Towards meaningful mobility: a research agenda for movement within and between places in later life

What the pandemic and its impact on the mobility and well-being of older people can teach us about age-friendly cities and communities

From the start of the pandemic, questions were raised concerning how the pandemic could change or even transform relationships to our living environments. COVID-19 has had a disproportionate impact on the health and well-being of older people due to the increased risk of severity of the disease with both advancing age and associated co-morbidities. Restrictions on the movement of older people have also been more severe, with many countries imposing restrictions based on chronological age. In Portugal, confinement measures were targeted at older persons in terms of sheltering-at-home orders for those over 70. This paper looks at the impact of these restrictions on the lives of older people and asks what we can learn from the pandemic about the concept of age-friendly cities (WHO, 2007a). We look at the lived experience of older people to understand how their well-being and mobility were impacted during the crisis and its aftermath. The study was undertaken in four urban areas: Aveiro, Coimbra, Lisbon, and Faro. Data was collected using semi-structured interviews analysed using a process of thematic coding based on the eight pillars of the WHO's Age-Friendly City Checklist (WHO, 2007b). The results are discussed using conceptualisations from the new mobilities paradigm: existential mobility, connection and (im)mobility governance, offering new ways of thinking about age-friendliness in and out of crisis.

Associations between biopsychosocial factors and transportation patterns of older adults residing in Klang Valley, Malaysia

Introduction

Aging is associated with physiological changes in multiple systems in the body and may impact the transportation choices of older adults. In this study, we examine the associations between biopsychosocial factors and the transportation choices of Malaysian older adults.

Methods

One hundred and nineteen (119) older adults, aged 60 and above, living in Klang Valley, Malaysia were recruited for this cross-sectional study. Participants were interviewed face-to-face to obtain sociodemographic data, health status (whether there were and, if yes, the number of comorbidities), outdoor mobility and transportation patterns, Instrumental Activity Daily Living (IADL) status and cognitive function. Participants' physical performance (dominant handgrip strength, 10-m walk, and timed up and go tests), hearing threshold (pure tone audiometry), and vision function (visual acuity, contrast sensitivity) were measured. Transportation patterns of older adults were categorized into three groups, that is, flexible (using public transport and/or private vehicles), using only private vehicles and restricted (relying on others or walking).

Results

Further information is needed to enable such older adults as older women, those with comorbidities and poorer functional status to access transportation, especially to meet their health care needs.

Discussion

The majority (51%) of participants were in the 'using only private vehicles' group, followed by the 'flexibles' (25%) and the 'restricted' (24%). Factors significantly associated with the restricted transportation group were: (a) being female (AdjOR 15.39, 95% CI 0.86-23.39, p < 0.001); (b) being Malay (AdjOR 21.72, 95% CI 0.36-16.12, p < 0.001); (c) having higher number of comorbidities (AdjOR 14.01, 95% CI 0.20-13.21, p = 0.007); and (d) being dependent in IADL (AdjOR 13.48, 95% CI 0.51-1.78, p = 0.002).

What happens behind doors? Exploring everyday indoor activities when ageing in place

Engaging in social interaction and physical movement during everyday activities has a positive influence on wellbeing in later life. For older adults who age in place, the majority of activities occur indoors, yet studies typically focus on outdoors. Gender influences social and physical activities but is understudied in an ageing-in-place context. We aim to address these gaps by increasing insight into the indoor activities in later life, with a focus on gender differences in social interaction and physical movement. Through a mixed-methods approach, data were collected using global positioning system (GPS) trackers, pedometers and activity diaries. Twenty community-dwelling older adults (11 women and 9 men) who were living in Lancashire collected these data over seven days. An exploratory spatio-temporal analysis was conducted on the 820 activities they undertook. We discovered that our participants spend large amounts of time indoors. We also found that social interaction increases the duration of the activity and, conversely, decreases levels of physical movement. When zooming in to gender differences, men's activities took significantly longer than women's activities and were characterised by higher level of social interaction. Based on these results, we argue that there is a trade-off between social interaction and physical movement in everyday activities. We suggest establishing a balance between socialising and moving in everyday activities in later life, specifically because maintaining high levels of movement and social interaction at the same time seems unachievable. In conclusion, it is important to design indoor environments that facilitate choice between being active and resting, and between being social and being on one's own rather than assume they are mutually-exclusive and/or universally "good" or "bad" per se.

(Im)mobile ageing: risks of exclusion in later life in liminal urban peripheries

Despite the recent policy impetus for age-friendly cities, there is still scope for more geographical insights into ageing in low- and middle-income countries (LMICs). Cities in LMICs, such as Bengaluru (India), are witnessing an increase in the size of the older population in their peripheral urban regions, but there is relatively little understanding of the risks of exclusion in later age in these liminal zones. This study, set in a peripheral ward of Bengaluru, focuses on the experiences of exclusion/inclusion of socio-economically marginalised older adults and their access to work, health care and leisure. The research uses a multidimensional old-age exclusion framework to highlight how the domains of neighbourhood, material resources, mobility infrastructure and social relations influence the risks for social exclusion. We use a qualitative approach by combining behavioural mapping and in-depth interviews. Our findings highlight some ways in which institutionalised exclusion from civic infrastructure accentuates the precariousness of ageing. The rigidity of traditional hierarchies in peri-urban regions has meant that older adults who were poor, women and belonged to marginalised castes experience constrained mobilities to access labour markets, health care and social life, compounding their place-based exclusion. Despite social networks and solidarities, older adults on the periphery faced individualisation of risks while trying to access the basic amenities, thereby falling between the gap of the urban–rural milieu and governance. Age-friendly cities need to accommodate such hybrid transitionary urban processes, in the absence of which, active ageing in these rising peripheries can be impeded.

Unpacking the role of transport inequalities among older adults for accessing healthcare in Bengaluru, India

Mobility, access to transport and healthcare play a crucial part in healthy ageing. However, these often posechallenges for older adults in the global South. This study applies the three concepts of 'motility' (access, competence and appropriation), to explore transport inequalities and barriers to access healthcare services for older adults in Bengaluru, India. The paper draws on interviews with sixty adults, aged 50 years and over, residing in urban Bengaluru. A semi-structured in-depth interview guide was employed to explore the transport inequalities. Applying thematic analysis, we present the mobility and transport barriers to access healthcare. Restricted access to healthcare services due to unavailable and unaffordable transportation resulted in missed appointments, delayed care and deterioration of health conditions. To cope with the barriers, older adults often visited less specialised clinics for regular check-ups and those with financial constraints resorted to self-medication. These actions further deteriorated health and led to adverse health outcomes. Our findings suggest that integrated health and transport policies must be designed to ensure equitable access to transportation services. Enabling older adults to have more independent lives and improve access to preventive healthcare is essential for better health outcomes.

Older adults' adaptations to life events: a mobility perspective

Mobility research tends to focus on physical movement and experiences in later life; however, changes in older adult mobility over time remains underexplored. Furthermore, older adults typically experience many life events, some of which result from cognitive and physical decline, and many of which impact mobility. This article aims to explore how life events affect the mobility of older adults over time. We conducted in-depth interviews with 22 older adults aged 55 years and over from Lancashire, United Kingdom. Of these participants, eight lived with memory problems. The findings show that both anticipated and unexpected life events play a profound role in the participants' mobility over time. Retirement, long-term illness and age-related illness were examples of anticipated life events, while the death of a loved one and developing memory problems were examples of unexpected life events. In both cases, participants' made external adaptations, such as moving home, or internal adaptations, such as self-awareness. The findings also emphasise the layered nature of life events and adaptations playing a role in the participants' mobility. Additionally, life events such as developing memory problems showed a domino effect, triggering further life events and adaptations which impacted the participants' mobility. This article emphasises how transition periods can occur before or after a life event, showing that adaptations can be pre-emptive to a life event. Our article contributes to calls for internal adaptations to be fully incorporated into age-related policy and also for age-related policy to be more inclusive for older adults who experience memory problems and dementia.

'We may be long in the tooth, but it makes us tough': exploring stillness for older adults during the COVID-19 lockdowns

Following the outbreak of the SARS-CoV-2 across the world in 2020, millions of people were reduced in their mobility to hinder the spread of the disease. The lockdown was particularly difficult for older adults, who were deemed 'vulnerable' because many felt unsafe leaving the house and often forced to self-isolate. In this paper, we interpret the lockdowns as a period of prolonged stillness: breaks from everyday practices, including withdrawnness, inefficiency, and retreat. We extend ideas of stillness by integrating the capability approach, which shows how the opportunities and challenges that arise from moments of stillness are dependent on a combination of individual agency and the role of structural or contextual factors. Using the accounts of thirty-eight older adults in the Netherlands and England, we show how the COVID-19 lockdowns established and encouraged different types of stillness which had differing impacts upon the older adults' lives. The effect of the prolonged stillness on these different areas of everyday life is based on individual agency and contextual factors, such as choosing to volunteer or having an adequate internet connection. Thus, our findings contribute to discussions around active ageing and demonstrate that slowing down, and spending more time at home, can provide respite from an otherwise active everyday life.

A Space-Time Analysis of Rural Older People's Outdoor Mobility and Its Impact on Self-Rated Health: Evidence from a Taiwanese Rural Village

With the aggravation of rural aging, the well-being and self-rated health level of older people in rural communities are significantly lower than those in urban communities. Past studies hold that mobility is essential to the quality of life of the elderly, and well-being depends on their own adaptation strategies in the built environment. Therefore, this study combines three key factors related to active aging: environment, health and mobility, and assumes that the elderly with good health status will have environmental proactivity and a wider range of daily mobility in a poor rural built environment. This study attempts to track daily mobility by using a space-time path method in time geography and then to explore the relationship between outdoor mobility and older people's self-rated health. A 1-week mobility path survey for 20 senior citizens of Xishi Village, a typical rural village in Taiwan, was conducted by wearing a GPS sports watch. A questionnaire survey and in-depth interviews were done to provide more information about the seniors' personal backgrounds and lifestyles. The results show that when the built environment is unfit to the needs of daily activities, half of the participants can make adjustment strategies to go beyond the neighborhoods defined by administrative units. Correlation analysis demonstrated that mental health is associated with daily moving time and distance. In addition, men have higher self-rated health scores than women, and there are significant statistical differences between married and widowed seniors in daily outing time and distance. This exploratory study suggests that in future research on rural health and active aging in rural areas, understanding the daily outdoor mobility of the elderly can help to assess their health status and living demands and quickly find out whether there is a lack of rural living services or environmental planning.

Technology to Improve Autonomy and Inform Housing Decisions for Older Adults With Memory Problems Who Live at Home in Canada, Sweden, and the Netherlands: Protocol for a Multipronged Mixed Methods Study

BACKGROUND

Understanding the mobility patterns and experiences of older adults with memory problems living at home has the potential to improve autonomy and inform shared decision making (SDM) about their housing options.

OBJECTIVE

We aim to (1) assess the mobility patterns and experiences of older adults with memory problems, (2) co-design an electronic decision support intervention (e-DSI) that integrates users' mobility patterns and experiences, (3) explore their intention to use an e-DSI to support autonomy at home, and (4) inform future SDM processes about housing options.

METHODS

Informed by the Good Reporting of A Mixed Methods Study (GRAMMS) reporting guidelines, we will conduct a 3-year, multipronged mixed methods study in Canada, Sweden, and the Netherlands. For Phase 1, we will recruit a convenience sample of 20 older adults living at home with memory problems from clinical and community settings in each country, for a total of 60 participants. We will ask participants to record their mobility patterns outside their home for 14 days using a GPS tracker and a travel diary; in addition, we will conduct a walking interview and a final debrief interview after 14 days. For Phase 2, referring to results from the first phase, we will conduct one user-centered co-design process per country with older adults with memory issues, caregivers, health care professionals, and information technology representatives informed by the Double Diamond method. We will ask participants how personalized information about mobility patterns and experiences could be added to an existing e-DSI and how this information could inform SDM about housing options. For Phase 3, using online web-based surveys, we will invite 210 older adults with memory problems and/or their caregivers, split equally across the three countries, to use the e-DSI and provide feedback on its strengths and limitations. Finally, in Phase 4, we will triangulate and compare data from all phases and countries to inform a stakeholder meeting where an action plan will be developed.

RESULTS

The study opened for recruitment in the Netherlands in November 2018 and in Canada and Sweden in December 2019. Data collection will be completed by April 2021.

CONCLUSIONS

This project will explore how e-DSIs can integrate the mobility patterns and mobility experiences of older adults with memory problems in three countries, improve older adults' autonomy, and, ultimately, inform SDM about housing options.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04267484; https://clinicaltrials.gov/ct2/show/NCT04267484.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/19244.

Giving Voice to the Environment as the Silent Partner in Aging: Examining the Moderating Roles of Gender and Family Structure in Older Adult Wellbeing

Gerontological scholarship has long seen the environment to be a silent partner in aging. Environmental Gerontology, an established approach in Social Gerontology, has shown how the everyday lives of older adults are deeply entangled in socio-spatial environments. Adopting an Environmental Gerontology approach, we explore social and cultural dimensions of the association between out-of-home mobility and wellbeing among older adults in a north western city of India. This was established by combining high resolution time-space data collected using GPS receivers, questionnaire data and time diaries. Following a multi-staged analytical strategy, we first examine the correlation between out-of-home mobility and wellbeing using bivariate correlation. Second, we introduce gender and family structure into regression models as moderating variables to improve the models' explanatory power. Finally, we use our results to reinterpret the Ecological Press Model of Aging to include familial structure as a factor that moderates environmental stress. Findings emphasize the central role that social constructs play in the long-established relationship between the environment and the wellbeing of older adults.