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Sheets KM, Kats AM, Fink HA, Langsetmo L, Yaffe K, Ensrud KE. Life-space mobility and cognition in community-dwelling late-life women: A cross-sectional analysis. J Am Geriatr Soc 2024. [PMID: 39275882 DOI: 10.1111/jgs.19190] [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: 03/20/2024] [Revised: 06/27/2024] [Accepted: 08/04/2024] [Indexed: 09/16/2024]
Abstract
BACKGROUND Life-space mobility captures the daily, enacted mobility of older adults. We determined cross-sectional associations between life-space mobility and cognitive impairment (CI) among community-dwelling women in the 9th and 10th decades of life. METHODS A total of 1375 (mean age 88 years; 88% White) community-dwelling women enrolled in a prospective cohort of older women. Life-space score was calculated with range 0 (daily restriction to one's bedroom) to 120 (daily trips leaving town without assistance) and categorized (0-20, 21-40, 41-60, 61-80, 81-120). The primary outcome was adjudicated CI defined as mild cognitive impairment or dementia; scores on a 6-test cognitive battery were secondary outcomes. RESULTS Compared to women with life-space scores of 81-120 and after adjustment for demographics and depressive symptoms, the odds of CI was 1.4-fold (OR 1.36, 95% CI 0.91-2.03) higher for women with life-space scores of 61-80, twofold (OR 1.98, 95% CI 1.33-2.94) higher for women with life-space scores of 41-60, 2.6-fold (OR 2.62, 95% CI 1.71-4.01) higher for women with life-space scores of 21-40, and 2.7-fold (OR 2.71, 95% CI 1.27-5.79) higher for women with life-space scores of 0-20. The association of life-space scores with adjudicated CI was primarily due to higher odds of dementia; the odds of dementia versus normal cognition was eightfold (OR 8.63, 95% CI 3.20-23.26) higher among women with life-space scores of 0-20 compared to women with life-space scores of 81-120. Lower life-space scores were associated in a graded manner with lower mean scores on tests of delayed recall (California Verbal Learning Test-II delayed recall) and language and executive function (phonemic fluency, category fluency, and Trails B). Life-space score was not associated with scores on tests of attention and working memory (forward and backward digit span). CONCLUSIONS Lower life-space mobility is associated in a graded manner with CI among community-dwelling White women in the 9th and 10th decades of life.
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Affiliation(s)
- Kerry M Sheets
- Geriatric Medicine Division, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Allyson M Kats
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Howard A Fink
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, Minnesota, USA
- Geriatric Research Education and Clinical Center, VA Health Care System, Minneapolis, Minnesota, USA
| | - Lisa Langsetmo
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, Minnesota, USA
| | - Kristine Yaffe
- Department of Psychiatry, Neurology, and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Kristine E Ensrud
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, Minnesota, USA
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Matsuda E, Crowe M, Howard VJ, Brown CJ, Sterling MR, Levitan EB. Life-space mobility and cognitive function: The REasons for geographic and racial differences in stroke (REGARDS) study. J Am Geriatr Soc 2024; 72:2595-2599. [PMID: 38745470 PMCID: PMC11323231 DOI: 10.1111/jgs.18923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 03/14/2024] [Accepted: 03/25/2024] [Indexed: 05/16/2024]
Affiliation(s)
- Emiri Matsuda
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham College of Arts and Sciences, Birmingham, AL, USA
| | - Virginia J Howard
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Cynthia J. Brown
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans
| | - Madeline R. Sterling
- Division of Internal Medicine, Weill- Cornell College of Medicine, New York, NY, USA
| | - Emily B. Levitan
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
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Laczó M, Svatkova R, Lerch O, Martinkovic L, Zuntychova T, Nedelska Z, Horakova H, Vyhnalek M, Hort J, Laczó J. Spatial navigation questionnaires as a supportive diagnostic tool in early Alzheimer's disease. iScience 2024; 27:109832. [PMID: 38779476 PMCID: PMC11108981 DOI: 10.1016/j.isci.2024.109832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/14/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
Impaired spatial navigation is early marker of Alzheimer's disease (AD). We examined ability of self- and informant-reported navigation questionnaires to discriminate between clinically and biomarker-defined participants, and associations of questionnaires with navigation performance, regional brain atrophy, AD biomarkers, and biomarker status. 262 participants (cognitively normal, with subjective cognitive decline, amnestic mild cognitive impairment [aMCI], and mild dementia) and their informants completed three navigation questionnaires. Navigation performance, magnetic resonance imaging volume/thickness of AD-related brain regions, and AD biomarkers were measured. Informant-reported questionnaires distinguished between cognitively normal and impaired participants, and amyloid-β positive and negative aMCI. Lower scores were associated with worse navigation performance, greater atrophy in AD-related brain regions, and amyloid-β status. Self-reported questionnaire scores did not distinguish between the groups and were weakly associated with navigation performance. Other associations were not significant. Informant-reported navigation questionnaires may be a screening tool for early AD reflecting atrophy of AD-related brain regions and AD pathology.
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Affiliation(s)
- Martina Laczó
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia
| | - Radka Svatkova
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia
| | - Ondrej Lerch
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia
| | - Lukas Martinkovic
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia
| | - Terezie Zuntychova
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia
| | - Zuzana Nedelska
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia
| | - Hana Horakova
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia
| | - Martin Vyhnalek
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia
| | - Jakub Hort
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia
| | - Jan Laczó
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia
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Rantakokko M, Matikainen-Tervola E, Aartolahti E, Sihvonen S, Chichaeva J, Finni T, Cronin N. Gait Features in Different Environments Contributing to Participation in Outdoor Activities in Old Age (GaitAge): Protocol for an Observational Cross-Sectional Study. JMIR Res Protoc 2024; 13:e52898. [PMID: 38684085 PMCID: PMC11091809 DOI: 10.2196/52898] [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: 09/22/2023] [Revised: 02/05/2024] [Accepted: 03/22/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND The ability to walk is a key issue for independent old age. Optimizing older peoples' opportunities for an autonomous and active life and reducing health disparities requires a better understanding of how to support independent mobility in older people. With increasing age, changes in gait parameters such as step length and cadence are common and have been shown to increase the risk of mobility decline. However, gait assessments are typically based on laboratory measures, even though walking in a laboratory environment may be significantly different from walking in outdoor environments. OBJECTIVE This project will study alterations in biomechanical features of gait by comparing walking on a treadmill in a laboratory, level outdoor, and hilly outdoor environments. In addition, we will study the possible contribution of changes in gait between these environments to outdoor mobility among older people. METHODS Participants of the study were recruited through senior organizations of Central Finland and the University of the Third Age, Jyväskylä. Inclusion criteria were community-dwelling, aged 70 years and older, able to walk at least 1 km without assistive devices, able to communicate, and living in central Finland. Exclusion criteria were the use of mobility devices, severe sensory deficit (vision and hearing), memory impairment (Mini-Mental State Examination ≤23), and neurological conditions (eg, stroke, Parkinson disease, and multiple sclerosis). The study protocol included 2 research visits. First, indoor measurements were conducted, including interviews (participation, health, and demographics), physical performance tests (short physical performance battery and Timed Up and Go), and motion analysis on a treadmill in the laboratory (3D Vicon and next-generation inertial measurement units [NGIMUs]). Second, outdoor walking tests were conducted, including walking on level (sports track) and hilly (uphill and downhill) terrain, while movement was monitored via NGIMUs, pressure insoles, heart rate, and video data. RESULTS A total of 40 people (n=26, 65% women; mean age 76.3, SD 5.45 years) met the inclusion criteria and took part in the study. Data collection took place between May and September 2022. The first result is expected to be published in the spring of 2024. CONCLUSIONS This multidisciplinary study will provide new scientific knowledge about how gait biomechanics are altered in varied environments, and how this influences opportunities to participate in outdoor activities for older people. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/52898.
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Affiliation(s)
- Merja Rantakokko
- Faculty of Sport and Health Sciences, Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
- The Wellbeing Services County of Central Finland, Jyväskylä, Finland
- Institute of Rehabilitation, JAMK University of Applied Sciences, Jyväskylä, Finland
| | | | - Eeva Aartolahti
- Institute of Rehabilitation, JAMK University of Applied Sciences, Jyväskylä, Finland
| | - Sanna Sihvonen
- Institute of Rehabilitation, JAMK University of Applied Sciences, Jyväskylä, Finland
| | - Julija Chichaeva
- Institute of Rehabilitation, JAMK University of Applied Sciences, Jyväskylä, Finland
| | - Taija Finni
- Faculty of Sport and Health Sciences, Neuromuscular Research Centre, University of Jyväskylä, Jyväskylä, Finland
| | - Neil Cronin
- Faculty of Sport and Health Sciences, Neuromuscular Research Centre, University of Jyväskylä, Jyväskylä, Finland
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
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Lindeman K, Karavirta L, Koivunen K, Keskinen KE, Eronen J, Portegijs E, Rantanen T. Longitudinal changes in life-space mobility and autonomy in participation outdoors among Finnish community-dwelling older adults from pre-COVID-19 to through the pandemic. Aging Clin Exp Res 2024; 36:85. [PMID: 38558262 PMCID: PMC10984880 DOI: 10.1007/s40520-024-02734-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/08/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Among older people, community mobility was reduced at the beginning of the COVID-19 pandemic, but the longer-term changes are unclear. AIMS To study lower extremity performance and car driving as predictors of changes in older adults' life-space mobility, autonomy in participation outdoors, and the risk of developing restricted life-space mobility from 2017 to 2022. METHODS Life-space mobility (scoring range 0-120) and autonomy in participation outdoors (scoring range 0-20) were assessed in community-dwelling individuals (n = 657) in 2017-2018 (baseline age 75, 80, or 85 years), during the first wave of COVID-19 in 2020, and in 2021-2022. Lower extremity performance was assessed using the Short Physical Performance Battery, and car driving was self-reported at baseline. Data were analysed using generalized estimating equations and Cox regression. RESULTS During the first wave of COVID-19 in 2020, life-space mobility decreased on average by 10.3 (SD 21.6) points and partially recovered in 2021-2022 (+ 2.7, SD 21.8). The same pattern was observed for autonomy in participation outdoors. Non-drivers and those with impaired lower extremity performance had a 2.4-to-3.6-fold adjusted risk of developing restricted life-space mobility over the follow-up period compared to drivers with intact lower extremity performance. CONCLUSIONS For older people, the recovery of community mobility was incomplete after the restrictions stemming from the pandemic were lifted. Older adults with impaired lower extremity performance and who did not drive were particularly vulnerable to developing restricted life-space mobility, a situation that could lead to social isolation and reduced well-being.
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Affiliation(s)
- Katja Lindeman
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland.
| | - Laura Karavirta
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Kaisa Koivunen
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Kirsi E Keskinen
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Johanna Eronen
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Erja Portegijs
- Center of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Taina Rantanen
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
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Paolillo EW, Saloner R, VandeBunte A, Lee S, Bennett DA, Casaletto KB. Multimodal lifestyle engagement patterns support cognitive stability beyond neuropathological burden. Alzheimers Res Ther 2023; 15:221. [PMID: 38111051 PMCID: PMC10726589 DOI: 10.1186/s13195-023-01365-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/03/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Modifiable lifestyle behaviors account for a large proportion of dementia risk. However, the combined contributions of multidomain lifestyle patterns to cognitive aging are poorly understood, as most studies have examined individual lifestyle behaviors in isolation and without neuropathological characterization. This study examined data-driven patterns of lifestyle behaviors across multiple domains among older adults and tested their associations with disease-specific neuropathological burden and cognitive decline. METHODS Participants included 2059 older adults enrolled in the longitudinal Memory and Aging Project (MAP) at the Rush Alzheimer's Disease Center; none of whom had dementia at baseline (73% no cognitive impairment (NCI), 27% mild cognitive impairment [MCI]). All participants completed cognitive testing annually. Lifestyle factors were measured during at least one visit and included (1) actigraphy-measured physical activity, as well as self-reported (2) sleep quality, (3) life space, (4) cognitive activities, (5) social activities, and (6) social network. A subset of participants (n = 791) had autopsy data for which burden of Alzheimer's disease (AD), cerebrovascular disease (CVD), Lewy body disease, and hippocampal sclerosis/TDP-43 was measured. Latent profile analysis across all 2059 participants identified distinct subgroups (i.e., classes) of lifestyle patterns. Linear mixed-effects models examined relationships between lifestyle classes and global cognitive trajectories, with and without covarying for all neuropathologies. Classes were also compared on rates of incident MCI/dementia. RESULTS Five classes were identified: Class 1Low Life Space (lowest lifestyle engagement), Class 2PA (high physical activity), Class 3Low Avg (low to average lifestyle engagement), Class 4Balanced (high average lifestyle engagement), and Class 5Social (large social network). Classes 4Balanced and 5Social had the lowest AD burden, and Class 2PA had the lowest CVD burden. Classes 2-5 had significantly less steep global cognitive decline compared to Class 1Low Life Space, with comparable effect sizes before and after covarying for neuropathological burden. Classes 4Balanced and 5Social exhibited the lowest rates of incident MCI/dementia. CONCLUSIONS Lifestyle behavior patterns among older adults account for differential rates of cognitive decline and clinical progression. Those with at least average engagement across all lifestyle domains exhibit greater cognitive stability after adjustment for neuropathology, highlighting the importance of engagement in multiple healthy lifestyle behaviors for later life cognitive health.
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Affiliation(s)
- Emily W Paolillo
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, USA.
| | - Rowan Saloner
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, USA
| | - Anna VandeBunte
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, USA
| | - Shannon Lee
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, USA
| | - David A Bennett
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, USA
| | - Kaitlin B Casaletto
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, CA, 94158, USA
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Eliassen M, Sørensen BA, Hartviksen TA, Holm S, Zingmark M. Emplacing reablement co-creating an outdoor recreation model in the rural Arctic. Int J Circumpolar Health 2023; 82:2273013. [PMID: 37883476 PMCID: PMC10997308 DOI: 10.1080/22423982.2023.2273013] [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: 07/24/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
Reablement aims to enable older persons with functional decline to re-engage in meaningful activities. The benefits of engagement in outdoor activities are significant; however, reablement services primarily target function in indoor environments whereas descriptions of outdoor activities are sparse. The aim of this study was to create a model that integrates outdoor recreation into reablement. We therefore elaborated on an experienced based co-design methodology to create a model that integrates outdoor recreation for older persons in reablement in an Arctic, rural context in northern Norway. Stakeholders (N = 35), including reablement participants, participated in workshops, focus groups, and individual interviews. Based on the results, we co-created a person-centred model for outdoor recreation in reablement, including an assessment tool that can guide reablement staff in goal-setting practices. Accordingly, we argue that cherished locations holds significant meaning in the lives of older people and warrant recognition in reablement programmes. There is a need to evaluate the effects and feasibility of the model and the possibility for its implementation in other health care settings.
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Affiliation(s)
- Marianne Eliassen
- Department of Health and Care Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Bodil A. Sørensen
- Department of Research, Development and Innovation, Municipality of Vestvågøy. Postboks 203, Leknes, Norway
| | - Trude A. Hartviksen
- Department of Health and Care Sciences, UiT, The Arctic University of Norway, Municipality of Vestvågøy. Postboks 203, Leknes, Norway
| | - Solrun Holm
- Department of Research, Development and Innovation, Municipality of Vestvågøy. Postboks 203, Leknes, Norway
| | - Magnus Zingmark
- Department of Epidemiology and Global Health, Faculty of medicine, Umeå University, Umeå, Sweden
- Health and Social Care administration, Municipality of Östersund, Health and Social Care Administration, Östersund, Sweden
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Yoshikawa H, Uzawa H, Ishida T, Asakawa T, Kubo J. Effects of interventions on life-space mobility for community-dwelling older adults: A systematic review and meta-analysis. Geriatr Gerontol Int 2023; 23:842-848. [PMID: 37818711 DOI: 10.1111/ggi.14694] [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: 04/12/2023] [Revised: 09/08/2023] [Accepted: 09/16/2023] [Indexed: 10/12/2023]
Abstract
AIM The present study aimed to conduct a meta-analysis to evaluate the methods and effects of interventions to increase life-space mobility among community-dwelling older adults. METHODS Records were identified through nine databases. Eligible study designs for inclusion in the review were randomized controlled trials of interventions on life-space mobility for community-dwelling older adults. The risk of bias was assessed using the Risk of Bias 2 tool. We followed the Grading of Recommendations, Assessment, Development, and Evaluation approach to summarize the evidence. RESULTS Four studies (558 participants) identified via search strategies were included. Two studies involved individualized exercise and lifestyle interventions. In three out of the four studies, individual interventions were applied. Overall, when compared with a control group, the intervention group was more likely to positively affect increasing life-space mobility (standardized mean difference 0.47, 95% confidence interval [0.020 to 0.92]). The heterogeneity statistic indicated considerable heterogeneity (I2 = 84%). The evidence was downgraded one step owing to imprecision. CONCLUSIONS Interventions on increasing life-space mobility for community-dwelling older adults have a positive effect. Combination interventions may be more effective than single interventions, and individual interventions may be more effective than group interventions. However, owing to the limited number of studies, conducting further research to enhance the generalizability of results is crucial. Additionally, subgroup analysis should be conducted to clarify differences in intervention methods and effects. Geriatr Gerontol Int 2023; 23: 842-848.
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Affiliation(s)
- Hiroki Yoshikawa
- Division of Rehabilitation, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan
| | - Hironobu Uzawa
- Department of Physical Therapy, International University of Health and Welfare, School of Health Sciences at Narita, Narita, Japan
| | - Takeki Ishida
- Department of Physical Therapy, International University of Health and Welfare, School of Health Sciences at Narita, Narita, Japan
| | - Takashi Asakawa
- Division of Rehabilitation, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan
| | - Jin Kubo
- Division of Rehabilitation, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan
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Wang GM, Teng MY, Yu WJ, Ren H, Cui XS. Life-space mobility among community-dwelling older persons: A scoping review. Geriatr Nurs 2023; 54:108-117. [PMID: 37722235 DOI: 10.1016/j.gerinurse.2023.08.021] [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: 07/21/2023] [Revised: 08/24/2023] [Accepted: 08/24/2023] [Indexed: 09/20/2023]
Abstract
To describe and analyze the current research status of life-space mobility of the older persons in community. The literature in PubMed, Web of Science, Cochrane Library, Embase, EBSCOhost, Scopus, OpenGrey, SinoMed, CNKI, WanFang, and VIP databases was computer searched, and the time frame was build to May 23, 2023. A total of 42 literatures were included, including 35 in English and 7 in Chinese, 30 of which were cross-sectional studies. Theoretical models related to spatial mobility included the "concentric circles" model and the "cone" model. 33 literatures reported the prevalence or level of spatial mobility limitations, and 9 assessment instruments were used, The influencing factors can be divided into four categories. 9 literatures reported on the adverse effects, and 9 literatures reported on the prevention and intervention. The limitation of life-space mobility is a common and under-recognized phenomenon among the older persons in the community,with serious adverse effects, complex and diverse influencing factors.
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Affiliation(s)
- Gui-Meng Wang
- School of Nursing, Yanbian University, 977 Park Rood, Yanji City, 133000 Yanbian Prefecture, Jilin Province, China
| | - Meng-Yuan Teng
- School of Nursing, Yanbian University, 977 Park Rood, Yanji City, 133000 Yanbian Prefecture, Jilin Province, China
| | - Wen-Jing Yu
- School of Nursing, Yanbian University, 977 Park Rood, Yanji City, 133000 Yanbian Prefecture, Jilin Province, China
| | - Hui Ren
- School of Nursing, Yanbian University, 977 Park Rood, Yanji City, 133000 Yanbian Prefecture, Jilin Province, China
| | - Xiang-Shu Cui
- School of Nursing, Yanbian University, 977 Park Rood, Yanji City, 133000 Yanbian Prefecture, Jilin Province, China.
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Prevratil MJ, Kossowska-Kuhn D, Gray N, Charness N. Components of navigation ability and their predictors in a community-dwelling sample of older adults. FRONTIERS IN AGING 2023; 4:1239094. [PMID: 37929217 PMCID: PMC10620738 DOI: 10.3389/fragi.2023.1239094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023]
Abstract
Introduction: Navigation, as a complex skill important for independent living, requires a variety of cognitive processes. Current scales tapping components are lengthy and can be burdensome for older adults. Methods: Community-dwelling older adults (n = 380, age 60-90 years) completed an online survey tapping wayfinding, being lost navigating, and needing help navigating. Participants then completed objective measures of navigation ability and self-reported memory ability. Cronbach's α was calculated for navigation subscales consisting of subsets of the Wayfinding Questionnaire and Santa Barbara Sense of Direction Questionnaire, and an exploratory factor analysis (EFA) was conducted. Regression analyses were used to test whether objective navigation, memory, and demographic information navigation predicted navigation subscale performance. Results: Each of the individual subscales demonstrated high reliability. EFA generated five unique factors: routing, mental mapping, navigation in near vicinities, feeling lost in far vicinities, and needing help in far vicinities. Across regression analyses, memory, gender, and performance on the Spatial Orientation Test were significant predictors. Discussion: Navigation is a multi-faceted construct that can be reliably measured using concise surveys. Further research is necessary to understand the intricacies of aging and navigation.
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Affiliation(s)
- Michael J. Prevratil
- Department of Psychology, Florida State University, Tallahassee, FL, United States
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Pope CN, Wheeler KM, Bell TR, Carroll BE, Ross LA, Crowe M, Black SR, Clay OJ, Ball KK. Social and Neighborhood Context Moderates the Associations Between Processing Speed and Driving Mobility: A 10-year Analysis of the ACTIVE Study. J Aging Health 2023; 35:26S-39S. [PMID: 37994848 DOI: 10.1177/08982643231163907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Objectives: Processing speed is essential to functional independence in later life, such as driving a vehicle. Few studies have examined processing speed and driving mobility in the context of racial differences and social determinants of health (SDoH). This study characterized the longitudinal association between processing speed and driving mobility, and how it varied by race and SDoH. Methods: Using data from the control arm of the Advanced Cognitive Training in Vital Elderly study (n = 581, 24.5% Black), multilevel models examined longitudinal associations between processing speed and driving mobility outcomes (driving space, exposure, and difficulty). Race and SDoH moderations were explored. Results: Decline in processing speed measures was associated with increased self-reported driving difficulty, but only for older adults with below-average to average scores for neighborhood and built environments and social community context SDoH domains. Discussion: Findings emphasize the influence of physical and social environmental characteristics on processing speed and driving mobility.
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Affiliation(s)
- Caitlin N Pope
- Department of Health, Behavior and Society, University of Kentucky, Lexington, KY, USA
| | - Katie M Wheeler
- Department of Psychology, University of Alabama at Birmingham, AL, USA
| | - Tyler R Bell
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Brooke E Carroll
- Department of Psychology, University of Alabama at Birmingham, AL, USA
| | - Lesley A Ross
- Department of Psychology, Clemson University, SC, USA
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham, AL, USA
| | - Shelia R Black
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
| | - Olivio J Clay
- Department of Psychology, University of Alabama at Birmingham, AL, USA
| | - Karlene K Ball
- Department of Psychology, University of Alabama at Birmingham, AL, USA
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12
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Shimokihara S, Maruta M, Han G, Ikeda Y, Kamasaki T, Hidaka Y, Akasaki Y, Tabira T. Real-World Navigation With Application: Characteristics of Gaze Behavior and Associated Factors in Older Adults. Innov Aging 2023; 7:igad108. [PMID: 37941830 PMCID: PMC10630010 DOI: 10.1093/geroni/igad108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Indexed: 11/10/2023] Open
Abstract
Background and Objectives Advancing age might impair real-world navigation ability. The use of mobile devices by older adults has grown rapidly in recent years. Navigation applications (apps) in mobile devices may facilitate the freedom of outings for older adults. Our aim is to investigate age-related differences in real-world app-based navigation walking in terms of accuracy, efficiency, and gaze behavior; and to explore clinical factors associated with navigation walking in older adults. Research Design and Methods A total of 20 community-dwelling older adults and 16 young adults completed a route navigation task using a navigation app while recording their gaze behavior. Outcomes were compared in both groups and a general linear regression was used to explore clinical factors associated with app-based navigation walk in older adults. Results Compared with young participants, older participants had more stops and root errors and less fixation time, smaller amplitude of saccades. Additionally, older adults were more likely to glance at their smartphones while app-based navigation walking. Furthermore, gait speed and the following assessment scores were significantly associated with navigation walking in older adults: Mini-Mental State Examination, Life-Space Assessment, and the short version of the Mobile Device Proficiency Questionnaire. Discussion and Implications For app-based navigation walks, differences in accuracy and gaze behavior were found to exist with age. Additionally, efficient real-world navigation walks in older adults require the extent of life space and proficiency with mobile devices, along with walking speed and cognitive function. It is possible that age-related functional decline, such as the visual field and shifting attention between mobile devices and the real world, may have influenced the results. The study also suggests the need to understand the level of proficiency with mobile devices so that older adults can continue to go out freely. These findings give the basis for providing older adults with appropriate navigation assistance.
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Affiliation(s)
- Suguru Shimokihara
- Graduate School of Health Sciences, Kagoshima University, Kagoshima, Japan
- Research Fellowship for Young Scientists, Japan Society for the Promotion of Science, Tokyo, Japan
| | - Michio Maruta
- Visiting Researcher, Faculty of Medicine, Kagoshima University, Sakuragaoka, Kagoshima, Japan
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Gwanghee Han
- Visiting Researcher, Faculty of Medicine, Kagoshima University, Sakuragaoka, Kagoshima, Japan
- Department of Occupational Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, Fukuoka, Japan
| | - Yuriko Ikeda
- Department of Occupational Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Taishiro Kamasaki
- Graduate School of Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Yuma Hidaka
- Department of Rehabilitation, Medical Corporation, Sanshukai, Okatsu Hospital, Kagoshima, Japan
| | - Yoshihiko Akasaki
- Department of Rehabilitation, Tarumizu Central Hospital, Tarumizu, Japan
| | - Takayuki Tabira
- Department of Occupational Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
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13
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Pappadis MR, Chou LN, Howrey B, Al Snih S. Life-space mobility and post-hospitalization outcomes among older Mexican American Medicare beneficiaries. J Am Geriatr Soc 2023; 71:1617-1626. [PMID: 36779619 PMCID: PMC10175172 DOI: 10.1111/jgs.18281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 12/22/2022] [Accepted: 01/15/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND Older adults with limited mobility are at an increased risk of adverse health outcomes, an outcome inadequately investigated in older Mexican Americans. We explored whether pre-admission life-space mobility predicts post-hospitalization outcomes among hospitalized Mexican American Medicare beneficiaries. METHODS Life-space mobility, using the Life-Space Assessment (LSA), was analyzed using quartiles and 5-point intervals. Using the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE) Waves 7 and 8 data linked to Medicare claims data, 426 older Mexican Americans with at least 2 months of Medicare coverage who were hospitalized within 2 years of completing the LSA were included. Logistic and Cox Proportional regression analyses estimated the association of pre-admission LSA with post-hospitalization outcomes. RESULTS Prior to hospitalization, 85.4% reported limited life-space mobility. Most patients (n = 322, 75.6%) were hospitalized for medical reasons. About 65% were discharged to the community. Pre-admission LSA scores were not associated with community discharge (Odds Ratio [OR] = 1.02, 0.95-1.10). Higher pre-admission LSA scores were associated with 30-day readmission (OR = 1.11, 1.01-1.22). Patients in the highest pre-admission LSA quartile (i.e., greatest life-space mobility) were less likely to die within 2 years after hospital discharge (OR = 0.61, 0.39-0.97) compared to those with lower pre-admission LSA scores. CONCLUSIONS Among older Mexican American Medicare beneficiaries, greater pre-admission LSA scores were associated with an increased risk of 30-day readmission and a decreased risk of mortality within 2 years following hospitalization. Future work should further investigate the relationship between LSA and post-hospitalization outcomes in a larger sample of Mexican American older adults.
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Affiliation(s)
- Monique R. Pappadis
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch (UTMB) at Galveston, Galveston, TX, USA
- Sealy Center on Aging, UTMB, Galveston, TX, USA
| | - Lin-Na Chou
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch (UTMB) at Galveston, Galveston, TX, USA
- Department of Biostatistics and Data Science, School of Public and Population Health, UTMB, Galveston, TX, USA
| | - Bret Howrey
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch (UTMB) at Galveston, Galveston, TX, USA
- Department of Family Medicine, School of Medicine, UTMB, Galveston, TX
| | - Soham Al Snih
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch (UTMB) at Galveston, Galveston, TX, USA
- Sealy Center on Aging, UTMB, Galveston, TX, USA
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14
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Lech S, Mümken S, Kessler EM, Gellert P. Life-space mobility among home-living older adults with care needs and clinical depression-A cross-sectional analysis. Int J Geriatr Psychiatry 2023; 38:e5875. [PMID: 36647245 DOI: 10.1002/gps.5875] [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: 06/09/2022] [Accepted: 01/09/2023] [Indexed: 01/14/2023]
Abstract
OBJECTIVES While life-space mobility is key for wellbeing, social participation and access to health care, vulnerable older adults face physical and mental barriers that may restrict mobility. The present exploratory study examined associations between physical functional limitations, depressive symptoms, life-space mobility and outpatient health care utilization. METHODS Cross-sectional data from 197 community-dwelling older adults with care needs and clinical depression was collected. Life-space assessment composite score (LS-C), instrumental activities of daily living scale (iADL), Geriatric Depression Scale (GDS-12) and outpatient health care utilization have been assessed. Multiple regression analyses were conducted. RESULTS Mean LS-C score was 31.8 (SD = 17.7, range: 0-92), indicating low mobility levels. Depressive symptoms (β = -0.21, p = 0.001) and iADL (β = 0.54, p < 0.001) were significantly related with life-space mobility, over and above age and living alone. An interaction effect between depressive symptoms and iADL was not significant (β = -0.07, 0.17, p = 0.26). Moreover, life-space mobility was positively associated with primary care (β = 0.19, p = 0.02) and mental health care utilization (β = 0.33, p < 0.001). CONCLUSIONS Life-space mobility appears to be largely restricted in home-living vulnerable older adults with clinically significant depression; and factors associated with these restrictions appear to be physical and mental. The interplay of depression, mobility and health care utilization and its potential for interventional approaches need further investigations. Present findings underline an urgent need for new health care services that allow mobility-impaired older patients to receive mental health outpatient treatment in their own home. CLINICAL TRIAL REGISTRATION The trial was prospectively registered with the ISRCTN registry (Trial registration number: ISRCTN55646265, registered February 15, 2019).
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Affiliation(s)
- Sonia Lech
- Institute for Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sandra Mümken
- Institute for Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Eva-Marie Kessler
- Department of Psychology, MSB Medical School Berlin, Berlin, Germany
| | - Paul Gellert
- Institute for Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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15
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Choi NG, Choi BY, Marti CN. Changes in Older Adults' Frequency of Going Outside between 2020 and 2021: Associations with Health Status and Environmental Factors. Clin Gerontol 2023; 46:745-758. [PMID: 36760067 PMCID: PMC10409875 DOI: 10.1080/07317115.2023.2177573] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVES To examine the changes in the frequency of going outside among U.S. older adults between 2020 and 2021 (post-COVID vaccine) and correlates of those changes. METHODS We used the 2019-2021 National Health and Aging Trend Study (NHATS) (N = 3,063, age 70+) and multinomial logistic regression to analyze associations of increased and decreased frequencies in going outside with physical, psychosocial, and cognitive health, environmental (COVID concerns and transportation) factors, and social media use as the independent variables. RESULTS In 2021 compared to 2020, 13% and 16% of those age 70+ reported increased and decreased frequencies, respectively. Increased frequency was associated with social media use. Decreased frequency was associated with poor physical health, depression/anxiety, and perceived memory decline. COVID concerns and transportation problems, as well as female gender, age 90+, and being non-Hispanic Black, were also significant correlates of decreased frequency. CONCLUSIONS Most U.S. adults age 70+ appear to have resumed their 2019 level of frequency of going outside in 2021 after the COVID vaccines became available; however, 16% reported decreased frequency of going outside in 2021 compared to 2020. CLINICAL IMPLICATIONS Older adults with physical, mental, and cognitive health challenges need help to increase their frequency of going outside.
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Affiliation(s)
- Namkee G. Choi
- Steve Hicks School of Social Work, University of Texas at Austin
| | - Bryan Y. Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine and Bayhealth Medical Center
| | - C. Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin
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16
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Merchant RA, Chan YH, Aprahamian I, Morley JE. Patterns of participation restriction among older adults at risk of falls and relationship with intrinsic capacity: A latent cluster analysis. Front Med (Lausanne) 2022; 9:1023879. [PMID: 36507507 PMCID: PMC9732451 DOI: 10.3389/fmed.2022.1023879] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/26/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction The concept of participation restriction was first described by the World Health Organization in 2001 as a component of The International Classification of Functioning, Disability and Health Framework. Both falls and fear of falling (FOF) are associated with social isolation, depression, anxiety, poor quality of life and cognitive impairment resulting in participation restriction. Life-space mobility (LSM) is an important indicator for participation restriction which depends on multiple inter-related factors. We aimed to determine participation patterns using latent cluster analysis (LCA) in older adults at risk of falls, its relationship with intrinsic capacity (IC) and its risk prediction. Methods Cross-sectional study of 154 community dwelling older adults ≥ 60 years with falls or risk of falls was conducted. Questionnaires were administered on demographics, hearing, LSM, frailty (FRAIL scale), anorexia of aging (SNAQ), cognition (Montreal Cognitive Assessment, MoCA), FOF (Falls Efficacy Scale-International), physical function, and assessment for handgrip strength (HGS), gait speed, 5-times sit to stand (STS), vision and times-up-and-go (TUG) were performed. Six IC domains (vision and hearing, cognition, nutrition, mobility and depression) were measured. Results Three pattern of participation cluster were identified, high (n = 63, 40.9%), moderate (n = 83, 53.9%) and low (n = 8, 33 5.2%). Individuals in the high participation cluster were significantly younger, had higher LSM scores and lower FES-I scores, more robust, fewer ADL and IADL limitations, lower prevalence of low HGS, higher gait speed and shorter TUG. In the fully adjusted model compared to the high participation cluster, moderate participation was significantly associated with low MoCA scores (OR 4.2, 95% CI 1.7-10.4, p = 0.02), poor STS (OR 7.1, 95% CI 3.0-17.0, p < 0.001) whereas low participation was associated with anorexia of aging (OR 9.9, 95% CI 1.6-60.9, p = 0.014), poor STS (OR 19.1, 95% CI 2.0-187.5, p = 0.011) and hearing impairment (OR 9.8, 95% CI 1.4-70.8, p = 0.024). Participants with 3 out of 6 IC decline had a probability of greater than 80% to belong to the low/moderate participation class. Discussion Physical function, cognition, hearing and nutrition were significantly associated with low and/or moderate participation class. Future studies are needed to evaluate improvement in participation of those with falls or at risk for falls through restoration of IC.
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Affiliation(s)
- Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ivan Aprahamian
- Geriatrics Division, Department of Internal Medicine, Jundiai Medical School, Jundiai, São Paulo, Brazil
| | - John E Morley
- Division of Geriatric Medicine, Department of Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
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17
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Vogel O, Otto AK, Zimmel H, Hinrichs T, Giannouli E, Wollesen B. Definition and Contextual Factors of Nursing Home Residents' Mobility in a Holistic View: A Delphi Study. Innov Aging 2022; 7:igac067. [PMID: 36789366 PMCID: PMC9912704 DOI: 10.1093/geroni/igac067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Indexed: 11/05/2022] Open
Abstract
Background and Objectives Current definitions of older adults' mobility do not cover the full range of influencing factors and do not consider nursing home residents. The present study reports expert ratings from a Delphi study regarding factors influencing the mobility of long-term nursing home residents. Research Design and Methods We invited 129 professionals with expertise in a field relevant to research on mobility in older adults such as health care, medicine, or human movement science to participate in a Delphi study comprising 3 rounds of online questionnaires. Up to 40 experts participated in each round. In the first round, we used open-ended questions to solicit possible definitions, contextual factors, and assessment tools. In the second round, the participants used Likert scales (1-10) to rate their suitability. In the final round, we presented a definition based on consensus as well as the top-rated contextual factors and assessment tools from the first 2 rounds for a final rating of agreement. Results The experts showed broad agreement on the final version of the mobility definition, with 8.9 ± 1.4 (mean ± standard deviation) out of 10 points. The experts also showed broad consensus on the selected contextual factors, with 8.4 ± 1.8 points to 8.9 ± 1.2 points (out of 10 points). This was also the case for the top 3 assessment tools selected from results of previous rounds, which showed an agreement of 7 or more points (out of 10 points) by 81.6% to 100% of all experts in the different categories. Discussion and Implications Given that an interdisciplinary group of experts considered various hitherto neglected contextual factors as relevant, the Delphi survey and its results imply the need for an updated interdisciplinary and holistic understanding of mobility in nursing home residents and can provide a basis for putting it into practice.
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Affiliation(s)
- Oliver Vogel
- Department of Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Ann-Kathrin Otto
- Department of Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Hanna Zimmel
- Department of Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Timo Hinrichs
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Eleftheria Giannouli
- Address correspondence to: Eleftheria Giannouli, PhD, ETH Zurich, Department of Health Sciences and Technology, Institute of HumanMovement Sciences and Sport, Leopold-Ruzicka-Weg 4, 8093 Zurich, Switzerland. E-mail:
| | - Bettina Wollesen
- Department of Human Movement Science, University of Hamburg, Hamburg, Germany
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18
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Brustio PR, Mulasso A, D’Emanuele S, Zia G, Feletti L, Del Signore S, Rainoldi A. Indoor Mobility, Frailty, and Disability in Community-Dwelling Older Adults: A Mediation Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11386. [PMID: 36141659 PMCID: PMC9517026 DOI: 10.3390/ijerph191811386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/18/2022] [Accepted: 09/05/2022] [Indexed: 06/16/2023]
Abstract
The general population, but especially older adults, were forced or encouraged to stay home during the recent COVID-19 pandemic. In this context, indoor mobility (IM, the number of steps performed daily at home) may be informative about the general health status of older adults. The present study aimed at evaluating the relationship between IM, frailty (loss of functional reserve including both physical and psychosocial domains), and disability (loss of autonomy measured as activities of daily life, ADLs) in a sample of community-dwelling Italian older adults. Specifically, the primary objective was to investigate IM and disability differences between robust and frail older adults. The secondary objective was to test if frailty is in the causal sequence between IM and disability, i.e., as a mediator in their relationship. Thirty-two participants (mean age = 70 ± 6 years; 56.2% women) were recruited. Frailty and disability were evaluated using the Tilburg Frailty Indicator and the Groningen Activity Restriction Scale, respectively. IM at home was measured via an Adamo wristwatch (a connected accelerometer). One-way analyses of covariance, controlling for age and gender, showed that robust participants, classified according to a score higher than five points in the Tilburg Frailty Indicator, performed significantly more IM (F1,28 = 4.639; p = 0.04) and presented lower disability grade than frail ones (F1,28 = 4.342; p =0.046). Only physical frailty was a mediator in the relationship between IM and disability (F2,29 = 8.538, p < 0.001), with a fully mediated model (z = -2.073, p < 0.04). Conversely, the total frailty score was not a mediator in the same relationship, but with IM accounted for the variance in disability (F2,29 = 8.538, p < 0.001; R2 = 33.7%). Our results suggested that frail older adults restricted their IM more and presented a higher level of disability compared to robust older adults. Moreover, data suggest that IM reduction may have a negative impact on physical frailty and indirectly increase disability.
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Affiliation(s)
- Paolo Riccardo Brustio
- NeuroMuscularFunction, Research Group, School of Exercise & Sport Sciences, University of Torino, 10126 Torino, Italy
- Department of Neuroscience, Biomedicine and Movement, University of Verona, 37124 Verona, Italy
- Department of Clinical and Biological Sciences, University of Torino, 10126 Torino, Italy
| | - Anna Mulasso
- NeuroMuscularFunction, Research Group, School of Exercise & Sport Sciences, University of Torino, 10126 Torino, Italy
- Department of Medical Sciences, University of Torino, 10126 Torino, Italy
| | - Samuel D’Emanuele
- Department of Neuroscience, Biomedicine and Movement, University of Verona, 37124 Verona, Italy
| | | | | | | | - Alberto Rainoldi
- NeuroMuscularFunction, Research Group, School of Exercise & Sport Sciences, University of Torino, 10126 Torino, Italy
- Department of Medical Sciences, University of Torino, 10126 Torino, Italy
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19
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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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20
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Geohagen O, Hamer L, Lowton A, Guerra S, Milton-Cole R, Ellery P, Martin FC, Lamb SE, Sackley C, Sheehan KJ. The effectiveness of rehabilitation interventions including outdoor mobility on older adults' physical activity, endurance, outdoor mobility and falls-related self-efficacy: systematic review and meta-analysis. Age Ageing 2022; 51:6612691. [PMID: 35737601 PMCID: PMC9220027 DOI: 10.1093/ageing/afac120] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To determine the effectiveness of community-based rehabilitation interventions which incorporate outdoor mobility on physical activity, endurance, outdoor mobility and falls-related self-efficacy in older adults. Design MEDLINE, Embase, CINAHL, PEDro and OpenGrey were searched systematically from inception to June 2021 for randomised controlled trials (RCTs) of community-based rehabilitation incorporating outdoor mobility on physical activity, endurance, outdoor mobility and/or falls-related self-efficacy in older adults. Duplicate screening, selection, extraction and appraisal were completed. Results were reported descriptively and with random-effects meta-analyses stratified by population (proactive [community-dwelling], reactive [illness/injury]). Results A total of 29 RCTs with 7,076 participants were identified (66% high bias for at least one domain). The outdoor mobility component was predominantly a walking programme with behaviour change. Rehabilitation for reactive populations increased physical activity (seven RCTs, 587 participants. Hedge’s g 1.32, 95% CI: 0.31, 2.32), endurance (four RCTs, 392 participants. Hedges g 0.24; 95% CI: 0.04, 0.44) and outdoor mobility (two RCTs with 663 participants. Go out as much as wanted, likelihood of a journey) at intervention end versus usual care. Where reported, effects were preserved at follow-up. One RCT indicated a benefit of rehabilitation for proactive populations on moderate-to-vigorous activity and outdoor mobility. No effect was noted for falls-related self-efficacy, or other outcomes following rehabilitation for proactive populations. Conclusion Reactive rehabilitation for older adults may include walking programmes with behaviour change techniques. Future research should address the potential benefit of a walking programme for proactive populations and address mobility-related anxiety as a barrier to outdoor mobility for both proactive and reactive populations.
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Affiliation(s)
- Olyvia Geohagen
- Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, UK
| | - Lydia Hamer
- Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, UK
| | - Alexandra Lowton
- Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, UK
| | - Stefanny Guerra
- Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, UK
| | - Rhian Milton-Cole
- Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, UK
| | | | - Finbarr C Martin
- Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, UK
| | - Sallie E Lamb
- Institute of Health Research, University of Exeter, UK
| | - Catherine Sackley
- Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, UK.,Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Katie J Sheehan
- Department of Population Health Sciences, School of Population and Environmental Sciences, Kings College London, UK
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21
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Smail EJ, Kaufmann CN, Riehm KE, Mardini MT, Cenko E, Bai C, Manini TM. Worsening sleep predicts lower life space mobility during the onset of the COVID-19 pandemic. J Am Geriatr Soc 2022; 70:1931-1938. [PMID: 35608359 PMCID: PMC9283282 DOI: 10.1111/jgs.17896] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/10/2022] [Accepted: 05/15/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Poor sleep health is an understudied yet potentially modifiable risk factor for reduced life space mobility (LSM), defined as one's habitual movement throughout a community. The objective of this study was to determine whether recalled changes in sleep traits (e.g., sleep quality, refreshing sleep, sleep problems, and difficulty falling asleep) because of the COVID-19 pandemic were associated with LSM in older adults. METHODS Data were obtained from a University of Florida-administered study conducted in May and June of 2020 (n = 923). Linear regression models were used to assess the impact of COVID-related change in sleep traits with summary scores from the Life Space Assessment. Analyses were adjusted for demographic, mental, and physical health characteristics, COVID-related avoidant behaviors, and pre-COVID sleep ratings. RESULTS In unadjusted models, reporting that any sleep trait got "a lot worse" or "a little worse" was associated with a decrease in LSM (all p < 0.05). Results were attenuated when accounting for demographic, mental, and physical health characteristics. In fully adjusted models, reporting that problems with sleep got "a lot worse" or that refreshing sleep got "a little worse" was associated with a lower standardized LSM score (β = -0.38, 95% CI: -0.74, -0.01, and β = -0.19, 95% CI: -0.37, -0.00, respectively). CONCLUSIONS While additional research is needed in diverse people and environments, the results demonstrate an association between sleep traits that worsen in response to a health threat and reduced LSM. This finding suggests that interventions that focus on maintaining sleep health in times of heightened stress could preserve LSM.
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Affiliation(s)
- Emily J Smail
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Christopher N Kaufmann
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Kira E Riehm
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Mamoun T Mardini
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Erta Cenko
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Chen Bai
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Todd M Manini
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
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22
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Lee J, Shields RK. Extracellular to Intracellular Body Water and Cognitive Function among Healthy Older and Younger Adults. J Funct Morphol Kinesiol 2022; 7:jfmk7010018. [PMID: 35225904 PMCID: PMC8883954 DOI: 10.3390/jfmk7010018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/16/2022] Open
Abstract
Compromised cognitive function is associated with increased mortality and increased healthcare costs. Physical characteristics including height, weight, body mass index, sex, and fat mass are often associated with cognitive function. Extracellular to intracellular body water ratio offers an additional anthropometric measurement that has received recent attention because of its association with systemic inflammation, hypertension, and blood−brain barrier permeability. The purposes of this study were to determine whether extracellular to intracellular body water ratios are different between younger and older people and whether they are associated with cognitive function, including executive function and attention, working memory, and information processing speed. A total of 118 healthy people (39 older; 79 younger) participated in this study. We discovered that extracellular to intracellular body water ratio increased with age, was predictive of an older person’s ability to inhibit information and stay attentive to a desired task (Flanker test; R2 = 0.24; p < 0.001), and had strong sensitivity (83%) and specificity (91%) to detect a lower executive function score. These findings support that extracellular to intracellular body water ratio offers predictive capabilities of cognitive function, even in a healthy group of elderly people.
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23
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Ryder‐Burbidge C, Wieler M, Nykiforuk CI, Jones CA. Life-Space Mobility and Parkinson's Disease. A Multiple-Methods Study. Mov Disord Clin Pract 2022; 9:351-361. [PMID: 35402649 PMCID: PMC8974890 DOI: 10.1002/mdc3.13406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 01/21/2023] Open
Abstract
Background Life-space mobility (LSM) captures a broad spectrum of mobility in physical and social environments; however, it has not been extensively studied in Parkinson's disease. Using a multiple-methods approach, individual, social and environmental factors that impact LSM were explored in PD. Methods Two hundred twenty-seven participants with PD (n = 113) and a comparative group without PD (n = 114) were recruited from the community. Within a cross-sectional survey, LSM (University of Alabama Birmingham Life-Space Assessment, LSA) was compared in the two groups. Using multiple linear regression, socio-demographics, lifestyle behaviors, medical, mobility and social factors were examined to identify factors that explained LSM. A qualitative narrative inquiry was completed to augment the findings from the survey; 10 participants with PD were interviewed regarding facilitators and barriers to mobility. Results The mean overall LSA-composite score for the PD group was 64.2 (SD = 25.8) and 70.3 (SD = 23.1) for the community comparative group (mean difference = 6 points, 95%CI:-0.4, 12.5) indicating most participants moved independently beyond their neighborhoods. A higher proportion of the PD group required assistance with mobility than the community comparison group. Not driving, receiving caregiving, lower social participation, and lower monthly family finances were associated with restricted LSM in the PD group. Data from qualitative interviews supported quantitative findings and offered insights into the features of the built environment that facilitate and restrict mobility. Conclusion Individual, social and environmental factors are associated with the LSM among persons with PD. Clinicians and policy-makers should include both individual and community-based factors when developing interventions to encourage the LSM of the PD population.
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Affiliation(s)
| | - Marguerite Wieler
- Department of Physical TherapyUniversity of AlbertaEdmontonAlbertaCanada
| | | | - C. Allyson Jones
- School of Public Health, University of AlbertaEdmontonAlbertaCanada,Department of Physical TherapyUniversity of AlbertaEdmontonAlbertaCanada
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24
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Mertens A, Theisen M, Funke J. Measuring Achievement, Affiliation, and Power Motives in Mobility Situations: Development of the Multi-Motive Grid Mobility. Front Psychol 2022; 12:765627. [PMID: 35046868 PMCID: PMC8761799 DOI: 10.3389/fpsyg.2021.765627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
The current study introduces the Multi-Motive Grid Mobility (MMG-M) in an age-stratified sample (N = 206) that aims to disentangle six motive components - hope of success, hope of affiliation, hope of power, fear of failure, fear of rejection, and fear of power - in mobility-related and mobility-unrelated scenarios. Similar to the classical Multi-Motive Grid (MMG), we selected 14 picture scenarios representing seven mobility and seven non-mobility situations. The scenarios were combined with 12 statements from the MMG. Both the MMG-M and MMG were assessed to allow comparability between psychometric criteria. The results of confirmatory factor analyses yielded a good model fit for a six-factor solution with an additional mobility factor for the MMG-M. Internal consistency of the items was similar to the MMG. Lastly, we investigated associations between the motive components and mobility-related variables. We found that risk awareness was positively related to all fear components in both mobility and non-mobility scenarios. Most importantly, physical constraint was positively associated with fear of rejection and fear of power in mobility situations underlining the importance to create support systems to reduce these concerns in people's everyday lives.
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Affiliation(s)
- Alica Mertens
- Institute of Psychology, Heidelberg University, Heidelberg, Germany
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25
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Lima MDCCD, Perracini MR, Guerra RO, Borim FDSA, Yassuda MS, Neri AL. Precisão da medida de mobilidade no espaço de vida para discriminar fragilidade e sarcopenia em idosos. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2022. [DOI: 10.1590/1981-22562022025.210219.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo Identificar o perfil de mobilidade nos espaços de vida em idosos que vivem na comunidade e estabelecer a precisão dos pontos de corte desse instrumento para discriminar entre níveis de fragilidade, fragilidade em marcha e de risco de sarcopenia. Método Estudo observacional e metodológico com 391 participantes com 72 anos e mais (80,4±4,6), que responderam ao Life Space Assessment (LSA) e a medidas de rastreio de fragilidade e risco de sarcopenia usando respectivamente o fenótipo de fragilidade e o SARC-F. Os pontos de corte para fragilidade e risco de sarcopenia foram determinados por meio da Curva ROC (Receiver Operating Characteristic) com intervalos de confiança de 95%. Resultados A média da pontuação no LSA foi 53,6±21,8. Os pontos de corte de melhor acurácia diagnóstica foram ≤54 pontos para fragilidade em marcha (AUC= 0,645 95%; p<0,001) e ≤60 pontos para risco de sarcopenia (AUC= 0,651 95%; p<0,001). Conclusão A capacidade de idosos de se deslocar nos vários níveis de espaços de vida, avaliado pelo LSA demonstrou ser uma ferramenta viável que pode contribuir no rastreio de fragilidade em marcha e de risco de sarcopenia e, com isso, prevenir desfechos negativos.
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26
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Lima MDCCD, Perracini MR, Guerra RO, Borim FDSA, Yassuda MS, Neri AL. Accuracy of the life-space mobility measure for discriminating frailty and sarcopenia in older people. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2022. [DOI: 10.1590/1981-22562022025.210219.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective To identify the profile of a sample of older people recruited at home based on a measure of life-space mobility and to establish the accuracy of the cut-off points of this instrument for discriminating between levels of frailty, frailty in walking speed and risk of sarcopenia. Method An observational methodological study of 391 participants aged ≥72 (80.4±4.6) years, who answered the Life-Space Assessment (LSA) and underwent frailty and risk of sarcopenia screening using the frailty phenotype and SARC-F measures, respectively, was performed. The cut-off points for frailty and risk of sarcopenia were determined using ROC (Receiver Operating Characteristic) curves and their respective 95% confidence intervals. Results Mean total LSA score was 53.6±21.8. The cut-off points with the best diagnostic accuracy for total LSA were ≤54 points for frailty in walking speed (AUC=0.645 95%; p<0.001) and ≤60 points for risk of sarcopenia (AUC=0.651 95%; p<0.001). Conclusion The ability of older people to move around life-space levels, as assessed by the LSA, proved a promising tool to screen for frailty in walking speed and risk of sarcopenia, thus contributing to the prevention of adverse outcomes.
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27
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Classen S, Mason JR, Hwangbo SW, Sisiopiku V. Predicting Autonomous Shuttle Acceptance in Older Drivers Based on Technology Readiness/Use/Barriers, Life Space, Driving Habits, and Cognition. Front Neurol 2021; 12:798762. [PMID: 34925223 PMCID: PMC8674351 DOI: 10.3389/fneur.2021.798762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
Shared autonomous vehicle services (i. e., automated shuttles, AS) are being deployed globally and may improve older adults (>65 years old) mobility, independence, and participation in the community. However, AS must be user friendly and provide safety benefits if older drivers are to accept and adopt this technology. Current potential barriers to their acceptance of AS include a lack of trust in the systems and hesitation to adopt emerging technology. Technology readiness, perceived ease of use, perceived barriers, and intention to use the technology, are particularly important constructs to consider in older adults' acceptance and adoption practices of AS. Likewise, person factors, i.e., age, life space mobility, driving habits, and cognition predict driving safety among older drivers. However, we are not sure if and how these factors may also predict older adults' intention to use the AS. In the current study, we examined responses from 104 older drivers (M age = 74.3, SD age = 5.9) who completed the Automated Vehicle User Perception Survey (AVUPS) before and after riding in an on-road automated shuttle (EasyMile EZ10). The study participants also provided information through the Technology Readiness Index, Technology Acceptance Measure, Life Space Questionnaire, Driving Habits Questionnaire, Trail-making Test Part A and Part B (TMT A and TMT B). Older drivers' age, cognitive scores (i.e., TMT B), driving habits (i.e., crashes and/or citations, exposure, and difficulty of driving) and life space (i.e., how far older adults venture from their primary dwelling) were entered into four models to predict their acceptance of AVs-operationalized according to the subscales (i.e., intention to use, perceived barriers, and well-being) and the total acceptance score of the AVUPS. Next, a partial least squares structural equation model (PLS-SEM) elucidated the relationships between, technology readiness, perceived ease of use, barriers to AV acceptance, life space, crashes and/or citations, driving exposure, driving difficulty, cognition, and intention to use AS. The regression models indicated that neither age nor cognition (TMT B) significantly predicted older drivers' perceptions of AVs; but their self-reported driving difficulty (p = 0.019) predicted their intention to use AVs: R 2 = 6.18%, F (2,101) = 4.554, p = 0.040. Therefore, intention to use was the dependent variable in the subsequent PLS-SEM. Findings from the PLS-SEM (R 2 = 0.467) indicated the only statistically significant predictors of intention to use were technology readiness (β = 0.247, CI = 0.087-0.411) and barriers to AV acceptance (β = -0.504, CI = 0.285-0.692). These novel findings provide evidence suggesting that technology readiness and barriers must be better understood if older drivers are to accept and adopt AS.
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Affiliation(s)
- Sherrilene Classen
- Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Justin R Mason
- Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Seung Woo Hwangbo
- Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Virginia Sisiopiku
- Department of Civil, Construction, and Environmental Engineering, School of Engineering, University of Alabama at Birmingham, Birmingham, AL, United States
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28
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Chung J, Boyle J, Wheeler DC. Relationship Between Life-Space Mobility and Health Characteristics in Older Adults Using Global Positioning System Watches. J Appl Gerontol 2021; 41:1186-1195. [PMID: 34719296 DOI: 10.1177/07334648211054834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aimed to examine the feasibility of using global positioning system (GPS) watches to examine relationships between GPS-based life-space mobility (LSM) metrics and self-report LSM and health measures (physical, psychological, and cognitive function) among older adults. Thirty participants wore a Fitbit Surge for 3 days. Eight spatial and temporal LSM measures were derived from GPS data. About 90% of in-home movement speeds were zero, indicating the sedentary lifestyle, but they made some active out-of-home trips as the total distance traveled and size of movement area indicated. There was a significant difference in total distance traveled and 95th percentile of movement speed between mild cognitive and intact cognition groups. GPS-based higher proportion of out-of-home time was significantly associated with greater functional fitness. Greater GPS use hours were significantly associated with higher cognition. These findings suggest the potential of GPS watches to continuously monitor changes in functional health to inform prevention efforts.
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Affiliation(s)
- Jane Chung
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Joseph Boyle
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - David C Wheeler
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
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29
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Liddle J, Ireland D, Krysinska K, Harrison F, Lamont R, Karunanithi M, Kang K, Reppermund S, Sachdev PS, Gustafsson L, Brauer S, Pachana NA, Brodaty H. Lifespace metrics of older adults with mild cognitive impairment and dementia recorded via geolocation data. Australas J Ageing 2021; 40:e341-e346. [PMID: 34698431 DOI: 10.1111/ajag.13007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Lifespace, the physical area in which someone conducts life activities, indicates lived community mobility. This study explored the feasibility of technology-based lifespace measurement for older people with dementia and mild cognitive impairment (MCI), including the generation of a range of lifespace metrics, and investigation of relationships with health and mobility status. METHODS An exploratory study was conducted within a longitudinal observational study. Eighteen older adults (mean age 86.7 years (SD: 3.2); 8 men; 15 MCI), participated. Lifespace metrics were generated from geolocation data (GPS and Bluetooth beacon) collected through a smartphone application for one week (2015-2016). Cognitive and mobility-related outcomes were compared from study data sets at baseline (2005-2007) and 6-year follow-up (2011-2014). RESULTS Lifespace data could be collected from all participants, and metrics were generated including percentage of time at home, maximum distance from home, episodes of travel in a week, days in a week participants left home, lifespace area (daily, weekly and total), indoor lifespace (regions in the home/hour), and a developed lifespace score that combined time, frequency of travel, distance and area. Results indicated a large range of lifespace areas (0.1 - 97.88 km2 ; median 6.77 km2 ) with similar patterns across lifespace metrics. Significant relationships were found between lifespace metrics and concurrent driving status and anteceding scores on the sit-to-stand test (at baseline and follow-up). CONCLUSIONS Further longitudinal exploration of lifespace is required to develop an understanding of the nature of lifespace of older community-dwelling people, and its relationship with health, mobility and well-being outcomes.
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Affiliation(s)
- Jacki Liddle
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Qld, Australia
| | - David Ireland
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Qld, Australia
| | - Karolina Krysinska
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia.,Centre for Mental Health, School of Population and Global Health, University of Melbourne, Melbourne, Vic, Australia
| | - Fleur Harrison
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, NSW, Australia
| | - Robyn Lamont
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia
| | - Mohan Karunanithi
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Qld, Australia
| | - Kristan Kang
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, NSW, Australia
| | - Simone Reppermund
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, NSW, Australia
| | - Louise Gustafsson
- School of Allied Health Sciences, Griffith University, Brisbane, Qld, Australia
| | - Sandra Brauer
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia
| | - Nancy A Pachana
- School of Psychology, University of Queensland, Brisbane, Qld, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, NSW, Australia
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30
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Dunlap PM, Rosso AL, Zhu X, Klatt BN, Brach JS. The Association of Mobility Determinants and Life Space Among Older Adults. J Gerontol A Biol Sci Med Sci 2021; 77:2320-2328. [PMID: 34529773 DOI: 10.1093/gerona/glab268] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is important to understand the factors associated with life space mobility so that mobility disability can be prevented/treated. The purpose of this study was to identify the association between mobility determinants and life space among older adults. METHODS This study was a cross-sectional analysis of 249 community-dwelling older adults (mean age=77.4 years, 65.5% female, 88% white) who were recruited for a randomized, controlled, clinical intervention trial. Associations between cognitive, physical, psychosocial, financial, and environmental mobility determinants and the Life Space Assessment (LSA) at baseline were determined using Spearman's correlation coefficients and one-way analysis of variance. Multivariate analysis was performed using multivariable linear regression models. RESULTS The mean LSA score for the sample was 75.3 (SD=17.8). Personal factors (age, gender, education, comorbidities), cognitive (Trail Making Test A and B), physical (gait speed, lower extremity power, Six Minute Walk Test, Figure of 8 Walk Test, tandem stance, energy cost of walking, and Late Life Function and Disability Function Scale), psychosocial (Modified Gait Efficacy Scale), and financial (neighborhood socio-economic status) domains of mobility were significantly associated with LSA score. In the final regression model, age (β=-0.43), lower extremity power (β=0.03), gait efficacy (β=0.19), and energy cost of walking (β=-57.41) were associated with life space (R 2=0.238). CONCLUSIONS Younger age, greater lower extremity power, more confidence in walking, and lower energy cost of walking were associated with greater life space. Clinicians treating individuals with mobility disability should consider personal, physical, and psychosocial factors assessing barriers to life space mobility.
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Affiliation(s)
- Pamela M Dunlap
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrea L Rosso
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Xiaonan Zhu
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brooke N Klatt
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
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31
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Hashimoto K, Hirashiki A, Kawamura K, Sugioka J, Mizuno Y, Tanioku S, Sato K, Ueda I, Itoh N, Nomoto K, Kokubo M, Shimizu A, Kondo I. Short physical performance battery score and driving a car are independent factors associated with life-space activities in older adults with cardiovascular disease. Geriatr Gerontol Int 2021; 21:900-906. [PMID: 34363304 DOI: 10.1111/ggi.14254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 06/26/2021] [Accepted: 07/16/2021] [Indexed: 12/24/2022]
Abstract
AIM Decreased use of life spaces, as reflected in decreased Life-Space Assessment (LSA) scores, is associated with poor prognosis in older adults. The purpose of this study was to examine factors affecting the extent of life-space activities in older adults with cardiovascular disease. METHODS We carried out a prospective observational study in 98 older adults (minimum age 65 years; mean age 79.5 ± 7.4 years) who were admitted to our hospital due to cardiovascular disease. Once their medical condition was stable, they underwent cardiopulmonary exercise testing, echocardiography and physical evaluation, and completed questionnaires. RESULTS The LSA score was significantly associated with the ability to drive a car (driving 95.1 ± 21.1 points, not driving 60.4 ± 30.3 points, P < 0.001). In addition, LSA was significantly correlated with age; peak VO2 ; brain natriuretic peptide; and Short Physical Performance Battery, Geriatric Depression Scale and Mini-Mental State Examination scores. In a multiple regression analysis, Short Physical Performance Battery and driving a car were significantly associated with LSA (β = 0.28, β = 0.37, respectively). CONCLUSION Assessment of motor function and social factors in addition to clinical cardiac function might be important to understand the complete context of life-space activity in older adults with cardiovascular disease. Geriatr Gerontol Int 2021; ••: ••-••.
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Affiliation(s)
- Kakeru Hashimoto
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Akihiro Hirashiki
- Department of Cardiology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Koki Kawamura
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Junpei Sugioka
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yumi Mizuno
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shunya Tanioku
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kenji Sato
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Ikue Ueda
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Naoki Itoh
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kenichiro Nomoto
- Department of Cardiology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Manabu Kokubo
- Department of Cardiology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Atsuya Shimizu
- Department of Cardiology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Izumi Kondo
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
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Liddle J, Stuart A, Worthy P, Levine M, Kastelle T, Wiles J, Pachana NA, Clare L. "Building the Threads of Connection that We Already Have": The Nature of Connections via Technology for Older People. Clin Gerontol 2021; 44:406-417. [PMID: 33263493 DOI: 10.1080/07317115.2020.1852638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: The social connectedness of older people is of increasing concern. Technology has been suggested for enhancing social inclusion. This study aimed to explore the nature and quality of connections via technology.Methods: Qualitative exploration of experiences, stories, and needs was undertaken through semi-structured interviews with older (7) and middle-aged (3) adults with rich experience of connections via technology in Australia and England. Core aspects of connections through technology were constructed through interpretive description analysis.Results: Four key aspects were: 1. The caliber of connections: descriptions of a range of subjective quality of connections and characteristics of good connections; 2. Experiences of poor connection (mis- and dis-connection) including descriptions of experiences creating isolation; 3. Reasons to connect described the purposes of technology-based connections including connecting with others, themselves and places important to them; 4. Making connections work described active strategies to enhance connection.Conclusions: Using technology is part of the social engagement of many people. Considering the related feelings of connection and support strategies and needs could enhance future research and practice with older people.Clinical implications: The different characteristics and potential positive and negative experiences of connection via technology need consideration in measuring social isolation and supporting older adults.
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Affiliation(s)
- Jacki Liddle
- School of Information Technology and Electrical Engineering, The University of Queensland, St Lucia, Australia
| | - Avelie Stuart
- Department of Psychology, University of Exeter, Exeter, UK
| | - Peter Worthy
- School of Information Technology and Electrical Engineering, The University of Queensland, St Lucia, Australia
| | - Mark Levine
- Department of Psychology, University of Exeter, Exeter, UK
| | - Tim Kastelle
- Business School, The University of Queensland, St Lucia, Australia
| | - Janet Wiles
- School of Information Technology and Electrical Engineering, The University of Queensland, St Lucia, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, St Lucia, Australia
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
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Sverdrup K, Bergh S, Selbæk G, Benth JŠ, Husebø B, Røen IM, Thingstad P, Tangen GG. Exploring life-space in the nursing home. An observational longitudinal study. BMC Geriatr 2021; 21:396. [PMID: 34187380 PMCID: PMC8243900 DOI: 10.1186/s12877-021-02345-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traditional performance-based measurements of mobility fail to recognize the interaction between the individual and their environment. Life-space (LS) forms a central element in the broader context of mobility and has received growing attention in gerontology. Still, knowledge on LS in the nursing home (NH) remains sparse. The aim of this study was to identify LS trajectories in people with dementia from time of NH admission, and explore characteristics associated with LS over time. METHODS In total, 583 people with dementia were included at NH admission and assessed biannually for 3 years. LS was assessed using the Nursing Home Life-Space Diameter. Association with individual (age, sex, general medical health, number of medications, pain, physical performance, dementia severity, and neuropsychiatric symptoms) and environmental (staff-to-resident ratio, unit size, and quality of the physical environment) characterises was assessed. We used a growth mixture model to identify LS trajectories and linear mixed model was used to explore characteristics associated with LS over time. RESULTS We identified four groups of residents with distinct LS trajectories, labelled Group 1 (n = 19, 3.5%), Group 2 (n = 390, 72.1%), Group 3 (n = 56, 10.4%), Group 4 (n = 76, 14.0%). Being younger, having good compared to poor general medical health, less severe dementia, more agitation, less apathy, better physical performance and living in a smaller unit were associated with a wider LS throughout the study period. CONCLUSION From NH admission most NH residents' LS trajectory remained stable (Group 2), and their daily lives unfolded within their unit. Better physical performance and less apathy emerged as potentially modifiable characteristics associated with wider LS over time. Future studies are encouraged to determine whether LS trajectories in NH residents are modifiable, and we suggest that future research further explore the impact of environmental characteristics.
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Affiliation(s)
- Karen Sverdrup
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Aldring og Helse, Postboks 2136, 3103, Tønsberg, Norway. .,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway. .,Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Sverre Bergh
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Aldring og Helse, Postboks 2136, 3103, Tønsberg, Norway.,Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Aldring og Helse, Postboks 2136, 3103, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Bettina Husebø
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.,Department of Nursing Home Medicine, Bergen, Norway
| | - Irene Mari Røen
- Centre for Development of Institutional and Home Care Services, Innlandet (Hedmark), Norway
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Gro Gujord Tangen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Aldring og Helse, Postboks 2136, 3103, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
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Change in GPS-assessed walking locations following a cluster-randomized controlled physical activity trial in older adults, results from the MIPARC trial. Health Place 2021; 69:102573. [PMID: 33934062 PMCID: PMC9177163 DOI: 10.1016/j.healthplace.2021.102573] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 04/10/2021] [Accepted: 04/11/2021] [Indexed: 11/22/2022]
Abstract
This study employed novel GPS methods to assess the effect of a multilevel physical activity (PA) intervention on device-measured walking locations in 305 community dwelling older adults, ages 65+ (mean age = 83, 73% women). Retirement communities were randomized to a 1-year PA intervention that encouraged neighborhood walking, or to a healthy aging control condition. Total time and time spent walking in four life-space domains were assessed using GPS and accelerometer devices. The intervention increased the time spent walking as a proportion of total time spent in the Campus, Neighborhood and Beyond Neighborhood domains. Intervention effects on walking location were observed in both genders and across physical and cognitive functioning groups. Results demonstrate that an intervention providing individual, social and environmental support for walking can increase PA in larger life-space domains for a broad spectrum of older adults.
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Ingram J, Hand CJ, Maciejewski G. Social isolation during COVID-19 lockdown impairs cognitive function. APPLIED COGNITIVE PSYCHOLOGY 2021; 35:935-947. [PMID: 34230768 PMCID: PMC8250848 DOI: 10.1002/acp.3821] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 02/04/2023]
Abstract
Studies examining the effect of social isolation on cognitive function typically involve older adults and/or specialist groups (e.g., expeditions). We considered the effects of COVID‐19‐induced social isolation on cognitive function within a representative sample of the general population. We additionally considered how participants ‘shielding’ due to underlying health complications, or living alone, performed. We predicted that performance would be poorest under strictest, most‐isolating conditions. At five timepoints over 13 weeks, participants (N = 342; aged 18–72 years) completed online tasks measuring attention, memory, decision‐making, time‐estimation, and learning. Participants indicated their mood as ‘lockdown’ was eased. Performance typically improved as opportunities for social contact increased. Interactions between participant sub‐groups and timepoint demonstrated that performance was shaped by individuals' social isolation levels. Social isolation is linked to cognitive decline in the absence of ageing covariates. The impact of social isolation on cognitive function should be considered when implementing prolonged pandemic‐related restrictive conditions.
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Affiliation(s)
- Joanne Ingram
- School of Education and Social Science University of the West of Scotland Paisley UK
| | | | - Greg Maciejewski
- School of Education and Social Science University of the West of Scotland Paisley UK
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Seinsche J, Zijlstra W, Giannouli E. Motility in Frail Older Adults: Operationalization of a New Framework and First Insights into Its Relationship with Physical Activity and Life-Space Mobility: An Exploratory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8814. [PMID: 33260952 PMCID: PMC7730834 DOI: 10.3390/ijerph17238814] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 01/06/2023]
Abstract
In order to design effective interventions to prevent age-related mobility loss, it is important to identify influencing factors. The concept of "motility" by Kaufmann et al. subdivides such factors into three categories: "access", "skills", and "appropriation". The aim of this study was to assemble appropriate quantitative assessment tools for the assessment of these factors in frail older adults and to get first insights into their relative contribution for life-space and physical activity-related mobility. This is an exploratory cross-sectional study conducted with twenty-eight at least prefrail, retired participants aged 61-94. Life-space mobility was assessed using the "University of Alabama at Birmingham Life-space Assessment" (LSA) and physical activity using the "German Physical Activity Questionnaire" (PAQ50+). Factors from the category "appropriation", followed by factors from the category "skills" showed the strongest associations with the LSA. Factors from the category "access" best explained the variance for PAQ50+. This study's findings indicate the importance of accounting for and examining comprehensive models of mobility. The proposed assessment tools need to be explored in more depth in longitudinal studies with larger sample sizes in order to yield more conclusive results about the appropriateness of the motility concept for such purposes.
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Affiliation(s)
| | | | - Eleftheria Giannouli
- Institute of Movement & Sport Gerontology, German Sport University Cologne, 50933 Cologne, Germany; (J.S.); (W.Z.)
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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] [MESH Headings] [Grants] [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.
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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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Parrish EM, Depp CA, Moore RC, Harvey PD, Mikhael T, Holden J, Swendsen J, Granholm E. Emotional determinants of life-space through GPS and ecological momentary assessment in schizophrenia: What gets people out of the house? Schizophr Res 2020; 224:67-73. [PMID: 33289659 DOI: 10.1016/j.schres.2020.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 10/02/2020] [Accepted: 10/03/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Previous research employing global positioning satellite (GPS) data and ecological momentary assessment (EMA) has shown a smaller life-space (distance traveled from home) was associated with poorer community functioning and more severe negative symptoms in people with schizophrenia. Momentary emotional experiences may influence how much time is spent outside of the home. We evaluated the associations between emotional experiences in relation to life-space among people with schizophrenia compared to healthy controls (HCs). METHODS 105 participants with schizophrenia and 76 HCs completed in-lab assessments of symptoms, cognition, and functioning. Participants completed EMA assessments of location and emotions seven times daily for seven days at stratified random intervals. GPS coordinates were collected 24 h a day over the 7-day study period. Analyses were performed at the momentary, day, and full week level using mixed effects models and Spearman correlations. RESULTS For HCs, greater happiness was associated with greater concurrent distance traveled away from home as measured by GPS. For participants with schizophrenia, greater anxiety was associated with greater distance traveled away from home and being outside of the home. Less happiness, but not anxiety, was also associated with greater negative symptoms, especially outside the home. DISCUSSION These findings suggest diminished positive emotion is associated with the experience of leaving the home in schizophrenia, but also suggest that anxiety may contribute to avoidance of out of home mobility. Interventions targeting both positive emotions and social anxiety may improve social functioning, and life-space may provide a useful outcome for functional rehabilitation interventions in schizophrenia.
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Affiliation(s)
- Emma M Parrish
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States of America
| | - Colin A Depp
- University of California San Diego Department of Psychiatry, San Diego, CA, United States of America; Veterans Affairs San Diego Healthcare System, San Diego, CA, United States of America.
| | - Raeanne C Moore
- University of California San Diego Department of Psychiatry, San Diego, CA, United States of America
| | - Philip D Harvey
- University of Miami Miller School of Medicine, Miami, FL, United States of America; Research Service Miami VA Medical Center, Miami, FL, United States of America
| | - Tanya Mikhael
- Johns Hopkins University School of Nursing, Baltimore, MD, United States of America
| | - Jason Holden
- University of California San Diego Department of Psychiatry, San Diego, CA, United States of America
| | - Joel Swendsen
- National Center for Scientific Research, University of Bordeaux, EPHE PSL Research University, France
| | - Eric Granholm
- University of California San Diego Department of Psychiatry, San Diego, CA, United States of America; Veterans Affairs San Diego Healthcare System, San Diego, CA, United States of America
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Johnson J, Rodriguez MA, Al Snih S. Life-Space Mobility in the Elderly: Current Perspectives. Clin Interv Aging 2020; 15:1665-1674. [PMID: 32982200 PMCID: PMC7501960 DOI: 10.2147/cia.s196944] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/10/2020] [Indexed: 11/30/2022] Open
Abstract
Life-space mobility (LSM) is a concept for assessing patterns of functional mobility over time. LSM is gaining traction in the research of geriatric population health. Several instruments have been developed to measure LSM, such as the University of Alabama at Birmingham Life-Space Assessment (LSA) or the Nursing Home Life-Space Diameter instrument. There has been exponential growth in the use of instruments measuring LSM in studies of older adults since the concept was introduced in 1985. In response to the increased volume of publications with clinical applicability to those working in geriatric health or conducting population-based research in older adults, we conducted a narrative review: a) to provide a summary of the articles that have assessed validation of the University of Alabama at Birmingham LSA instrument, the most widely used instrument to assess LSM in older adults; and b) to provide a summary of the research articles that have examined LSM as independent or outcome variable. Studies for this review were obtained with an organized search format and were included if they were published in the past 20 years, written in English, published in peer-reviewed literature, and included LSM as an independent or outcome variable. Seventy-nine articles were identified: 36 that employed a cross-sectional design and 22 that employed a longitudinal/prospective design to examine LSM as outcome variable; 17 longitudinal/prospective design articles that examined LSM as primary independent variable; 3 review articles; and 1 systematic review. Areas of research included physical function, cognitive function, sensory impairment, mental health, falls, frailty, comorbidities, healthcare use, mortality, and social/environmental factors. These studies showed that LSM instruments can accurately predict morbidity, mortality, and healthcare use.
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Affiliation(s)
- Jason Johnson
- Division of Rehabilitation Sciences/School of Health Professions, The University of Texas Medical Branch, Galveston, TX, USA
| | - Martin A Rodriguez
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA
| | - Soham Al Snih
- Division of Rehabilitation Sciences/School of Health Professions, The University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA
- Division of Geriatrics/Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA
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Kuspinar A, Verschoor CP, Beauchamp MK, Dushoff J, Ma J, Amster E, Bassim C, Dal Bello-Haas V, Gregory MA, Harris JE, Letts L, Neil-Sztramko SE, Richardson J, Valaitis R, Vrkljan B. Modifiable factors related to life-space mobility in community-dwelling older adults: results from the Canadian Longitudinal Study on Aging. BMC Geriatr 2020; 20:35. [PMID: 32005107 PMCID: PMC6995110 DOI: 10.1186/s12877-020-1431-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/15/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The most common methods for measuring mobility in older adulthood include performance-based tests, such as the Timed-Up-and-Go and gait speed. While these measures have strong predictive validity for adverse outcomes, they are limited to assessing what older adults do in standardized settings, rather than what they do in their daily life. Life-space mobility, which is the ability to move within environments that expand from one's home to the greater community, has been proposed as a more comprehensive measure of mobility. The aim of this study was to determine the association between modifiable factors and life-space mobility in older adults enrolled in the Canadian Longitudinal Study on Aging (CLSA). METHODS Life-space mobility was measured using the Life Space Index (LSI). Explanatory factors included physical, psychosocial and cognitive determinants, as well as pain, fatigue, driving status, nutrition, body mass index, smoking status, and vision. To estimate the association between the LSI and explanatory variables, univariate and multivariable ordinary least squares regression analyses were performed. RESULTS All adults 65 years and older (n = 12,646) were included in the analysis. Fifty percent were women and the mean age was 73.0 (SD5.7). The mean LSI score was 80.5, indicating that, on average, the sample was able to move outside of their neighborhood independently. All explanatory variables were significantly associated with the LSI except for balance and memory. The top 3 variables that explained the most variation in the LSI were driving, social support and walking speed. CONCLUSION To our knowledge, this was the first study to examine the association between life-space mobility and a comprehensive set of modifiable factors that were selected based on a theoretical framework and existing research evidence. This study had two important messages. First, driving, social support and walking speed emerged as the most significant correlates of life-space mobility in older adults. Second, life-space mobility is multifactorial and interventions that are pragmatic in their design and testing are needed that consider the complexity involved. A multi-disciplinary approach to examining life-space mobility in older adults is needed to optimize opportunities for healthy aging and develop strategies that support mobility in older adulthood.
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Affiliation(s)
- A Kuspinar
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - C P Verschoor
- Health Sciences North Research Institute, Sudbury, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - M K Beauchamp
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - J Dushoff
- Department of Biology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - J Ma
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - E Amster
- Department of History, Faculty of Humanities, McMaster University, Hamilton, Ontario, Canada
| | - C Bassim
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - V Dal Bello-Haas
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - M A Gregory
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - J E Harris
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - L Letts
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - S E Neil-Sztramko
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - J Richardson
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - R Valaitis
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - B Vrkljan
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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