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Delhey LM, Shi X, Morgenstern LB, Brown DL, Smith MA, Case EC, Springer MV, Lisabeth LD. Neighborhood Resources and Health Outcomes Among Stroke Survivors in a Population-Based Cohort. J Am Heart Assoc 2024; 13:e034308. [PMID: 38958125 DOI: 10.1161/jaha.124.034308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/05/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Stroke survivors believe neighborhood resources such as community centers are beneficial; however, little is known about the influence of these resources on stroke outcomes. We evaluated whether residing in neighborhoods with greater resource density is associated with favorable post-stroke outcomes. METHODS AND RESULTS We included Mexican American and non-Hispanic White stroke survivors from the Brain Attack Surveillance in Corpus Christi project (2009-2019). The exposure was density of neighborhood resources (eg, community centers, restaurants, stores) within a residential census tract at stroke onset. Outcomes included time to death and recurrence, and at 3 months following stroke: disability (activities of daily living/instrumental activities of daily living), cognition (Modified Mini-Mental State Exam), depression (Patient Health Questionnaire-8), and quality of life (abbreviated Stroke-Specific Quality of Life scale). We fit multivariable Cox regression and mixed linear models. We considered interactions with stroke severity, ethnicity, and sex. Among 1786 stroke survivors, median age was 64 years (interquartile range, 56-73), 55% men, and 62% Mexican American. Resource density was not associated with death, recurrence, or depression. Greater resource density (75th versus 25th percentile) was associated with more favorable cognition (Modified Mini-Mental State Exam mean difference=0.838, 95% CI=0.092, 1.584) and among moderate-severe stroke survivors, with more favorable functioning (activities of daily living/instrumental activities of daily living=-0.156 [95% CI, -0.284 to 0.027]) and quality of life (abbreviated Stroke-Specific Quality of Life scale=0.194 [95% CI, 0.029-0.359]). CONCLUSIONS We observed associations between greater resource density and cognition overall and with functioning and quality of life among moderate-severe stroke survivors. Further research is needed to confirm these findings and determine if neighborhood resources may be a tool for recovery.
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Affiliation(s)
- Leanna M Delhey
- Department of Epidemiology University of Michigan School of Public Health Ann Arbor MI USA
| | - Xu Shi
- Department of Biostatistics University of Michigan School of Public Health Ann Arbor MI USA
| | - Lewis B Morgenstern
- Department of Epidemiology University of Michigan School of Public Health Ann Arbor MI USA
- Stroke Program, University of Michigan Medical School Ann Arbor MI USA
| | - Devin L Brown
- Stroke Program, University of Michigan Medical School Ann Arbor MI USA
| | - Melinda A Smith
- Department of Epidemiology University of Michigan School of Public Health Ann Arbor MI USA
| | - Erin C Case
- Department of Epidemiology University of Michigan School of Public Health Ann Arbor MI USA
| | | | - Lynda D Lisabeth
- Department of Epidemiology University of Michigan School of Public Health Ann Arbor MI USA
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Paredes-Arturo YV, Flórez-Madroñero AC, Diaz-Velásquez DM, Yarce-Pinzon E, Aguirre-Acevedo DC. Factors influencing living space utilization among older Afro-Colombian adults. ETHNICITY & HEALTH 2024; 29:267-277. [PMID: 38087430 DOI: 10.1080/13557858.2023.2293448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 12/04/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVES Investigate the factors influencing life space utilization in older Afro-descendant adults residing in Tumaco, Colombia - a marginalized region of the country. DESIGN This cross-sectional study included 388 Afro-descendant older adults. The study assessed living space using the Life Space Assessment (LSA) scale and collected demographic data. Cognitive levels were measured with the Mini-Mental State Examination (MMSE), and depressive symptoms were assessed using the Yesavage scale. Socio-emotional indicators were determined with the Medical Outcomes Study (MOS). The research employed linear and logistic regression models for data analysis. RESULTS On average, participants scored 27.0 on the LSA scale. A lack of perceived income resulted in a 10.44-point decrease on the LSA scale. For each unit increase in the MOS-Instrumental Dimension score, the LSA score increased by 0.52 points (95% CI 0.17-0.87). As for cognitive performance (MMSE scale), each one-point increase resulted in a 0.69 decrease in the LSA score (95% CI -1.25 to -0.12). CONCLUSION Socioeconomic disadvantages limit living space utilization, particularly in the Afro-descendant population. Yet, social support can enhance living space use despite environmental and economic constraints.
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Affiliation(s)
| | | | | | - Eunice Yarce-Pinzon
- Health Sciences Faculty, Occupational Therapy Program, Mariana University, Pasto, Colombia
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Wang Y, Ma L, Pei J, Li W, Zhou Y, Dou X, Wang X. The level of life space mobility among community-dwelling elderly: A systematic review and meta-analysis. Arch Gerontol Geriatr 2024; 117:105278. [PMID: 37988853 DOI: 10.1016/j.archger.2023.105278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Multiple countries have conducted surveys on the level of life space mobility for community-dwelling elderly through the Life-Space Assessment, the results vary greatly, from 41.7 to 88.6. However, there is no meta-analysis on the current situation of community-dwelling elderly life space mobility. OBJECTIVE To systematically assess the global level of life space mobility for community-dwelling elderly, to identify potential covariates such as geographical regions, survey years, gender, and age that contribute to the heterogeneity between the studies, and to identify the dynamic trend based on survey years. DESIGN Systematic review and meta-analysis. DATA SOURCES Two reviewers searched the following 8 electronic bibliographic databases from inception until May 28, 2023: PubMed, The Cochrane Library, Web of Science, Embase, Chinese Biomedical Database, China Knowledge Resource Integrated Database, WanFang, and Weipu Database. REVIEW METHODS This review was conducted using the Stata 14.1 and R 4.3.1. The Cochrane's Q statistical and I2 index were used to test for heterogenicity and assess the degree of heterogenicity, respectively. Studies were appraised using the Agency for Healthcare Research and Quality tool, the Newcastle-Ottawa Scale for the quality of cross-sectional studies, cohort studies, respectively. RESULTS A total of 29 studies were selected from databases and reference lists. The pooled score of Life-Space Assessment was 66.84 (95% CI: 63.30-70.39) and the prevalence of restricted life space was 42% (95% CI: 0.27-0.57). The geographical regions, survey years, gender were found to be a significant covariate of the pooled score of life space mobility estimate in the subgroup analysis. The mean score of Life-Space Assessment gradually achieved stability after 2017. CONCLUSIONS The life space mobility of community-dwelling elderly in the global is at a moderate level, with 42% of them experiencing restricted life space. South America, females and earlier survey years have a lower level of life space mobility. In the future, the government should identify vulnerable groups for targeted intervention to promote the level of LSM in the community-dwelling elderly. REGISTRATION PROSPERO [CRD42023443054].
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Affiliation(s)
- Yingqiao Wang
- School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China
| | - Li Ma
- LanZhou University Second Hospital, Lanzhou City, Gansu Province, China
| | - Juhong Pei
- First College of Clinical Medicine of Lanzhou University, China
| | - Weiping Li
- School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China
| | - Yihan Zhou
- LanZhou University Second Hospital, Lanzhou City, Gansu Province, China
| | - Xinman Dou
- LanZhou University Second Hospital, Lanzhou City, Gansu Province, China
| | - Xinglei Wang
- School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China; Department of Liver Diseases Branch, Lanzhou University Second Hospital, Lanzhou, Gansu, China.
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4
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Taylor RA, Bakitas M, Wells R, Dionne‐Odom JN, Kennedy R, Williams GR, Frank J, Li P. Restricted life-space mobility impacts physical but not mental quality of life in older cancer survivors. Cancer Med 2023; 13:e6850. [PMID: 38140781 PMCID: PMC10807608 DOI: 10.1002/cam4.6850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Older cancer survivors often value quality of life (QOL) over survival. Life-space mobility (LSM), defined as the individual's spatial geographic mobility range, is an important QOL indicator in older adults with chronic illnesses; however, this relationship is unexplored in older cancer survivors. METHODS We examined the longitudinal associations and causal relationships between LSM and QOL in 153 older cancer survivors (≥65 years) from the University of Alabama at Birmingham (UAB) Study of Aging. LSM was assessed using the UAB Life-Space Assessment-Composite score (LSA-C), and QOL was assessed by the SF-12 Mental Component Score (MCS12) and Physical Component Score (PCS12) at 0 (study entry), 6, 18, 36, 54, and 72 months. We examined the causal relationship between LSM and QOL using a cross-lagged panel model (CLPM). RESULTS The cohort (n = 153) was 76 years old on average and predominantly White (58%), female (58%), and married (55%). Longitudinal analyses found LSM decreased over time (p < 0.0001), and this decrease was associated with decreased QOL (PCS12, p < 0.0001, MCS12, p < 0.0001). In the CLPM causal analysis, lower LSM resulted in worse PCS12 (p < 0.001), but not worse MSC12. CONCLUSIONS Restricted LSM resulted in worse physical QOL over 72 months in a sample of 153 older cancer survivors. Developing and evaluating interventions to preserve greater LSM could be a promising approach to improving QOL.
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Affiliation(s)
- Richard A. Taylor
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Marie Bakitas
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Rachel Wells
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - J. Nicholas Dionne‐Odom
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Department of Medicine—Division of Gerontology, Geriatrics, and Palliative CareUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Richard Kennedy
- Department of Medicine—Division of Gerontology, Geriatrics, and Palliative CareUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Grant R. Williams
- Department of Medicine—Division of Hematology & OncologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Jennifer Frank
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Peng Li
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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Oliva A, West JS, Smith SL, Huang RJ, Riska KM. Association Between Hearing Handicap and Life-Space Mobility in a Patient Population. Am J Audiol 2023; 32:360-368. [PMID: 37059051 PMCID: PMC10468117 DOI: 10.1044/2023_aja-22-00052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 10/07/2022] [Accepted: 01/21/2023] [Indexed: 04/16/2023] Open
Abstract
PURPOSE The purpose of this study was to evaluate the association between self-reported hearing handicap and life-space mobility utilizing the Life-Space Questionnaire (LSQ). Life-space mobility reflects how an individual moves through their daily physical and social environment, and the role of hearing loss in life-space mobility is not fully understood. We hypothesized that those with higher self-reported hearing handicap would be more likely to demonstrate restricted life-space mobility. METHOD A total of 189 older adults (M age = 75.76 years, SD = 5.81) completed a mail-in survey packet including the LSQ and Hearing Handicap Inventory for the Elderly (HHIE). Participants were categorized into one of three groups ("no/none," "mild/moderate," or "severe" hearing handicap) according to HHIE total score. LSQ responses were dichotomized to either "nonrestricted/typical" or "restricted" life-space mobility groups. Logistic regression models were performed to analyze life-space mobility differences among the groups. RESULTS Logistic regression results demonstrated no statistically significant association between hearing handicap and LSQ. CONCLUSIONS The results of this study indicate that there is no association between self-reported hearing handicap and life-space mobility as evaluated using a mail-in version of the LSQ. This counters other studies that have demonstrated that life space is associated with chronic illness, cognitive functioning, and social and health integration.
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Affiliation(s)
| | - Jessica S. West
- Duke Center for the Study of Aging and Human Development, Durham, NC
- Department of Population Health Sciences, Duke University School of Medicine, Durham NC
| | - Sherri L. Smith
- Department of Head & Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC
- Duke Center for the Study of Aging and Human Development, Durham, NC
- Department of Population Health Sciences, Duke University School of Medicine, Durham NC
- Durham Veterans Affairs Health Care System, NC
| | | | - Kristal M. Riska
- Department of Head & Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC
- Duke Center for the Study of Aging and Human Development, Durham, NC
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Tsunoda S, Shimizu S, Suzuki Y, Tsunoda A, Yamada R, Shimose R, Kawabata M, Ogura M, Matsunaga A. Longitudinal changes in life-space mobility and the factors influencing it among chronic community-dwelling post-stroke patients. Disabil Rehabil 2022; 44:7872-7876. [PMID: 34894964 DOI: 10.1080/09638288.2021.2001054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE To identify longitudinal changes in life-space mobility and the factors influencing it among chronic, stable post-stroke patients. MATERIALS AND METHODS This prospective study included Japanese post-stroke patients who received day-care rehabilitation services and could undergo three life-space mobility assessments (at baseline, 12, and 24 months) for over 2 years, using the Life-Space Assessment (LSA) tool. Physical function, cognitive function, and activities of daily living were assessed by self-selected comfortable gait speed, Mini-Mental State Examination (MMSE), and Functional Independence Measure Motor subscale (FIM motor) scores, respectively, in addition to age, sex, time from onset, stroke type, and comorbidities. A multivariable linear mixed-effects model was used to examine the longitudinal changes in LSA scores and associated factors. RESULTS A total of 89 participants were enrolled. At baseline, the median age was 74 years, 33% were women, and median time from onset was 75 months. The LSA scores significantly declined over the two-year period. In the multivariate linear mixed-effects model adjusted for clinical characteristics, comfortable gait speed and age were significantly associated with changes in the LSA score, independent of FIM motor scores and MMSE scores. CONCLUSIONS Life-space mobility may persistently decline, and gait function may be a determinant influencing these changes in community-dwelling chronic post-stroke patients.Implications for RehabilitationLimited life-space mobility leads to less frequent participation in social activities and an increased risk of adverse health outcomes such as hospitalization.Changes in life-space mobility should be considered in the rehabilitation care plan for chronic post-stroke patients.Life-space mobility may decline persistently in stable post-stroke patients, even if they have periodically received day-care rehabilitation services.Since gait speed is a predominant factor affecting life-space mobility, regular assessment of gait function and appropriate strategies are needed to prevent deterioration of gait speed in chronic post-stroke patients.
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Affiliation(s)
- S Tsunoda
- Department of Rehabilitation, Shonan Fujisawa Tokushukai Hospital, Fujisawa, Japan.,Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - S Shimizu
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan.,Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - Y Suzuki
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - A Tsunoda
- Department of Rehabilitation, Chigasaki Tokushukai Hospital, Chigasaki, Japan
| | - R Yamada
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - R Shimose
- Department of Physical Therapy, Okayama Healthcare Professional University, Okayama, Japan
| | - M Kawabata
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - M Ogura
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan.,Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - A Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan.,Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
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7
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Kalu ME, Bello-Haas VD, Griffin M, Boamah S, Harris J, Zaide M, Rayner D, Khattab N, Abrahim S, Richardson TK, Savatteri N, Wang Y, Tkachyk C. Cognitive, psychological and social factors associated with older adults' mobility: a scoping review of self-report and performance-based measures. Psychogeriatrics 2022; 22:553-573. [PMID: 35535013 DOI: 10.1111/psyg.12848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 11/28/2022]
Abstract
Although many factors have been associated with mobility among older adults, there is paucity of research that explores the complexity of factors that influence mobility. This review aims to synthesise the available evidence for factors comprising the cognitive, psychological, and social mobility determinants and their associations with mobility self-reported and performance-based outcomes in older adults (60 years). We followed Arksey and O'Malley's five stages of a scoping review and searched PubMed, EMBASE, PsychINFO, Web of Science, AgeLine, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature and Sociological Abstract databases. Reviewers in pairs independently conducted title, abstract, full-text screening and data extraction. We reported associations by analyses rather than articles because articles reported multiple associations for factors and several mobility outcomes. Associations were categorised as significantly positive, negative, or not significant. We included 183 peer-reviewed articles published in 27 countries, most of which were cross-sectional studies and conducted among community-dwelling older adults. The 183 articles reported 630 analyses, of which 381 (60.5%) were significantly associated with mobility outcomes in the expected direction. For example, older adults with higher cognitive functioning such as better executive functioning had better mobility outcomes (e.g., faster gait speed), and those with poor psychological outcomes, such as depressive symptoms, or social outcomes such as reduced social network, had poorer mobility outcomes (e.g., slower gait speed) compared to their counterparts. Studies exploring the association between cognitive factors, personality (a psychological factor) and self-reported mobility outcomes (e.g., walking for transportation or driving), and social factors and performance-based mobility outcomes in older adults are limited. Understanding the additive relationships between cognitive, psychological, and social factors highlights the complexity of older adults' mobility across different forms of mobility, including independence, use of assistive devices, transportation, and driving.
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Affiliation(s)
- Michael E Kalu
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Vanina Dal Bello-Haas
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Meridith Griffin
- Department of Health, Aging & Society, Faculty of Social Science, McMaster University, Hamilton, Ontario, Canada
| | - Sheila Boamah
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jocelyn Harris
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Mashal Zaide
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Daniel Rayner
- Department of Health Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nura Khattab
- Department of Kinesiology, Faculty of Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Salma Abrahim
- Department of Kinesiology, Faculty of Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Yimo Wang
- Myodetox Markham, Markham, Ontario, Canada
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8
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Wang F, Qin W, Yu J. Neighborhood Social Cohesion and Mobility Limitations Among Community-dwelling Older Americans: The Mediating Roles of Depressive Symptoms and Mastery. Int J Aging Hum Dev 2021; 94:290-311. [PMID: 34409865 DOI: 10.1177/00914150211037657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neighborhood environment plays an important role in late-life health; yet, the social aspect of neighborhood environment and its impact on mobility limitations have rarely been examined. This nonexperimental, cross-sectional study examines the relationship between neighborhood social cohesion and mobility limitations and the potential mediators (i.e., depressive symptoms, mastery) of this relationship. A total of 8,317 Americans aged 65 years and older were selected from the Health and Retirement Study. Using ordinary least squares regressions, this study shows that neighborhood social cohesion was negatively associated with mobility limitations (B = -0.04, p < .01). A Sobel test of mediation indicated that this relationship was significantly mediated by depressive symptoms (z = -9.10, p < .001) and mastery (z = -8.86, p < .001). Findings suggest that neighborhood cohesion can reduce mobility limitations through mitigating depressive symptoms and increasing mastery. Future research should disentangle the temporal ordering of the mediators.
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Affiliation(s)
- Fei Wang
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, 114588Case Western Reserve University, Cleveland, OH, USA
| | - Weidi Qin
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, 114588Case Western Reserve University, Cleveland, OH, USA
| | - Jiao Yu
- Department of Sociology, College of Arts and Sciences, 142585Case Western Reserve University, Cleveland, OH, USA
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Hayashi C, Tanaka H, Ogata S. Assessing timewise changes over 15 months in life-space mobility among community-dwelling elderly persons. BMC Geriatr 2020; 20:502. [PMID: 33238895 PMCID: PMC7687835 DOI: 10.1186/s12877-020-01882-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 11/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to examine the differences of timewise changes in life-space mobility between elderly people living alone and those living with others among community-dwelling elderly people from a day care facility with a rehabilitation service for seniors. Methods The present study used a longitudinal design with repeated measures every 3 months. In conformity with our inclusion criteria, this study included 233 community-dwelling elderly users of a day care facility with rehabilitation services for seniors in Japan. We analyzed the life-space assessment (LSA) scores collected at five time points (baseline, 3 months, 6 months, 9 months, and 12 months) using mixed-effects models with random intercepts and slopes over time. In the present study, the explanatory variables of interest were time, and living situation (living alone or with others). As possible confounders, we considered the following: (a) age, (b) sex, (c) social frailty, (d) physical frailty, (e) mild cognitive impairment (MCI), (f) depression, and (g) economic satisfaction. Results The mean age of participants was 78.9 years (SD = 7.7), their mean LSA score was 60.1 points (SD = 25.7), and 42.9% of the participants were men. After adjusting for age, gender, frailty, depression, MCI, and economic satisfaction, the mean LSA score of older adults who lived with others was significantly lower (7.42 points, 95%CI = − 18.30 to − 0.15, p = 0.048) than that older adults who lived alone. Discussion Community-dwelling older adults who used a day care center with rehabilitation services and lived with others had a smaller life-space at baseline than those who lived alone. This suggests that there is a need to pay more attention to social frailty among both older adults who live alone and those who live with others. Conclusions According to a multilevel analysis growth model, elderly persons who lived with others had significantly lower life-space mobility than those who lived alone. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-020-01882-4.
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Affiliation(s)
- Chisato Hayashi
- University of Hyogo, 13-71 Kitaoji-cho, Akashi, Hyogo, 673-8588, Japan.
| | - Haruka Tanaka
- Nagoya University, Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nahgoya City, Aichi Prefecture, 461-8673, Japan
| | - Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, 6-1, Kishibe - Shimmachi, Suita, Osaka, 564-8565, Japan
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10
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Xu Y, Richardson J, MacDermid J, Dal Bello-Haas V. Mobility in community-dwelling adults with chronic conditions: the contribution of age and sex. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2018.1503717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ying Xu
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Joy MacDermid
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- School of Physical Therapy and Surgery, Western University, London, Canada
- Clinical Research Lab, Hand and Upper Limb Centre, St. Joseph’s Health Centre, London, Canada
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Examining the Association between Life-Space Mobility and Cognitive Function in Older Adults: A Systematic Review. J Aging Res 2019; 2019:3923574. [PMID: 31275650 PMCID: PMC6589294 DOI: 10.1155/2019/3923574] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/16/2019] [Accepted: 05/06/2019] [Indexed: 12/26/2022] Open
Abstract
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.
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12
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Ang S. Intersectional cohort change: Disparities in mobility limitations among older Singaporeans. Soc Sci Med 2019; 228:223-231. [PMID: 30927616 DOI: 10.1016/j.socscimed.2019.03.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/05/2019] [Accepted: 03/22/2019] [Indexed: 11/18/2022]
Abstract
Mobility is fundamental to independent living, but past research on physical function and mobility in older adults has not considered both intersectional social identities and cohort change in tandem. This paper utilizes data on mobility limitations from older adults in multi-ethnic Singapore to test whether cohort change varies simultaneously by gender and ethnicity. Panel data (n = 9334 person-years) collected over six years (2009-2015) were used to estimate aging vector models. Findings show that after adjusting for all covariates, Malay and Indian males in later-born cohorts have an increased number of mobility limitations compared to earlier-born cohorts. While a similar trend was also found for Chinese males and females in unconditional models, these were fully mediated by sociodemographic and health variables. These results highlight the importance of considering cohort change at the intersection of gender and ethnicity, bringing attention to possible inequities between ethnic groups.
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Affiliation(s)
- Shannon Ang
- Department of Sociology, University of Michigan, Ann Arbor, USA; Population Studies Center, University of Michigan, Ann Arbor, USA; Sociology, School of Social Sciences, Nanyang Technological University, Singapore.
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13
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Béland F, Julien D, Bier N, Desrosiers J, Kergoat MJ, Demers L. Association between cognitive function and life-space mobility in older adults: results from the FRéLE longitudinal study. BMC Geriatr 2018; 18:227. [PMID: 30249199 PMCID: PMC6154880 DOI: 10.1186/s12877-018-0908-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 09/04/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Cross-sectional and longitudinal studies show conflicting results regarding the association between cognition and life-space mobility, and little is known regarding the mediators and moderators of the association. The aim of this study was to investigate the association between cognition and life-space mobility in older adults, as well as the intervening variables modifying the relationship. METHODS Community-dwelling older adults aged 65 years and older (N = 1643) were assessed at three time points over a period of 2 years. Growth mixture models with mediation and moderation analysis were utilised to investigate association between cognitive function and life-space mobility. The potential mediators and moderators were depressive symptoms, locus of control, gait speed and grip strength. Analysis was controlled for age, sex, education, annual income, number of chronic illnesses, and living site. RESULTS The direct association between initial scores of cognitive function and life-space was mediated by initial scores of depressive symptoms and gait speed, and moderated by initial scores of grip strength. No direct association between change in cognitive function and change in life-space mobility was found; the scores were mediated by change in depressive symptoms. CONCLUSIONS We conclude that the relationship between change in cognitive function and life-space mobility in older adults is not well-defined over an observation period of 2 years.
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Affiliation(s)
- François Béland
- Groupe de recherche Solidage, CSSS de la Montagne, site Metro, 1801, boulevard de Maisonneuve Ouest, bureau 600, Montréal, Québec H3H 1J9 Canada
- École de santé publique, Département d’administration de la santé, Université de Montréal, C.P. 6128, succ. Centre-Ville, Montréal, Québec H3C 3J7 Canada
- Faculté de médecine, Division de médecine gériatrique, Université McGill, Hôpital général juif, 3755, chemin de la Côte-Ste-Catherine, Montréal, Québec H3T 1E2 Canada
| | - Dominic Julien
- Groupe de recherche Solidage, CSSS de la Montagne, site Metro, 1801, boulevard de Maisonneuve Ouest, bureau 600, Montréal, Québec H3H 1J9 Canada
- Département de psychologie, Université de Montréal, Pavillon Marie-Victorin, C. P. 6128, succ. Centre-Ville, Montréal, Québec H3C 3J7 Canada
- Centre de recherche, Institut universitaire en santé mentale de Montréal, 7331, rue Hochelaga, Montréal, Québec H1N 3V2 Canada
| | - Nathalie Bier
- Centre de recherche, Institut Universitaire de Gériatrie de Montréal, 4545, Chemin Queen Mary, Montréal, Québec H3W 1W5 Canada
- Faculté de médecine, École de réadaptation, Université de Montréal, C.P. 6128, succ. Centre-Ville, Montréal, Québec H3C 3J7 Canada
| | - Johanne Desrosiers
- École de réadaptation, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Québec J1H 5N4 Canada
- Centre de recherche sur le vieillissement, Centre intégré universitaire de santé et de services sociaux de l’Estrie, Centre hospitalier universitaire de Sherbrooke, 1036, rue Belvédère Sud, Sherbrooke, Québec J1H 4C4 Canada
| | - Marie-Jeanne Kergoat
- Centre de recherche, Institut Universitaire de Gériatrie de Montréal, 4545, Chemin Queen Mary, Montréal, Québec H3W 1W5 Canada
- Faculté de médecine, Département de médecine, Université de Montréal, C.P. 6128, succ. Centre-Ville, Montréal, Québec H3C 3J7 Canada
| | - Louise Demers
- Centre de recherche, Institut Universitaire de Gériatrie de Montréal, 4545, Chemin Queen Mary, Montréal, Québec H3W 1W5 Canada
- Faculté de médecine, École de réadaptation, Université de Montréal, C.P. 6128, succ. Centre-Ville, Montréal, Québec H3C 3J7 Canada
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14
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Raggi A, Corso B, De Torres L, Quintas R, Chatterji S, Sainio P, Martinuzzi A, Zawisza K, Haro JM, Minicuci N, Leonardi M. Determinants of mobility in populations of older adults: Results from a cross-sectional study in Finland, Poland and Spain. Maturitas 2018; 115:84-91. [PMID: 30049352 DOI: 10.1016/j.maturitas.2018.06.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/21/2018] [Accepted: 06/30/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To identify the determinants of mobility among people aged 50+ from Finland, Spain and Poland. STUDY DESIGN Observational cross-sectional population study. MAIN OUTCOME MEASURES A mobility score was based on responses to items referring to body movements, walking, moving around and using transportation. Determinants of mobility were entered in hierarchical regression models in the following order: sociodemographic characteristics, health habits, chronic conditions, description of general state of health, vision and hearing, social networks, built environment. RESULTS Complete data were available for 3902 participants (mean age 65.1, SD 9.8). The final model explained 64.7% of the variation in mobility. The most relevant predictors were: pain, age and living in Finland, presence of arthritis, stroke and diabetes, high-risk waist circumference, physical inactivity, and perceiving the neighborhood environment as more exploitable. CONCLUSIONS Our results provide public health indications that could support concrete actions to address the modifiable determinants of mobility. These include the identification and treatment of pain-related problems, increasing the level of physical activity and the improvement of neighborhood features in terms of presence of general utility places or means of transportation. These factors can be modified with short- to medium-term interventions and such a change could improve the mobility of ageing population, with evident benefits for health.
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Affiliation(s)
- Alberto Raggi
- Neurological Institute C. Besta IRCCS Foundation, Neurology, Public Health and Disability Unit, Milan, Italy.
| | - Barbara Corso
- National Research Council, Neuroscience Institute, Padova, Italy.
| | - Laura De Torres
- Neurological Institute C. Besta IRCCS Foundation, Neurology, Public Health and Disability Unit, Milan, Italy.
| | - Rui Quintas
- Neurological Institute C. Besta IRCCS Foundation, Neurology, Public Health and Disability Unit, Milan, Italy.
| | - Somnath Chatterji
- World Health Organization, Information, Evidence and Research Unit, Geneva, Switzerland.
| | - Päivi Sainio
- National Institute for Health and Welfare, Ageing, Disability and Functioning Unit, Helsinki, Finland.
| | - Andrea Martinuzzi
- E. Medea Scientific Institute, Conegliano-Pieve di Soligo Research Centre, Conegliano Veneto, Italy.
| | - Katarzyna Zawisza
- Department of Medical Sociology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College. Krakow, Poland.
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, University of Barcelona, CIBERSAM, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain.
| | - Nadia Minicuci
- National Research Council, Neuroscience Institute, Padova, Italy.
| | - Matilde Leonardi
- Neurological Institute C. Besta IRCCS Foundation, Neurology, Public Health and Disability Unit, Milan, Italy.
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15
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Rantakokko M, Portegijs E, Viljanen A, Iwarsson S, Rantanen T. Task Modifications in Walking Postpone Decline in Life-Space Mobility Among Community-Dwelling Older People: A 2-year Follow-up Study. J Gerontol A Biol Sci Med Sci 2017; 72:1252-1256. [PMID: 28329074 DOI: 10.1093/gerona/glw348] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 12/22/2016] [Indexed: 11/13/2022] Open
Abstract
Background Task modification refers to performing a task differently than before. While task modification in walking may be a sign of looming walking difficulty, it may also be adaptive in and postpone the decline in life-space mobility. However, this has not been studied. This study examined whether changes in life-space mobility over a 2-year period differ between people who at baseline report no walking difficulty and no task modification, those who report no walking difficulty but task modification, and those who report walking difficulty. Methods Community-dwelling people aged 75-90 years were interviewed face-to-face at baseline (N = 848), and over phone one (n = 816) and two (n = 761) years later. Life-space mobility was assessed annually with the Life-Space Assessment (range 0-120, higher scores indicate better life-space mobility). Self-reported ability to walk 2 km was assessed at baseline and categorized into "no difficulty," "no difficulty but task modifications" (reduced frequency, given up walking, walking slower or resting during walking) and "difficulty." The analyses were adjusted for age, gender, number of chronic conditions, cognitive impairment, lower extremity performance and education. Results The life-space mobility score was highest and remained stable over 2-years among those with no walking difficulties at baseline and lowest and showing a steady decline among those with walking difficulties. Those with task modifications formed the middle group. They showed no marked changes in life-space mobility during the first year, but significant decline during the second year. Conclusion Task modifications in walking may help community-dwelling older people to postpone life-space mobility decline.
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Affiliation(s)
- Merja Rantakokko
- Gerontology Research Center and Department of Health Sciences, University of Jyvaskyla, Finland
| | - Erja Portegijs
- Gerontology Research Center and Department of Health Sciences, University of Jyvaskyla, Finland
| | - Anne Viljanen
- Gerontology Research Center and Department of Health Sciences, University of Jyvaskyla, Finland
| | | | - Taina Rantanen
- Gerontology Research Center and Department of Health Sciences, University of Jyvaskyla, Finland
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16
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Klous G, Smit LAM, Borlée F, Coutinho RA, Kretzschmar MEE, Heederik DJJ, Huss A. Mobility assessment of a rural population in the Netherlands using GPS measurements. Int J Health Geogr 2017; 16:30. [PMID: 28793901 PMCID: PMC5551017 DOI: 10.1186/s12942-017-0103-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 08/04/2017] [Indexed: 12/22/2022] Open
Abstract
Background The home address is a common spatial proxy for exposure assessment in epidemiological studies but mobility may introduce exposure misclassification. Mobility can be assessed using self-reports or objectively measured using GPS logging but self-reports may not assess the same information as measured mobility. We aimed to assess mobility patterns of a rural population in the Netherlands using GPS measurements and self-reports and to compare GPS measured to self-reported data, and to evaluate correlates of differences in mobility patterns. Method In total 870 participants filled in a questionnaire regarding their transport modes and carried a GPS-logger for 7 consecutive days. Transport modes were assigned to GPS-tracks based on speed patterns. Correlates of measured mobility data were evaluated using multiple linear regression. We calculated walking, biking and motorised transport durations based on GPS and self-reported data and compared outcomes. We used Cohen’s kappa analyses to compare categorised self-reported and GPS measured data for time spent outdoors. Results Self-reported time spent walking and biking was strongly overestimated when compared to GPS measurements. Participants estimated their time spent in motorised transport accurately. Several variables were associated with differences in mobility patterns, we found for instance that obese people (BMI > 30 kg/m2) spent less time in non-motorised transport (GMR 0.69–0.74) and people with COPD tended to travel longer distances from home in motorised transport (GMR 1.42–1.51). Conclusions If time spent walking outdoors and biking is relevant for the exposure to environmental factors, then relying on the home address as a proxy for exposure location may introduce misclassification. In addition, this misclassification is potentially differential, and specific groups of people will show stronger misclassification of exposure than others. Performing GPS measurements and identifying explanatory factors of mobility patterns may assist in regression calibration of self-reports in other studies. Electronic supplementary material The online version of this article (doi:10.1186/s12942-017-0103-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gijs Klous
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands. .,Institute for Risk Assessment Sciences (IRAS), Division Environmental Epidemiology and Veterinary Public Health (EEPI-VPH), Utrecht University, Yalelaan 2, 3584 CM, Utrecht, The Netherlands.
| | - Lidwien A M Smit
- Institute for Risk Assessment Sciences (IRAS), Division Environmental Epidemiology and Veterinary Public Health (EEPI-VPH), Utrecht University, Yalelaan 2, 3584 CM, Utrecht, The Netherlands
| | - Floor Borlée
- Institute for Risk Assessment Sciences (IRAS), Division Environmental Epidemiology and Veterinary Public Health (EEPI-VPH), Utrecht University, Yalelaan 2, 3584 CM, Utrecht, The Netherlands.,Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Roel A Coutinho
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.,Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Mirjam E E Kretzschmar
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.,National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Dick J J Heederik
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.,Institute for Risk Assessment Sciences (IRAS), Division Environmental Epidemiology and Veterinary Public Health (EEPI-VPH), Utrecht University, Yalelaan 2, 3584 CM, Utrecht, The Netherlands
| | - Anke Huss
- Institute for Risk Assessment Sciences (IRAS), Division Environmental Epidemiology and Veterinary Public Health (EEPI-VPH), Utrecht University, Yalelaan 2, 3584 CM, Utrecht, The Netherlands
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Silberschmidt S, Kumar A, Raji MM, Markides K, Ottenbacher KJ, Snih SA. Life-Space Mobility and Cognitive Decline Among Mexican Americans Aged 75 Years and Older. J Am Geriatr Soc 2017; 65:1514-1520. [PMID: 28276089 PMCID: PMC5507720 DOI: 10.1111/jgs.14829] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the association between life-space mobility and cognitive decline over a five-year period among older Mexican Americans. DESIGN Longitudinal study. SETTING Hispanic Established Population for the Epidemiologic Study of the Elderly survey conducted in the southwestern of United States (Texas, Colorado, Arizona, New Mexico, and California). PARTICIPANTS Four hundred thirty-two Mexican Americans aged 75 and older with normal or high cognitive function at baseline. MEASUREMENTS Socio-demographic factors, living arrangement, type of household, social support, financial strain, self-reported medical conditions, Mini-Mental State Examination (MMSE), depressive symptoms, activities of daily living (ADLs), and Short Physical Performance Battery. Life-space assessment (LSA) during the past 4 weeks was assessed during in-home interview. Scores ranged from 0 (daily restriction to the bedroom) to 120 (daily trips outside of their own town without assistance) and categorized as 0 to 20, 21 to 40, 41 to 60, 61 to 80, and 81 to 120. Because of the small sample size in the category of 81 to 120, the two highest categories were combined into a single group. RESULTS The mean LSA score and MMSE score of participants at baseline was 44.6 (Standard Deviation [SD], 20.7) and 25.7 (SD, 3.2), respectively. Mixed Model analyses showed that participants in the highest life-space category (≥61) experienced slower rates of cognitive decline over time compared to participants in the lowest category (0 to 20) (β = 1.03, Standard Error [SE] = 0.29, P = 0.0004), after adjusting for all covariates. CONCLUSION Greater life-space mobility at baseline was predictor of slower rates of cognitive decline over 5 years in older Mexican Americans.
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Affiliation(s)
- Seraina Silberschmidt
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX
- University of Geneva, Switzerland
| | - Amit Kumar
- Center for Gerontology and Health Care Research, Brown University, Providence, RI
| | - Mukaila M Raji
- Division of Geriatrics, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
| | - Kyriakos Markides
- University of Geneva, Switzerland
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
| | - Kenneth J. Ottenbacher
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX
| | - Soham Al Snih
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX
- Division of Geriatrics, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX
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18
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Windham BG, Harrison KL, Lirette ST, Lutsey PL, Pompeii LA, Gabriel KP, Koton S, Steffen LM, Griswold ME, Mosley TH. Relationship Between Midlife Cardiovascular Health and Late-Life Physical Performance: The ARIC Study. J Am Geriatr Soc 2017; 65:1012-1018. [PMID: 28165626 PMCID: PMC5435564 DOI: 10.1111/jgs.14732] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To examine the association between midlife cardiovascular health and physical performance 25 years later. DESIGN Cohort study (Atherosclerosis Risk in Communities Study); multinomial logistic and logistic regression adjusted for demographic characteristics and clinical measures. SETTING Four U.S. communities: Forsyth County, North Carolina; Washington County, Maryland; Minneapolis, Minnesota; and Jackson, Mississippi. PARTICIPANTS Individuals aged 54.2 ± 5.8 at baseline (N = 15,744; 55% female, 27% black). MEASUREMENTS Cardiovascular health was measured at baseline using the American Heart Association's Life's Simple 7 (LS7) score (0-14) and LS7 component categories (poor, intermediate, ideal) for each risk factor. The Short Physical Performance Battery (SPPB) was used to quantify physical function as ordinal (0-12) and categorical (low (0-6), fair (7-9), good (10-12) outcomes. RESULTS Mean baseline LS7 score was 7.9 ± 2.4; 6,144 (39%) individuals returned 25 years later for the fifth ARIC examination, at which point the SPPB was administered. Of 5,916 individuals who completed the SPPB, 3,288 (50%) had good physical performance. Each 1-unit increase in LS7 score was associated with a 17% higher SPPB score (rate ratio (RR) = 1.17, 95% confidence interval (CI) = 1.15-1.19) and a 29% greater chance of having a late-life SPPB score of 10 or greater compared to SPPB score of less than 10 (RR = 1.29, 95% CI = 1.25-1.34). Ideal baseline glucose (RR = 2.53, 95% CI = 2.24-2.87), smoking (RR = 1.97, 95% CI = 1.81-2.15), blood pressure (RR = 1.70, 95% CI = 1.54-1.88), body mass index (RR = 1.51, 95% CI = 1.37-1.66), and physical activity (RR = 1.31, 95% CI = 1.20-1.43) had the strongest associations with late-life SPPB score, adjusting for other LS7 components. CONCLUSION Better cardiovascular health during midlife may lead better physical functioning in older age.
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Affiliation(s)
- B Gwen Windham
- Dept. of Medicine, Division of Geriatrics, University of Mississippi Medical Center
| | | | - Seth T Lirette
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center
| | | | - Lisa A Pompeii
- University of Texas Health Science Center at Houston School of Public Health
| | - Kelley Pettee Gabriel
- University of Texas Health Science Center at Houston School of Public Health Austin Campus
| | | | | | - Michael E Griswold
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center
| | - Thomas H Mosley
- Dept. of Medicine, Division of Geriatrics, University of Mississippi Medical Center
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Kennedy RE, Sawyer P, Williams CP, Lo AX, Ritchie CS, Roth DL, Allman RM, Brown CJ. Life-Space Mobility Change Predicts 6-Month Mortality. J Am Geriatr Soc 2017; 65:833-838. [PMID: 28152168 DOI: 10.1111/jgs.14738] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine 6-month change in life-space mobility as a predictor of subsequent 6-month mortality in community-dwelling older adults. DESIGN Prospective cohort study. SETTING Community-dwelling older adults from five Alabama counties in the University of Alabama at Birmingham (UAB) Study of Aging. PARTICIPANTS A random sample of 1,000 Medicare beneficiaries, stratified according to sex, race, and rural or urban residence, recruited between November 1999 and February 2001, followed by a telephone interview every 6 months for the subsequent 8.5 years. MEASUREMENTS Mortality data were determined from informant contacts and confirmed using the National Death Index and Social Security Death Index. Life-space was measured at each interview using the UAB Life-Space Assessment, a validated instrument for assessing community mobility. Eleven thousand eight hundred seventeen 6-month life-space change scores were calculated over 8.5 years of follow-up. Generalized linear mixed models were used to test predictors of mortality at subsequent 6-month intervals. RESULTS Three hundred fifty-four deaths occurred within 6 months of two sequential life-space assessments. Controlling for age, sex, race, rural or urban residence, and comorbidity, life-space score and life-space decline over the preceding 6-month interval predicted mortality. A 10-point decrease in life-space resulted in a 72% increase in odds of dying over the subsequent 6 months (odds ratio = 1.723, P < .001). CONCLUSIONS Life-space score at the beginning of a 6-month interval and change in life-space over 6 months were each associated with significant differences in subsequent 6-month mortality. Life-space assessment may assist clinicians in identifying older adults at risk of short-term mortality.
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Affiliation(s)
- Richard E Kennedy
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,Comprehensive Center for Healthy Aging, Birmingham, Alabama
| | - Patricia Sawyer
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,Comprehensive Center for Healthy Aging, Birmingham, Alabama
| | - Courtney P Williams
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alexander X Lo
- Comprehensive Center for Healthy Aging, Birmingham, Alabama.,Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christine S Ritchie
- Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California.,Jewish Home San Francisco, San Francisco, California
| | - David L Roth
- Division of Geriatric Medicine and Gerontology, Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
| | - Richard M Allman
- Geriatrics and Extended Care Services, Office of Patient Care Services, Veterans Health Administration, Washington, District of Columbia
| | - Cynthia J Brown
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,Comprehensive Center for Healthy Aging, Birmingham, Alabama.,Geriatric Research, Education, and Clinical Center, Birmingham/Atlanta Veterans Affairs, Birmingham, Alabama
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20
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Polku H, Mikkola TM, Gagné JP, Rantakokko M, Portegijs E, Rantanen T, Viljanen A. Perceived Benefit From Hearing Aid Use and Life-Space Mobility Among Community-Dwelling Older Adults. J Aging Health 2016; 30:408-420. [DOI: 10.1177/0898264316680435] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: To examine the association between perceived benefit from hearing aid (HA) use and life-space mobility among older adults. Method: Cross-sectional analysis of 76- to 91-year-old community-dwelling adults ( n = 702). Data on perceived hearing with and without a HA were obtained via postal questionnaire and data on life-space mobility (Life-Space Assessment, range = 0-120) via phone interview. Results: Participants who perceived more benefit from HA use, had a better life-space mobility score ( M = 65, SD = 2.6) than participants who had less benefit from using a HA ( M = 55, SD = 3.2). Participants who benefitted more from HA use did not differ from those who did not have a HA ( M = 63, SD = 0.9) in their life-space mobility score. Discussion: Perceived benefit from HA use is associated with higher life-space mobility among community-dwelling older adults. Future studies are needed to examine whether use of an appropriate HA promotes life-space mobility among those with difficulties in hearing.
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Affiliation(s)
- Hannele Polku
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
| | - Tuija M. Mikkola
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Jean-Pierre Gagné
- École d’orthophonie et d’audiologie, Université de Montréal, Québec, Canada
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, Canada
| | - Merja Rantakokko
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
| | - Erja Portegijs
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
| | - Taina Rantanen
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
| | - Anne Viljanen
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
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Kim S, Marsh AP, Rustowicz L, Roach C, Leng XI, Kritchevsky SB, Rejeski WJ, Groban L. Self-reported Mobility in Older Patients Predicts Early Postoperative Outcomes after Elective Noncardiac Surgery. Anesthesiology 2016; 124:815-25. [PMID: 26978144 DOI: 10.1097/aln.0000000000001011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Specific geriatric assessment tools may complement traditional perioperative risk stratification. The aim of this study was to evaluate whether self-reported mobility is predictive of postoperative outcomes in older patients undergoing elective noncardiac surgery. METHODS Patients aged 69 yr or older (n = 197) underwent (1) traditional risk assessments (American Society of Anesthesiologists physical status classification and Revised Cardiac Risk Index), (2) five-point frailty evaluation, (3) self-reported mobility assessment using the Mobility Assessment Tool-short form (range, 30.21 [poor] to 69.76 [excellent]), and (4) measurements of high-sensitivity C-reactive protein. Outcomes were postoperative complications, time to discharge, and nursing home placement (NHP). RESULTS In the sample of this study (mean age, 75 ± 5 yr; 51% women), 72% had intermediate- or high-risk surgery. Median time to discharge was 3 days (interquartile range, 1 to 4 days). Thirty patients (15%) developed postoperative complications, and 27 (13%) required NHP. After controlling for age, sex, body mass index, pain score, Revised Cardiac Risk Index, American Society of Anesthesiologist physical status, surgical risk, and high-sensitivity C-reactive protein, worse self-reported mobility (per 10-point decrease in Mobility Assessment Tool, which is equivalent to 1 SD) was associated with more postoperative complications (odds ratio [OR], 1.69; 95% CI, 1.05 to 2.73), later time to discharge (hazards ratio, 0.81; 95% CI, 0.68 to 0.96), and increased NHP (OR, 2.01; 95% CI, 1.13 to 3.56). By using the same model, intermediate frailty or frailty increased NHP (OR, 3.11; 95% CI, 1.02 to 9.54) but was not related to either postoperative complications or time to discharge. CONCLUSIONS Preoperative self-reported mobility using a novel and brief assessment may help identify elderly patients at risk for adverse postoperative events.
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Affiliation(s)
- Sunghye Kim
- From the Department of Internal Medicine, Section of General Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.K.); Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, North Carolina (A.P.M., X.I.L., S.B.K., W.J.R., L.G.); Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina (A.P.M., W.J.R.); Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina (L.R., C.R., L.G.); Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina (X.I.L.); Department of Internal Medicine, Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.B.K.); Department of Internal Medicine, Section of Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (L.G.); and Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina (L.G.)
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22
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Lanzino D, Sander E, Mansch B, Jones A, Gill M, Hollman J. Life Space Assessment in Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2016; 22:173-182. [PMID: 29339859 DOI: 10.1310/sci2203-173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objectives: To examine the Life Space Assessment (LSA) in persons with spinal cord injury (SCI), exploring its psychometric properties, differences between persons with cervical versus thoracolumbar injuries, and cutoff score differentiating a restricted from an unrestricted life space. Method: We conducted a test-retest reliability study in a community setting involving 50 persons with SCI (25 injured above C7, 25 injured below T1). Data were collected in 2 phone interviews approximately 9 days apart using the LSA. Results: Mean LSA scores were 66 ± 25 (n = 50): 62 ± 23 for the cervical group, and 70 ± 25 for the thoracolumbar group. Scores were not significantly different between phone interviews [t(49) = 0.379, p = .706] or between groups [t(48) = -1.214, p = .231]. Test-retest reliability intraclass correlation coefficient (ICC) was 0.876 (95% CI, 0.792-0.928). Spearman's rho correlations between the LSA and Reintegration to Normal Living Index total and subscores ranged from .509 to .538 (p < .001). LSA scores were normally distributed. The minimum detectable change was approximately 23 points. A cutoff score of 78.5 (sensitivity 76.9%, specificity 81.1%) differentiated between persons with a restricted from an unrestricted life space if equipment and personal assistance were not needed for mobility. If equipment was needed, the cutoff score was found to be 49 (sensitivity of 90%, specificity of 90%). Conclusions: The LSA is a reliable and valid measure of life space in persons with SCI and can be used to identify persons with a restricted life space who may be at increased risk of mobility disability.
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Affiliation(s)
- Desiree Lanzino
- Mayo School of Health Sciences, College of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth Sander
- Minneapolis Veteran's Administration Health Care System, Physical Medicine and Rehabilitation, Minneapolis, Minnesota
| | - Bethany Mansch
- Allina Health: Mercy Hospital - Sister Kenny Rehabilitation Institute, Coon Rapids, Minnesota
| | - Ashley Jones
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Megan Gill
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - John Hollman
- Mayo School of Health Sciences, College of Medicine, Mayo Clinic, Rochester, Minnesota
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Tsai LT, Rantakokko M, Rantanen T, Viljanen A, Kauppinen M, Portegijs E. Objectively Measured Physical Activity and Changes in Life-Space Mobility Among Older People. J Gerontol A Biol Sci Med Sci 2016; 71:1466-1471. [PMID: 26975981 DOI: 10.1093/gerona/glw042] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 02/19/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Our aim was to study the relationship between objectively measured physical activity and subsequent changes in life-space mobility over 2 years among older people. Life-space mobility refers to the area a person moves through in daily life, taking into account frequency, and need of assistance. Life-space mobility and physical activity correlate, but whether different intensities of objectively assessed physical activity predicts decline in life-space mobility is not known. METHODS Prospective cohort study of the "Life-space Mobility in Old Age" (LISPE) project accelerometer substudy. Participants were community-dwelling older people aged 75-90 (n = 164). Life-space mobility was measured with the Life-Space Assessment at baseline face-to-face home interview and telephone follow-up interviews 1 and 2 years after baseline. Physical activity (step count and time spent in moderate activity, low activity, and sedentary behavior) was measured by a tri-axial accelerometer (Hookie "AM20 Activity Meter") for 7 days at baseline. Generalized estimating equations (GEE models) were used to compare changes in life-space mobility between participants categorized according to the baseline physical activity measures. RESULTS Median age of the participants was 79.5 (IQR 6.7) and 64% were women. Over the 2 years, life-space mobility declined significantly among those with lower step counts and less time spent in moderate activity measured at baseline. Time spent in low activity and sedentary behavior did not predict changes in life-space mobility. CONCLUSIONS In old age, more time spent walking outdoors and accumulation of moderate-intensity physical activity may help to maintain higher life-space mobility, a correlate of good quality of life.
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Affiliation(s)
- Li-Tang Tsai
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland.
| | - Merja Rantakokko
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
| | - Taina Rantanen
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
| | - Anne Viljanen
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
| | - Markku Kauppinen
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
| | - Erja Portegijs
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
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24
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Polku H, Mikkola TM, Rantakokko M, Portegijs E, Törmäkangas T, Rantanen T, Viljanen A. Self-reported hearing difficulties and changes in life-space mobility among community-dwelling older adults: a Two-year follow-Up study. BMC Geriatr 2015; 15:121. [PMID: 26459630 PMCID: PMC4603343 DOI: 10.1186/s12877-015-0119-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 10/06/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Life-space mobility reflects individuals' actual mobility and engagement with society. Difficulty in hearing is common among older adults and can complicate participation in everyday activities, thus restricting life-space mobility. The aim of this study was to examine whether self-reported hearing predicts changes in life-space mobility among older adults. METHODS We conducted a prospective cohort study of community-dwelling older adults aged 75-90 years (n = 848). At-home face-to-face interviews at baseline and telephone follow-up were used. Participants responded to standardized questions on perceived hearing at baseline. Life-space mobility (the University of Alabama at Birmingham Life-Space Assessment, LSA, range 0-120) was assessed at baseline and one and two years thereafter. Generalized estimating equations were used to analyze the effect of hearing difficulties on changes in LSA scores. RESULTS At baseline, participants with major hearing difficulties had a significantly lower life-space mobility score than those without hearing difficulties (mean 54, 95 % CI 50-58 vs. 57, 95 % CI 53-61, p = .040). Over the 2-year follow-up, the life-space mobility score declined in all hearing categories in a similar rate (main effect of time p < .001, group x time p = .164). Participants with mild or major hearing difficulties at baseline had significantly higher odds for restricted life-space (LSA score < 60) at two years (OR 1.8, 95 % CI 1.0-3.2 and 2.0, 95 % CI 1.0-3.9, respectively) compared to those without hearing difficulties. The analyses were adjusted for chronic conditions, age, sex and cognitive functioning. CONCLUSIONS People with major hearing difficulties had lower life-space mobility scores at baseline but did not exhibit accelerated decline over the follow-up compared to those without hearing difficulties. Life-space mobility describes older people's possibilities for participating in out-of-home activities and access to community amenities, which are important building blocks of quality of life in old age. Early recognition of hearing difficulties may help prevent life-space restriction.
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Affiliation(s)
- Hannele Polku
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, P.O. Box 35, FI-40014, Jyväskylä, Finland.
| | - Tuija M Mikkola
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, P.O. Box 35, FI-40014, Jyväskylä, Finland.
| | - Merja Rantakokko
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, P.O. Box 35, FI-40014, Jyväskylä, Finland.
| | - Erja Portegijs
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, P.O. Box 35, FI-40014, Jyväskylä, Finland.
| | - Timo Törmäkangas
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, P.O. Box 35, FI-40014, Jyväskylä, Finland.
| | - Taina Rantanen
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, P.O. Box 35, FI-40014, Jyväskylä, Finland.
| | - Anne Viljanen
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, P.O. Box 35, FI-40014, Jyväskylä, Finland.
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25
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Pilot study on the Chinese version of the Life Space Assessment among community-dwelling elderly. Arch Gerontol Geriatr 2015; 61:301-6. [DOI: 10.1016/j.archger.2015.06.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 06/15/2015] [Accepted: 06/18/2015] [Indexed: 11/20/2022]
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26
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McCaskill GM, Sawyer P, Burgio KL, Kennedy R, Williams CP, Clay OJ, Brown CJ, Allman RM. The Impact of Veteran Status on Life-Space Mobility among Older Black and White Men in the Deep South. Ethn Dis 2015; 25:255-62. [PMID: 26675739 DOI: 10.18865/ed.25.3.255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To examine life-space mobility over 8.5 years among older Black and White male veterans and non-veterans in the Deep South. DESIGN A prospective longitudinal study of community-dwelling Black and White male adults aged >65 years (N=501; mean age=74.9; 50% Black and 50% White) enrolled in the University of Alabama at Birmingham (UAB) Study of Aging. Data from baseline in-home assessments with follow-up telephone assessments of life-space mobility completed every 6 months were used in linear mixed-effects modeling analyses to examine life-space mobility trajectories. MAIN OUTCOME MEASURES Life-space mobility. RESULTS In comparison to veterans, non-veterans were more likely to be Black, single, and live in rural areas. They also reported lower income and education. Veterans had higher baseline life-space (73.7 vs 64.9 for non-veterans; P<.001). Race-veteran subgroup analyses revealed significant differences in demographics, comorbidity, cognition, and physical function. Relative to Black veterans, there were significantly greater declines in life-space trajectories for White non-veterans (P=.009), but not for White veterans (P=.807) nor Black non-veterans (P=.633). Mortality at 8.5 years was 43.5% for veterans and 49.5% for non-veterans (P=.190) with no significant differences by race-veteran status. CONCLUSIONS Veterans had significantly higher baseline life-space mobility. There were significantly greater declines in life-space trajectories for White non-veterans in comparison to other race-veteran subgroups. Black veterans and non-veterans did not have significantly different trajectories.
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Affiliation(s)
- Gina M McCaskill
- 1. Birmingham/Atlanta VA GRECC ; 2. Comprehensive Center for Healthy Aging, University of Alabama at Birmingham ; 3. UAB Division of Gerontology, Geriatrics, and Palliative Care
| | - Patricia Sawyer
- 2. Comprehensive Center for Healthy Aging, University of Alabama at Birmingham ; 3. UAB Division of Gerontology, Geriatrics, and Palliative Care
| | - Kathryn L Burgio
- 1. Birmingham/Atlanta VA GRECC ; 2. Comprehensive Center for Healthy Aging, University of Alabama at Birmingham ; 3. UAB Division of Gerontology, Geriatrics, and Palliative Care
| | - Richard Kennedy
- 2. Comprehensive Center for Healthy Aging, University of Alabama at Birmingham ; 3. UAB Division of Gerontology, Geriatrics, and Palliative Care
| | | | - Olivio J Clay
- 2. Comprehensive Center for Healthy Aging, University of Alabama at Birmingham ; 4. University of Alabama at Birmingham, Department of Psychology
| | - Cynthia J Brown
- 1. Birmingham/Atlanta VA GRECC ; 2. Comprehensive Center for Healthy Aging, University of Alabama at Birmingham ; 3. UAB Division of Gerontology, Geriatrics, and Palliative Care
| | - Richard M Allman
- 5. Geriatrics and Extended Care Services, Office of Patient Care Services, Veterans Health Administration, Washington, DC
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Choi M, O'Connor ML, Mingo CA, Mezuk B. Gender and Racial Disparities in Life-Space Constriction Among Older Adults. THE GERONTOLOGIST 2015; 56:1153-1160. [PMID: 26185148 DOI: 10.1093/geront/gnv061] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 04/14/2015] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY "Life-space" is the spatial area through which a person experiences and interacts with the world. Life-space constriction, the shrinking of the spatial area that a person traverses, is associated with negative health outcomes in later life. Racial and gender disparities in mobility as indicated by life-space constriction are thought to contribute to broader disparities in health and functioning among older adults. DESIGN AND METHODS Data come from the 5-year follow-up of the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Study (N = 2,765; mean age = 73.6; 75.8% women; 73.7% White). Life-space constriction was defined as "not traveling beyond one's town." A series of logistic regression and Cox proportional hazard models were used to estimate risk for incident life-space constriction by race and gender. RESULTS Blacks and women had greater likelihood of life-space constriction at baseline. Women were more likely to experience incident life-space constriction at follow-up relative to men (Hazard ratio [HR]: 1.89, 95% Confidence interval [CI]: 1.26-2.83). Blacks were associated with lower risk of life-space constriction over time (HR: 0.67, 95% CI: 0.45-0.99) relative to Whites. IMPLICATIONS Disparities in life-space constriction by gender and race exist in later life. Understanding the processes underlying these mobility restrictions is important to developing intervention programs to enhance health and functioning for older adults.
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Affiliation(s)
- Moon Choi
- Graduate School of Science and Technology Policy, Korea Advanced Institute of Science and Technology, Daejeon, South Korea. .,College of Social Work, University of Kentucky, Lexington
| | - Melissa L O'Connor
- Department of Human Development and Family Science, North Dakota State University, Fargo
| | - Chivon A Mingo
- Gerontology Institute, Georgia State University, Atlanta
| | - Briana Mezuk
- Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, Virginia.,Institute for Social Research, University of Michigan, Ann Arbor
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Race Differences: Use of Walking Speed to Identify Community-Dwelling Women at Risk for Poor Health Outcomes--Osteoarthritis Initiative Study. Phys Ther 2015; 95:955-65. [PMID: 25655879 PMCID: PMC4498144 DOI: 10.2522/ptj.20140028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 01/28/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND Onset of disability, risk for future falls, frailty, functional decline, and mortality are strongly associated with a walking speed of less than 1.0 m/s. OBJECTIVE The study objective was to determine whether there were differences in slow walking speed (<1.0 m/s) between community-dwelling African American and white American adult women with osteoarthritis symptoms. An additional aim was to examine whether racial differences in walking speed can be attributed to age, obesity, socioeconomic factors, disease severity, or comorbidities. DESIGN A cross-sectional design was used. METHODS Community-dwelling adults were recruited from Baltimore, Maryland; Columbus, Ohio; Pittsburgh, Pennsylvania; and Pawtucket, Rhode Island. Participants were 2,648 women (23% African American) who were 45 to 79 years of age and had a self-selected baseline walking speed of 20 m/s in the Osteoarthritis Initiative Study. Mixed-effects logistic regression models were used to examine racial differences in walking speed (<1.0 m/s versus ≥1.0 m/s), with adjustments for demographic factors, socioeconomic factors, disease severity, and comorbidities. RESULTS Walking speed was significantly slower for African American women than for white American women (mean walking speed=1.19 and 1.33 m/s, respectively). The prevalence of a walking speed of less than 1.0 m/s in this cohort of middle-aged women was 9%; about 50% of the women with a walking speed of less than 1.0 m/s were younger than 65 years. Women with a walking speed of less than 1.0 m/s had lower values for socioeconomic factors, higher values for disease severity, and higher prevalences of obesity and comorbidities than those with a walking speed of ≥1.0 m/s. After controlling for these covariates, it was found that African American women were 3 times (odds ratio=2.9; 95% confidence interval=2.0, 4.1) more likely to have a walking speed of less than 1.0 m/s than white American women. LIMITATIONS The study design made it impossible to know whether a walking speed of less than 1.0 m/s in women who were 45 years of age or older was a predictor of future poor health outcomes. CONCLUSIONS In this study, race was independently associated with a walking speed of less than 1.0 m/s in community-dwelling women who had or were at risk for osteoarthritis, with African American women having 3 times the risk for slow walking as white American women. This finding suggests that middle-aged African American women have an increased risk for poor health outcomes. Further longitudinal evaluations are needed to confirm the long-term health outcomes in a middle-aged population and to establish walking speed as a useful tool for identifying middle-aged women at high risk for poor health outcomes.
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Higher mobility scores in patients with cystic fibrosis are associated with better lung function. Pulm Med 2015; 2015:423219. [PMID: 25789173 PMCID: PMC4348578 DOI: 10.1155/2015/423219] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 01/20/2015] [Accepted: 01/21/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine whether mobility and physical activity were associated with lung function in adults with cystic fibrosis (CF). DESIGN This was a prospective cohort observational study in an urban, academic, specialized care center. Participants were ambulatory, nonhospitalized adults with CF. MAIN OUTCOME MEASURES Mobility was assessed monthly by the Life-Space Assessment (LSA) questionnaire and quarterly by pedometer. Lung function was assessed by spirometry. RESULTS Twenty-seven subjects participated. Subjects recorded mean pedometer steps of 20,213 ± 11,331 over three days and FEV1% predicted of 77.48% ± 22.60% over one year. The LSA score at enrollment was correlated with initial pedometer steps (r = 0.42 and P = 0.03), and mean LSA score over one year was correlated with mean number of steps (r = 0.51 and P = 0.007). LSA mobility and pedometer scores were correlated with FEV1% predicted at enrollment and throughout the study. CONCLUSIONS Mobility and physical activity measured by LSA questionnaire and pedometer are positively associated with lung function in adults with CF. This study confirms the importance of mobility and physical activity and supports the utility of a simple office-based questionnaire as a measure of mobility in adults with CF.
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Tsai LT, Portegijs E, Rantakokko M, Viljanen A, Saajanaho M, Eronen J, Rantanen T. The association between objectively measured physical activity and life-space mobility among older people. Scand J Med Sci Sports 2014; 25:e368-73. [DOI: 10.1111/sms.12337] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2014] [Indexed: 11/28/2022]
Affiliation(s)
- L.-T. Tsai
- Gerontology Research Center; Department of Health Sciences; University of Jyväskylä; Jyväskylä Finland
| | - E. Portegijs
- Gerontology Research Center; Department of Health Sciences; University of Jyväskylä; Jyväskylä Finland
| | - M. Rantakokko
- Gerontology Research Center; Department of Health Sciences; University of Jyväskylä; Jyväskylä Finland
| | - A. Viljanen
- Gerontology Research Center; Department of Health Sciences; University of Jyväskylä; Jyväskylä Finland
| | - M. Saajanaho
- Gerontology Research Center; Department of Health Sciences; University of Jyväskylä; Jyväskylä Finland
| | - J. Eronen
- Gerontology Research Center; Department of Health Sciences; University of Jyväskylä; Jyväskylä Finland
| | - T. Rantanen
- Gerontology Research Center; Department of Health Sciences; University of Jyväskylä; Jyväskylä Finland
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Wheeler TL, Illston JD, Markland AD, Goode PS, Richter HE. Life Space Assessment in Older Women Undergoing Non-Surgical Treatment for Urinary Incontinence. ACTA ACUST UNITED AC 2014; 4:809-816. [PMID: 25525562 DOI: 10.4236/ojog.2014.414112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Urinary incontinence (UI) impacts all aspects of life activities. This study aims to characterize change in mobility within the community utilizing the Life Space Assessment (LSA) questionnaire in women undergoing non-surgical UI treatment. DESIGN Prospective cohort study, performed from July 2007 to March 2009, which followed women seeking non-surgical UI treatment and assessed their mobility and symptoms using LSA, Urogenital Distress Inventory (UDI-6), and Incontinence Impact Questionnaire (IIQ-7) at baseline and 2, 6, and 12 months post-treatment. Estimated Percent Improvement (EPI) and Patient Satisfaction Question (PSQ) were obtained post-treatment. SETTING Outpatient tertiary-care clinic. PARTICIPANTS 70 ambulatory, community-dwelling women, aged 65 years or older, seeking non-surgical care for UI. INTERVENTION Multi-component behavioral and/or pharmacologic therapies. MEASUREMENTS We hypothesized LSA would improve with treatment. Repeated measures analysis with Tukey's HSD and backwards selection linear regression model were performed. RESULTS LSA score decreased from baseline to 2 months (mean±SD; 63±29 to 56±28, p<0.001) and was sustained at 6 and 12 months (54±28, 54±28). UDI scores improved from 36±23 to 25±24, p<0.001, at 2 months, and improvement persisted at 6 and 12 months (22±22, 21±24). Improvements in UDI and patient perceived improvement in UI were not associated with LSA change. Age, race, and depression impacted LSA, which decreased 1-point for each additional year of age (p=0.004), 6-points for each point higher on the Geriatric Depression Scale (GDS) (p=0.002), and 6-points for African American race (p=0.048). CONCLUSION Decreased mobility represented by LSA was related to age, depression, and race, but not UI symptom improvement.
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Affiliation(s)
- Thomas L Wheeler
- Department of Obstetrics and Gynecology, University of South Carolina School of Medicine-Greenville, Greenville, SC
| | - Jana D Illston
- Department of Obstetrics and Gynecology, University of South Carolina School of Medicine-Greenville, Greenville, SC
| | - Alayne D Markland
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL
| | - Patricia S Goode
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL
| | - Holly E Richter
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
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Rosso AL, Tabb LP, Grubesic TH, Taylor JA, Michael YL. Neighborhood social capital and achieved mobility of older adults. J Aging Health 2014; 26:1301-19. [PMID: 25502243 PMCID: PMC9773217 DOI: 10.1177/0898264314523447] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Evaluate associations of neighborhood social capital and mobility of older adults. METHOD A community-based survey (Philadelphia, 2010) assessed mobility (Life-Space Assessment [LSA]; range = 0-104) of older adults (n = 675, census tracts = 256). Social capital was assessed for all adults interviewed from 2002-2010 (n = 13,822, census tracts = 374). Generalized estimating equations adjusted for individual- and neighborhood-level characteristics estimated mean differences and 95% confidence intervals (CIs) in mobility by social capital tertiles. Interactions by self-rated health, living arrangement, and race were tested. RESULTS Social capital was not associated with mobility after adjustment for other neighborhood characteristics (mean difference for highest versus lowest tertile social capital = 0.79, 95% CI = [-3.3, 4.8]). We observed no significant interactions. In models stratified by race, Black participants had higher mobility in high social capital neighborhoods (mean difference = 7.4, CI = [1.0, 13.7]). DISCUSSION Social capital may not contribute as much as other neighborhood characteristics to mobility. Interactions between neighborhood and individual-level characteristics should be considered in research on mobility.
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Affiliation(s)
- Andrea L. Rosso
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, USA
| | - Loni P. Tabb
- Department of Epidemiology and Biostatistics, School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Tony H. Grubesic
- Geographic Information Systems and Spatial Analysis Laboratory, College of Information Science and Technology, Drexel University, Philadelphia, PA, USA
| | - Jennifer A. Taylor
- Department of Epidemiology and Biostatistics, School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Yvonne L. Michael
- Department of Epidemiology and Biostatistics, School of Public Health, Drexel University, Philadelphia, PA, USA
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Portegijs E, Iwarsson S, Rantakokko M, Viljanen A, Rantanen T. Life-space mobility assessment in older people in Finland; measurement properties in winter and spring. BMC Res Notes 2014; 7:323. [PMID: 24886670 PMCID: PMC4055210 DOI: 10.1186/1756-0500-7-323] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 05/22/2014] [Indexed: 11/10/2022] Open
Abstract
Background Life-space mobility refers to the spatial area an individual moves through, the frequency and need for assistance. Based on the assumption that measurement scale properties are context-specific, we tested the scale distribution, responsiveness, and reproducibility of the 15-item University of Alabama at Birmingham Study of Aging Life-Space Assessment in older people in Finland, specifically accounting for season. Methods Community-dwelling older men and women in central Finland aged 75-90 years were interviewed to determine life-space mobility (score range 0-120). Baseline (January-June 2012) and one-year follow-up data (January-June 2013; n = 806) from the cohort study “Life-space mobility in old age” were used to investigate the scale distribution and responsiveness over a period of one year. In addition, with a sub-sample in conjunction with the one-year follow-up, we collected data to study the two-week test-retest reproducibility (n = 18 winter and n = 21 spring 2013). Results The median life-space mobility score at baseline was 64. The median change in score over the one-year follow-up was zero. However, participants reporting a decline in health (repeated measures ANOVA p = .016) or mobility (p = .002) status demonstrated a significantly larger decrease in life-space mobility score than those reporting no or positive changes over the year. The two-week intra-class correlation (ICC) coefficient was .72. Lower ICC was found in the winter than in the spring sample and for items that represent higher life-space levels. Conclusions The test-retest reproducibility of the Life-Space Assessment was fair but somewhat compromised in the winter. Mobility of older people at the life-space levels of “town” and “beyond town” may be more variable. Life-space mobility was responsive to change, regardless of season. Further study is warranted to obtain insight in the factors contributing to seasonal effects.
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Affiliation(s)
- Erja Portegijs
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, P,O, Box 35 (viv), Jyväskylä FI-40014, Finland.
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Liddle J, Ireland D, McBride SJ, Brauer SG, Hall LM, Ding H, Karunanithi M, Hodges PW, Theodoros D, Silburn PA, Chenery HJ. Measuring the lifespace of people with Parkinson's disease using smartphones: proof of principle. JMIR Mhealth Uhealth 2014; 2:e13. [PMID: 25100206 PMCID: PMC4114414 DOI: 10.2196/mhealth.2799] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 01/21/2014] [Accepted: 02/07/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Lifespace is a multidimensional construct that describes the geographic area in which a person lives and conducts their activities, and reflects mobility, health, and well-being. Traditionally, it has been measured by asking older people to self-report the length and frequency of trips taken and assistance required. Global Positioning System (GPS) sensors on smartphones have been used to measure Lifespace of older people, but not with people with Parkinson's disease (PD). OBJECTIVE The objective of this study was to investigate whether GPS data collected via smartphones could be used to indicate the Lifespace of people with PD. METHODS The dataset was supplied via the Michael J Fox Foundation Data Challenge and included 9 people with PD and 7 approximately matched controls. Participants carried smartphones with GPS sensors over two months. Data analysis compared the PD group and the control group. The impact of symptom severity on Lifespace was also investigated. RESULTS Visualization methods for comparing Lifespace were developed including scatterplots and heatmaps. Lifespace metrics for comparison included average daily distance, percentage of time spent at home, and number of trips into the community. There were no significant differences between the PD and the control groups on Lifespace metrics. Visual representations of Lifespace were organized based on the self-reported severity of symptoms, suggesting a trend of decreasing Lifespace with increasing PD symptoms. CONCLUSIONS Lifespace measured by GPS-enabled smartphones may be a useful concept to measure the progression of PD and the impact of various therapies and rehabilitation programs. Directions for future use of GPS-based Lifespace are provided.
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Affiliation(s)
- Jacki Liddle
- UQ Centre for Clinical Research, Asia-Pacific Centre for Neuromodulation, The University of Queensland, Herston, QLD, Australia.
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Garrett SL, Sawyer P, Kennedy RE, McGuire D, Simon RP, Strothers HS, Allman RM. Racial and sex differences in associations between activities of daily living and cognition in community-dwelling older adults. J Am Geriatr Soc 2014; 61:2174-2180. [PMID: 24479147 DOI: 10.1111/jgs.12543] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the association between function measured according to activities of daily living (ADLs), instrumental activ1ities of daily living (IADLs), and cognition assessed according to Mini-Mental State Examination (MMSE) scores of older African-American and non-Hispanic white community-dwelling men and women. DESIGN Cross-sectional study assessing associations between self-reported ADL and IADL difficulty and MMSE scores for race- and sex-specific groups. SETTING Homes of community-dwelling older adults. PARTICIPANTS A random sample of 974 African-American and non-Hispanic white Medicare beneficiaries aged 65 and older living in west-central Alabama and participating in the University of Alabama at Birmingham Study of Aging, excluding those with reported diagnoses of dementia or with missing data. MEASUREMENTS Function, based on self-reported difficulty in performing ADLs and IADLs, and cognition, using the MMSE. Multivariable linear regression models were used to test the association between function and cognition in race- and sex-specific groups after adjusting for covariates. RESULTS Mini-Mental State Examination scores were modestly correlated with ADL and IADL difficulty in all four race- and sex-specific groups, with Pearson correlation coefficients ranging from −0.189 for non-Hispanic white women to −0.429 for African-American men. Correlations between MMSE and ADL or IADL difficulty in any of the race- and sex-specific groups were no longer significant after controlling for sociodemographic factors and comorbidities. CONCLUSION Mini-Mental State Examination was not significantly associated with functional difficulty in older African-American and non-Hispanic white men and women after adjusting for sociodemographic factors and comorbidities, suggesting a mediating role in the relationship between cognition and function.
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Affiliation(s)
- Stephanie L Garrett
- Department of Family Medicine, National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia
| | - Patricia Sawyer
- Comprehensive Center for Healthy Aging, Gerontology Education Program, University of Alabama at Birmingham, Birmingham, Alabama.,Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - Richard E Kennedy
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - Dawn McGuire
- Neuroscience Institute, Morehouse School of Medicine, Atlanta, Georgia
| | - Roger P Simon
- Translational Programs in Stroke, Morehouse School of Medicine, Atlanta, Georgia.,Department of Medicine (Neurology), Morehouse School of Medicine, Atlanta, Georgia.,Department of Neurobiology, Morehouse School of Medicine, Atlanta, Georgia
| | - Harry S Strothers
- Department of Family Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Richard M Allman
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama.,Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center, Birmingham, Alabama.,Comprehensive Center for Healthy Aging, Deep South Resource Center for Minority Aging Research, University of Alabama at Birmingham, Birmingham, Alabama.,Southeast Center of Excellence in Geriatric Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Deshpande N, Metter JE, Guralnik J, Bandinelli S, Ferrucci L. Sensorimotor and psychosocial determinants of 3-year incident mobility disability in middle-aged and older adults. Age Ageing 2014; 43:64-9. [PMID: 24042004 DOI: 10.1093/ageing/aft135] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE to identify sensorimotor and psychosocial determinants of 3-year incident mobility disability. DESIGN prospective. SETTING population-based sample of community-dwelling older persons. PARTICIPANTS community-living middle-aged and older persons (age: 50-85 years) without baseline mobility disability (n = 622). MEASUREMENTS mobility disability, defined as self-reported inability to walk a quarter mile without resting or inability to walk up a flight of stairs unsupported, was ascertained at baseline and 3-year follow-up. Potential baseline determinant characteristics included demographics, education, social support, financial condition, knee extensor strength, visual contrast sensitivity, cognition, depression, presence of chronic conditions and history of falls. RESULTS a total of 13.5% participant reported 3-year incident mobility disability. Age ≥75 years, female sex, knee extensor strength in the lowest quartile, visual contrast sensitivity <1.7 on the Pelli-Robson chart or significant depressive symptoms (CESD score >16) were independent determinants of 3-year incident mobility disability (ORs 1.84-16.51). CONCLUSIONS low visual contrast sensitivity, poor knee extensor strength and significant depressive symptoms are independent determinants of future onset of mobility disability.
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Affiliation(s)
- Nandini Deshpande
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
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Sun F, Park NS, Wardian J, Lee BS, Roff LL, Klemmack DL, Parker MW, Koenig HG, Sawyer PL, Allman RM. Predicting the Trajectories of Perceived Pain Intensity in Southern Community-Dwelling Older Adults: The Role of Religiousness. Res Aging 2013; 35. [PMID: 24187410 DOI: 10.1177/0164027512456402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study focuses on the identification of multiple latent trajectories of pain intensity, and it examines how religiousness is related to different classes of pain trajectory. Participants were 720 community-dwelling older adults who were interviewed at four time points over a 3-year period. Overall, intensity of pain decreased over 3 years. Analysis using latent growth mixture modeling (GMM) identified three classes of pain: (1) increasing (n = 47); (2) consistently unchanging (n = 292); and (3) decreasing (n = 381). Higher levels of intrinsic religiousness (IR) at baseline were associated with higher levels of pain at baseline, although it attenuated the slope of pain trajectories in the increasing pain group. Higher service attendance at baseline was associated with a higher probability of being in the decreasing pain group. The increasing pain group and the consistently unchanging group reported more negative physical and mental health outcomes than the decreasing pain group.
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Rosso AL, Grubesic TH, Auchincloss AH, Tabb LP, Michael YL. Neighborhood amenities and mobility in older adults. Am J Epidemiol 2013; 178:761-9. [PMID: 23666814 DOI: 10.1093/aje/kwt032] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Diversity of neighborhood amenities may promote the mobility of older adults. A 2010 community-based sample of 510 adults aged ≥65 years in Philadelphia, Pennsylvania, and geospatial data from the Esri Business Analyst database (Esri, Inc., Redlands, California) were used to assess associations of neighborhood amenity diversity with mobility. Neighborhoods were defined by census tract, and diversity of amenities was derived by using the Leadership in Energy and Environmental Design's neighborhood development index (US Green Building Council, Washington, DC). Generalized estimating equations adjusted for demographic, socioeconomic, and neighborhood characteristics were used to estimate differences in mobility score by tertile of amenity diversity. Analyses were stratified by participants' routine travel habits (stayed at home, stayed in home zip code, or traveled beyond home zip code). We found that for those who spent most of their time in their home neighborhoods, mobility scores (from the Life-Space Assessment, which ranges from 0 to 104 points) were 8.3 points higher (95% confidence interval: 0.1, 16.6) among those who lived in neighborhoods with the most amenity diversity compared with those who lived in neighborhoods with the least amenity diversity. No significant associations between amenity diversity and mobility were observed for those who did not leave home or who regularly traveled outside their neighborhoods. Neighborhoods with a high diversity of amenities may be important promoters of mobility in older adults who do not routinely travel outside their neighborhoods.
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Affiliation(s)
- Andrea L Rosso
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
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Rosso AL, Taylor JA, Tabb LP, Michael YL. Mobility, disability, and social engagement in older adults. J Aging Health 2013; 25:617-37. [PMID: 23548944 DOI: 10.1177/0898264313482489] [Citation(s) in RCA: 178] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine cross sectional associations between mobility with or without disability and social engagement in a community-based sample of older adults. METHODS Social engagement of participants (n = 676) was outside the home (participation in organizations and use of senior centers) and in home (talking by phone and use of Internet). Logistic or proportional odds models evaluated the association between social engagement and position in the disablement process (no mobility limitations, mobility limitations/no disability, and mobility limitations/disability). RESULTS Low mobility was associated with lower level of social engagement of all forms (Odds ratio (OR) = 0.59, confidence intervals (CI): 0.41-0.85 for organizations; OR = 0.67, CI: 0.42-1.06 for senior center; OR = 0.47, CI: 0.32-0.70 for phone; OR = 0.38, CI: 0.23-0.65 for Internet). For social engagement outside the home, odds of engagement were further reduced for individuals with disability. DISCUSSION Low mobility is associated with low social engagement even in the absence of disability; associations with disability differed by type of social engagement.
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Affiliation(s)
- Andrea L Rosso
- Center for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Wan N, Qu W, Whittington J, Witbrodt BC, Henderson MP, Goulding EH, Schenk AK, Bonasera SJ, Lin G. Assessing Smart Phones for Generating Life-space Indicators. ACTA ACUST UNITED AC 2013; 40:350-361. [PMID: 28819332 DOI: 10.1068/b38200] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Life-space is a promising method for estimating older adults' functional status. However, traditional life-space measures are costly and time consuming because they often rely on active subject participation. This study assesses the feasibility of using the global positioning system (GPS) function of smart phones to generate life-space indicators. We first evaluated the location accuracy of smart phone collected GPS points versus those acquired by a commercial GPS unit. We then assessed the specificity of the smart phone processed life-space information against the traditional diary method. Our results suggested comparable location accuracy between the smart phone and the standard GPS unit in most outdoor situations. In addition, the smart phone method revealed more comprehensive life-space information than the diary method, which leads to higher and more consistent life-space scores. We conclude that the smart phone method is more reliable than traditional methods for measuring life-space. Further improvements will be required to develop a robust application of this method that is suitable for health-related practices.
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Affiliation(s)
- Neng Wan
- The University of Nebraska Medical Center, Department of Health Services Research & Administration, College of Public Health, 984350 University of Nebraska Medical Center, Omaha, NE 68198-4350
| | - Wenyu Qu
- Department of Biological Sciences, College of Arts of Science, Vanderbilt University, Nashville, TN 37240
| | - Jackie Whittington
- The University of Nebraska Medical Center, Department of Internal Medicine, Division of Geriatrics, 3028 Durham Research Center II, University of Nebraska Medical Center, Omaha, NE 68198-5039
| | - Bradley C Witbrodt
- The University of Nebraska, College of Medicine, 986155 Nebraska Medical Center, Omaha, NE 68198-6155
| | | | - Evan H Goulding
- Northwestern University, Department of Psychiatry and Behavioral Sciences, 446 E. Ontario, Chicago IL 60611
| | - A Katrin Schenk
- Randolph College, Department of Physics, 2500 Rivermont Ave, Lynchburg, VA 24503
| | - Stephen J Bonasera
- The University of Nebraska Medical Center, Department of Internal Medicine, Division of Geriatrics, 3028 Durham Research Center II, University of Nebraska Medical Center, Omaha, NE 68198-5039
| | - Ge Lin
- The University of Nebraska Medical Center, Department of Health Services Research & Administration, College of Public Health, 984350 University of Nebraska Medical Center, Omaha, NE 68198-4350
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Skarupski KA, Fitchett G, Evans DA, de Leon CFM. Race differences in the association of spiritual experiences and life satisfaction in older age. Aging Ment Health 2013; 17:888-95. [PMID: 23627686 PMCID: PMC4545598 DOI: 10.1080/13607863.2013.793285] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The primary objective of this study was to examine an African American 'faith advantage' in life satisfaction. Specifically, we sought to test the hypothesis that the positive relationship between spiritual experiences and life satisfaction is stronger among older African Americans than among older Whites. METHOD The data came from 6864 community-dwelling persons aged 65+ (66% African American) who participated in the Chicago Health and Aging Project. Life satisfaction was measured using a five-item composite and we used a five-item version of the Daily Spiritual Experiences scale. RESULTS In a regression model adjusting for age, sex, marital status, education, income and worship attendance, we found that African American race was associated with lower life satisfaction. We also found a positive association between spiritual experiences and life satisfaction. In an additional model, a significant race by spiritual experiences interaction term indicates that spiritual experiences are more positively associated with life satisfaction among African Americans. CONCLUSION The data suggest that at higher levels of spiritual experiences, racial differences in life satisfaction are virtually non-existent. However, at lower levels of spiritual experiences, older African Americans show modestly lower levels of life satisfaction than do older Whites. This pattern suggests that spiritual experiences are a positive resource - distinct from worship attendance - that enable older African Americans to overcome decrements in life satisfaction and, in fact, that lower spiritual experiences may be especially harmful for older African American's life satisfaction.
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Affiliation(s)
- Kimberly A. Skarupski
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, IL,Department of Internal Medicine, Rush University Medical Center, Chicago, IL
| | - George Fitchett
- Dept. of Religion, Health, and Human Values, Rush University Medical Center, Chicago, IL,Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
| | - Denis A. Evans
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, IL,Department of Internal Medicine, Rush University Medical Center, Chicago, IL,Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
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Al Snih S, Peek KM, Sawyer P, Markides KS, Allman RM, Ottenbacher KJ. Life-space mobility in Mexican Americans aged 75 and older. J Am Geriatr Soc 2012; 60:532-7. [PMID: 22283683 PMCID: PMC3996837 DOI: 10.1111/j.1532-5415.2011.03822.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine the factors associated with life-space mobility in older Mexican Americans. DESIGN Cross-sectional study involving a population-based survey. SETTING Hispanic Established Population for the Epidemiologic Study of the Elderly survey conducted in the southwestern of United States (Texas, Colorado, Arizona, New Mexico, and California). PARTICIPANTS Seven hundred twenty-eight Mexican-American men and women aged 75 and older. MEASUREMENTS Sociodemographic factors, self-reported physician diagnoses of medical conditions (arthritis, diabetes mellitus, heart attack, stroke, hip fracture, and cancer), depressive symptoms, cognitive function, body mass index (BMI), upper and lower extremity muscle strength, Short Physical Performance Battery (SPPB), activities of daily living (ADLs), and the life-space assessment (LSA) were assessed in in-home interviews. RESULTS The mean age of participants was 84.2 ± 4.2. Sixty-five percent were female. Mean LSA score was 41.7 ± 20.9. Multiple regression analysis showed that older age, being female, limitation in ADLs, stroke, high depressive symptoms, and a BMI index of 35 kg/m(2) and greater were significantly associated with lower LSA scores. Education and better lower extremity function and muscle strength were factors significantly associated with higher LSA scores. CONCLUSION Older Mexican Americans had restricted life-space, with approximately 80% limited to their home or neighborhood. Older age, female sex, stroke, high depressive symptoms, BMI of 35 kg/m(2) or greater, and ADL disability were related to less life-space. Future studies are needed to examine the association between life-space and health outcomes and to characterize the trajectory of life-space over time in this population.
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Affiliation(s)
- Soham Al Snih
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, Texas 77555, USA.
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Sun F, Park NS, Roff LL, Klemmack DL, Parker M, Koenig HG, Sawyer P, Allman RM. Predicting the trajectories of depressive symptoms among southern community-dwelling older adults: the role of religiosity. Aging Ment Health 2012; 16:189-98. [PMID: 22032625 PMCID: PMC3258845 DOI: 10.1080/13607863.2011.602959] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND This study examined the effects of religiosity on the trajectories of depressive symptoms in a sample of community-dwelling older adults over a four-year period in a Southern state in the U.S. METHODS Data from the University of Alabama at Birmingham (UAB) Study of Aging were analyzed using a hierarchical linear modeling (HLM) method. This study involved 1000 participants aged 65 and above (M age = 75 at baseline, SD = 5.97) and data were collected annually from 1999 to 2003. The Geriatric Depression Scale measured depressive symptoms; the Duke University Religion Index measured religious service attendance, prayer, and intrinsic religiosity; and control variables included sociodemographics, health, and social and economic factors. RESULTS The HLM analysis indicated a curvilinear trajectory of depressive symptoms over time. At baseline, participants who attended religious services more frequently tended to report fewer depressive symptoms. Participants with the highest levels of intrinsic religiosity at baseline experienced a steady decline in the number of depressive symptoms over the four-year period, while those with lower levels of intrinsic religiosity experienced a short-term decline followed by an increase in the number of depressive symptoms. IMPLICATIONS In addition to facilitating access to health, social support and financial resources for older adults, service professionals might consider culturally appropriate, patient-centered interventions that boost the salutary effects of intrinsic religiosity on depressive symptoms.
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Affiliation(s)
- Fei Sun
- School of Social Work, Arizona State University, Phoenix, AZ, USA.
| | - Nan S. Park
- School of Social Work at the University of South Florida
| | | | | | | | | | | | - Richard M. Allman
- Birmingham VA Medical Center, the Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center and UAB
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Thorpe RJ, Clay OJ, Szanton SL, Allaire JC, Whitfield KE. Correlates of mobility limitation in African Americans. J Gerontol A Biol Sci Med Sci 2011; 66:1258-63. [PMID: 21798864 DOI: 10.1093/gerona/glr122] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study identified demographic and health-related characteristics that were related to mobility limitation in a sample of community-dwelling African Americans. METHODS The sample consisted of 602 community-dwelling African-American men and women ages 48-92 years at study inception. Participants who reported being limited "a lot" or "a little" in climbing one flight of stairs or walking several blocks were considered to have mobility limitation. Logistic regression was conducted to estimate the independent effect of each demographic and health-related characteristic on odds of mobility limitation. RESULTS African Americans who reported two or more medical conditions had higher odds of mobility limitation (women: odds ratio = 3.52; 95% confidence interval: 1.89-6.53 and men: odds ratio = 2.53; 95% confidence interval: 1.10-5.85) than those who reported one or fewer medical conditions. African Americans with major depressive symptoms had higher odds of mobility limitation (women: odds ratio = 2.98; 95% confidence interval: 1.55-5.71 and men: odds ratio = 3.19; 95% confidence interval: 1.33-7.65) than those without major depressive symptoms. CONCLUSIONS These results highlight the importance of creating interventions particularly focused on chronic disease prevention and management for African American men and women during midlife to attempt to delay the onset or impede the progression of mobility problems that will likely become exacerbated in late life and severely affect the quality of life.
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Affiliation(s)
- Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Makhija SK, Gilbert GH, Clay OJ, Matthews JC, Sawyer P, Allman RM. Oral health-related quality of life and life-space mobility in community-dwelling older adults. J Am Geriatr Soc 2011; 59:512-8. [PMID: 21361883 DOI: 10.1111/j.1532-5415.2010.03306.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To quantify the associations between measures of oral health-related quality of life (OHRQoL) and life-space mobility (LSM) in community-dwelling older adults. DESIGN Cross-sectional study using a 54-item OHRQoL questionnaire. SETTING Five counties in central Alabama: Jefferson and Tuscaloosa (urban), and Bibb, Hale, and Pickens (rural). PARTICIPANTS The 288 dental study volunteers were recruited from participants in the University of Alabama at Birmingham Study of Aging, a longitudinal study of mobility in community-dwelling adults aged 65 and older. MEASUREMENTS Participants completed an in-home interview about their OHRQoL and LSM. Life-space was assessed by asking questions about where and how often participants got to areas ranging from the home to beyond town and the degree of independence in getting there. Unadjusted and adjusted regression models were used to quantify associations between OHRQoL and LSM. Other factors examined were age, race, sex, income, education, residence, transportation difficulty, marital status, depressive symptoms, and comorbidity. RESULTS Unadjusted and adjusted analyses suggested significant associations between OHRQoL and LSM in oral functional limitation, oral pain and discomfort, oral disadvantage, and self-rated oral health. CONCLUSION OHRQoL decrements that participants reported were associated with less LSM, suggesting that perceptions of oral well-being have a significant effect on mobility and the social participation of older adults.
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Affiliation(s)
- Sonia K Makhija
- Department of General Dental Sciences, School of Dentistry Center for Aging, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Gottlieb ER, Smith EC, Wolfenden LL, Allman RM, Tangpricha V. Life-space mobility is associated with frequency of hospitalization in adults with cystic fibrosis. CLINICAL RESPIRATORY JOURNAL 2010; 5:245-51. [PMID: 21801325 DOI: 10.1111/j.1752-699x.2010.00225.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES The Life-Space Assessment can be used to measure a patient's level of mobility. This study evaluated the relationship between life-space mobility and frequency of hospitalization in the previous year and other clinical markers of health among adults with cystic fibrosis (CF). METHODS The Life-Space Assessment was administered to ambulatory adults with CF in clinic or by telephone. Life-space mobility was correlated with the most recent forced expiratory volume in one second as a percent of the predicted value (FEV(1) % predicted), body mass index (BMI) and number of hospitalizations in the previous year. RESULTS Forty-eight subjects completed the Life-Space Assessment. Subjects had a life-space score of 88 ± 26, FEV(1) % predicted of 66% ± 26% and BMI of 22.5 ± 3.3. There was a statistically significant negative linear correlation between the number of times a subject was hospitalized in the previous year and life-space mobility (P = 0.001, R(2) = 0.20). This association was independent of FEV(1) % predicted and BMI. CONCLUSION The life-space mobility score is associated with frequency of hospitalization in adults with CF. A prospective study should be undertaken to assess the ability of the Life-Space Assessment to predict hospitalization and other outcomes in adults with CF.
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Auger C, Demers L, Gélinas I, Miller WC, Jutai JW, Noreau L. Life-Space Mobility of Middle-Aged and Older Adults at Various Stages of Usage of Power Mobility Devices. Arch Phys Med Rehabil 2010; 91:765-73. [DOI: 10.1016/j.apmr.2010.01.018] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 01/18/2010] [Accepted: 01/24/2010] [Indexed: 11/25/2022]
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Hernandez S, McClendon MJ, Zhou XHA, Sachs M, Lerner AJ. Pharmacological treatment of Alzheimer's disease: effect of race and demographic variables. J Alzheimers Dis 2010; 19:665-72. [PMID: 20110610 DOI: 10.3233/jad-2010-1269] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Existing research shows differences in medication use for Alzheimer's disease (AD) based on demographics such as race, ethnicity, and geographical location. To determine individual and community characteristics associated with differences in acetylcholinesterase inhibitor (AChEI) and memantine use in AD, 3,049 AD subjects were drawn from 30 centers and evaluated using the Uniform data set (UDS). Cases were evaluated at the individual level within the context of 31 communities (one center encompassed two separate geographical regions). Multivariate analysis was used to determine the significance of individual variables on medication use. Compared to non-Hispanic Whites, Blacks were less likely to use AChEI and memantine with odds ratios (OR) of 0.59 (95% CI 0.46-0.76) and 0.43 (95% CI 0.32-0.57), respectively. Compared to non-Hispanic Whites, non-Black Hispanics were less likely to use memantine (OR=0.69 (95% CI 0.49-0.98)). No association was found between the proportion of Blacks or non-Black Hispanics versus non-Hispanic Whites at an Alzheimer Disease Center and individual use of AChEI or memantine. Other significant variables include gender, age, marital status, dementia severity, source of referral, AChEI use, and education. Education and age somewhat mitigated disparity. Significant racial and ethnic differences in AChEI and memantine use exist at the individual level regardless of the racial and ethnic composition of the individual's community. Research and initiatives at the societal level may be an important consideration toward addressing these differences.
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Park NS, Roff LL, Sun F, Parker MW, Klemmack DL, Sawyer P, Allman RM. Transportation Difficulty of Black and White Rural Older Adults. J Appl Gerontol 2010; 29:70-88. [PMID: 22068835 PMCID: PMC2758564 DOI: 10.1177/0733464809335597] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to understand self-reported transportation difficulty among rural older adults. We used data from the UAB Study of Aging (255 Black and 259 White), community-dwelling participants residing in rural areas. We examined the relationship of predisposing characteristics, enabling resources, and measures of need for care with self-reports of transportation difficulty. Blacks reported having more transportation difficulty than Whites (24.7% vs. 11.6%; p ≤ .05). When we introduced other variables, race differences disappeared, but there was a race by income interaction with transportation difficulty. Whites with lower incomes were more likely to have transportation difficulty than Whites with higher incomes. When data from Blacks and Whites were analyzed separately, income was the only variable associated with transportation difficulty among Whites. Among Blacks, income was not related to transportation difficulty but several variables other than income (age, gender, marital status, MMSE scores and depression) were.
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Affiliation(s)
- Nan Sook Park
- School of Social Work, The University of Alabama
- Center for Mental Health and Aging, The University of Alabama
| | - Lucinda L. Roff
- School of Social Work, The University of Alabama
- Center for Mental Health and Aging, The University of Alabama
| | - Fei Sun
- Center for Mental Health and Aging, The University of Alabama
- Department of Social Work, Arizona State University
| | - Michael W. Parker
- School of Social Work, The University of Alabama
- Center for Mental Health and Aging, The University of Alabama
| | - David L. Klemmack
- Center for Mental Health and Aging, The University of Alabama
- New College Program and Department of Criminal Justice, The University of Alabama
| | - Patricia Sawyer
- The Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham
- Center for Aging, University of Alabama at Birmingham
| | - Richard M. Allman
- The Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham
- Center for Aging, University of Alabama at Birmingham
- Birmingham/Atlanta VA Geriatric Research, Education and Clinical Center
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