Environmental predictors of objectively measured out-of-home time among older adults with cognitive decline

Walking trail access, exercise behavior, and going out-of-home among older adults: Examining longitudinal associations and mediators

AIM

Although the presence of a walking trail within a neighborhood would be an important environmental determinant of health behaviors, such as exercise and going out-of-home, their longitudinal associations and mediators are still unconfirmed. This study examined the longitudinal associations of walking trail access with exercise behavior and going out-of-home and mediating roles of awareness and use of walking trails on their associations among older adults.

METHODS

A four-wave questionnaire-based longitudinal survey was conducted among Japanese older adults (Wave 1: baseline; Wave 2: after one year; Wave 3: after three years; and Wave 4: after five years). Each survey measured weekly exercise time and frequency of going out-of-home. Wave 4 survey also measured awareness and use of walking trails. This study calculated distance to nearest walking trail using geographic information systems. This study analyzed the data from all waves (n = 834) for longitudinal associations and the data from Wave 4 (n = 567) for mediated associations.

RESULTS

Latent growth modeling showed insignificant longitudinal associations of walking trail access with weekly exercise time and frequency of going out-of-home. The path analyses showed that a shorter distance to the walking trail was indirectly and significantly associated with longer weekly exercise time (standardized indirect effect=-0.03, p<.001) and a higher weekly frequency of going out-of-home (standardized indirect effect=-0.03, p<.001), mediated by awareness and use of walking trails.

CONCLUSIONS

These findings indicate that the influence of walking trail access on exercise behavior and going out-of-home would be attenuated by awareness and use of walking trails among older adults.

Effects of neighborhood built environment on cognitive function in older adults: a systematic review

BACKGROUND

In the background of an aging population, the risk of cognitive impairment in the older population is prominent. Exposure to complex neighborhood built environments may be beneficial to the cognitive health of older adults, and the purpose of this study was to systematically review the scientific evidence on the effects of neighborhood built environments on cognitive function in older adults.

METHODS

Keywords and references were searched in Web of Science, Pubmed, PsycINFO, and MEDLINE. Studies examining the relationship between the built environment and cognitive function in older adults were included. The neighborhood built environment as an independent variable was classified according to seven aspects: density, design, diversity, destination accessibility, public transportation distance, blue/green space, and built environment quality. The cognitive function as the dependent variable was classified according to overall cognitive function, domain-specific cognitive function, and incidence of dementia. The quality of the included literature was assessed using the National Institutes of Health's Observational Cohort and Cross-Sectional Study Quality Assessment Tool.

RESULTS

A total of 56 studies were included that met the inclusion criteria, including 31 cross-sectional studies, 23 longitudinal studies, 1 cross-sectional study design combined with a case-control design, and 1 longitudinal study design combined with a case-control design. Most of the studies reviewed indicate that the built environment factors that were positively associated with cognitive function in older adults were population density, street connectivity, walkability, number of public transportation stops around the residence, land use mix, neighborhood resources, green space, and quality of the neighborhood built environment. Built environment factors that were negatively associated with cognitive function in older adults were street integration, distance from residence to main road. The relationship between residential density, destination accessibility, and blue space with cognitive function in older adults needs to be further explored.

CONCLUSION

Preliminary evidence suggests an association between the neighborhood built environment and cognitive function in older adults. The causal relationship between the built environment and cognitive function can be further explored in the future using standardized and combined subjective and objective assessment methods, and longitudinal or quasi-experimental study designs. For public health interventions on the cognitive health of older adults, it is recommended that relevant authorities include the neighborhood built environment in their intervention programs.

Hilly environment and frequency of going out-of-home among older adults: Examining moderating effect of driving status

AIM

The health benefits of "going out-of-home" frequently among older adults are well known. A hilly environment would inhibit this habit. This study examined (i) longitudinal associations between a hilly environment and the frequency of going out-of-home, and (ii) the moderating effect of driving status on their association among older adults.

METHODS

This study involved a longitudinal study design. Data on 856 older adults in Nada Ward, Kobe, Japan, was obtained from a three-wave questionnaire survey (Wave 1: December 2017 to January 2018; Wave 2: after 1 year; Wave 3: after 3 years). In each survey, the frequency of going out-of-home time was measured. The average land slope within 500 m network buffers of each participant's home was calculated as the index of the hilly environment. Driving status was also measured.

RESULTS

The latent growth model revealed that while a higher value of average land slope was not significantly associated with changes in the frequency of going out-of-home over time, it was significantly associated with a lower frequency of going out-of-home at the initial level. The interaction term in the latent growth model showed that driving status did not moderate the associations of the average land slope with the initial level of, and changes in, the frequency of going out-of-home.

CONCLUSIONS

Although it remains unclear whether a hilly environment would accelerate a decline in the frequency of going out-of-home over time, this study found that older adults living in a hilly environment were less likely to leave their homes. Geriatr Gerontol Int 2022; ••: ••-••.

Wearable and Portable GPS Solutions for Monitoring Mobility in Dementia: A Systematic Review

Dementia is the most common neurodegenerative disorder globally. Disease progression is marked by declining cognitive function accompanied by changes in mobility. Increased sedentary behaviour and, conversely, wandering and becoming lost are common. Global positioning system (GPS) solutions are increasingly used by caregivers to locate missing people with dementia (PwD) but also offer a non-invasive means of monitoring mobility patterns in PwD. We performed a systematic search across five databases to identify papers published since 2000, where wearable or portable GPS was used to monitor mobility in patients with common dementias or mild cognitive impairment (MCI). Disease and GPS-specific vocabulary were searched singly, and then in combination, identifying 3004 papers. Following deduplication, we screened 1972 papers and retained 17 studies after a full-text review. Only 1/17 studies used a wrist-worn GPS solution, while all others were variously located on the patient. We characterised the studies using a conceptual framework, finding marked heterogeneity in the number and complexity of reported GPS-derived mobility outcomes. Duration was the most frequently reported category of mobility reported (15/17), followed by out of home (14/17), and stop and trajectory (both 10/17). Future research would benefit from greater standardisation and harmonisation of reporting which would enable GPS-derived measures of mobility to be incorporated more robustly into clinical trials.

Social and Built Environments Related to Cognitive Function of Older Adults: A Multi-Level Analysis Study in Taiwan

The purpose of this study was to examine the associations between cognitive function, the city’s social environment, and individual characteristics of older adults. The individual data of older people were from the Nutrition and Health Survey in Taiwan 2013–2016. The participants who were aged 65 and above were included in the analysis (n = 1356). City-level data were obtained for twenty cities in Taiwan. The data of city-level indicators were from governmental open data and Taiwan’s Age Friendly Environment Monitor Study. A multilevel mixed-effect model was applied in the analysis. Population density, median income, safety in the community, barrier-free sidewalks, high education rate of the population, low-income population rate, household income inequality, and elderly abuse rate were related to cognitive function in the bivariate analysis. When controlling for individual factors, the city’s low-income population rate was still significantly related to lower cognitive function. In addition, the participants who were at younger age, had a higher education level, had a better financial satisfaction, had worse self-rated health, had higher numbers of disease, and had better physical function had better cognitive function. Social and built environments associated with cognitive function highlight the importance of income security and the age friendliness of the city for older adults. Income security for older people and age-friendly city policies are suggested.

Cross-sectional study of individual and environmental factors associated with life-space mobility among community-dwelling independent older people

BACKGROUND

Life-space mobility is reflected in comprehensive longevity and health outcomes and is also an important indicator for preventing mortality and decline in well-being among older people. However, a comprehensive framework of life-space mobility and modifiable individual and environmental factors has not been well validated among community-dwelling independent older people, for primary prevention. We examined individual and environmental factors affecting life-space mobility among community-dwelling independent older people.

METHODS

This cross-sectional study included 3500 community-dwelling independent older people randomly selected using the National Basic Resident Registration System in Japan. Life-space mobility was measured using the Japanese version of the Life-Space Assessment (LSA) instrument, which is used to assess an individual's pattern of mobility. Negative multivariate binomial regression analysis was performed in a final sample of 1258 people. Individual factors (including physical, mental, and social characteristics) and environmental factors (including the social and material environment) were measured and analyzed as potential factors.

RESULTS

Negative multivariable binomial regression analysis, adjusted for demographics, showed that LSA score was associated with locomotive syndrome (β = - 0.48, 95% confidence interval [CI] = - 0.24 to - 0.73), depression (β = - 0.29, 95% CI = - 0.03 to - 0.55), health literacy (β = 0.20, 95% CI = 0.39-0.01), and participation in community activities (β = 0.23, 95% CI = 0.03-0.43) among individual factors, and receipt of social support (β = - 0.19, 95% CI = 0.00 to - 0.38) and social network (β = 0.29, 95% CI = 0.48-0.10) among environmental factors.

CONCLUSIONS

Our findings suggest that modifiable individual factors and environmental factors are related to life-space mobility among community-dwelling older people.

Distance to supermarkets and dietary variety among Japanese older adults: examining the moderating role of grocery delivery services

OBJECTIVE

To examine whether using grocery delivery services moderates the relationship between distance to supermarket and dietary variety among Japanese older adults.

DESIGN

We conducted a 1-year prospective cohort study. Distance to supermarket was measured using geographic information systems. We collected information on dietary variety score (range 0-10), regular use of grocery delivery services and socio-demographic factors using a questionnaire delivered via post.

SETTING

The current study was performed in Nada Ward, Kobe City, Japan, from 2017 to 2018.

PARTICIPANTS

Older adults living in Nada Ward (n 778).

RESULTS

The linear mixed model showed that a longer distance to supermarket (per 100 m: B = -0·07, 95 % CI -0·14, -0·01, P = 0·048) significantly predicted lower dietary variety after adjusting for socio-demographic factors. Using grocery delivery services (B = 0·28, 95 % CI -0·08, 0·64, P = 0·127) did not significantly predict dietary variety, and neither did its interaction with distance to supermarket (B = -0·04, 95 % CI -0·17, 0·10, P = 0·604).

CONCLUSIONS

The current study found that longer distance to supermarket was associated with lower dietary variety among Japanese older adults and that the use of grocery delivery services did not moderate this association. The findings imply that the use of grocery delivery services is insufficient to reduce the negative influence of inconvenient food access on dietary variety among older adults.

The Effect of a Multicomponent Dual-Task Exercise on Cortical Thickness in Older Adults with Cognitive Decline: A Randomized Controlled Trial

The aim of this study was to examine cortical thickness changes associated with a multicomponent exercise intervention combining physical exercise and cognitive training in older adults with cognitive decline. This study involved a secondary analysis of neuroimaging data from a randomized controlled trial with 280 older adults having cognitive decline who were randomly assigned to either a multicomponent exercise group (n = 140) that attended weekly 90-minute exercise and cognitive training sessions or a health education control group (n = 140). The cortical thickness and cognitive performance were assessed at the baseline and at trial completion (10 months). The cortical thickness in the frontal and temporal regions was determined using FreeSurfer software. Cognitive performance was evaluated using the Gerontology-Functional Assessment Tool (NCGG-FAT). The cortical thickness significantly increased in the middle temporal (p < 0.001) and temporal pole (p < 0.001) in the multicomponent exercise group compared with the control group. Cortical thickness changes were significantly associated with change in trail making test (TMT)-A, TMT-B, and story memory after a 10-month multicomponent exercise intervention. This study suggests that multicomponent exercise programs combining physical exercise and cognitive training have important implications for brain health, especially in providing protection from age-related cortical thinning.