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

Changing the focus: Facilitating engagement in physical activity for people living with mild dementia in a local community-Protocol for a pre-post mixed methods feasibility study

This study aims to address and improve the low physical activity levels among people with mild dementia by implementing a novel shared decision-making and motivational support program, named "Changing the Focus". It will utilise a pre-post mixed methods approach, aiming to recruit 60 community living older people with mild dementia and their care-partners. The shared decision-making process will involve the person living with dementia, their care-partner, and a research therapist, using a purpose-designed discussion tool including factors such as preferred physical activities, health status, local opportunities and program accessibility. This process aims to identify personalised local physical activity opportunities. Participants will be supported with the help of a research therapist to engage in targeted community-based physical activities for 12-months, to progress towards the recommended physical activity guidelines of 150 minutes per week. The intervention provided by the research therapist will include three home visits (baseline, 6- and 12-months) and seven motivational support phone calls (within the first six months). Research therapists may provide additional home visits and support calls as needed. Primary outcomes include program participation (participants living with dementia continuing with the program after 12-months), total physical activity time per week (measured using the Active Australia Survey at baseline, 6- and 12- months) and program acceptability (assessed through semi-structured interviews with participants, care-partners, referrers, and physical activity providers). Secondary outcomes include physical performance, mental health, wellbeing measures, and impact on care-partners (evaluated through physical tests or validated scales at baseline, 6- and 12-months). Other implementation aspects include reach, maintenance, safety (falls, other adverse events) and an economic evaluation. Results will inform feasibility, potential benefits, and challenges associated with this innovative shared decision-making and supported physical activity program for people living with mild dementia. Findings will guide future large-scale studies and contribute to enhancing physical activity opportunities for this population.

Multimodal home-based rehabilitation intervention after discharge from inpatient geriatric rehabilitation (GeRas): study protocol for a multicenter randomized controlled trial

BACKGROUND

Geriatric rehabilitation aims to maintain the functional reserves of older adults in order to optimize social participation and prevent disability. After discharge from inpatient geriatric rehabilitation, patients are at high risk for decreased physical capacity, increased vulnerability, and limitations in mobility. As a result, ageing in place becomes uncertain for a plethora of patients after discharge from geriatric rehabilitation and effective strategies to prevent physical decline are required. Collaboration between different health-care providers is essential to improve continuity of care after discharge from inpatient geriatric rehabilitation. The aim of this study is to evaluate the effectiveness of a multi-professional home-based intervention program (GeRas) to improve functional capacity and social participation in older persons after discharge from inpatient geriatric rehabilitation.

METHODS

The study is a multicenter, three-arm, randomized controlled trial with a three-month intervention period. Two hundred and seventy community-dwelling older people receiving inpatient geriatric rehabilitation will be randomized with a 1:1:1 ratio to one of the parallel intervention groups (conventional IG or tablet IG) or the control group (CG). The participants of both IGs will receive a home-based physical exercise program supervised by physical therapists, a nutritional recommendation by a physician, and social counseling by social workers of the health insurance company. The collaboration between the health-care providers and management of participants will be realized within a cloud environment based on a telemedicine platform and supported by multi-professional case conferences. The CG will receive usual care, two short handouts on general health-related topics, and facultative lifestyle counseling with general recommendations for a healthy diet and active ageing. The primary outcomes will be the physical capacity measured by the Short Physical Performance Battery and social participation assessed by the modified Reintegration to Normal Living Index, three months after discharge.

DISCUSSION

The GeRas program is designed to improve the collaboration between health-care providers in the transition from inpatient geriatric rehabilitation to outpatient settings. Compared to usual care, it is expected to improve physical capacity and participation in geriatric patients after discharge from inpatient geriatric rehabilitation.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS00029559). Registered on October 05, 2022.

Assessing the measurement properties of life-space mobility measures in community-dwelling older adults: a systematic review

BACKGROUND

Preserving and enhancing mobility is an important part of healthy ageing. Life-space mobility is a construct that captures actual mobility within the home and the community. The objective of this systematic review was to synthesise the measurement properties and interpretability of scores produced by life-space mobility measures in community-dwelling older adults.

METHODS

This systematic review followed Consensus-based Standards for the selection of health Measurement Instruments (COSMIN). Multiple databases were searched to identify potentially relevant articles. Data extraction and assessment of methodological quality was conducted by two independent reviewers. When possible, results were quantitatively pooled for each measurement property. If studies could not be combined quantitatively, then findings were summarised qualitatively using means and percentage of confirmed hypothesis. Synthesised results were assessed against the COSMIN criteria for good measurement properties.

RESULTS

A total of 21 full text articles were included in the review. The University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA) was the most evaluated life-space mobility measure. The LSA demonstrated content validity, internal consistency (Cronbach's alpha 0.80-0.92), reliability [intra-class correlation value 0.89 (95% confidence interval (CI): 0.80, 0.94)] and convergent validity with measures of physical function in community-dwelling older adults.

CONCLUSION

This systematic review summarised the measurement properties of life-space mobility measures in community-dwelling older adults following COSMIN guidelines. The LSA has been translated into multiple languages and has sufficient measurement properties for assessing life-space mobility among community-dwelling older adults.

Effects of a Home-Based Physical Training and Activity Promotion Program in Community-Dwelling Older Persons with Cognitive Impairment after Discharge from Rehabilitation: A Randomized Controlled Trial

BACKGROUND

Older people with cognitive impairment (CI) are at high risk for mobility limitations and adverse outcomes after discharge from geriatric rehabilitation settings. The aim was to estimate the effects of a specifically designed home-based physical training and activity promotion program on physical capacity, different aspects of physical activity (PA), and psychosocial status.

METHODS

Patients with mild to moderate CI (Mini-Mental State Examination [MMSE]: 17-26 points) discharged home after rehabilitation were included in this randomized, double-blind, placebo-controlled trial with a 12-week intervention and 12-week follow-up period. The intervention group performed a CI-specific, autonomous, home-based strength, balance, and walking training supported by tailored motivational strategies to foster training adherence and promote PA. The control group participated in an unspecific motor placebo activity. Primary outcomes were physical capacity (Short Physical Performance Battery [SPPB]) and PA (sensor-based activity time).

RESULTS

Among 118 randomized participants (82.3 ± 6.0 years) with CI (MMSE: 23.3 ± 2.4) and high levels of multimorbidity, those participants undergoing home-based training demonstrated superior outcomes to the control group in SPPB (mean difference between groups 1.9 points; 95% CI: 1.0-2.8; p < .001), with persistent benefits over the follow-up (1.3 points; 95% CI: 0.4-2.2; p < .001). There were no differences in PA across any time points. Among secondary outcomes, fear of falling and activity avoidance behavior were reduced in the intervention group at all time points, life-space mobility improved short-term.

CONCLUSIONS

The results demonstrate clinically important benefits of an individually tailored autonomous physical training and activity promotion program on physical capacity and secondary outcomes in different domains in a vulnerable, multimorbid population.

CLINICAL TRIAL REGISTRATION

ISRCTN82378327.

Using Wearable Sensors to Measure Goal Achievement in Older Veterans with Dementia

Aligning treatment with patients' self-determined goals and health priorities is challenging in dementia care. Wearable-based remote health monitoring may facilitate determining the active participation of individuals with dementia towards achieving the determined goals. The present study aimed to demonstrate the feasibility of using wearables to assess healthcare goals set by older adults with cognitive impairment. We present four specific cases that assess (1) the feasibility of using wearables to monitor healthcare goals, (2) differences in function after goal-setting visits, and (3) goal achievement. Older veterans (n = 17) with cognitive impairment completed self-report assessments of mobility, then had an audio-recorded encounter with a geriatrician and wore a pendant sensor for 48 h. Follow-up was conducted at 4-6 months. Data obtained by wearables augments self-reported data and assessed function over time. Four patient cases illustrate the utility of combining sensors, self-report, notes from electronic health records, and visit transcripts at baseline and follow-up to assess goal achievement. Using data from multiple sources, we showed that the use of wearable devices could support clinical communication, mainly when patients, clinicians, and caregivers work to align care with the patient's priorities.

Changes in physical and mental functions in patients with cardiovascular disease during the first two waves of COVID-19 in Japan

BACKGROUND AND OBJECTIVES

The goal of this study was to determine whether changes in life-space mobility and quality of life (QoL) recovered in patients with cardiovascular disease (CVD) during the first two waves of the pandemic of Coronavirus disease 2019 (COVID-19) in Japan.

METHODS

We performed a follow-up survey in 20 CVD patients using the Life-Space Assessment (LSA) scale and the five-level EuroQoL five-dimensional questionnaire (EQ-5D-5L), Japanese version, at three time points: January-March 2020 (before the first wave of the COVID-19 pandemic), July 2020 (following the first wave of the pandemic), and November 2020 (following the second wave of the pandemic).

RESULTS

The LSA score in November 2020 (median [interquartile range], 90 [83.5-100] points) did not recover from the July 2020 score (83 [76.5-93] points). However, the EQ-5D-5L QoL score in November 2020 (0.89 [0.82-1]) had improved from that in July 2020 (0.80 [0.71-0.87]).

CONCLUSIONS

The QoL of CVD patients might have been more affected by psychological factors rather than by physical factors during the first two waves of the COVID-19 pandemic in Japan.

Assessing life-space mobility : A systematic review of questionnaires and their psychometric properties

BACKGROUND

Life-space mobility (LSM), as the extent of mobility within one's environment, is a key for successful aging and has become a relevant concept in gerontology and geriatric research. Adequate assessment instruments are needed to identify older persons with LSM restrictions, and to initiate, adapt or evaluate intervention strategies.

OBJECTIVE

To systematically identify, describe and analyze the psychometric properties of LSM questionnaires, with a special focus on their availability in the German language.

METHODS

A systematic literature search was conducted in PubMed, PsycINFO, Cochrane Library, CINAHL, and Web of Science. Studies that examined at least one psychometric property of LSM questionnaires published up to August 2021 were included and evaluated based on the consensus-based standards for the selection of health measurement instruments (COSMIN) guidelines.

RESULTS

This study included 37 validation studies describing 13 different LSM questionnaires. Methodological quality and comprehensiveness of validations were heterogeneous. Based on comprehensive and high-quality results, four LSM questionnaires stood out: the University of Alabama at Birmingham life-space assessment (UAB-LSA), life-space assessment in persons with cognitive impairment (LSA-CI), interview-based and proxy-based versions of the life-space assessment in institutionalized settings (LSA-IS), all of them available in the German language.

CONCLUSION

This systematic review provides a concise overview of available LSM questionnaires and their psychometric properties to facilitate the selection for use in clinical practice and research. The UAB-LSA and LSA-CI for community settings and the interview-based or proxy-based LSA-IS for institutional settings were found to be the most appropriate LSM questionnaires.

Physical and Mental Functions of Cardiovascular Diseased Patients Decrease During the State of Emergency Initiated by the COVID-19 Pandemic in Japan

BACKGROUND AND OBJECTIVE

We aimed to examine the differences in life-space mobility and quality of life (QoL) of patients with cardiovascular disease (CVD) between the pre- and postnationwide state of emergency initiated by the Coronavirus disease 2019 (COVID-19) pandemic in Japan and to show the factors associated with the decrease in life-space mobility and QoL in these patients.

METHODS

We undertook a longitudinal study of 20 out of 51 consecutive CVD patients with coronary artery disease (CAD) who met the study criteria. We used the Life-Space Assessment (LSA) tool to evaluate Life-space mobility and assessed QoL with the five-level EuroQoL five-dimensional questionnaire (EQ-5D-5L) in Japanese.

RESULTS

The LSA scores and EQ-5D-5L QoL score decreased significantly from the pre- to postnationwide state of emergency in Japan (p < 0.01). ΔLSA was significantly positively associated with body mass index and significantly negatively associated with knee extensor muscle strength and pre-LSA score (p < 0.05). There were no significant relationships between ΔLSA and ΔEQ- 5D-5L QoL scores and between ΔEQ-5D-5L QoL scores and patient characteristics.

CONCLUSION

The policies promoted to address the state of emergency in Japan might affect life-space mobility and QoL of CAD patients. Moreover, CAD patients in Japan who were not obese and maintained their physical function and activity tended to refrain from activity during the period between the pre- and post-nationwide state of emergency. Clarification of the effects of the COVID-19 pandemic on the relationship between living space motility and QoL in CAD patients will require further study.

Validation of the German Life-Space Assessment (LSA-D): cross-sectional validation study in urban and rural community-dwelling older adults

OBJECTIVES

To develop a German version of the original University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA-D) for measurement of community mobility in older adults within the past 4 weeks and to evaluate its construct validity for urban and rural populations of older adults.

DESIGN

Cross-sectional validation study.

SETTING

Two study centres in urban and rural German outpatient hospital settings.

PARTICIPANTS

In total, N=83 community-dwelling older adults were recruited (n=40 from urban and n=43 from rural areas; mean age was 78.5 years (SD=5.4); 49.4% men).

PRIMARY AND SECONDARY OUTCOME MEASURES

The final version of the translated LSA-D was related to limitations in activities and instrumental activities of daily living (ADL/iADL) as primary outcome measure (primary hypothesis); and with sociodemographic factors, functional mobility, self-rated health, balance confidence and history of falls as secondary outcome measures to obtain construct validity. Further descriptive measurements of health included hand grip strength, screening of cognitive function, comorbidities and use of transportation. To assess construct validity, correlations between LSA-D and the primary and secondary outcome measures were examined for the total sample, and urban and rural subsamples using bivariate regression and multiple adjusted regression models. Descriptive analyses of LSA-D included different scoring methods for each region. All parameters were estimated using non-parametric bootstrapping procedure.

RESULTS

In the multiple adjusted model for the total sample, number of ADL/iADL limitations (β=-0.26; 95% CI=-0.42 to -0.08), Timed Up and Go Test (β=-0.37; 95% CI=-0.68 to -0.14), shared living arrangements (β=0.22; 95% CI=0.01 to 0.44) and history of falls in the past 6 months (β=-0.22; 95% CI=-0.41 to -0.05) showed significant associations with the LSA-D composite score, while living in urban area (β=-0.19; 95% CI=-0.42 to 0.03) and male gender (β=0.15; 95% CI=-0.04 to 0.35) were not significant.

CONCLUSION

The LSA-D is a valid tool for measuring life-space mobility in German community-dwelling older adults within the past 4 weeks in ambulant urban and rural settings.

TRIAL REGISTRATION NUMBER

DRKS00019023.

Psychometric Properties of the Proxy-Reported Life-Space Assessment in Institutionalized Settings (LSA-IS-Proxy) for Older Persons with and without Cognitive Impairment

(1) Background: Life-space mobility assessments for institutionalized settings are scarce and there is a lack of comprehensive validation and focus on persons with cognitive impairment (CI). This study aims to evaluate the psychometric properties of the Life-Space Assessment for Institutionalized Settings by proxy informants (LSA-IS-proxy) for institutionalized, older persons, with and without CI. (2) Methods: Concurrent validity against the self-reported version of the LSA-IS, construct validity with established construct variables, test-retest reliability, sensitivity to change during early multidisciplinary geriatric rehabilitation treatment, and feasibility (completion rate, floor/ceiling effects) of the LSA-IS-proxy, were assessed in 94 hospitalized geriatric patients (83.3 ± 6.1 years), with and without CI. (3) Results: The LSA-IS-proxy total score showed good-to-excellent agreement with the self-reported LSA-IS (Intraclass Correlations Coefficient, ICC_3,1 = 0.77), predominantly expected small-to-high correlations with construct variables (r = 0.21–0.59), good test–retest reliability (ICC_3,1 = 0.74), significant sensitivity to change over the treatment period (18.5 ± 7.9 days; p < 0.001, standardized response mean = 0.44), and excellent completion rates (100%) with no floor/ceiling effects. These results were predominantly confirmed for the sub-scores of the LSA-IS-proxy and were comparable between the sub-groups with different cognitive status. (4) Conclusions: The LSA-IS-proxy has proven to be feasible, valid, reliable, and sensitive to change in hospitalized, geriatric patients with and without CI.

Validation of the Life-Space Assessment (LSA-CI) in multi-morbid, older persons without cognitive impairment

PURPOSE

The "Life-Space Assessment in Persons with Cognitive Impairment" (LSA-CI) to assess mobility within the environment including frequency and independence in 1 week has been developed for and successfully validated in older persons with mild to moderate cognitive impairment. However, its psychometric properties in persons without cognitive impairment are unknown. This study aims to validate the LSA-CI in older persons without cognitive impairment.

METHODS

Comprehensive validation with construct validity, test-retest reliability and sensitivity to change of the LSA-CI including the main composite score and three sub-scores in community-dwelling older persons recruited during geriatric rehabilitation.

RESULTS

Excellent feasibility with 100% completion rate and an average assessment duration of 4 min in 65 older, multimorbid persons (mean age: 81.4 ± 5.9 years; 72.3% female; average number of diagnoses: 11.1 ± 4.4). The LSA-CI composite score stood out with moderate to high construct validity (Spearman correlation coefficients |0.26|-|0.60|), excellent test-retest reliability (intraclass correlation coefficient 0.890) and moderate sensitivity to change (adjusted standardized response mean 0.70). Analysis of sub-scores confirmed most of the composite score results.

CONCLUSIONS

The LSA-CI represents a valid, reliable, responsive, and highly feasible assessment method in multi-morbid, older persons without cognitive impairment, supporting the use of the LSA-CI in clinical practice and research.

Validation of the interview-based life-space assessment in institutionalized settings (LSA-IS) for older persons with and without cognitive impairment

BACKGROUND

Self-reported life-space assessment methods so far focus on community-dwelling persons, with a lack of validated assessment methods for institutionalized settings. This study evaluated construct validity, test-retest reliability, sensitivity to change, and feasibility of a new Life-Space Assessment for Institutionalized Settings (LSA-IS) in geriatric patients.

METHODS

Psychometric properties of the LSA-IS in 119 hospitalized geriatric patients (83.0 ± 6.2 years) with and without cognitive impairment (CI) [Mini-Mental State Examination: 22.4 ± 4.9 scores] were evaluated within a comprehensive validation design. For the total group and subgroups according to cognitive status, construct validity was assessed by calculating Spearman's rank correlation coefficients (rho) with established construct variables, test-retest reliability by intra-class correlation coefficients (ICCs), sensitivity to change by standardized response means (SRMs) calculated for effects of early ward-based rehabilitation during hospital stay.

RESULTS

The LSA-IS (total score) demonstrated good test-retest reliability (ICC = .704), and large sensitivity to change (SRM = .806), while construct validity was small to high indicated by significant correlations of the LSA-IS to construct variables (rho = .208-716), depending on relative construct association. On average results of LSA-IS sub-scores confirmed results of the total score. Subgroups according to cognitive status did not differ for most analyzed variables. A completion rate of 100% and a completion time of 3.2 ± 1.2 min documented excellent feasibility.

CONCLUSIONS

The interview-based LSA-IS has proven to be valid, reliable, sensitive, and feasible in hospitalized, multi-morbid, geriatric patients with and without CI documenting good psychometric properties for institutionalized settings.

TRIAL REGISTRATION

DRKS00016028.

Map-based assessment of older adults' life space: validity and reliability

Background

Map-based tools have recently found their way into health-related research. They can potentially be used to quantify older adults’ life-space. This study aimed to evaluate the validity (vs. GPS) and the test-retest reliability of a map-based life-space assessment (MBA).

Methods

Life-space of one full week was assessed by GPS and by MBA. MBA was repeated after approximately 3 weeks. Distance-related (mean and maximum distance from home) and area-related (convex hull, standard deviational ellipse) life-space indicators were calculated. Intraclass correlations (MBA vs. GPS and test-retest) were calculated in addition to Bland-Altman analyses (MBA vs. GPS).

Results

Fifty-eight older adults (mean age 74, standard deviation 5.5 years; 39.7% women) participated in the study. Bland-Altman analyses showed the highest agreement between methods for the maximum distance from home. Intraclass correlation coefficients ranged between 0.19 (95% confidence interval 0 to 0.47) for convex hull and 0.72 (95% confidence interval 0.52 to 0.84) for maximum distance from home. Intraclass correlation coefficients for test-retest reliability ranged between 0.04 (95% confidence interval 0 to 0.30) for convex hull and 0.43 (95% confidence interval 0.19 to 0.62) for mean distance from home.

Conclusions

While acceptable validity and reliability were found for the distance-related life-space parameters, MBA cannot be recommended for the assessment of area-related life-space parameters.

Increasing Life-Space Mobility in Community-Dwelling Older Persons With Cognitive Impairment Following Rehabilitation: A Randomized Controlled Trial

BACKGROUND

Community-dwelling older persons with cognitive impairment (CI) following discharge from geriatric rehabilitation are at high risk of losing life-space mobility (LSM). Interventions to improve their LSM are, however, still lacking. The aim of this study was to evaluate the effects of a CI-specific, home-based physical training and activity promotion program on LSM.

METHODS

Older persons with mild-to-moderate CI (Mini-Mental State Examination: 17-26 points) discharged home from rehabilitation were included in this double-blinded, randomized, placebo-controlled trial with a 12-week intervention period and 12-week follow-up period. The intervention group received a CI-specific, home-based strength, balance, and walking training supported by tailored motivational strategies. The control group received a placebo activity. LSM was evaluated by the Life-Space Assessment in Persons with Cognitive Impairment, including a composite score for LSM and 3 subscores for maximal, equipment-assisted, and independent life space. Mixed-model repeated-measures analyses were used.

RESULTS

One hundred eighteen participants (82.3 ± 6.0 years) with CI (Mini-Mental State Examination: 23.3 ± 2.4) were randomized. After the intervention, the home-based training program resulted in a significant benefit in the Life-Space Assessment in Persons with Cognitive Impairment composite scores (b = 8.15; 95% confidence interval: 2.89-13.41; p = .003) and independent life-space subscores (b = 0.39; 95% confidence interval: 0.00-0.78; p = .048) in the intervention group (n = 63) compared to control group (n = 55). Other subscores and follow-up results were not significantly different.

CONCLUSIONS

The home-based training program improved LSM and independent life space significantly in this vulnerable population. Effects were not sustained over the follow-up. The program may represent a model for improved transition from rehabilitation to the community to prevent high risk of LSM restriction.

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.

Gait speed, life-space mobility and mild cognitive impairment in patients with coronary artery disease

Slow gait speed and restricted life-space mobility predict cognitive decline and dementia in healthy older adults, yet the relation between gait speed or life-space mobility and cognitive function remains poorly understood in patients with coronary artery disease (CAD). We, therefore, examined the following relations: that between gait speed and cognitive function, and mild cognitive impairment (MCI) and that between life-space mobility and cognitive function, and MCI. We conducted a cross-sectional study of 240 non-dementia patients who met the study criteria from 2132 consecutive CAD patients. MCI was estimated with the Japanese version of the Montreal Cognitive Assessment (MoCA-J). Gait speed was measured to perform gait trials at the patients' usual walking pace, and life-space mobility was evaluated using the Life-Space Assessment (LSA). We investigated the relation between gait speed or life-space mobility and cognitive function by Pearson correlation analysis, whereas multivariable logistic regression analysis was conducted for detecting MCI. Gait speed and LSA scores were positively associated with the MoCA-J score (r = 0.54, p < 0.001 and r = 0.44, p < 0.001, respectively), and both were independently associated with MCI in the multivariable logistic regression analysis (odds ratio 0.007, p < 0.001, and odds ratio 0.98, p = 0.038, respectively). Cognitive impairment can be easily detected by assessment of gait speed and life-space mobility. Interventions to improve gait speed and life-space mobility may lead to the improvement of cognitive function and MCI in patients with CAD.

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.

The Life-Space Assessment Measure of Functional Mobility Has Utility in Community-Based Physical Therapist Practice in the United Kingdom

BACKGROUND

The Life-Space Assessment (LSA) has demonstrable validity and reliability among people sampled from nonclinical settings. Its properties in clinical settings, especially physical therapy services, are less well established.

OBJECTIVE

The aim of this study was to test the construct/convergent validity, responsiveness, and floor/ceiling effects of the LSA among patients who had musculoskeletal, orthopedic, neurological, or general surgical presentations and were receiving individually tailored, community-based physical therapist interventions to address gait/balance impairments in an urban location in the United Kingdom.

DESIGN

A prospective, repeated-measures, comparative cohort design was used.

METHODS

Two hundred seventy-six community-dwelling, newly referred patients were recruited from three cohorts (outpatients; domiciliary, nonhospitalized; and domiciliary, recent hospital discharge). Data were collected from the LSA and the Performance-Oriented Mobility Assessment (POMA1) at initial assessment and discharge. Two hundred twenty-eight participants were retained at follow-up.

RESULTS

The median age was 80.5 years, 73.6% were women, and the median number of physical therapist contacts over 53 days was five. LSA scores at assessment and changes over treatment distinguished between cohorts, even after adjustment for covariates. Weak correlations (0.14-0.41) were found between LSA and POMA1 scores. No LSA floor/ceiling effects were found. Significant improvements in the LSA score after the intervention were found for each cohort and for the sample overall. For the whole sample, the mean change in the LSA score was 10.5 points (95% CI = 8.3-12.8).

LIMITATIONS

The environmental demands participants faced were not measured. Caregivers answered the LSA questions on behalf of participants when necessary. Assessors were not always masked with regard to the measurement point.

CONCLUSIONS

The LSA has utility as an outcome measure in routine community-based physical therapist practice. It has satisfactory construct validity and is sensitive to change over a short time frame. The LSA is not a substitute for the POMA1; these measures complement each other, with the LSA bringing the added value of measuring real-life functional mobility.

Validity, reliability, and feasibility of the uSense activity monitor to register physical activity and gait performance in habitual settings of geriatric patients

OBJECTIVE

The aim of the study was to investigate the psychometric quality of a newly developed activity monitor (uSense) to document established physical activity parameters as well as innovative qualitative and quantitative gait characteristics in geriatric patients.

APPROACH

Construct and concurrent validity, test-retest reliability, and feasibility of established as well as innovative characteristics for qualitative gait analysis were analyzed in multi-morbid, geriatric patients with cognitive impairment (CI) (n  =  110), recently discharged from geriatric rehabilitation.

MAIN RESULTS

Spearman correlations of established and innovative uSense parameters reflecting active behavior with clinically relevant construct parameters were on average moderate to high for motor performance and life-space and low to moderate for other parameters, while correlations with uSense parameters reflecting inactive behavior were predominantly low. Concurrent validity of established physical activity parameters showed consistently high correlations between the uSense and an established comparator system (PAMSys^™), but the absolute agreement between both sensor systems was low. On average excellent test-retest reliability for all uSense parameters and good feasibility could be documented.

SIGNIFICANCE

The uSense monitor allows the assessment of established and-for the first time-a semi-qualitative gait assessment of habitual activity behavior in older persons most affected by motor and CI and activity restrictions. On average moderate to good construct validity, high test-retest reliability, and good feasibility indicated a sound psychometric quality of most measures, while the results of concurrent validity as measured by a comparable system indicated high correlation but low absolute agreement based on different algorithms used.

Cut-off for the Life-Space Assessment in persons with cognitive impairment

BACKGROUND

A version of the Life-Space Assessment in persons with cognitive impairment (LSA-CI) has recently been developed.

AIMS

To establish a cut-off value for the newly developed Life-Space Assessment in persons with cognitive impairment (LSA-CI).

METHODS

In a cross-sectional study including 118 multimorbid, older persons with cognitive impairment, life-space mobility (LSM) was documented by the LSA-CI. The analysis was rationalized by Global Positioning System (GPS)-based measures of spatial distance from home. A receiver-operating characteristic (ROC) curve was created and the cut-off point for the LSA-CI was identified with the Youden's Index.

RESULTS

ROC curve analysis indicated a critical value of 26.75 (within a range of 0-90) to differentiate between low and high LSM with a sensitivity of 78.1% and specificity of 84.2%.

DISCUSSION

Diagnostic interpretation of the ROC curves revealed that low and high LSM groups can be differentiated with the proposed cut-off.

CONCLUSIONS

The proposed LSA-CI cut-off score can be recommended to tailor clinical interventions and evaluate change over time.

Examining the Association between Life-Space Mobility and Cognitive Function in Older Adults: A Systematic Review

Purpose

The purpose of this review is to investigate the relationship between life-space mobility and cognition in older adults.

Methods

MEDLINE, Embase, CINAHL, and PsycINFO were searched through December 2018 for studies containing measures of life-space mobility and cognitive function. Two independent reviewers screened studies. Eligible studies were combined using a random-effects model, and heterogeneity was assessed using the I².

Results

Thirty-five articles were identified for review. A moderate and statistically significant association (pooled r = 0.30, 95% confidence interval 0.19 to 0.40.) was observed between life-space mobility and cognition among nine studies. Life-space mobility demonstrated small-to-moderate associations with domain-specific cognitive functioning, particularly executive function, learning, memory, and processing speed. Furthermore, individuals who had restricted life-space mobility (Life-Space Assessment ≤ 40) experienced a steeper decline in cognition (β = 0.56 and p = 0.0471) compared to those who did not (Life-Space Assessment ≥ 41).

Conclusion

This review examined the association between life-space mobility and cognitive function in older adults. The results suggest that a moderate relationship between life-space mobility and cognition exists, whether adjusted or unadjusted for covariates such as sociodemographics, mental health, functional capacity, and comorbidities.