Environmental mobility barriers and walking for errands among older people who live alone vs. with others

"I Go Outdoors for Activities Every Day": Go-Along With Seniors With Slow Walking Speeds to Explore Environmental Factors Influencing Mobility

Objectives

This study aims to: 1) Explore the mobility experiences of seniors with slow walking speeds (SSWS) in urban neighborhoods; and 2) Investigate their environmental barriers and supports.

Methods

Go-along interviews were conducted with 36 SSWS residing in urban neighborhoods of Chongqing City, China. The mobility patterns and built environment factors influencing their mobility were revealed through cartographic analysis and thematic analysis.

Results

SSWS primarily focused their activities within a 400-meter radius of their homes. Built environment themes included topography, neighborhood services, sidewalks, seating, traffic safety, weather, greenery, and lighting. Significant mobility barriers included long stairs, steep slopes, fast-moving objects on sidewalks, road crossings, and fast traffic. Available handrails, nearby food-service places, ample seating, and greenery were identified as supportive factors for their mobility.

Conclusion

This study stands out as the first to specifically examine the mobility of SSWS within the built environment. We suggest that SSWS should be taken into account when establishing a benchmark for general design frameworks. These improvements not only contribute to the mobility of slow walkers but also have positive impacts on the broader population.

Barriers and motivators to undertaking physical activity in adults over 70-a systematic review of the quantitative literature

BACKGROUND

Physical activity (PA) has multiple benefits for older adults (≥70 years old). Despite this many older adults do not undertake the World Health Organisation guideline recommended amount of PA. This systematic review examines barriers and motivators to PA in adults aged ≥70 years.

METHODS

We analysed the quantitative literature, including observational studies and baseline data from randomised controlled trials. Studies examining specific diseases (e.g. cognitive impairment), or care home residents were excluded. Database searches of ASSIA, CINAHL, Embase, Medline, PsycINFO and Web of Science were undertaken on 7 March 2023. Quality assessment was performed using the ROBANS tool. We synthesised the results using the socioecological model. The protocol was registered on PROSPERO (CRD42021160503).

RESULTS

We identified 37 papers, n = 26,961, age 70-101 years (median 78), 62% female. We undertook a narrative review; meta-analysis was not possible. Overall risk of bias was low. A total of 23 studies addressed barriers, seven motivators, seven both. The most cited barriers were: concern about physical health/fitness (14 studies), lack of motivation/interest (13 studies), fear of falls/history of falling (11 studies) and environmental barriers (10 studies). Key motivators were: support from family/friends (five studies), social interaction (five studies), personal benefits (five studies) and outside facilities (five studies). Results varied across gender, age, functional ability and geographical location.

DISCUSSION

To maximise PA in older adults, important modifiable factors identified in this review should be targeted: support from healthcare professionals; reducing fear of falls; and prioritising ease of access and safety of outdoor facilities. When considering future policy, a person-centred, age group appropriate approach will have the most impact.

The difference in the elderly's visual impact assessment of pocket park landscape

As an important part of urban public open space, pocket parks have become an important activity place for the elderly in the context of the aging society in China. With the pocket parks in Nanjing, Jiangsu province, China as research object, this paper set six landscape features to be studied, namely, Height of trees, Green color richness, Stratification of green landscapes, Green space ratio, Leisure facilities, and Water landscape. The elderly respondents with different demographic characteristics, such as age, gender, education level and residential type, were subjected to the picture stimulation experiment whose results were then statistically analyzed. The results indicate that gender and residential type exert certain influence on the elderly's visual impact assessment of pocket park landscape. To be specific, the male elderly prefer the pocket park landscape with 3-6 m high trees, medium green space ratio, and more leisure facilities; the female elderly are in greater favor of pocket park landscapes with 0-3 m high trees, five or more colors, three or more layers; the elderly who live with their families prefer pocket park landscapes with medium green space ratio and more leisure facilities; to the elderly who live alone, pocket park landscapes with trees which are 0-3 m high, five or more colors, and medium leisure facilities are more attractive. This study can provide valuable reference for pocket park design in China.

Exploring outdoor activity limitation (OAL) factors among older adults using interpretable machine learning

BACKGROUND

The occurrence of outdoor activity limitation (OAL) among older adults is influenced by multidimensional and confounding factors associated with aging.

AIM

The aim of this study was to apply interpretable machine learning (ML) to develop models for multidimensional aging constraints on OAL and identify the most predictive constraints and dimensions across multidimensional aging data.

METHODS

This study involved 6794 community-dwelling participants older than 65 from the National Health and Aging Trends Study (NHATS). Predictors included related to six dimensions: sociodemographics, health condition, physical capacity, neurological manifestation, daily living habits and abilities, and environmental conditions. Multidimensional interpretable machine learning models were assembled for model construction and analysis.

RESULTS

The multidimensional model demonstrated the best predictive performance (AUC: 0.918) compared to the six sub-dimensional models. Among the six dimensions, physical capacity had the most remarkable prediction (AUC: physical capacity: 0.895, daily habits and abilities: 0.828, physical health: 0.826, neurological performance: 0.789, sociodemographic: 0.773, and environment condition: 0.623). The top-ranked predictors were SPPB score, lifting ability, leg strength, free kneeling, laundry mode, self-rated health, age, attitude toward outdoor recreation, standing time on one foot with eyes open, and fear of falling.

DISCUSSION

Reversible and variable factors, which are higher in the set of high-contribution constraints, should be prioritized as the main contributing group in terms of interventions.

CONCLUSION

The integration of potentially reversible factors, such as neurological performance in addition to physical function into ML models, yields a more accurate assessment of OAL risk, which provides insights for targeted, sequential interventions for older adults with OAL.

Living Alone, Environmental Hazards, and Falls Among U.S. Older Adults

Background and Objectives

Physical conditions of living environments can affect the incidence of falls; however, prior work has focused typically on 1 domain at a time-either neighborhood or home, capturing limited environmental boundaries of older adults. We examined how neighborhood together with the home environment affect the incidence of falls over time and whether living arrangement modifies the influence of the environmental risks on falls.

Research Design and Methods

Using the 2012-2020 waves of the Health and Retirement Study (HRS; N = 1,893), we fitted logistic regression to estimate the incidence of falls over an 8-year study period. We used the neighborhood and housing data that are collected systematically by trained observers in the HRS to assess environmental hazards. Sidewalk quality, neighborhood disorder, and the presence of green space were measured to capture outdoor environmental hazards. Indoor environmental hazards included the presence of housing decay and poorly maintained stairways. All models were stratified by living arrangement.

Results

Neighborhood and housing environment were independently associated with the odds of falls net of demographic characteristics and preexisting health conditions, and effects were significant for people living alone only. The presence of green space and poorly maintained stairways were associated with greater odds of falling, net of covariates during 8 years of follow-up (odds ratios = 2.10 and 2.65, p < .05, respectively). None of the environmental risk factors were significant for those living with others.

Discussion and Implications

Falls in old age may be determined in part by a combination of outdoor and indoor risk factors. More research is needed to understand pathways that lead to greater vulnerability among older adults living alone to environmental hazards.

Perspectives on the popularization of smart senior care to meet the demands of older adults living alone in communities of Southwest China: A qualitative study

Background

Older adults who live alone face challenges in daily life and in maintaining their health status quo. Currently, however, their growing demands cannot be satisfied with high quality; therefore, these demands expressed by elders may be settled in the form of smart senior care. Hence, the improvement in smart senior care may produce more positive meanings in promoting the health and sense of happiness among this elderly population. This study aimed to explore the perceptions of demands and satisfaction with regard to the provision of senior care services to the community-dwelling older adults who live alone in Southwest China, thus providing a reference for the popularization of smart senior care.

Methods

This study adopted a qualitative descriptive approach on demands and the popularization of smart senior care. Semi-structured and in-depth individual interviews were conducted with 15 community-dwelling older adults who lived alone in Southwest China between March and May 2021. Thematic analysis was applied to analyze the data.

Results

Through data analysis, three major themes and subcategories were generated: "necessities" (contradiction: more meticulous daily life care and higher psychological needs vs. the current lower satisfaction status quo; conflict: higher demands for medical and emergency care against less access at present), "feasibility" (objectively feasible: the popularization of smart devices and applications; subjectively feasible: interests in obtaining health information), and "existing obstacles" (insufficient publicity; technophobia; patterned living habits; and concerns).

Conclusions

Smart senior care may resolve the contradiction that prevails between the shortage of medical resources and the increasing demands for eldercare. Despite several obstacles that stand in the way of the popularization of smart senior care, the necessities and feasibility lay the preliminary foundation for its development and popularization. Decision-makers, communities, developers, and providers should cooperate to make smart senior care more popular and available to seniors living alone, facilitating independence while realizing aging in place by promoting healthy aging.

Analysing the travel behaviour of older adults: what are the determinants of sustainable mobility?

In recent years, various authorities launched projects that aim to make their cities more age-friendly. Designing age-friendly cities is a complex and context-dependent process that requires clear implementation guidelines for policy makers. As one of the eight domains of age-friendly cities, transportation is a critical component of making our cities more liveable for older adults and their families. This paper contributes to the literature by exploring the travel behaviour of older adults with a focus on the factors that lead to sustainable mobility patterns. Our empirical analysis is based on survey data collected from 1,221 older adults as part of the Age-Friendly Columbus project in Columbus, Ohio in the United States of America. We develop multinomial logistic regression models to investigate the travel mode choices of older adults (auto only, non-auto options only and multimodal (auto and at least one non-auto option)). We include age and built environment characteristics as the key variables, with lifestyle-related factors and socio-demographics as controls in our analysis. We find older respondents were more likely to use autos only compared to younger respondents. Our analysis also reveals significant associations between built environment characteristics and travel mode choices. Interaction effects show that the relationships between built environment characteristics and travel preferences differed by age cohorts among older individuals. The primary contribution of this study is that it provides evidence on what built environmental improvements help to promote sustainable travel among older adults in mid-sized and auto-dependent metropolitan cities. We argue that these improvements contribute to older adults' sustainable mobility, as well as out-of-home activity behaviour, social engagement and individual health. The results of this study may especially benefit non-driver older adults who lack reliable non-auto alternatives for their daily travel.

Exploring the Influencing Factors on Living Alone and Social Isolation among Older Adults in Rural Areas of Thailand

Older adults living alone present a vulnerable physical and mental health group with public health and service needs. This situation has risen and is therefore expected to increase calls for urgent attention from concerned authorities. This article focuses on the study of factors related to different living arrangements of older adults and also examines the extent to which baseline variables explained the association between living alone and social isolation characteristics. A questionnaire survey restricted to respondents aged 60 years and over, living in Ban Phaeo, Samutsakhon, Thailand, was scoped for data collection. Older adults living alone and in co-residence (living together) constitute a total of 1162 samples. The binary logistic regression model was applied to examine the association between living alone and social isolation characteristics. The result found that factors relating to older adults' different living arrangements are marital status, household members numbers, level of dependency, and type of caregivers. An association was found between the characteristics of living alone and social isolation in three relative variables, which are age, activities of daily living (ADLs), and type of caregivers. In conclusion, household living arrangements have different related factors like marital status, where a single or divorced person is more likely to live alone. Furthermore, it is also influenced by the need for caregiving on the part of the older adult or family members; particularly, their children typically emerge as the unpaid assistance from families. When only a sample of older adults living alone with social isolation is considered, it was discovered that with the advancing age of older adults living alone, whether single or married, encountered problems with the activities of daily living (ADLs). This set of people rarely goes out to perform activities outside their home and seldom attend social and physical activities. This could lead to a risk of social isolation with a greater risk of physical and mental health problems, including the well-being of older adults living alone in later life. Thus, family caregivers play a key role as a primary source of support to prevent older adults from being socially isolated, which has become an integral part of our healthcare system in promoting physical, mental, and functional health among older adults in a positive way.

Impact of Religious Activities on Quality of Life and Cognitive Function Among Elderly

Religiosity and spirituality have previously been found to have significant effects on mental and physical health. This study aimed to compare elderly people utilizing different types of religious activities in their daily routine and the effects upon their quality of life and cognitive function. A cross-sectional study was conducted among elderly people dwelling in suburban areas of Malaysia. The Malay version of Short Form (36) Health Survey (SF-36), Geriatric Depression Scale (GDS-15), Older Americans Resources and Services's Instrumental Activities of Daily Living (OARS's IADL), and the Montreal Cognitive Assessment (MoCA) questionnaires were used in this study. Independent t test was utilized to determine the difference in the quality of life and the cognitive function between groups of elderly people that were categorized based on their level of participation in different religious activities. The study involved 432 participants. The mean score for all domain of SF-36 was significantly higher among those who engaged in the religious activities as compared to those elderly who were either less engaged or did not practice religious activities. The mean score of GDS-15, OARS's IADL, and MoCA was also significantly higher among those who participated in religious activities. There was a significant impact on the quality of life and cognitive function among elderly people practicing religious activities. This study proved the importance of practicing religious activities among the elderly in achieving healthy aging.

The barriers and enablers to service access for older women living alone in Australia

Older women living alone are at risk of being socially and financially disadvantaged, which impacts their wellbeing. Currently there is a significant gap in knowledge relating to older women living alone. This study aimed to identify the barriers and enablers to service access in this group. We undertook a qualitative study comprising semi-structured interviews in metropolitan Melbourne, Australia. Thematic analysis was conducted to elucidate key themes. Thirty-seven women were interviewed between May and August 2017. Six key themes were identified: financial; mental and emotional health; mobility and ability; transport; social connections; and knowledge. Access issues for older women living alone are multifaceted and interconnected. Barriers and enablers to service access, as well as their intersections with gender and living situation, should be considered in service design and re-design.

Older Adults' Physical Activity and the Relevance of Distances to Neighborhood Destinations and Barriers to Outdoor Mobility

Aim: To determine the relevance of features located close to home and further away, our aim was to study associations between older adults' physical activity and self-reported neighborhood destinations and barriers to outdoor mobility categorized by presence and maximal distance from home. Methods: Cross-sectional analyses comprising men and women 79-94 years old (57%) living independently in Central Finland (n = 185). Self-reported physical activity was categorized into lower (≤3 h moderate activity a week) and higher (≥4 h moderate or intense activity a week) activity. Assisted by interviewers, participants located on an interactive map destinations perceived to facilitate and barriers perceived to hinder outdoor mobility in their neighborhood. Participants' home addresses were geolocated. Euclidean distances between home and reported locations were computed, and the maximal distance from home to neighborhood destinations and barriers, respectively, was categorized based using four common buffer distances, i.e., 250 m, 500 m, 750 m, and 1 km. Participants reporting destinations or barriers within and beyond the respective distance were compared with those reporting none. Results: About 80% of participants reported neighborhood destinations and 55% neighborhood barriers to outdoor mobility. Barriers were generally located closer to home than destinations [median 166 m (range 25 m-6.10 km) vs. 492 m (5 m-2.7 km)]. Logistic regression analyses adjusted for age, sex, and physical performance showed that neighborhood destinations increased the odds for higher physical activity when located beyond 500 m from home [OR 2.95, 95% confidence interval (CI) 1.02-8.54], but not when located solely within 500 m (OR 1.70, 95% CI 0.30-9.61), in comparison with when reporting no destinations. In contrast, neighborhood barriers decreased the odds for higher physical activity when solely located within 500 m (OR 0.31, 95% CI 0.14-0.72), but not when any barrier was located beyond 500 m (OR 0.96, 95% CI 0.23-3.99), compared with when reporting no barriers. Associations were similar for 250-m buffer distances, but not robust for 750-m and 1,000-m buffers because of lower prevalence. Conclusion: Neighborhood barriers to outdoor mobility located close to home were associated with lower physical activity of older adults, whereas barriers further away were not. Attractive destinations for outdoor mobility located further away from home correlated with higher physical activity, potentially by motivating one to go out and be physically active. Temporal relationships warrant further study.

Associations between Perceived Outdoor Environment and Walking Modifications in Community-Dwelling Older People: A Two-Year Follow-Up Study

Objectives: To examine associations of perceived outdoor environment with the prevalence and development of adaptive (e.g., slower pace) and maladaptive (e.g., avoiding walking) modifications in walking 2 km among older people. Methods: Community-dwelling 75-90 -year-old persons (N = 848) reported environmental outdoor mobility facilitators and barriers at baseline. Modifications in walking 2 km (adaptive, maladaptive, or no) were assessed at baseline and one and two years later. Results: Outdoor mobility facilitators were more often reported by those not using modifications or using adaptive versus maladaptive walking modifications. Differences in health and physical capacity explained most of the associations between outdoor mobility barriers and walking modifications. Perceived outdoor environment did not systematically predict future adaptive or maladaptive walking modifications. Discussion: Facilitators may compensate the declined physical capacity and alleviate the strain of walking longer distances by enabling the use of adaptive walking modifications, while lack of such facilitators fuels avoidance of walking longer distances.

Determinants of ADL and IADL disability in older adults in southeastern Poland

Background

The extension of the life span has led to an increase in the number of older people and an increase in the prevalence of disability in people over 60 years of age. The aim of this study was to assess the prevalence of ADL and IADL disability and to analyze its determinants among people aged 60 and older living in southeastern Poland.

Methods

This cross-sectional study was carried out among a randomly selected, representative population of people aged 60 and older living in southeastern Poland. Disability was assessed using the Katz Index of Independence in Basic Activities of Daily Living and Instrumental Activities of Daily Living. Logistic regression models were used to identify the factors related to ADLs and IADLs. For the variables that were included in the above models, their clustered influence on the increase in the odds ratio for the occurrence of an ADL or IADL limitation was also examined.

Results

The research results show that 35.75% of the participants reported at least one problem with IADLs. At least one problem with ADLs was reported by 17.13% of the participants. The most significant modifiable factors influencing the occurrence of disability were the presence of barriers in the participant’s environment, poor relations with relatives, a lack of social contacts, multimorbidity and pain. A multiple increase in the odds ratio of disability was found with the presence of pairs of analyzed factors. The highest odds ratio of at least one ADL limitation was observed for the combination of barriers in the participant’s environment with multimorbidity (OR 74.07). With regard to IADL disability, the highest odds ratio was observed for the combination of pain on the VAS scale ≥3 points with older age (OR 19.47).

Conclusions

The study showed a high prevalence of ADL and IADL disability in older people living in southeastern Poland. It also indicated the extent to which modifiable factors influenced the occurrence of disability and the extent to which the risk of disability increased with the presence of pairs of factors, especially those that included environmental barriers in the participant’s environment.

Environmental Factors Associated with Older Adult’s Walking Behaviors: A Systematic Review of Quantitative Studies

The aim of this study is to systematically review the relationship between neighborhood environments and all types of walking behaviors among older adults. Seventy peer-reviewed journal articles which met the selection criteria were examined. Research designs were summarized by geographical location and the associations of environmental characteristics and walking were calculated. Interactions between moderators and environmental characteristics for all types of walking were also categorized. Results have shown that transport walking is the most supported by neighborhood environmental characteristics. The positively related environmental characteristics are walkability, urbanization, land use mix-diversity and accessibility, walking amenities, and bicycle lanes. Total walking was positively associated with walkability and urbanization. Recreational walking was associated with neighborhood employment/income level, nearness to public transport/bus stops, and social cohesion. The most commonly used moderators were age and gender, but inconsistent moderating effects between neighborhood environments and walking were also found. In densely populated environments such as Hong Kong, older adults walked mostly for both transport and recreation. In contrast, American older adults in low density areas walked less for transport and more for recreation. Findings support a strong relationship between neighborhood environments and older adults’ walking. Future research should focus on longitudinal studies and comparison studies by geographic location.

Revealing Methodological Challenges in Chronic Obstructive Pulmonary Disease Studies Assessing Comorbidities: A Narrative Review

Beyond respiratory impairment, patients with chronic obstructive pulmonary disease (COPD) often suffer from comorbidities which are associated with worse health status, higher health care costs and worse prognosis. Reported prevalences of comorbidities largely differ between studies which might be explained by different assessment methods (objective assessment, self-reported assessment, or assessment by medical records), heterogeneous study populations, inappropriate control groups, incomparable methodologies, etc. This narrative review demonstrates and further evaluates the variability in prevalence of several comorbidities in patients with COPD and control individuals and discusses several shortcomings and pitfalls which need to be considered when interpreting comorbidity data. Like in other chronic organ diseases, the accurate diagnosis and integrated management of comorbidities is a key for outcome in COPD. This review highlights that there is a need to move from the starting point of an established index disease towards the concept of the development of multimorbidity in the elderly including COPD as an important and highly prevalent pulmonary component.

Hilliness and the Development of Walking Difficulties Among Community-Dwelling Older People

Objective: The objective of this study is to study the associations of objectively defined hilliness with the prevalence and incidence of walking difficulties among community-dwelling older adults, and to explore whether behavioral, health, or socioeconomic factors would fully or partially explain these associations. Method: Baseline interviews ( n = 848, 75-90 years) on difficulties in walking 500 m, frequency of moving through the neighborhood, and perceived hilliness as a barrier to outdoor mobility were conducted. Two-year follow-up interviews ( n = 551) on difficulties in walking 500 m were conducted among participants without baseline walking difficulties. Hilliness objectively defined as the mean slope in 500-m road network. Results: Logistic regression showed that hilliness was associated with incident walking difficulties at the 2-year follow-up (odds ratio [OR] = 1.66, 95% confidence interval [CI] = [1.09, 2.51]) but not with the prevalence of walking difficulties at baseline. Adding behavioral, health, or socioeconomic factors to the models did not markedly change the results. Discussion: Greater hilliness should be considered a risk factor for developing walking difficulties among older adults.

Examining the relationships between walkability and physical activity among older persons: what about stairs?

BACKGROUND

Walkability is considered an important dimension of healthy communities. However, variable associations between measures of walkability and physical activity have been observed, particularly among older persons. Given the challenges older persons may have navigating stairs on walking routes, the presence of stairs may be an explanatory factor for these mixed associations. The purposes of this scoping review were to determine whether studies examining the relationship between walkability and physical activity included items that assessed stairs and what relationships were found.

METHODS

Systematic reviews were identified by entering search terms into five database search engines. Eligibility criteria were: a) published between 2008 and 2017, b) examined the relationship between walkability and physical activity, c) included a focus on persons aged 65 years and older, and d) written in English. The full articles for all primary studies included in eligible systematic reviews were then retrieved. Duplicates were removed. Information about where the study took place, walkability measures used, types of walkability data obtained (objective and/or subjective) and questions asked about stairs were extracted from the full text articles.

RESULTS

Eleven systematic reviews were identified; seven were eligible. After removing duplicates, 289 primary studies remained for review. Measures of neighborhood walkability were present in 205 studies; a minority (n = 5, 2.4%) included items about stairs. No information was obtained on the structural features of the stairs.

CONCLUSIONS

The presence of stairs may deter older persons (and others) from walking outdoors. Standard measures to document the presence and characteristics of stairs, and sampling approaches to select stairs for assessment are needed. The inclusion of these measures would augment the utility and comparability of studies examining relationships between walkability and physical activity and better inform planning and policy decisions.

The neighbourhood physical environment and active travel in older adults: a systematic review and meta-analysis

BACKGROUND

Perceived and objectively-assessed aspects of the neighbourhood physical environment have been postulated to be key contributors to regular engagement in active travel (AT) in older adults. We systematically reviewed the literature on neighbourhood physical environmental correlates of AT in older adults and applied a novel meta-analytic approach to statistically quantify the strength of evidence for environment-AT associations.

METHODS

Forty two quantitative studies that estimated associations of aspects of the neighbourhood built environment with AT in older adults (aged ≥ 65 years) and met selection criteria were reviewed and meta-analysed. Findings were analysed according to five AT outcomes (total walking for transport, within-neighbourhood walking for transport, combined walking and cycling for transport, cycling for transport, and all AT outcomes combined) and seven categories of the neighbourhood physical environment (residential density/urbanisation, walkability, street connectivity, access to/availability of services/destinations, pedestrian and cycling infrastructure, aesthetics and cleanliness/order, and safety and traffic).

RESULTS

Most studies examined correlates of total walking for transport. A sufficient amount of evidence of positive associations with total walking for transport was found for residential density/urbanisation, walkability, street connectivity, overall access to destinations/services, land use mix, pedestrian-friendly features and access to several types of destinations. Littering/vandalism/decay was negatively related to total walking for transport. Limited evidence was available on correlates of cycling and combined walking and cycling for transport, while sufficient evidence emerged for a positive association of within-neighbourhood walking with pedestrian-friendly features and availability of benches/sitting facilities. Correlates of all AT combined mirrored those of walking for transport. Positive associations were also observed with food outlets, business/institutional/industrial destinations, availability of street lights, easy access to building entrance and human and motorised traffic volume. Several but inconsistent individual- and environmental-level moderators of associations were identified.

CONCLUSIONS

Results support strong links between the neighbourhood physical environment and older adults' AT. Future research should focus on the identification of types and mixes of destinations that support AT in older adults and how these interact with individual characteristics and other environmental factors. Future research should also aim to clarify dose-response relationships through multi-country investigations and data-pooling from diverse geographical regions.

The neighbourhood physical environment and active travel in older adults: a systematic review and meta-analysis

BACKGROUND

Perceived and objectively-assessed aspects of the neighbourhood physical environment have been postulated to be key contributors to regular engagement in active travel (AT) in older adults. We systematically reviewed the literature on neighbourhood physical environmental correlates of AT in older adults and applied a novel meta-analytic approach to statistically quantify the strength of evidence for environment-AT associations.

METHODS

Forty two quantitative studies that estimated associations of aspects of the neighbourhood built environment with AT in older adults (aged ≥ 65 years) and met selection criteria were reviewed and meta-analysed. Findings were analysed according to five AT outcomes (total walking for transport, within-neighbourhood walking for transport, combined walking and cycling for transport, cycling for transport, and all AT outcomes combined) and seven categories of the neighbourhood physical environment (residential density/urbanisation, walkability, street connectivity, access to/availability of services/destinations, pedestrian and cycling infrastructure, aesthetics and cleanliness/order, and safety and traffic).

RESULTS

Most studies examined correlates of total walking for transport. A sufficient amount of evidence of positive associations with total walking for transport was found for residential density/urbanisation, walkability, street connectivity, overall access to destinations/services, land use mix, pedestrian-friendly features and access to several types of destinations. Littering/vandalism/decay was negatively related to total walking for transport. Limited evidence was available on correlates of cycling and combined walking and cycling for transport, while sufficient evidence emerged for a positive association of within-neighbourhood walking with pedestrian-friendly features and availability of benches/sitting facilities. Correlates of all AT combined mirrored those of walking for transport. Positive associations were also observed with food outlets, business/institutional/industrial destinations, availability of street lights, easy access to building entrance and human and motorised traffic volume. Several but inconsistent individual- and environmental-level moderators of associations were identified.

CONCLUSIONS

Results support strong links between the neighbourhood physical environment and older adults' AT. Future research should focus on the identification of types and mixes of destinations that support AT in older adults and how these interact with individual characteristics and other environmental factors. Future research should also aim to clarify dose-response relationships through multi-country investigations and data-pooling from diverse geographical regions.

Risk Factors for Six Types of Disability among the Older People in Thailand in 2002, 2007, and 2011

Background. There is an important need to characterize risk factors for disability in Thailand, in order to inform effective prevention and control strategies. This study investigated factors associated with risk of 6 types of disability in Thailand's ageing population in 2002, 2007, and 2011. Methods. Data came from the Cross-Sectional National Surveys of Older Persons in Thailand conducted by the National Statistical Office (NSO) in 2002, 2007, and 2011. Stratified two-stage sampling was employed. Interviews of 24,835, 30,427, and 34,173 elderly people aged 60 and above were conducted in the respective study years. Prevalence of disabilities was measured, and factors associated with disability risk were assessed with probability-weighted multiple logistic regression. Results. Disability prevalence decreased slightly over the study period. The characteristics with greatest positive impact on disability prevalence were not working over the past week (average impact: 61.2%), age (53.7% per decade), and suffering from one or more chronic illnesses (46.3%). Conclusions. The strong observed positive impact of not working on disability prevalence suggests that raising the mandatory retirement age might result in some reduction of disability risk. Also, the observed positive impact of living with others (versus alone) on disability risk was somewhat unexpected.

Mobility Modification Alleviates Environmental Influence on Incident Mobility Difficulty among Community-Dwelling Older People: A Two-Year Follow-Up Study

Background

Environmental barriers increase risk for mobility difficulties in old age. Mobility difficulty is preceded by a phase where people try to postpone a difficulty through mobility modification. We studied whether perceived environmental mobility barriers outdoors correlate with mobility modification and mobility difficulty, predict development of mobility difficulty over a two-year follow-up, and whether mobility modification alleviates the risk for difficulty.

Methods

At baseline, 848 people aged 75–90 were interviewed face-to-face. Telephone follow-up interviews were conducted one (n = 816) and two years (n = 761) later. Environmental barriers to mobility were self-reported using a15-item structured questionnaire at baseline, summed and divided into tertiles (0, 1 and 2 or more barriers). Mobility difficulty was assessed as self-reported ability to walk 2 km at all assessment points and categorized into ‘no difficulty’, ‘no difficulty but mobility modifications’ (reducing frequency, stopping walking, using an aid, slowing down or resting during the performance) and ‘difficulty’.

Results

At baseline, 212 participants reported mobility modifications and 356 mobility difficulties. Those reporting one or multiple environmental barriers had twice the odds for mobility modifications and up to five times the odds for mobility difficulty compared to those reporting no environmental barriers. After multiple adjustments for health and functioning, reporting multiple environmental barriers outdoors continued to predict the development of incident mobility difficulty over the two-year follow-up. Mobility modifications attenuated the association.

Conclusion

For older people who successfully modify their performance, environmental influence on incident mobility difficulty can be diminished. Older people use mobility modification to alleviate environmental press on mobility.

Associations between environmental characteristics and life-space mobility in community-dwelling older people

OBJECTIVE

To examine the association between perceived environmental barriers to and facilitators for outdoor mobility with life-space among older people.

METHODS

Community-dwelling, 75- to 90-year-old people (n = 848) were interviewed face-to-face using standard questionnaires. The Life-Space Assessment (LSA), indicating distance and frequency of moving and assistance needed in moving (range 0-120), was used. Environmental barriers and facilitators outdoors were self-reported.

RESULTS

Altogether, 41% (n = 348) of the participants had restricted life-space (LSA score < 60). Those reporting one or more environmental barriers had more than double the odds for restricted life-space compared with those reporting no barriers after adjustments for ill health, functioning, and socioeconomic status (SES) differences. Similarly, those reporting four to seven facilitators had lower odds for restricted life-space compared with those reporting three or fewer facilitators.

DISCUSSION

Perceptions of one's environment may either constrain or extend older people's life-space. Longitudinal studies are needed to study the causality of the findings.