Location monitoring of physical activity and participation in community dwelling older people: a scoping review

Community-Based Physical Activity Programs for Blood Pressure Management in African Americans: A Scoping Review

BACKGROUND

Hypertension is a significant risk factor for cardiovascular disease, with a higher prevalence among African Americans (AA) than other racial groups. The impact of community-based interventions on managing blood pressure (BP) in AA communities is not fully understood. The purpose of this review was to synthesize literature on community-based physical activity (PA) programs designed to manage BP in AA populations.

METHODS

We conducted a scoping review by searching 4 databases (PubMed, CINAHL, MEDLINE, and APA PsycInfo) and reference lists of studies. Search terms included community PA, community-based, hypertension, high BP, AA, Black Americans, PA, and exercise. Inclusion criteria were studies (1) conducted in the United States and (2) published in English language from January 2013 to September 2023, with community-based interventions that included PA for BP management among AA aged ≥18 years.

RESULTS

Search results yielded 260 studies, of which 11 met the inclusion criteria. BP decreased over time in studies that incorporated PA, faith-based therapeutic lifestyle changes with nutritional education. The duration of the PA interventions varied, with moderate to vigorous PAs implemented for 12 weeks or longer having a greater impact on BP management.

CONCLUSIONS

Evidence suggests that community-based PA programs can potentially reduce BP among AA. PA programs incorporating faith-based therapeutic lifestyle change with nutritional education appear to reduce BP. Practitioners should consider multicomponent community-based PA initiatives to improve BP outcomes in AA communities.

Neighborhood Walkability Is Associated With Global Positioning System-Derived Community Mobility of Older Adults

BACKGROUND

Neighborhood walkability may encourage greater out-of-home travel (ie, community mobility) to support independent functioning in later life. We examined associations between a novel walkability audit index and Global Positioning System (GPS)-derived community mobility in community-dwelling older adults. We compared associations with the validated Environmental Protection Agency (EPA) National Walkability Index and further examined moderation by clinical walking speed.

METHODS

Participants were 146 older adults (Mean = 77.0 ± 6.5 years, 68% women) at baseline of a randomized trial to improve walking speed. A walkability index (range: 0-5; eg, land-use mix, crosswalks, and so on) was created using Google Street View audits within 1/8-mile of the home. Participants carried a GPS device for 5-7 days to derive objective measures of community mobility (eg, time spent out of home, accumulated distance from home).

RESULTS

Each 1 SD (~1.3-point) greater walkability audit score was associated with a median 2.16% more time spent out of home (95% confidence interval [95% CI]: 0.30-4.03, p = .023), adjusting for individual demographics/health and neighborhood socioeconomic status. For slower walkers (4-m walking speed <1 m/s), each 1 SD greater audit score was also associated with a median 4.54 km greater accumulated distance from home (95% CI: 0.01-9.07, p (interaction) = .034). No significant associations were found for the EPA walkability index.

CONCLUSIONS

Walkability immediately outside the home was related to greater community mobility, especially for older adults with slower walking speeds. Results emphasize the need to consider the joint influence of local environment and individual functioning when addressing community mobility in older populations.

Psychometric properties of a Turkish version of the social activities scale for community-dwelling older people requiring support

BACKGROUND

Social activities decelerate the deterioration of mental capacity in older people and improve their physical and psychosocial health. Valid and reliable measurement tools are needed to determine the social activity status of older people and plan health services to protect their mental health.

OBJECTIVE

This study aimed to adapt the Social Activities Scale for Community-Dwelling Older People Requiring Support (SASOS) into Turkish.

METHODS

This methodological study was conducted in Northern Cyprus between January and June 2022. Convenience sampling was used to recruit 155 community-dwelling older people who needed support. Expert opinion, item-content validity index, and scale-content validity index were used to evaluate content validity. Internal consistency and test-retest reliability tests were used to evaluate reliability. Exploratory factor analysis was used to evaluate construct validity. The Loneliness Scale for Elderly was used to evaluate concurrent validity.

RESULTS

The Cronbach's alpha of SASOS was 0.90. Additionally, correlation coefficients of all items ranged between 0.61 and 0.79. Exploratory factor analysis revealed a three-factor structure. 'Interactions with friends and neighbors' was the factor that explained the highest variance (46%). There was a negative, weak, and statistically significant relationship between the scores obtained from the social loneliness subscale of LSE and all three subscales of SASOS.

CONCLUSIONS

The Turkish version of SASOS is a valid, reliable instrument to evaluate social activities in community-dwelling older people who needed support.

IMPLICATIONS FOR PRACTICE

The SASOS has been identified as a valuable measure for assessing the social support needs of older individuals. It serves as a guide for both planning and evaluating interventions to enhance their health.

Using GPS Technologies to Examine Community Mobility in Older Adults

BACKGROUND

Objective measures of community mobility are advantageous for capturing movement outside the home. Compared with subjective, self-reported techniques, global positioning system (GPS) technologies leverage passive, real-time location data to reduce recall bias and increase measurement precision. We developed methods to quantify community mobility among community-dwelling older adults and assessed how GPS-derived indicators relate to clinical measures of physical and cognitive performance.

METHODS

Participants (n = 149; M ± standard deviation [SD] = 77.1 ± 6.5 years) from the program to improve mobility in aging (PRIMA) study, a physical therapy intervention to improve walking ability, carried a GPS device for 7 days. Community mobility was characterized by assessing activity space, shape, duration, and distance. Associations between GPS-derived indicators and cognition and physical function were evaluated using Spearman correlations.

RESULTS

In adjusted models, a larger activity space, greater duration (eg, time out-of-home), and greater distance traveled from home were correlated with better 6-Minute Walk Test performance (ρ = 0.17-0.23, p's < .05). A more circular activity shape was related to poorer performance on the Trail Making Test, Part A (ρ = 0.18, p < .05). More time out-of-home and a larger activity space were correlated with faster times on the Trail Making Test, Part B (ρ = -0.18 to -0.24, p's < .05). Community mobility measures were not associated with global cognition, skilled walking, or usual gait speed.

CONCLUSION

GPS-derived community mobility indicators capture real-world activity among older adults and were correlated with clinical measures of executive function and walking endurance. These findings will guide the design of future interventions to promote community mobility.

Older Adults' Self-Reported Physical Activity and Distance to and Land Use Around Reported Physical Exercise Destinations

Little is known about older adults' physical exercise destinations. We studied associations between physical activity (PA) level and physical exercise destinations (total number and surrounding environment) in community-dwelling 75- to 85-year-old adults living in Central Finland. Participants (N = 901) reported the amount of at least moderate-intensity PA and physical exercise destinations. Distance from home, land use, and locations of sport facilities were defined using a geographic information system. A general linear model showed that older adults with higher PA reported higher numbers of physical exercise destinations and destinations further away from home than those reporting lower PA. Binary logistic regression showed that higher PA increased the odds of reporting a distant destination identified as a sports facility and of reporting destinations located in residential, service, forest, and water body areas, respectively. Physical exercise destinations in different environments may attract older people to go out and be more physically active.

Facilitators and barriers to real-life mobility in community-dwelling older adults: a narrative review of accelerometry- and global positioning system-based studies

Real-life mobility, also called "enacted" mobility, characterizes an individual's activity and participation in the community. Real-life mobility may be facilitated or hindered by a variety of factors, such as physical abilities, cognitive function, psychosocial aspects, and external environment characteristics. Advances in technology have allowed for objective quantification of real-life mobility using wearable sensors, specifically, accelerometry and global positioning systems (GPSs). In this review article, first, we summarize the common mobility measures extracted from accelerometry and GPS. Second, we summarize studies assessing the associations of facilitators and barriers influencing mobility of community-dwelling older adults with mobility measures from sensor technology. We found the most used accelerometry measures focus on the duration and intensity of activity in daily life. Gait quality measures, e.g., cadence, variability, and symmetry, are not usually included. GPS has been used to investigate mobility behavior, such as spatial and temporal measures of path traveled, location nodes traversed, and mode of transportation. Factors of note that facilitate/hinder community mobility were cognition and psychosocial influences. Fewer studies have included the influence of external environments, such as sidewalk quality, and socio-economic status in defining enacted mobility. Increasing our understanding of the facilitators and barriers to enacted mobility can inform wearable technology-enabled interventions targeted at delaying mobility-related disability and improving participation of older adults in the community.

Effects of the CarFreeMe Traumatic Injuries, a Community Mobility Group Intervention, to Increase Community Participation for People With Traumatic Injuries: A Randomized Controlled Trial With Crossover

Introduction

After traumatic injuries community participation is a common goal, promoting wellbeing and independence. Community mobility and transportation influence an individual's independence in community participation. With the ability to drive safely often compromised after traumatic injuries, the adverse consequences of driving cessation include a loss of identity and reduced participation in chosen activities. In rehabilitation, individualized community mobility intervention is not routinely provided. The primary aim of this trial was to evaluate whether a group-based intervention, the CarFreeMe TI program was more effective than standard intervention, an information sheet of alternative transport, in improving community mobility for people following traumatic injuries. The secondary aim of this study was to evaluate the effect: types of transport used, transport satisfaction, community mobility self-efficacy, quality of life, goal satisfaction and performance, for people following traumatic injuries; and to undertake a preliminary assessment of the potential resource use associated with the intervention, and lessons for implementation.

Design

Prospective, pilot, randomized, blind observer, controlled trial with crossover.

Participants

Twenty individuals with traumatic injuries.

Intervention

Six-week group-based support and education program, the CarFreeMe TI delivered in community settings (intervention) and standard information related to transport options available (control).

Primary Outcome Measures

Community participation using a Global Positioning System device to record the location and number of outings from home.

Secondary Outcome Measures

CarFreeMe TI Transport Questionnaire, Community Mobility Self-efficacy Scale, quality of life measures, Modified Canadian Occupational Performance Measure for goals (importance and satisfaction), participant satisfaction survey results and researcher logs.

Results

Those who received the intervention were more likely to use public transport and transport services and had an improved quality of life, when compared to the control group. The intervention group also reported high levels of improvement in goal performance and satisfaction. Global Positioning System data collection was incomplete, with geolocation data unusable. There was no significant change in number/type of visits away from home.

Conclusions

A group-based community mobility education program promoted modes of active independent transport but did not impact on outings from home. Future research could include passive collection methods using a smartphone to record community participation.

Clinical Trial Registration

https://www.anzctr.org.au/, identifier: ACTRN12616001254482.

Active Aging and Public Health: Evidence, Implications, and Opportunities

By 2050, 20% of the world's population will be over the age of 65 years, with projections that 80% of older adults will be living in low- to middle-income countries. Physical inactivity and sedentary time are particularly high in older adults, presenting unique public health challenges. In this article, we first review evidence that points to multiple beneficial outcomes of active aging, including better physical function, cognitive function, mental health, social health, and sleep and suggest the need to shift the research focus from chronic disease outcomes to more relevant outcomes that affect independence and quality of life. Second, we review the critical role of age-friendly environments in facilitating active aging equitably across different countries and cultures. Finally, we consider emerging opportunities related to social engagement and technology-enabled mobility that can facilitate active aging. In all these contexts, it is a priority to understand and address diversity within the global aging population. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Psychometric properties testing of a Cantonese version of the Life-Space Assessment in people with stroke

The Life-Space Assessment (LSA) advances measurements of mobility by determining the extent of the spatial area in which a person moves in real life. Yet there is no Cantonese version of the LSA. This study aimed to translate and culturally adapt the LSA into Cantonese (C-LSA) and examine its psychometric properties in people with stroke. Psychometric properties were examined in 112 people with stroke. The life-space of stroke survivors was compared with that of healthy older people with and without depressive symptoms. The content validity of the C-LSA was good. The Cronbach’s α was 0.73. The test–retest reliability was 0.95. The standard error of measurement was 4.21 and the minimal detectable change was 11.66, without any ceiling or floor effects in the C-LSA composite score. The composite score correlated significantly with the Fugl-Meyer Assessment of lower extremities score (r_s = 0.31), the Five Times Sit-To-Stand time (r_s =  − 0.43), and the Frenchay Activities Index score (r_s = 0.48). People with stroke had significantly lower C-LSA composite scores than healthy older people. Depressive symptoms worsened the composite and assisted life-space scores only of people with stroke. The C-LSA is a reliable and valid tool for measuring life-space in stroke populations.

Fidelity and utility of GPS loggers as a tool for understanding community participation of older adults

OBJECTIVE

The purpose of this research was to examine the fidelity and utility of global positioning system (GPS) technology for studying community mobility indicators, and to explore implications for community participation for older adults.

METHOD

A longitudinal cohort design with community-dwelling older adults (n = 33) was employed. GPS spatial data and activity logs were collected at baseline and one year later. Data were analysed to evaluate the fidelity of the GPS protocol, the nature and frequency of destinations, and the stability of community mobility over time.

RESULTS

Findings include evidence for high reliability of the GPS loggers to record out-of-home trips when compared to activity logs; utility of the technology for identifying frequency and type of occupational destinations; and the relative stability of two community mobility variables over time. GPS loggers generate key insights into how older adults move in and through their community as they engage in a range of occupations.

CONCLUSION

GPS technology is a robust and useful tool for gathering novel information, especially when combined with qualitative data. GPS loggers may be incorporated in evaluation or to tailor interventions. Community mobility enables social participation, and warrants further research using these methods to support processes of aging in place.

Community participation of community dwelling older adults: a cross-sectional study

BACKGROUND

With the advancing age of the population, and increasing demands on healthcare services, community participation has become an important consideration for healthy ageing. Low levels of community participation have been linked to increased mortality and social isolation. The extent to which community participation has been measured objectively in older adults remains scarce. This study aims to describe where and how older adults participate in the community and determine the feasibility of measurement methods for community participation.

METHODS

This observational cross-sectional study obtained data from 46 community dwelling older adults. A combination of Global Positioning Systems (GPS), accelerometry, and self-reported diaries were used over a 7-day monitoring period. Feasibility of methods were determined by calculating the loss of GPS data, questionnaires, and comparison of self-reported locations with GPS co-ordinates. Relationships between community participation, physical activity, social interactions, health related quality of life, sleep quality and loneliness were explored.

RESULTS

Older adults took a median (IQR) of 15 (9.25-18.75) trips out of home over the 7-day monitoring period, most frequently visiting commercial and recreational locations. In-home activities were mainly sedentary in nature, with out of home activities dependent on location type. Self-reported and GPS measures of trips out of home and the locations visited were significantly correlated (self-report 15.7 (5.6) GPS 14.4 (5.8) (r = 0.94)). Significant correlations between both the number of trips taken from home, with social interactions (r = 0.62) and the minutes of moderate to vigorous physical activity (MVPA) (r = 0.43) were observed. Daily MVPA was higher in participants who visited local walk/greenspaces (r = 0.48).

CONCLUSION

Participants performed more activities with social interactions out of home and visited commercial locations most frequently. The combination of GPS, accelerometry and self-report methods provided a detailed picture of community participation for older adults. Further research is required with older adults of varying health status to generalise the relationships between community participation, location and physical activity.

TRIAL REGISTRATION

Ethical approval was gained from the Flinders University Social and Behavioural Research Ethics Committee (protocol no. 8176).

Use of Connected Technologies to Assess Barriers and Stressors for Age and Disability-Friendly Communities

Background: The benefits of engaging in outdoor physical activity are numerous for older adults. However, previous work on outdoor monitoring of physical activities did not sufficiently identify how older adults characterize and respond to diverse elements of urban built environments, including structural characteristics, safety attributes, and aesthetics.

Objective: To synthesize emerging multidisciplinary trends on the use of connected technologies to assess environmental barriers and stressors among older adults and for persons with disability.

Methods: A multidisciplinary overview and literature synthesis.

Results: First, we review measurement and monitoring of outdoor physical activity in community environments and during transport using wearable sensing technologies, their contextualization and using smartphone-based applications. We describe physiological responses (e.g., gait patterns, electrodermal activity, brain activity, and heart rate), stressors and physical barriers during outdoor physical activity. Second, we review the use of visual data (e.g., Google street images, Street score) and machine learning algorithms to assess physical (e.g., walkability) and emotional stressors (e.g., stress) in community environments and their impact on human perception. Third, we synthesize the challenges and limitations of using real-time smartphone-based data on driving behavior, incompatibility with software data platforms, and the potential for such data to be confounded by environmental signals in older adults. Lastly, we summarize alternative modes of transport for older adults and for persons with disability.

Conclusion: Environmental design for connected technologies, interventions to promote independence and mobility, and to reduce barriers and stressors, likely requires smart connected age and disability-friendly communities and cities.

Social environment and quality of life among older people with diabetes and multiple chronic illnesses in New Zealand: Intermediary effects of psychosocial support and constraints

Purpose: In older people with diabetes, multimorbidity is highly prevalent and it can lead to poor quality of life. The overall purpose of this study was to examine the association between the social environment, psychosocial support and constraints, and overall quality of life among older people with and without with diabetes and multiple chronic illnesses.Methods: Self-reported data from participants in a cohort study of older New Zealanders was analysed. Responses from 380 older people diagnosed with diabetes and multiple chronic illnesses were compared with 527 older people with no health issues on indicators related to the associations of neighbourhood, health and ageing, using structural equation modelling.Results: The final model suggests that social provision, purpose in life and capabilities mediated between the social environment and quality of life, indicate that older people with positive social environment (i.e., neighbourhood advantage, residential stability) are much less likely to experience depression due to having good social support, meaningful life purpose and opportunities to engage.Conclusions: Perceived neighbourhood advantages, such as positive neighbourhood qualities, social cohesion and housing satisfaction, along with the focus on increasing social support, enhancing purpose in life and supporting one's capability to achieve, may serve as protective factors against depression.IMPLICATIONS FOR REHABILITATIONEnvironmental and personal circumstances can contribute to quality of life among older people with diabetes and multimorbidity.By providing older people with diabetes and multiple chronic illnesses a socially just environment that challenges ageism and other forms of oppression, this could reduce social disparities in health, improve inclusion and access to resources.Social and healthcare professionals are encouraged to design clinical care guidelines and rehabilitation goals from a wholistic and person/client centred approach to support older people with diabetes and multiple chronic illnesses.