A park-based group mobility program for older adults with difficulty walking outdoors: a quantitative process evaluation of the Getting Older Adults Outdoors (GO-OUT) randomized controlled trial

BACKGROUND

Process evaluations of randomized controlled trials (RCTs) of community exercise programs are important to help explain the results of a trial and provide evidence of the feasibility for community implementation. The objectives of this process evaluation for a multi-centre RCT of outdoor walking interventions for older adults with difficulty walking outdoors, were to determine: 1) implementation fidelity (the extent to which elements of the intervention were delivered as specified in the original protocol) and 2) participant engagement (the receipt of intervention components by the participants) in the Getting Older Adults Outdoors (GO-OUT) trial.

METHODS

GO-OUT participants attended an active 1-day workshop designed to foster safe, outdoor walking skills. After the workshop, 190 people at 4 sites were randomized to an outdoor walk group (OWG) (n = 98) which met 2x/week for 10 weeks, or the weekly reminders (WR) group (n = 92) which received a phone reminder 1x/week for 10 weeks. The OWG had 5 components - warm-up, continuous distance walk, task-oriented walking activities, 2nd continuous distance walk, and cool-down. Data on implementation fidelity and participant engagement were gathered during the study through site communications, use of standardized forms, reflective notes of the OWG leaders, and accelerometry and GPS assessment of participants during 2 weeks of the OWG.

RESULTS

All sites implemented the workshop according to the protocol. Participants were engaged in all 8 activity stations of the workshop. WR were provided to 96% of the participants in the WR intervention group. The 5 components of the OWG sessions were implemented in over 95% of the sessions, as outlined in the protocol. Average attendance in the OWG was not high - 15% of participants did not attend any sessions and 64% of participants in the OWG attended > 50% of the sessions. Evaluations with accelerometry and GPS during week 3 and 9 OWG sessions suggest that participants who attended were engaged and active during the OWG.

CONCLUSIONS

This process evaluation helps explain the main study findings and demonstrates the flexibility required in the protocol for safe and feasible community implementation. Future research could explore the use of additional behaviour change strategies to optimize attendance for community implementation.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03292510 Date of registration: September 25, 2017.

Association between meaningful activities at home and subjective well-being in older adults with long-term care needs: A cross-sectional study

For this study, we examined whether engaging in meaningful activities at home is associated with subjective well-being (SWB) in older adults with long-term care needs according to their preference for going out. We distributed a self-administered questionnaire to long-term care facilities in Japan and performed a linear mixed-effects model regression analysis of the responses. The dependent variable was SWB, and the independent variables were the number of meaningful home activities, preference for going out, and the interaction between them. In our survey (n = 217), we found that both number of meaningful home activities (B = 0.43; 95%CI: 0.17, 0.70) and its interaction with preference (B = -0.43; 95%CI: -0.79, -0.08) were associated with SWB. These results suggest the importance of engaging in meaningful activities at home for older adults who do not prefer going out. We should encourage older adults to participate in activities that match their preference.

COVID-19 infection and decline in outdoor activities associated with depression in older adults: A multicenter study in Vietnam

BACKGROUND

The coronavirus disease (COVID-19) pandemic has caused a serious global communicable disease burden. Although COVID-19 and its policy responses have significantly influenced older adults, the impact of COVID-19 on depression in the older population is not fully understood. We aimed to investigate whether a history of COVID-19 infection and a decline in outdoor activities during the COVID-19 pandemic were associated with depression among older adults in Vietnam.

METHODS

This multicenter cross-sectional study was conducted on 1,004 outpatients (aged ≥60 years; mean age 70.8 ± 7.3 years; men, 33.0%) visiting three hospitals for a comprehensive geriatric assessment between November 2021 and July 2022. Depression over the past week was evaluated using the 15-item Geriatric Depression Scale. History of COVID-19 infection and decline in outdoor activities were included as binary variables. We adjusted these two factors with sociodemographic and geriatric variables and comorbidities using a logistic regression analysis in separate models.

RESULTS

A total of 156 participants (15.5%) experienced depression. The proportion of mild, moderate, and severe depressive symptoms was 14.1%, 44.9%, and 41.0%, respectively. In the multivariate model, decline in outdoor activities (odds ratio [OR] 17.2, 95% confidence interval [CI] 9.15-32.2, p <0.001) and history of COVID-19 infection (OR 2.22, 95% CI 1.28-3.84, p = 0.004) were associated with depression. Additionally, we found that age ≥ 75 years, female sex, being underweight, limitations in functional status, poor sleep quality, and stroke were associated with depression. Of the associated factors, decline in outdoor activities had a moderate strength of association with depression (r = 0.419), while each of the remaining factors had a weak strength of association.

CONCLUSIONS

COVID-19 had a direct and indirect impact on depression in older adults, reflecting an association between both a history of COVID-19 infection and a decline in outdoor activities during the COVID-19 pandemic and depression in the older population.

Association between Prevention from Going Out and Incidence of Falls among Community-Dwelling Older Adults during COVID-19 Pandemic

To prevent falls, community-dwelling older adults must maintain regular physical activities. This study aimed to explore the association between the prevention from going out and the incidence of falls among community-dwelling older adults during the COVID-19 pandemic. We conducted a prospective cohort study that consisted of 381 individuals aged 65 years or older, living in a local community in Japan, and ranging from being independent to being physically and cognitively frail. The finding revealed that among those who had been going out five or more times weekly pre-pandemic, the prevention from going out at the time of the first state of emergency (SOE) (AOR = 6.84; 95%CI = 1.51-31.02), having history of falls (AOR = 7.35; 95%CI = 1.81-29.84), participating in group gatherings (AOR = 6.09; 95%CI = 1.48-25.12), living with spouses (AOR = 0.08; 95%CI = 0.02-0.40), and living with other than spouse (AOR = 0.15; 95%CI = 0.03-0.73) were associated with the incidence of falls. The study highlights the importance of providing regular opportunities to go out to community-dwelling older adults in order to prevent falls.

Poor Health Behaviors among Housebound Japanese Community-Dwelling Older Adults Due to Prolonged Self-Restraint during the First COVID-19 Pandemic: A Cross-Sectional Survey

BACKGROUND

Prolonged self-restraining behaviors induced by the coronavirus disease 2019 (COVID-19) pandemic's containment measures can limit various positive health behaviors.

OBJECTIVE

We examined the decline in going-out and certain other positive health behaviors and investigated the relationship between excessive decreases in going-out frequency and declining engagement in positive health behaviors among community-dwelling older adults during the self-restraint period.

DESIGN

This study employed a cross-sectional survey design.

SETTING

This study was conducted in Nishi Tokyo City, Tokyo, Japan.

PARTICIPANTS

The participants were 294 respondents (150 women) aged 50 years and older who lived in public housing that were permitted to be surveyed during the self-restraint period.

MEASUREMENTS

Their pre-pandemic going-out frequency around February 2020 and going-out frequency during the self-restraint period starting in April 2020 were reported. We mainly assessed the existence of home health behaviors (i.e., exercise, in-person and phone conversations, and healthy diet). A self-report questionnaire was used to obtain data.

RESULTS

Going-out frequency decreased in 41.2% of the 294 respondents owing to the government's request for self-restraint. In total, 13 individuals had been going out less than one time per week (housebound) before the request. Of the 281 people who were not housebound before the government's self-restraint request, 13.9% were newly housebound. Newly housebound individuals were 5.3 times less likely to exercise, had 2.1 times fewer social contacts, and 2.6 times less balanced or healthy diets than those who maintained their frequency of going out.

CONCLUSIONS

Prolonged self-restraint due to the COVID-19 pandemic may lead to housebound status and poor health behaviors. Public health intervention is needed to prevent excessive self-restraint, along with new measures integrating information and communication technologies to enable older adults to live active lives.

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

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.

Developing a mental health index using a machine learning approach: Assessing the impact of mobility and lockdown during the COVID-19 pandemic

Governments worldwide have implemented stringent restrictions to curtail the spread of the COVID-19 pandemic. Although beneficial to physical health, these preventive measures could have a profound detrimental effect on the mental health of the population. This study focuses on the impact of lockdowns and mobility restrictions on mental health during the COVID-19 pandemic. We first develop a novel mental health index based on the analysis of data from over three million global tweets using the Microsoft Azure machine learning approach. The computed mental health index scores are then regressed with the lockdown strictness index and Google mobility index using fixed-effects ordinary least squares (OLS) regression. The results reveal that the reduction in workplace mobility, reduction in retail and recreational mobility, and increase in residential mobility (confinement to the residence) have harmed mental health. However, restrictions on mobility to parks, grocery stores, and pharmacy outlets were found to have no significant impact. The proposed mental health index provides a path for theoretical and empirical mental health studies using social media.

The impact pathways of environmental, social, and behavioural factors on healthy ageing for urban dwellers aged 85+: Longitudinal study of the Tokyo Oldest Old Survey on Total Health (TOOTH)

In the context of global population ageing and concentration in cities, the population aged 80 and over (80+) is growing rapidly. Japan has the fastest ageing population and longest healthy average life expectancy, while health decline becomes pronounced and care needs increase in the 85+ age group post the ‘average life expectancy’. The healthy ageing of older urban community dwellers is a pressing issue in world initiatives for sustainable urbanisation. However, for the 85+ age group, less is known about how promoting/inhibiting factors and their pathways influence healthy ageing, and related longitudinal studies remain insufficient. Using data from a longitudinal cohort study conducted from 2008–2009 to 2014–2015 among independent dwellers aged 85+ in central Tokyo (men = 203, women = 232), this study analysed the impact pathways of environmental, social, and behavioural factors on health and survival to explore promoters and potential risks on healthy ageing by gender, with multi-group structural equation modelling (SEM) and Bayesian SEM. For both genders, there was a positive chained pathway starting from friends as facilitators through positive interactions between 'social participation’ and 'active behaviour' to 'ageing-related health'. Additionally, their personal networks were small, suggesting that men with family-centred networks and women with non-family-centred networks require different approaches and supports. Implications of the results are discussed, and an organised social watch and support system, which becomes more important in the ‘new normal’ for urban dwellers aged 85+, is recommended.

•

A 6-year longitudinal cohort study for independent urban dwellers aged 85+.

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SEM analysis among environmental, social, and behavioural factors on health.

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Friends can facilitate positive chained path through activities to health.

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Gender-differences in nature of personal networks affect healthy ageing.

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Social watching, support are necessary for this group in sustainable urbanisation.

Multidimensional factors affecting homebound older adults: A systematic review

PURPOSE

To systematically identify the multidimensional factors affecting homebound older adults.

DESIGN

Systematic review.

METHODS

We searched PubMed, MEDLINE, Cochrane Library, CINAHL, EMBASE, and PsycINFO from inception to November 15, 2020. This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. The Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies was used for quality assessment.

FINDINGS

Nineteen studies met the review criteria; the studies were either cross-sectional or longitudinal. Most studies have focused on personal factors affecting homebound older adults. The individual construct consisted of demographic, biological, psychological, functional, and health-related factors. The structural construct included architectural, environmental, community, and social factors. Based on the different definitions of homebound used in the studies, the prevalence of homebound status ranged from 3.5% to 39.8%.

CONCLUSIONS

The prevalence of homebound status among older adults varied depending on how homebound was defined. Homebound status is the interaction between the individual and structural constructs. Variations in cultural, political, and economic conditions could influence homebound status across countries over time. Comprehensive assessment and interventions for homebound older adults based on multidisciplinary approaches are recommended for nurses.

CLINICAL RELEVANCE

This research will impact the development of nursing strategies to screen homebound older adults and provide targeted preventive interventions so that older adults with many risk factors do not become homebound.

Change in subjective health status among frail older Japanese people owing to the coronavirus disease pandemic and characteristics of their responses

Aim

The coronavirus disease 2019 (COVID‐19) pandemic remains a major global public health issue, and it has led to restrictions in physical and social activities among community‐dwelling people, including frail older adults. This study aimed to determine the impact of the pandemic on the subjective health status and characteristics of community‐dwelling frail older adults by assessing their knowledge of infection, behaviors and negative psychological response.

Methods

During October 2019, 720 older adults participated in “The Otassha Study.” A year after the COVID‐19 outbreak, between June 29 and July 31, 2020, a health status questionnaire, comprising questions concerning knowledge about infection, behaviors and psychological responses during the pandemic, was sent to all participants of the health examination in 2019. Respondents were divided into the robust and frail groups, and their responses were compared.

Results

Although the self‐reported health status of the older adults in both groups was worse in 2020 than in 2019, differences were not observed in the degree of deterioration between the groups. Those in the frail group had fewer resources of information related to COVID‐19 and had fewer coping behaviors for health maintenance compared with the robust group.

Conclusion

Information gathering and actions aimed at health maintenance tended to be weaker among older adults with frailty, although the influence of COVID‐19 on subjective health status did not differ significantly between robust and frail adults. Therefore, robust and frail older adults may need to adopt different countermeasures to prevent worse health during this pandemic. Geriatr Gerontol Int 2021; 21: 1053–1059.

Self-rated Changes of Health Status during Stay-at-home Orders among Older Adults Using the Long-term Care Insurance System of Japan: A Cross-sectional Study

OBJECTIVES

To reveal self-rated changes of health status during stay-at-home orders among older adults and to verify whether decrease in frequency of going outdoors during these orders was related to self-rated changes in health status.

METHOD

A self-completed questionnaire for older adults was provided in 2 dayservice facilities and a nursing station. We operationally defined health status with 4 domains (motor function, oral and swallowing function, depression, and social networks) and designed the questionnaire to determine self-rated changes in health status using factor analysis. After factor analysis, regression analyses were conducted. Dependent variable was each factor score (self-rated changes of health status), and independent variable was decrease in frequency of going outdoors.

RESULTS

Approximately 80% of participants answered that their health status had "worsened" in motor function (75.0%-87.2%). Moreover, more than 70% of participants answered "worsened" in "Feeling energy" and "Getting together and speaking with friends" (72.3% and 75.7%, respectively). Regression analyses demonstrated that, after adjusting for covariates, the decrease in frequency of going outdoors was related to self-rated changes of motor function and friend network.

CONCLUSION

During stay-at-home orders, older adults felt deterioration in their motor function, in feeling energy, and in their friend network, especially people who had decreased their frequency of going outdoors felt more deterioration in their motor function and in their friend network.

Physical Activity and Cumulative Long-Term Care Cost among Older Japanese Adults: A Prospective Study in JAGES

This study aimed to determine the impact of physical activity on the cumulative cost of long-term care insurance (LTCI) services in a cohort of community-dwelling people (65 years and older) in Japan. Using cohort data from the Japan Gerontological Evaluation Study (JAGES) on those who were functionally independent as of 2010/11, we examined differences in the cumulative cost of LTCI services by physical activity. We followed 38,875 participants with LTCI service costs for 59 months. Physical activity was assessed by the frequency of going out and time spent walking. We adopted a generalized linear model with gamma distribution and log-link function, and a classical linear regression with multiple imputation. The cumulative LTCI costs significantly decreased with the frequency of going out and the time spent walking after adjustment for baseline covariates. LTCI's cumulative cost for those who went out once a week or less was USD 600 higher than those who went out almost daily. Furthermore, costs for those who walked for less than 30 min were USD 900 higher than those who walked for more than 60 min. Physical activity among older individuals can reduce LTCI costs, which could provide a rationale for expenditure intervention programs that promote physical activity.

A Scoping Review of Homebound Older People: Definition, Measurement and Determinants

Being homebound (HB) can affect people's physical and mental health by decreasing movement, which can itself be exacerbated by the deterioration of people's health. To break this vicious cycle of HB and being in poor health, it is necessary to identify and address the factors influencing HB status. Thus, we used a scoping review to identify an HB trend, focusing on the definition, measurements, and determinants of HB status. We analyzed 47 studies according to the five-stage methodological framework for scoping reviews. The common attribute of definitions of HB status was that the boundaries of daily life are limited to the home. However, this varied according to duration and causes of becoming HB; thus, the understanding of HB shifted from the presence or absence of being HB to the continuum of daily activity. Various definitions and measurements have been used to date. Many studies have focused on individual factors to analyze the effect of HB. In the future, it will be necessary to develop a standardized measurement that reflects the multidimensional HB state. In addition, it is necessary to utilize a theoretical framework to explore the social and environmental factors affecting HB.

Environmental stressors and well-being on middle-aged and elderly people: the mediating role of outdoor leisure behaviour and place attachment

This study develops a relational model of how environmental stressors, place attachment and outdoor leisure are related to urban green zones and, accordingly, Fujian Province in China is studied as our case problem. The research is participated by primarily middle-aged and elderly residents. In total, 871 valid questionnaires are retrieved. Structural equation modelling and path analysis are used to verify the model's fitness. The results indicate that environmental stressors and outdoor leisure are significantly negatively correlated. In addition, the outdoor leisure and place attachment are significantly positively correlated. As such, the place attachment and well-being are significantly positively correlated. However, the place attachment and outdoor leisure mediated the relationship between environmental stressors and well-being. The mediating path indicated that middle-aged and elderly residents face severe environmental stressors and will engage in a few outdoor leisure activities, resulting in low well-being. Furthermore, when middle-aged and elderly residents face severe environmental stressors, they have increased place attachment, thereby increasing their well-being. The findings can serve as a reference for environmental management agencies and future researchers.

Health Promotion as a Motivational Factor in Alpine Cycling

The present study examines motives for cycling in the alpine region and focuses on the relative importance of health promotion with respect to other motives. Furthermore, the influences of person-specific characteristics on the rank of the motives are examined, and possibilities for advertising bike tourism based on these motives and characteristics are derived. By applying a quantitative approach, a total of 175 cyclists were surveyed using questionnaires on person-specific characteristics, motives, and their relevance for alpine cycling. Data analysis revealed that health promotion is the most important motive for alpine cycling after fun and action as well as nature experience. Further health-related motives such as stress reduction are also perceived as important. The social component, on the other hand, was given the least priority. The results also showed that person-specific characteristics influence the relative importance of motives. For example, elderly persons and people with children perceive the motive of health promotion as the most important. The study shows that the health-promoting effect of alpine cycling is noticed and may be further encouraged. This study demonstrates that alpine cyclists are a heterogeneous group and that health benefits are perceived by various sub-groups therein. Therefore, any marketing for alpine cycling needs to reflect the diversity of cyclists, and approaches need to be adapted according to the respective target group.

Designing an Elderly Hospital Admission Risk Prediction Model in Iran's Hospitals

Background:

The identification of elderly at risk of new functional disabilities in activities of daily living at admission to the hospital may facilitate referral for purposive interventions to prevent decline and institutionalization. This study was aimed at designing a risk prediction model for identifying the elderly at risk of admission in Iran's hospitals.

Materials and Methods:

This is a cross-sectional descriptive study conducted in 2017. In order to formulate and validate a prediction model, the study was done in two development and validation cohort study. Functional decline was defined as a decline of at least one point on the Katz ADL index at follow-up compared with preadmission status.

Results:

In development cohort, the mean age was 71 years including 54% of men and 46% women, 22% of men and 17% of women experienced functional decline after 3 months. In the validation cohort, the mean age was 70 years, including 49% of men and 51% women, 19% of men and 15% of women, functional decline after 3 months was observed.

Conclusion:

On the basis of the findings, aging at risk of hospital admission can be identified by easy designed model with four questions: (1) Is the patient's age more than 85 years? (2) Does the patient's mini mental status <22? (3) Does the patient need help for using general transporting? (4) Has the patient lost weight <5% over the past 6 months and body mass index <18.5? And also geriatrics experts can use the designed model as a predictive tool in order to improve the quality level of healthcare services to elderly as a vulnerable and high risk group. The important point of model is easy to use even for nonspecialists.

Indoor vs. Outdoor Walking: Does It Make Any Difference in Joint Angle Depending on Road Surface?

Measurement of the joint angle during walking in real-world environments facilitates comprehension of the adaptation strategy corresponding to road surfaces. This study investigated the differences between the joint angles in the lower limb when walking on flat road surfaces in indoor and outdoor environments. Ten healthy young males who walked on a carpet-lined corridor in the indoor environment and on an interlocking block pavement surface in the outdoor environment participated in the study. The joint angles of their lower limbs were measured using seven inertial measurement units, and the average and coefficient of variation (%CV) of the joint angular excursion in the two environments were evaluated. The %CVs of the ankle plantar flexion excursion in the early stance was 45% higher in the outdoor environment compared with that in the indoor, although the spatiotemporal parameters and joint angular excursion of the proximal joints showed no difference between the environments. Though the road surfaces were flat from a macroscopic point of view, the interlocking block pavement had stiffer and more irregular characteristics. The variability in the ankle plantar flexion motion in the early stance may be most likely affected by these surface characteristics in the real-world outdoor environment.

Development of a scale measuring barriers to going out among community-dwelling older adults

AIM

To maintain the frequency of going out and to improve homebound status among older adults, specific barriers need to be identified. Hence, this study developed a scale to measure barriers to going out.

METHODS

A preliminary study was carried out to collect items for the scale. We conducted semi-structured interviews with five homebound older adults, and created 14 items as a draft barrier scale. The main study included 2273 older adults and their cohabitating family members in rural Japan. For older adults, the questions included demographic characteristics, responses to the draft scale and variables to examine its validity. For family members, the questions included demographic characteristics, their relationship with the older adult and their assessment of their older relative's willingness to go out. We used data from 892 pairs for our analysis.

RESULTS

We selected nine items through the criterion group strategy, and confirmed the unidimensional structure of the scale through factor analysis. The results showed significant relationships between the scale and older adults' self-efficacy about going out, their health locus of control, the frequency of going out and their reluctance to go out as assessed by family members. We carried out a receiver operating characteristic analysis to determine the scale's cut-off point. Our multivariate analysis showed that the scale had a significantly stronger association with homebound status than with other variables.

CONCLUSION

We developed a highly reliable and valid scale on barriers to going out among community-dwelling older adults and confirmed its usability. Geriatr Gerontol Int 2021; 21: 238-244.

Outdoor exposure and perceived outdoor environments correlated to fear of outdoor falling among assisted living residents

BACKGROUND

Fear of falling is a major health concern among older adults. Although several studies have addressed general fear of falling in relation to personal factors, little is known about the specific relationship between fear of outdoor falling and perceptions of the outdoor environments.

PURPOSE

This study is to identify perceived environmental factors and outdoor exposure associated with fear of outdoor falling among assisted living residents aged 65 or older stratified by the amount of time spent outdoors.

METHODS

This study used survey data collected from a multiregional study conducted in 2007 that surveyed residents in 68 assisted living facilities in Houston, Texas; Chicago, Illinois; and Seattle, Washington. Out of 1,043 total participants, this study used a subset of 907 residents who used outdoor areas at least five minutes a day. Multivariate logistic regression was used after controlling for covariates.

RESULTS

Approximately 31% of the participants reported having worried about falling while using the outdoor areas in their assisted living community. Multivariate analyses showed that adequately designed walkways (OR = 0.614, 95% CI = 0.405-0.931), comfort levels in using outdoor areas (OR = 0.657, 95% CI = 0.437-0.989), and frequency of outdoor usage (OR = 0.538, 95% CI = 0.368-0.787) were associated with decreased fear of outdoor falling after adjusting for individual factors (i.e. age, sex, health condition, fall history, vision problems, mobility aids).

CONCLUSION

Improved walkways and comfort levels when using outdoor areas, as well as the amount of time spent outdoors, would be helpful in reducing fear of outdoor falling, which can help promote healthy lifestyle among assisted living residents.

Influence of co-existing social isolation and homebound status on medical care utilization and expenditure among older adults in Japan

Objective

To examine whether co-existing social isolation and homebound status influence medical care utilization and expenditure in older adults.

Methods

Postal surveys on social isolation and homebound status were performed on older adults aged ≥65 years residing in a Japanese suburban city. Information on medical care utilization and expenditure was obtained from insurance claims data. These outcomes were examined over a three-year period (December 2008 to November 2011) for all participants (Analysis I, n = 1386) and during the last year of life for mortality cases (Analysis II, n = 107). A two-part model was used to analyze the influence of social isolation and homebound status on medical care utilization (first model: logistic regression model) and its related expenditure (second model: generalized linear model).

Results

Almost 12 % of participants were both socially isolated and homebound. Analysis I showed that these participants were significantly less likely to use outpatient and home medical care than participants with neither characteristic (odds ratio: 0.536, 95 % confidence interval: 0.303−0.948). However, Analysis II showed that participants with both characteristics had significantly higher daily outpatient and home medical expenditure in the year before death than participants with neither characteristic (risk ratio: 2.155, 95 % confidence interval: 1.338−3.470).

Discussion

Older adults who are both socially isolated and homebound are less likely to regularly utilize medical care, which may eventually lead to serious health problems that require more intensive treatment. Measures are needed to encourage the appropriate use of medical care in these individuals to effectively manage any existing conditions.

Associations of older adults' excursions from home with health-related physical activity and sedentary behavior

BACKGROUND

As people age, they spend more time in and around their domestic environments, within which opportunities for health-enhancing physical activity (PA) may be limited. We examined the associations of frequency of excursions from home with accelerometer-determined PA and the total and prolonged sedentary behavior (SB, sitting for ≥30 min) among community-dwelling older adults.

METHODS

Overall, 434 older adults (men, 57.1 %; age, 70-79 years) wore an accelerometer (HJA-350IT, Omron Healthcare) for 7 days. Time spent in SB, light-intensity PA (LPA), moderate-to-vigorous PA (MVPA), and prolonged SB bout (≥30 min) were calculated. Frequencies of excursions from home were categorized as 0-3, 4-5, and 6-7 days/week. Associations of excursions with PA and SB were tested by analysis of covariance adjusted for sociodemographic characteristics.

RESULTS

Frequencies were 14.3 %, 31.1 %, and 54.6 % for excursions 0-3, 4-5, and 6-7 days/week, respectively. For men, less frequent excursions from home were significantly associated with less MVPA and more total and prolonged SB times (estimated means [minutes/day]: MVPA, 32, 42, and 48; total SB, 589, 549, and 539; prolonged SB, 344, 288, and 265; respectively; p < 0.05). LPA was not statistically significant (p = 0.09). For women, less frequent excursions were significantly associated with all PA outcomes (SB: 536, 497, and 467; prolonged SB: 260, 213, and 204; LPA: 328, 363, and 379; MVPA: 36, 39, and 54, respectively).

CONCLUSIONS

Among community-dwelling Japanese older adults, more frequent excursions from home were associated with more PA, less SB, and more-favorable SB patterns, suggesting a potential strategy for preventive-health initiatives.

Neighborhood Mobility and Unmet Physical Activity Need in Old Age: A 2-Year Follow-Up

BACKGROUND

Many older people report a willingness to increase outdoor physical activity (PA), but no opportunities for it, a situation termed as unmet PA need. The authors studied whether lower neighborhood mobility and PA precede the development of unmet PA need.

METHODS

Community-dwelling 75- to 90-year-old people (n = 700) were interviewed annually for 2 years. Unmet PA need, neighborhood mobility, and PA were self-reported. In addition, accelerometer-based step counts were assessed among a subgroup (n = 156).

RESULTS

Logistic regression analyses revealed that lower baseline neighborhood mobility (odds ratio 3.02, 95% confidence interval [1.86, 4.90] vs. daily) and PA (odds ratio 4.37, 95% confidence interval [2.62, 7.29] vs. high) were associated with the development of unmet PA need over 2 years. The participants with higher step counts had a lower risk for unmet PA need (odds ratio 0.68, 95% confidence interval, [0.54, 0.87]).

CONCLUSION

Maintaining higher PA levels and finding solutions for daily outdoor mobility, especially for those with declines in health, may protect from the development of unmet PA need.

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

BACKGROUND

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

AIMS

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

METHODS

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

RESULTS

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

DISCUSSION

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

CONCLUSIONS

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

Co-existence of social isolation and homebound status increase the risk of all-cause mortality

ABSTRACTBackground:Social isolation and homebound statuses are possible risk factors for increased mortality among older adults. However, no study has addressed the impact of accumulation of these two factors on mortality. The aim of this study was to examine whether such accumulation increased the risk of all-cause mortality.

METHODS

The analyzed sample was drawn from a mail survey of 1,023 older adults without instrumental activities of daily living disability. Participants were classified into four groups according to the frequency of both face-to-face and non-face-to-face interactions with others (social isolation and non-social isolation) and the frequency of going outdoors (homebound and non-homebound). Social isolation and homebound statuses were defined as having a social interaction less than once a week and going outdoors either every few days or less, respectively. All-cause mortality information during a six-year follow-up was obtained.

RESULTS

In total, 78 (7.6%) participants were both socially isolated and homebound. During the follow-up period, 65 participants died, with an overall mortality rate of 10.6 per 1000 person-years. Cox proportional hazards regression analyses demonstrated that older adults who were socially isolated and homebound showed a significantly higher risk of subsequent all-cause mortality compared with healthy adults who were neither socially isolated nor homebound, independent of potential covariates (aHR, 2.19; 95% CI: 1.04-4.63).

CONCLUSION

Our results suggest that the co-existence of social isolation and homebound statuses may synergistically increase risk of mortality. Both active and socially integrated lifestyle in later life might play a major role in maintaining a healthy status.

Housing conditions and risk of physical function limitations: a prospective study of community-dwelling older adults

Background

Poor housing conditions have been associated with an increased risk of morbidity and mortality in old age.

Methods

Prospective cohort of 1602 older adults followed from 2012 to 2015. Poor conditions were defined as living in a walk-up building, lacking piped hot water or heating, feeling frequently cold at home, lacking a bathtub/shower, a refrigerator, a washing machine, an own room or a landline. Frailty was assessed with the Fried criteria, lower extremities performance with the Short Physical Performance Battery (SPPB), and disability in instrumental activities of daily living (IADL) with the Lawton and Brody questionnaire.

Results

During follow-up, 55 individuals (4.2%) developed frailty and 107 (7.2%) IADL disability. Mean (SD) SPPB values at baseline and at follow-up were 8.5 (2.5) and 8.6 (2.4), respectively. After multivariate adjustment, participants who lived in homes with ≥1 poor conditions showed a higher risk of frailty (odds ratio [OR] = 2.02; 95% confidence interval [95% CI]: 1.09-3.75) and transportation disability (OR = 3.50; 95% CI: 1.38-8.88). Lacking heating and feeling frequently cold were associated with an increased risk of exhaustion (OR = 2.34; 95% CI: 1.00-5.48) and transportation disability (OR = 3.31; 95% CI: 1.07-10.2), respectively.

Conclusions

Prevention programs targeting functional limitations in older adults should ensure that they live in suitable housing conditions.

Activity outside the home, environmental barriers, and healthy aging for community-dwelling elderly individuals in China

Elderly individuals benefit from frequently engaging in activities outside the home because such activities sustain the overall health and functioning of an aging body. However, environmental barriers can limit participation in activities outside the home by elderly individuals. The current study examined the factors that influence the frequency with which elderly individuals living in China engage in activity outside the home. Data were collected from 2,402 elderly individuals residing in the Jiangning district of Shanghai, China in 2015. Face-to-face interviews were conducted based on a questionnaire, and multiple regression analysis was used to measure influencing factors. Results revealed that elderly respondents with a better self-reported health status (p = 0.2499) engaged in activities outside the home more frequently. In addition, elderly respondents residing on higher floors of multi-floor residential buildings (p < 0.001) were less likely to participate in activities outside of the home. This effect was virtually eliminated, however, when the residence in question was equipped with an elevator (p < 0.001).

Prospective analysis of time out-of-home and objectively measured walking duration during a week in a large cohort of older adults

BACKGROUND

Physical activity is considered an effective measure to promote health in older people. There is evidence that the number of outdoor trips increases physical activity by increasing walking duration. The objective of this study was to analyse the relationship between daily time out-of-home and walking duration. Furthermore, predictors for walking duration and time out-of-home were evaluated.

METHODS

Walking duration was measured prospectively over a 1 week period by a body-fixed sensor and the time out-of-home was assessed by a questionnaire at the same days. Seven thousand, two hundred and forty-three days from 1289 older people (mean age 75.4 years) with both sensor-based measures and completed questionnaires were included in the analyses. To account for several observation days per participant multilevel regression analyses were applied. Analyses were stratified according to the time out-of-home (more or less than 100 min/day).

RESULTS

In the group with less than 100 min out-of-home, each additional minute out-of-home added 20 s to overall walking duration. If the time exceeded 100 min the additional increase of walking duration was only moderate or weak. Leaving the home once added 40 min of walking, the following trips 15 to 20 min. Increasing age, lower gait speed, comorbidities, low temperature, rain and specific week days (Sunday) decreased both the time out-of-home and walking duration. Other variables like gender (female), isolation or living with a spouse reduced the time out-of-home without affecting walking duration.

CONCLUSIONS

Being out-of-home increases daily walking duration. The association is strongest if the time out-of-home is 100 min or less.

Time spent outdoors, activity levels, and chronic disease among American adults

Chronic diseases-including cancer, cardiovascular diseases, and metabolic conditions such as diabetes and obesity-account for over 60% of overall global mortality. Sedentary time increases the risk for chronic disease incidence and mortality, while moderate to vigorous physical activity is known to decrease risk. Most Americans spend at least half of their time sedentary, with a trend toward increasingly sedentary lifestyles, and few Americans achieve recommended levels of physical activity. Time spent outdoors has been associated with reduced sedentary time and increased physical activity among children/youth and the elderly, but few population-based studies have examined this relationship among working age adults who may face greater constraints on active, outdoor time. This study examines the relationship between time spent outdoors, activity levels, and several chronic health conditions among a population-based sample of working age American adults in the National Health and Nutrition Examination Survey (NHANES) for 2009-2012. Findings provide evidence that time spent outdoors, on both work days and non-work days, is associated with less time spent sedentary and more time spent in moderate to vigorous physical activity. Further, findings indicate that time spent outdoors is associated with lower chronic disease risk; while these associations are partially explained by activity levels, controlling for activity levels does not fully attenuate the relationship between time outdoors and chronic disease risk. While cross-sectional, study findings support the notion that increasing time spent outdoors could result in more active lifestyles and lower chronic disease risk. Future work should examine this relationship longitudinally to determine a causal direction. Additional work is also needed to identify mechanisms beyond physical activity, such as psychosocial stress, that could contribute to explaining the relationship between time spent outdoors and chronic disease risk.

Frequency of going outdoors and health-related quality of life among older adults: Examining the moderating role of living alone and employment status

AIM

Going outdoors more frequently is beneficial for maintaining and improving health-related quality of life (HRQOL) among older adults. However, individual differences can alter the effects of going outdoors. The present study aimed to examine whether relationships between going outdoors and HRQOL were moderated by living alone and employment status.

METHODS

The present study was a secondary analysis of 14-month prospective data (n = 613). Variables used in this study were baseline data on the frequency of going outdoors, HRQOL (physical and mental component summary scores assessed using the Japanese version of the Medical Outcomes study Short Form 8-Item Health Survey), living alone, employment status, potential confounders (sex, age, educational level and instrumental activities of daily living) and follow-up data on HRQOL.

RESULTS

Mixed models showed that the interaction term of going outdoors and currently living alone on both the physical and mental component summary and that of going outdoors and current employment status on the mental component were significant. Stratified analyses showed that going outdoors more frequently predicted the physical and mental component summary among those who lived with others, and the mental component summary among those who were unemployed.

CONCLUSIONS

These results show that the influence of going outdoors on HRQOL was moderated by living alone and employment status. Going outdoors more frequently might be important for the maintenance of HRQOL, especially among unemployed older adults living with others. Geriatr Gerontol Int 2018; 18: 640-647.

Frequency of Leaving the House and Mortality from Age 70 to 95

OBJECTIVES

To determine the association between frequency of leaving the house and mortality.

DESIGN

Prospective follow-up of an age-homogenous, representative, community-dwelling birth cohort (born 1920-21) from the Jerusalem Longitudinal Study (1990-2015).

SETTING

Home.

PARTICIPANTS

Individuals aged 70 (n = 593), 78 (n = 973), 85 (n = 1164), and 90 (n = 645), examined in 1990, 1998, 2005, and 2010, respectively.

MEASUREMENTS

Frequency of leaving the house, defined as daily (6-7/week), often (2-5/week), and rarely (≤1/week); geriatric assessment; all-cause mortality (2010-15). Kaplan-Meier survival charts and proportional hazards models adjusted for social (sex, marital status, financial status, loneliness), functional (sex, self-rated health, fatigue, depression, physical activity, activity of daily living difficulty), and medical (sex, chronic pain, visual impairment, hearing impairment, diabetes mellitus, hypertension, ischemic heart disease, chronic kidney disease) covariates.

RESULTS

At ages 70, 78, 85, and 90, frequency of going out daily was 87.0%, 80.6%, 65.6%, and 48.4%; often was 6.4%, 9.5%, 17.4%, and 11.3%; and rarely was 6.6%, 10.0%, 17.0%, and 40.3% respectively. Decreasing frequency of going out was associated with negative social, functional, and medical characteristics. Survival rates were lowest among those leaving rarely and highest among those going out daily throughout follow-up. Similarly, compared with rarely leaving the house, unadjusted mortality hazard ratios (HRs) were lowest among subjects leaving daily and remained significant after adjustment for social, functional and medical covariates. Among subjects leaving often, unadjusted HRs showed a similar effect of smaller magnitude, with attenuation of significance after adjustment in certain models. Findings were unchanged after excluding subjects dying within 6 months of follow-up.

CONCLUSION

In community-dwelling elderly adults aged 70 to 90, leaving the house daily was associated with lower mortality risk, independent of social, functional, or medical status.

Task Modifications in Walking Postpone Decline in Life-Space Mobility Among Community-Dwelling Older People: A 2-year Follow-up Study

Background

Task modification refers to performing a task differently than before. While task modification in walking may be a sign of looming walking difficulty, it may also be adaptive in and postpone the decline in life-space mobility. However, this has not been studied. This study examined whether changes in life-space mobility over a 2-year period differ between people who at baseline report no walking difficulty and no task modification, those who report no walking difficulty but task modification, and those who report walking difficulty.

Methods

Community-dwelling people aged 75-90 years were interviewed face-to-face at baseline (N = 848), and over phone one (n = 816) and two (n = 761) years later. Life-space mobility was assessed annually with the Life-Space Assessment (range 0-120, higher scores indicate better life-space mobility). Self-reported ability to walk 2 km was assessed at baseline and categorized into "no difficulty," "no difficulty but task modifications" (reduced frequency, given up walking, walking slower or resting during walking) and "difficulty." The analyses were adjusted for age, gender, number of chronic conditions, cognitive impairment, lower extremity performance and education.

Results

The life-space mobility score was highest and remained stable over 2-years among those with no walking difficulties at baseline and lowest and showing a steady decline among those with walking difficulties. Those with task modifications formed the middle group. They showed no marked changes in life-space mobility during the first year, but significant decline during the second year.

Conclusion

Task modifications in walking may help community-dwelling older people to postpone life-space mobility decline.

Facilitating Wellness in Urban-Dwelling, Low-Income Older Adults Through Community Mobility: A Mixed-Methods Study

OBJECTIVE. Community participation is integral to wellness. This study examined the outcomes of Let’s Go, a program designed to facilitate community participation of urban-dwelling, low-income older adults.

METHOD. Fifty-two older adults participated in a mixed-methods, single-group pretest–posttest study. The Impact on Participation and Autonomy Questionnaire, participant surveys, and semistructured interviews were used to evaluate self-reported participation in community-based occupations, confidence, isolation, frequency of community trips, autonomy outdoors, and satisfaction with social life and relationships.

RESULTS. Significant improvement was found in participation, confidence, frequency of community trips, autonomy outdoors, and satisfaction with social life and relationships at 4 wk and 6 mo. Qualitative themes were decreased isolation, importance of peer and community support, increased knowledge of mobility options, and a shift from fear to confidence.

CONCLUSION. Community mobility programming can facilitate the participation of marginalized older adults in community-based occupations.

Relationship between Social Isolation and Indoor and Outdoor Physical Activity in Community-Dwelling Older Adults in Germany: Findings from the ActiFE Study

The purpose of this study was to establish the feasibility of using an aerobics class to produce potentially bone protective vertical impacts of ≥ 4g in older adults and to determine whether impacts can be predicted by physical function. Participants recruited from older adult exercise classes completed an SF-12 questionnaire, short physical performance battery, and an aerobics class with seven different components, performed at low and high intensity. Maximum g and jerk values were identified for each activity. Forty-one participants (mean 69 years) were included. Mean maximal values approached or exceeded the 4g threshold for four of the seven exercises. In multivariate analyses, age (–0.53; –0.77, –0.28) (standardized beta coefficient; 95% CI) and 4-m walk time (–0.39; –0.63, –0.16) were inversely related to maximum g. Aerobics classes can be used to produce relatively high vertical accelerations in older individuals, although the outcome is strongly dependent on age and physical function.

Self-reported hearing is associated with time spent out-of-home and withdrawal from leisure activities in older community-dwelling adults

BACKGROUND

Hearing difficulties are prevalent among older people and can lead to difficulties in social interaction. These difficulties may increase the tendency to remain at home and withdraw from leisure activities.

AIMS

To investigate whether self-reported hearing problems are associated with time spent out-of-home and withdrawal from a leisure activity among older persons.

METHODS

Cross-sectional and longitudinal data on 75- to 90-year-old community-dwelling men and women (n = 767) was used. Self-reports of hearing, diseases, and difficulty walking 2 km were obtained via home interviews at baseline, and withdrawal from a leisure activity via 1- and 2-year follow-up telephone interviews. Time spent out-of-home was obtained from a subsample (n = 532) via seven-day diaries at baseline.

RESULTS

Hearing problems were associated with time spent out-of-home (p = 0.025) and withdrawal from a leisure activity (p = 0.025) among persons reporting no walking difficulty, but not among those reporting walking difficulty (p = 0.269 and 0.396, respectively). Among the former, persons with major hearing problems spent significantly less time out-of-home (estimated marginal mean 161 min, 95 % CI 122-212) than those with good hearing (242, 95 % CI 218-270). Persons with major hearing problems also had 3.0 times higher odds (95 % CI 1.3-7.1) for withdrawal from a leisure activity than persons with good hearing during the two-year follow-up.

DISCUSSION AND CONCLUSIONS

Among older adults without walking difficulty, hearing problems may reduce time spent out-of-home and increase the likelihood for withdrawal from a leisure activity. Decreased leisure and out-of-home activity may have negative effects on older persons' social, mental and physical functioning.

Are Total and Domain-Specific Sedentary Time Associated with Overweight in Older Taiwanese Adults?

This study investigated the associations between total and domain-specific sedentary time with the risk of overweight in older adults. A cross-sectional study was conducted by administering computer-assisted telephone interviews to 1046 Taiwanese older adults (aged ≥65 years) residing in two regions in Taiwan in 2015. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to examine the associations between self-reported total and six domain-specific sedentary times and body mass index status (calculating by self-reported height and weight) by using logistic regression analyses. The results showed that compared with older women in the lowest quartile of the total sedentary time, those in the highest quartile were 1.87 (95% CI: 1.10–3.21) times more likely to be overweight, after adjustment for potential confounders. The total sedentary time was stratified into six specific domains, and only watching television more than 2 h per day was positively associated with overweight (OR, 1.55; 95% CI: 1.08–2.25) in older women, whereas no other sedentary time domains were associated with the risk of overweight. No significant associations were observed in older men. Further studies using prospective designs are required to confirm the presently observed effects of total and domain-specific sedentary behavior on the health of older adults.

Moving through Life-Space Areas and Objectively Measured Physical Activity of Older People

OBJECTIVES

Physical activity-an important determinant of health and function in old age-may vary according to the life-space area reached. Our aim was to study how moving through greater life-space areas is associated with greater physical activity of community-dwelling older people. The association between objectively measured physical activity and life-space area reached on different days by the same individual was studied using one-week longitudinal data, to provide insight in causal relationships.

METHODS

One-week surveillance of objectively assessed physical activity of community-dwelling 70-90-year-old people in central Finland from the "Life-space mobility in old age" cohort substudy (N = 174). In spring 2012, participants wore an accelerometer for 7 days and completed a daily diary including the largest life-space area reached (inside home, outside home, neighborhood, town, and beyond town). The daily step count, and the time in moderate (incl. walking) and low activity and sedentary behavior were assessed. Differences in physical activity between days on which different life-space areas were reached were tested using Generalized Estimation Equation models (within-group comparison).

RESULTS

Participants' mean age was 80.4±4.2 years and 63.5% were female. Participants had higher average step counts (p < .001) and greater moderate and low activity time (p < .001) on days when greater life-space areas were reached, from the home to the town area. Only low activity time continued to increase when moving beyond the town.

CONCLUSION

Community-dwelling older people were more physically active on days when they moved through greater life-space areas. While it is unknown whether physical activity was a motivator to leave the home, intervention studies are needed to determine whether facilitation of daily outdoor mobility, regardless of the purpose, may be beneficial in terms of promoting physical activity.

The Impact of Weather on Mobility and Participation in Older U.S. Adults

OBJECTIVES

We examined the impact of weather on the daily lives of US adults to understand which populations are most vulnerable to various weather conditions.

METHODS

Data came from a 2013 supplement to the University of Michigan-Thomson Reuters Surveys of Consumers, a nationally representative telephone survey of 502 adults in the contiguous United States. We used logistic regressions to assess the odds of mobility difficulty and participation restriction during different weather conditions, as well as age group differences.

RESULTS

Ice was most likely to change the way respondents got around (reported by 47%). In icy conditions, participants had difficulty leaving home (40%) and driving (35%). Facing ice, older adults (≥ 65 years) had twice the odds of having great difficulty leaving home (odds ratio [OR] = 2.22; 95% confidence interval [CI] = 1.12, 4.42) and curtailing work or volunteer activities (OR = 2.01; 95% CI = 1.01, 4.06), and 3 times the odds of difficulty driving (OR = 3.33; 95% CI = 1.62, 6.86) as younger respondents. We also found significant differences in mobility and participation by gender and region of residence.

CONCLUSIONS

Weather can affect social isolation, health, well-being, and mortality among older US adults.

Outdoor areas of Australian residential aged care facilities do not facilitate appropriate sun exposure

OBJECTIVE

The aim of the present study was to assess whether the outdoor areas of residential aged care facilities used for a sunlight intervention trial had the design features that encouraged participants' use of these spaces.

METHODS

The design principles recommended in the 'Vitamin D and the Built Environment in Victoria' guidelines were used to assess the outdoor spaces of residential aged care facilities that were used in a randomised controlled trial (RCT) of sunlight exposure. Attendance rates in the sunlight RCT were analysed in relation to global impression scores of the facilities using one-way analysis of variance.

RESULTS

Thirty-six outdoor areas of 31 facilities were assessed. The facilities met the guidelines for sun exposure, and were generally safe and accessible. However, many lacked privacy, security and aesthetic appeal. Most of the outdoor spaces were not used for regularly scheduled activities. Attendance rates were higher in those facilities with the highest global impression scores compared with those with the lowest scores (F(2,367) = 3.262, P = 0.039).

CONCLUSIONS

The physical environment of the outdoor areas of residential aged care facilities was associated with their use for sunlight exposure. Suitably designed or modified spaces have the potential to encourage their greater use, and residential aged care facilities should also plan regular activities in those areas. These measures can facilitate safe sun exposure, as well as physical activity and social interaction in older people.

Clinical use of sensory gardens and outdoor environments in norwegian nursing homes: a cross-sectional e-mail survey

Gardens and outdoor environments offer multiple therapeutic possibilities for the residents in nursing homes. Web-based questionnaires were sent to 488 nursing home leaders and 121 leaders responded. The clinical impressions of the leaders and staff regarding the benefits of sensory gardens (SGs) to the residents were consistent with previous research. SGs facilitated taking residents outdoors, offered convenient topics for communication and facilitated social privacy for relatives. For improved clinical use of SGs and outdoor environments, systematic assessment of residents' interests, performance and experiences when outdoors, implementation of seasonal clinical programmes and educational programmes for leaders and staff are recommended.

Association between out-of-home trips and older adults' functional fitness

AIM

To explore the purposes of older adults' out-of-home trips, and to investigate the association between the frequency of these trips and older adults' functional fitness.

METHODS

A total of 412 older adults in Taiwan were recruited from 2009 to 2010. Participants were asked to fill out questionnaires on out-of-home trips, and trained volunteers assessed the functional fitness of respondents using objective measures. Descriptive statistics, univariate analysis, multivariate regression analysis and canonical correlation analysis were then used to analyze the resulting data.

RESULTS

Results show that exercise is most frequently the purpose for going out at least once a day, and that parks are the most preferred places to visit. Sex and age are the significant variables explaining variance in older adults' flexibility and physical power, respectively. Canonical correlation analysis showed one significant variate pair (R(2)(c)  = 8.80) between the frequency of out-of-home trips (engaging in exercise and participating in religious activities) and fitness measure test scores including the chair stand, arm curl, 2-min step, and 8-foot up-and-go. The relationship did not exist for the back scratch, nor chair sit-and-reach test scores.

CONCLUSION

The present study provides empirical and objective evidence on older adults' purposes for taking out-of-home trips, and for the positive association between the frequency of these trips, and the muscular strength and cardiovascular endurance, but not flexibility, of older adults.