULTS

In the month after hospitalization, 92 (53%) participants had a clinically significant decrease in life-space mobility, while 42 (24%) were unchanged, and 39 (23%) had an increase from the month preceding hospitalization. Of participants with a life-space decrease, the majority recovered their prehospitalization mobility status during 6 months of follow-up, whereas 34% did not recover. Participants whose life-space decreased were hospitalized significantly longer (P=.01) and, on average, had higher prehospital life-space scores (P=.01) than those who maintained or increased their life-space.

CONCLUSION

A clinically significant loss of community mobility was common after hospitalization, but most participants recovered to prehospitalization mobility within 6 months of discharge. Research examining in-hospital and posthospitalization interventions to achieve faster recovery of community mobility is needed.

Life-Space Predicts Health Care Utilization in Community-Dwelling Older Adults

OBJECTIVE

To determine whether decline in life-space mobility predicts increased health care utilization among community-dwelling older adults.

METHOD

Health care utilization (number of emergency department [ED] visits and hospitalizations) was self-reported during monthly interviews among 419 community-dwelling African American and non-Hispanic White adults aged 75 years and older in The University of Alabama at Birmingham (UAB) Study of Aging II. Life-space was measured using the UAB Life-Space Assessment. Generalized estimating equations were used to examine associations of life-space at the beginning of each interval with health care utilization over the 1-month interval.

RESULTS

Overall, 400 participants were followed for 36 months. A 10-point decrease in life-space was associated with 14% increased odds of an ED visit and/or hospitalization over the next month, adjusting for demographics, transportation difficulty, comorbidity, and having a doctor visit in the last month.

DISCUSSION

Life-space is a practical alternative in predicting future health care utilization to performance-based measures, which can be difficult to incorporate into clinical or public health practice.

Rhythmic Interlimb Coordination Impairments and the Risk for Developing Mobility Limitations

BACKGROUND

The identification of novel rehabilitative impairments that are risk factors for mobility limitations may improve their prevention and treatment among older adults. We tested the hypothesis that impaired rhythmic interlimb ankle and shoulder coordination are risk factors for subsequent mobility limitations among older adults.

METHODS

We conducted a 1-year prospective cohort study of community-dwelling older adults (N = 99) aged 67 years and older who did not have mobility limitations (Short Physical Performance Battery score > 9) at baseline. Participants performed antiphase coordination of the right and left ankles or shoulders while paced by an auditory metronome. Using multivariable logistic regression, we determined odds ratios (ORs) for mobility limitations at 1-year follow-up as a function of coordination variability and asymmetry.

RESULTS

After adjusting for age, sex, body mass index, Mini-Mental State Examination score, number of chronic conditions, and baseline Short Physical Performance Battery score, ORs were significant for developing mobility limitations based on a 1 SD difference in the variability of ankle (OR = 1.88; 95% confidence interval [CI]: 1.16-3.05) and shoulder (OR = 1.96; 95% CI: 1.17-3.29) coordination. ORs were significant for asymmetry of shoulder (OR = 2.11; 95% CI: 1.25-3.57), but not ankle (OR = 0.95; 95% CI: 0.59-1.55) coordination. Similar results were found in unadjusted analyses.

CONCLUSIONS

The results support our hypothesis that impaired interlimb ankle and shoulder coordination are risk factors for the development of mobility limitations. Future work is needed to further examine the peripheral and central mechanisms underlying this relationship and to test whether enhancing coordination alters mobility limitations.

Neighborhood Disadvantage and Life-Space Mobility Are Associated with Incident Falls in Community-Dwelling Older Adults

OBJECTIVES

To determine the relationship between neighborhood-level socioeconomic characteristics, life-space mobility, and incident falls in community-dwelling older adults.

DESIGN

Prospective, observational cohort study with a baseline in-home assessment and 6-month telephone follow-up.

SETTING

Central Alabama.

PARTICIPANTS

Community-dwelling adults aged 65 and older recruited from a random sample of Medicare beneficiaries (N = 1,000).

MEASUREMENTS

Neighborhood disadvantage was measured using a composite index derived from baseline neighborhood-level residential census tract socioeconomic variables. Data on individual-level socioeconomic characteristics, clinical variables, and life-space collected at baseline were included as covariates in a multivariate model using generalized estimating equations to assess the association with incident falls in the 6 months after baseline.

RESULTS

Of the 940 participants who completed baseline and follow-up assessments, 126 (13%) reported one or more new falls in the 6 months after baseline. There was an independent nonlinear association between neighborhood disadvantage (according to increasing quartiles of disadvantage) and incident falls after adjusting for confounders: The lowest quartile served as reference; 2nd quartile odds ratio (OR) = 2.4, 95% confidence interval (CI) = 1.2-4.6; 3rd quartile OR = 1.9, 95% CI = 1.0-3.7; 4th quartile OR = 3.2, 95% CI = 1.7-6.0. Each 10-point decrement in life-space (OR = 1.2, 95% CI = 1.0-1.3) was associated with a higher risk of falls.

CONCLUSION

Greater neighborhood disadvantage was associated with greater risk of falls. Life-space also contributes separately to fall risk. Community-dwelling older adults in disadvantaged neighborhoods, particularly those with limited mobility, may benefit from a more-rigorous assessment of their fall risk by healthcare providers. Neighborhood level socioeconomic characteristics should also be an important consideration when identifying vulnerable populations that may benefit the most from fall prevention programs.

Life-Space Mobility and Cognitive Decline Among Mexican Americans Aged 75 Years and Older

OBJECTIVES

To examine the association between life-space mobility and cognitive decline over a five-year period among older Mexican Americans.

DESIGN

Longitudinal study.

SETTING

Hispanic Established Population for the Epidemiologic Study of the Elderly survey conducted in the southwestern of United States (Texas, Colorado, Arizona, New Mexico, and California).

PARTICIPANTS

Four hundred thirty-two Mexican Americans aged 75 and older with normal or high cognitive function at baseline.

MEASUREMENTS

Socio-demographic factors, living arrangement, type of household, social support, financial strain, self-reported medical conditions, Mini-Mental State Examination (MMSE), depressive symptoms, activities of daily living (ADLs), and Short Physical Performance Battery. Life-space assessment (LSA) during the past 4 weeks was assessed during in-home interview. Scores ranged from 0 (daily restriction to the bedroom) to 120 (daily trips outside of their own town without assistance) and categorized as 0 to 20, 21 to 40, 41 to 60, 61 to 80, and 81 to 120. Because of the small sample size in the category of 81 to 120, the two highest categories were combined into a single group.

RESULTS

The mean LSA score and MMSE score of participants at baseline was 44.6 (Standard Deviation [SD], 20.7) and 25.7 (SD, 3.2), respectively. Mixed Model analyses showed that participants in the highest life-space category (≥61) experienced slower rates of cognitive decline over time compared to participants in the lowest category (0 to 20) (β = 1.03, Standard Error [SE] = 0.29, P = 0.0004), after adjusting for all covariates.

CONCLUSION

Greater life-space mobility at baseline was predictor of slower rates of cognitive decline over 5 years in older Mexican Americans.

Aging effect on the instrumented Timed-Up-and-Go test variables in nursing home women aged 80-93 years

Although the total “Timed-Up-and Go” test (TUG) performance time can characterize an age-related decline of general mobility, this result alone doesn’t give any detailed information about the test subtasks. The primary objective of the study was to identify in nursing home women a variable extracted from instrumented TUG (iTUG) that is the best predictor of age. The secondary objective was to assess whether this variable is associated with the results of the isometric knee extension peak torque (IKEPT); lower limb strength measured by the 30-s chair stand test (30sCST), and walking capacity measured by the 6-min walk test (6MWT). Twenty-six women (mean ± SD: age—85.8 ± 3.6 years; body weight—59.4 ± 12.3 kg; body height—151.0 ± 7.3 cm; BMI—26.0 ± 4.9 kg/m²) performed iTUG (while wearing a body-fixed inertial sensor) and functional tests. Total iTUG performance time significantly correlated with age (r = 0.484; p < 0.05), 30sCST (r = −0.593; p < 0.01), and 6MWT (r = −0.747; p < 0.001) but not with absolute nor relative IKEPT (p > 0.05). Additionally, the subjects’ age correlated with 30sCST (r = −0.422; p < 0.05), 6MWT (r = −0.482; p < 0.05), IKEPT (r = −0.392; p < 0.05) and IKEPT/FFM (r = −0.407; p < 0.05). Five out of 16 analyzed iTUG variables were significantly related to age, and multiple regression analysis showed the best correlation with the sit-to-stand vertical acceleration range (STSVAR) (r² = 0.430; SEE = 3.041; β = −0.544 ± 0.245; B = −1.204 ± 0.543; p < 0.05). Moreover, STSVAR was significantly associated with %Fat (r = 0.415; p < 0.05), 30sCST (r = 0.519; p < 0.01), 6MWT (r = 0.585; p < 0.01) but not with absolute nor relative IKEPT (p > 0.05). The obtained results suggest that in the oldest old group of nursing home women an age-related decline in TUG performance is mainly associated with a reduction of “explosive” strength of lower limb muscles.

Fear of falling and its association with life-space mobility of older adults: a cross-sectional analysis using data from five international sites

Background

fear of falling (FOF) is a major health concern among community-dwelling older adults that could restrict mobility.

Objective

to examine the association of FOF with life-space mobility (i.e. the spatial area a person moves through in daily life) of community-dwelling older adults from five diverse sites.

Methods

in total, 1,841 older adults (65-74 years) were recruited from Kingston, Canada; Saint-Hyacinthe, Canada; Tirana, Albania; Manizales, Colombia and Natal, Brazil. FOF was assessed using the Fall Efficacy Scale-International (FES-I total score), and the life space was quantified using the Life-Space Assessment (LSA), a scale that runs from 0 (minimum life space) to 120 (maximum life space).

Results

the overall average LSA total score was 68.7 (SD: 21.2). Multiple-linear regression analysis demonstrated a significant relationship of FOF with life-space mobility, even after adjusting for functional, clinical and sociodemographic confounders (B = -0.15, 95% confidence interval (CI) -0.26 to -0.04). The FOF × site interaction term was significant with a stronger linear relationship found in the Canadian sites and Tirana compared with the South American sites. After adjusting for all confounders, the association between FOF with LSA remained significant at Kingston (B = -0.32, 95% CI -0.62 to -0.01), Saint-Hyacinthe (B = -0.81, 95% CI -1.31 to -0.32) and Tirana (B = -0.57, 95% CI -0.89 to -0.24).

Conclusion

FOF is an important psychological factor that is associated with reduction in life space of older adults in different social and cultural contexts, and the strength of this association is site specific. Addressing FOF among older adults would help improve their mobility in local communities, which in turn would improve social participation and health-related quality of life.

Mobility impairment, social engagement, and life satisfaction among the older population in China: a structural equation modeling analysis

PURPOSE

Revealing the relationship between mobility impairment and life satisfaction can help to propose effective interventions to secure mobility and life satisfaction. However, the relationship remains unclear and lacks quantitative evidence in China. This study therefore assesses the association of mobility impairment, social engagement, and life satisfaction among the older population in China.

METHODS

Based on the sample of China Health and Retirement Longitudinal Survey database in 2013, a structural equation modeling is established. The sample size is 4245 with 55.9% with mobility impairment.

RESULTS

The model shows that the length of suffering from disability is significantly related to mobility impairment (β = 0.058, p < 0.001). Mobility impairment is inversely related to social engagement (β = -0.300, p < 0.001) and life satisfaction (β = -0.311, p < 0.001). Social engagement is positively related to life satisfaction (β = 0.211, p < 0.001). Moreover, the relationships have some differences for the seniors with different sociodemographic characteristics and living in different residential areas.

CONCLUSIONS

As seniors get older, they tend to have more severe mobility impairment and participate less in social activities. Those with higher mobility impairment are more likely to report lower life satisfaction partly because they usually participate less in social activities. Different strategies are suggested to be adopted to improve the life satisfaction of the older population from the aspects of promoting mobility and social engagement, including improving the design of transport facilitates, providing assistive facilities for the seniors with severe mobility impairment, promoting the accessibility of community leisure and healthcare services, and constructing more community senior activity centers.