Older people's experiences of everyday travel in the urban environment: a thematic synthesis of qualitative studies in the United Kingdom

Are physical activity and everyday mobility independently associated with quality of life at older age?

Background

Physical activity and everyday mobility are concepts that overlap but tend to be located in different disciplinary fields. We used the English Longitudinal Study of Ageing (ELSA) to: identify whether physical activity and everyday mobility are separate constructs at younger (60-69) and/or older (>=70) age bands, and for men and women; derive measures of the two constructs from variables in the ELSA; and assess whether they are independently associated with quality of life (QoL).

Methods

We derived composite measures for physical activity and everyday mobility from ELSA variables. 'Physical Activity' combined items recording directly-measured activity for movement (walk-speed) and self-report measures of physical mobility difficulties and amount of vigorous, moderate and mild physical activity undertaken. 'Everyday Mobility' combined self-report responses about activities likely to involve leaving the house. QoL was measured using the 'CASP-19' scale. Using Wave 9 of ELSA (data collection in 2018-2020), we used a factor analysis to explore the constructs, and a regression analysis to examine associations with QoL.

Results

The factor analysis confirmed that these were discrete constructs, which explained between them 36% of the variance. This was robust across age bands, and in factor analyses for men and women separately. The regression analysis identified that lower physical activity and everyday mobility are independently associated with lower QoL, when controlling for a range of contextual variables including age.

Conclusions

Findings suggest that a social model of QoL at older age should focus on the broader mobility determinants of QoL as well as individual levels of physical activity.

The 'Double Risk' of Aging: Examining Vulnerability and (Un)supportive Built Environments in Canadian Cities

The confluence of rapid population aging and the overwhelming desire of older adults to age in place begs the question: Do our cities support the health and well-being of aging populations? Using a neighbourhood-by-neighbourhood approach, this macro-scale investigation explores the "double risk" that many older adults live with - the potential of being disadvantaged by socio-demographic risk factors (being older, living alone, low income) and by living in an unsupportive built environment. It is an integration of what we know about supportive built form for older adults and applies this knowledge to Canadian cities, using a spectrum approach to classifying built environments. We found that most older adults with socio-demographic risk factors are living in unsupportive built environments in Canada; however, the distribution between built environments along the spectrum and between municipalities reveals a variegated landscape of double risk. Previous research suggests that unsupportive built environments can be supplemented with services, small-scale improvements in the built environment, and larger-scale retrofitting of neighbourhoods. Since the spatial distribution of vulnerability varies greatly within the 33 Canadian cities analysed, it highlights the need for this kind of inquiry to target age-friendly policy interventions.

Making Chile More Pedestrian-Friendly for Older Persons: Expert Perspectives

Walking provides numerous benefits to older persons, but its practice is hindered by social factors and the built environment. This article aims to understand the factors that encourage or discourage older people's walking behaviors, as well as the policies influencing those factors in Chile. It does so by reporting the analysis of twenty-five semi-structured interviews with Chilean policymakers and local leaders. The experts consistently represented walking as a beneficial activity for older persons that, nonetheless, occurs in adverse built environments. They asserted that the absence of older people in the public discussion and a top-down policy-making structure hamper its promotion.

A Scoping Review of the Factor Associated with Older Adults' Mobility Barriers

The phenomenon of ageing may contribute to the rise of the dependent population. Due to the obstacles and difficulties they confront, the elderly's mobility decreases significantly. The aim of this article is to identify factors associated with mobility barriers in older adults. The method employed is an examination of articles published between 2011 and 2022 to identify common themes in previous studies. Four search engines were being used, and 32 articles have been included. This study demonstrated that health is a major factor associated with decreased mobility. This review identified four types of barriers which are health, built environment, socio-economic background and social relation change. This review could help policy makers and gerontologist in identifying solutions to resolve the mobility issues in older people.

Mild cognitive impairment and fitness to drive: An audit of practice in a driving specialist clinic in Australia

OBJECTIVE

To describe current practice and outcomes relating to fitness to drive for people with mild cognitive impairment (MCI) attending a specialist driving clinic.

METHODS

Retrospective medical record audit from a driving fitness assessment clinic at a tertiary medical centre, South Australia, from 2015 to 2019.

RESULTS

Of 100 notes audited, n = 40 had a documented diagnosis of MCI and n = 60 had subjective cognitive concerns characteristic of MCI. Participants mean age was 80.0 years (SD 6.7), and mean Mini-Mental State Examination score was 26.1 (SD 2.1). Medical practitioners completed a comprehensive initial assessment relating to medical fitness to drive, considering scores from a cognitive assessment battery and non-cognitive factors (driving history, current driving needs, vision, physical abilities and collateral from family). After the initial assessment, most participants (84%) were referred for a practical on-road assessment, before receiving a final driving recommendation. Over half of participants continued driving (51%), most with conditions, while 35% ceased driving. Outcomes for the remaining 14% are unknown as we were unable to determine whether the practical assessment (11%) or lessons (3%) were completed.

CONCLUSIONS

Driving outcomes for people with MCI with questionable driving capabilities are variable, with both cognitive and non-cognitive factors important in guiding medical fitness to drive recommendations. There is a need for more driving clinics to provide in-depth assessment for people with MCI who demonstrate uncertain driving capabilities and improved support for decision-making in other non-driving specialist settings.

Neighbourhood environment and dementia in older people from high-, middle- and low-income countries: results from two population-based cohort studies

BACKGROUND

A growing number of studies have explored how features of the neighbourhood environment can be related to cognitive health in later life. Yet few have focused on low- and middle-income countries and compared the results across different settings. The aim of this study is to investigate the cross-sectional associations between neighbourhood amenities and dementia in older people from high-, middle- and low-income countries.

METHODS

This study was based on two population-based cohort studies of people aged≥65: the Cognitive Function and Ageing Study II (CFAS II) in UK (N = 4955) and a subset of the 10/66 study in China, Dominican Republic and Mexico (N = 3386). In both cohorts, dementia was assessed using the Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) algorithm. The 10/66 dementia diagnostic algorithm was also used as an additional criterion in the 10/66 study. Publicly accessible databases, Google Maps and Open Street Map, were used to obtain geographic information system data on distance to neighbourhood amenities, including lifestyle (cafés, libraries, movie theatres, parks), daily life (post offices, convenience stores), healthcare (hospitals, pharmacies) and percentages of local green and blue spaces within 400 and 800 m of participants' residences. Multilevel logistic regression was used to investigate the associations between these environmental features and dementia adjusting for sociodemographic factors and self-rated health.

RESULTS

Living far from daily life amenities was associated with higher odds of dementia in both CFAS II (1.47; 95% CI: 0.96, 2.24) and the 10/66 study (1.53; 95% CI: 1.15, 2.04), while living far from lifestyle (1.50; 95% CI: 1.13, 1.99) and healthcare amenities (1.32; 95% CI: 0.93, 1.87) was associated with higher odds of dementia only in the 10/66 study. A high availability of local green and blue spaces was not associated with dementia in either cohort yet living far from public parks was associated with lower odds of dementia in CFAS II (0.64; 95% CI: 0.41, 1.00).

CONCLUSIONS

The different relationships across cohorts may indicate a varying role for local amenities in diverse settings. Future research may investigate mechanisms related to these differences and social, cultural and historical influences on the interaction between neighbourhood amenities and older people.

Independent living with mobility restrictions: older people's perceptions of their out-of-home mobility

We studied older people's perceptions of how they organise their out-of-home mobility and independent living when they face mobility restrictions, based on seven focus groups with older people (N = 28) from a suburb in Finland. This article provides an everyday life view of how the ability to move outside the home evolves through interdependencies between older people and their neighbourhoods, social relations and societal arrangements. Our findings show that supportive socio-material surroundings can provide older people with new ways to move outside their home despite mobility restrictions and new ways to organise their daily life with decreased mobility. In contrast, restrictive socio-material surroundings can lead to situations in which older people forgo certain out-of-home journeys and activities. The findings contribute to an understanding that organising one's daily life and out-of-home mobility is an act of interdependence. Policies promoting independent living in old age should recognise these fundamental interdependencies and support versatile ways of living rather than overemphasise activity and self-reliance. Based on older people's everyday life perspectives, both sides of the coin need to be considered: how to enable the out-of-home mobility of older people facing mobility restrictions and how to support them in managing and enjoying daily life with decreased mobility.

Perceived Accessibility, Satisfaction with Daily Travel, and Life Satisfaction among the Elderly

People are living longer than they did previously, and the proportion of older people is increasing worldwide. This rapid development will have implications for the transport system, in general, and for travel behavior and accessibility to daily activities, in particular. In recent years, both research and politics have drawn the attention of the public to issues affecting the opportunities of the elderly to participate in everyday life. The debate has so far mostly focused on health issues, with limited work having been done on the ability of the elderly to live the lives they want to considering how they travel. With this view, a theoretical model, grounded in a model of travel and subjective wellbeing was developed to explore the role of perceived accessibility in satisfaction with travel and life satisfaction. Empirical data were collected from a sample of 2950 respondents (aged 60–92) from five cities in Northern Europe (Stockholm, Helsinki, Oslo, Copenhagen, Bergen) and analyzed using partial least square structural equation modeling (PLS-SEM). The findings confirmed the link between perceived accessibility, travel satisfaction, and life satisfaction. The findings also showed the role of sociodemographic and travel attributes in perceived accessibility and satisfaction with travel, as well as the moderating effects of different age groups. We conclude that this moderating role played by age clearly indicates that we should not treat the elderly as a homogenous group in research and transport planning.