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

Short-term effects of a park-based group mobility program on increasing outdoor walking in older adults with difficulty walking outdoors: the Getting Older Adults Outdoors (GO-OUT) randomized controlled trial

BACKGROUND

We estimated the short-term effects of an educational workshop and 10-week outdoor walk group (OWG) compared to the workshop and 10 weekly reminders (WR) on increasing outdoor walking (primary outcome) and walking capacity, health-promoting behavior, and successful aging defined by engagement in meaningful activities and well-being (secondary outcomes) in older adults with difficulty walking outdoors.

METHODS

In a 4-site, parallel-group randomized controlled trial, two cohorts of community-living older adults (≥ 65 years) reporting difficulty walking outdoors participated. Following a 1-day workshop, participants were stratified and randomized to a 10-week OWG in parks or 10 telephone WR reinforcing workshop content. Masked evaluations occurred at 0, 3, and 5.5 months. We modeled minutes walked outdoors (derived from accelerometry and global positioning system data) using zero-inflated negative binomial regression with log link function, imputing for missing observations. We modeled non-imputed composite measures of walking capacity, health-promoting behavior, and successful aging using generalized linear models with general estimating equations based on a normal distribution and an unstructured correlation matrix. Analyses were adjusted for site, participation on own or with a partner, and cohort.

RESULTS

We randomized 190 people to the OWG (n = 98) and WR interventions (n = 92). At 0, 3, and 5.5 months, median outdoor walking minutes was 22.56, 13.04, and 0 in the OWG, and 24.00, 26.07, and 0 in the WR group, respectively. There was no difference between groups in change from baseline in minutes walked outdoors based on incidence rate ratio (IRR) and 95% confidence interval (CI) at 3 months (IRR = 0.74, 95% CI 0.47, 1.14) and 5.5 months (IRR = 0.77, 95% CI 0.44, 1.34). Greater 0 to 3-month change in walking capacity was observed in the OWG compared to the WR group (βz-scored difference = 0.14, 95% CI 0.02, 0.26) driven by significant improvement in walking self-efficacy; other comparisons were not significant.

CONCLUSIONS

A group, park-based OWG was not superior to WR in increasing outdoor walking activity, health-promoting behavior or successful aging in older adults with difficulty walking outdoors; however, the OWG was superior to telephone WR in improving walking capacity through an increase in walking self-efficacy. Community implementation of the OWG is discussed.

TRIAL REGISTRATION

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

Cold weather isolation is worse in poor and non-white neighborhoods in the United States

Social isolation can cause a variety of adverse physical and mental health effects and is central to understanding broader social disparities among marginalized groups in the United States. This study aims to assess whether temperature variation is associated with daily social isolation at the neighborhood level. I test a series of two-way fixed effects models to see if mean daily temperature is associated with individuals spending the entire day at home, as measured using smartphone data, across a sample of 45 million devices in 2019 in the United States. Using interaction terms, I specifically examine heterogeneity in temperature effects by neighborhood racial composition and socioeconomic status. The two-way fixed effects models reveal highly statistically significant negative coefficients for the interaction between temperature and neighborhood proportion Black, temperature and neighborhood proportion Hispanic, and temperature and neighborhood residential disadvantage, in predicting the probability of spending the entire day at home. In marginal terms, the findings indicate the gap in the probability of spending the entire day at home between an all-Black neighborhood and an all-White neighborhood grows by nearly 10 percentage points from the warmest day of the year to the coldest day of the year in some parts of the United States. My models highlight how residents of poor and majority Black and Hispanic neighborhoods experience disproportionate social isolation in the form of a greater propensity to spend the entire day at home.

Radiology weather forecast: A retrospective analysis of predictability of median daily polytrauma-CT occurrence based on weather data

OBJECTIVES

Resource planning is a crucial component in hospitals, particularly in radiology departments. Since weather conditions are often described to correlate with emergency room visits, we aimed to forecast the amount of polytrauma-CTs using weather information.

DESIGN

All polytrauma-CTs between 01/01/2011 and 12/31/2022 (n = 6638) were retrieved from the radiology information system. Local weather data was downloaded from meteoblue.com. The data was normalized and smoothened. Daily polytrauma-CT occurrence was stratified into below median and above median number of daily polytrauma-CTs. Logistic regression and machine learning algorithms (neural network, random forest classifier, support vector machine, gradient boosting classifier) were employed as prediction models. Data from 2012 to 2020 was used for training, data from 2021 to 2022 for validation.

RESULTS

More polytrauma-CTs were acquired in summer compared with winter months, demonstrating a seasonal change (median: 2.35; IQR 1.60-3.22 vs. 2.08; IQR 1.36-3.03; p <.001). Temperature (rs = 0.45), sunshine duration (rs = 0.38) and ultraviolet light amount (rs = 0.37) correlated positively, wind velocity (rs = -0.57) and cloudiness (rs = -0.28) correlated negatively with polytrauma-CT occurrence (all p <.001). The logistic regression model for identification of days with above median number of polytrauma-CTs achieved an accuracy of 87 % on training data from 2011 to 2020. When forecasting the years 2021-2022 an accuracy of 65 % was achieved. A neural network and a support vector machine both achieved a validation accuracy of 72 %, whereas all classifiers regarded wind velocity and ultraviolet light amount as the most important parameters.

CONCLUSION

It is possible to forecast above or below median daily number of polytrauma-CTs using weather data.

CLINCICAL RELEVANCE STATEMENT

Prediction of polytrauma-CT examination volumes may be used to improve resource planning.

Neighborhood Socioeconomic Status, Green Space, and Walkability and Risk for Falls Among Postmenopausal Women: The Women's Health Initiative

PURPOSE

This study estimated associations between neighborhood socioeconomic status (NSES), walkability, green space, and incident falls among postmenopausal women and evaluated modifiers of these associations, including study arm, race and ethnicity, baseline household income, baseline walking, age at enrollment, baseline low physical functioning, baseline fall history, climate region, and urban-rural residence.

METHODS

The Women's Health Initiative recruited a national sample of postmenopausal women (50-79 years) across 40 U.S. clinical centers and conducted yearly assessments from 1993 to 2005 (n = 161,808). Women reporting a history of hip fracture or walking limitations were excluded, yielding a final sample of 157,583 participants. Falling was reported annually. NSES (income/wealth, education, occupation), walkability (population density, diversity of land cover, nearby high-traffic roadways), and green space (exposure to vegetation) were calculated annually and categorized into tertiles (low, intermediate, high). Generalized estimating equations assessed longitudinal relationships.

RESULTS

NSES was associated with falling before adjustment (high vs. low, odds ratio, 1.01; 95% confidence interval, 1.00-1.01). Walkability was significantly associated with falls after adjustment (high vs. low, odds ratio, 0.99; 95% confidence interval, 0.98-0.99). Green space was not associated with falling before or after adjustment. Study arm, race and ethnicity, household income, age, low physical functioning, fall history, and climate region modified the relationship between NSES and falling. Race and ethnicity, age, fall history, and climate region modified relationships between walkability and green space and falling.

CONCLUSIONS

Our results did not show strong associations of NSES, walkability, or green space with falling. Future research should incorporate granular environmental measures that may directly relate to physical activity and outdoor engagement.

Hot Instantaneous Temperature and Affect: Meaningful Activities as a Buffer for Older Adults With Low Socioeconomic Status

Background and Objectives

Extremely hot temperature affects psychological well-being negatively, especially for older adults with lower socioeconomic status (SES). The objectives of this study are to examine: (a) the impact of hot instantaneous temperature on older adults' emotional well-being and (b) whether meaningful engagement could reduce the above impact, particularly for those of lower SES.

Research Design and Methods

We conducted a quantitative time-sampling study during hot-weather months (May-September) in 2021 and 2022. The sample comprises 344 participants aged 60 years or older (Mage = 67.15, SDage = 5.26) living in urban areas of Hong Kong, where hot days (daily maximum temperature ≥33°C) accounted for 23% of the study days. Participants reported positive and negative affect, and engagement in meaningful activities, three times a day over a 10-day period, and wore sensors that tracked the instantaneous temperature of their immediate environment. Multilevel modeling was employed to examine the impacts on affect from temperature, SES, and meaningful activity engagement.

Results

Hotter instantaneous temperature predicted greater momentary negative affect and less positive affect immediately afterwards. Meaningful engagement significantly buffered against the affective impacts of hotter temperature, and this buffering effect was more salient among older adults of lower SES.

Discussion and implications

This study highlights the role of meaningful engagement in reducing the impact of hotter instantaneous temperature on older adults' emotional well-being, particularly for those of lower SES. Meaningful activity engagement may be capitalized on, as a strategy, to reduce climate-related social inequality.

Mapping health vulnerability to short-term summer heat exposure based on a directional interaction network: Hotspots and coping strategies

Health risk resulting from non-optimal temperature exposure, referred to as "systematic risk", has been a sustainable-development challenge in the context of global warming. Previous studies have recognized interactions between and among system components while assessing the vulnerability to climate change, but have left open the question of indicator directional interactions. The question is important, not least because indicator directional association analysis provides guidance to address climate risks by revealing the key nodes and pathways. The purpose of this work was to assess health vulnerability to short-term summer heat exposure based on a directional interaction network. Bayesian network model and network analysis were used to conduct a directional interaction network. Using indicator directional associations as weights, a weighted technique for the order of preference by similarity to ideal solution method was then proposed to assess heat-related health vulnerability. Finally, hotspots and coping strategies were explored based on the directional interaction network and health vulnerability assessments. The results showed that (1) indicator directional interactions were revealed in the health vulnerability framework, and the interactions differed between northern and southern China; (2) there was a dramatic spatial imbalance of health vulnerability in China, with the Beijing-Tianjin-Hebei Region and the Yangtze River Basin identified as hotspots; (3) particulate matter and ozone were recognized as priority indicators in the most vulnerable cities of northern China, while summer heat exposure level and variation were priority indicators in southern China; and (4) adaptive capacity could alter the extent of risk; thus, mitigation and adaptation should be implemented in an integrated way. Our study has important implications for strengthening the theoretical basis for the vulnerability assessment framework by providing indicator directional associations and for guiding policy design in dealing with heat-related health vulnerability in China.

Green Space, Air Pollution, Weather, and Cognitive Function in Middle and Old Age in China

Prior research has shown that environmental hazards, such as limited green space, air pollution, and harmful weather, have the strong adverse impact on older adults' cognitive function; however, most of the studies were conducted in developed countries and limited to cross-sectional analyses. China has the largest aging population in the world so the research evidence from it can offer an insight to the study in other developing countries facing similar issues and inform future public health policy and disease control. This study examined the long-term impact of environmental factors, namely, green space coverage, air pollution, and weather conditions on cognitive function using a nationally representative sample consisting of adults aged 45 years and older selected from the China Health and Retirement Longitudinal Study (CHARLS 2011–2018), the China City Statistical Yearbook, and other sources. Multilevel growth curve models were utilized for analysis and the mediator effects of physical activity and social engagement on the relationship between environmental factors and cognitive function were examined. Findings of this study showed that after controlling for sociodemographic characteristics, annual precipitation of 80 cm or more, living in areas with July temperature of 28°C or higher, urban community, and green space coverage were positively associated with cognition score at the baseline and lower precipitation, urban community, and greater green space coverage were associated with slower cognitive decline over a 7-year period. The impact of gross domestic product (GDP) seemed to take into effect more and more over time. These effects did not substantially change after weekly total hours of physical activities and levels of social engagement were added. More research on the mechanisms of the effect of environmental factors on cognition is needed such as the subgroup analyses and/or with more aspects of environmental measures.

Ecological Predictors of Older Adults' Participation and Retention in a Physical Activity Intervention

Research is still lacking regarding the question as to how programs to promote healthy ageing should be organized in order to increase acceptance and thus effectiveness. For older adults, ecological factors, such as the physical distance to program sites, might predict participation and retention. Thus, the key aim of this analysis was to examine these factors in a physical activity intervention trial. Adults (N = 8299) aged 65 to 75 years were invited to participate and n = 589 participants were randomly assigned to one of two intervention groups with 10 weeks of physical activity home practice and exercise classes or a wait-list control group. Response, participation, and dropout data were compared regarding ecological, individual, and study-related variables. Kaplan-Meier curves and Cox regression models were used to determine predictors of dropout. In total, 405 participants completed the study. Weekly class attendance rates were examined regarding significant weather conditions and holiday periods. The highest rates of nonresponse were observed in districts with very high neighborhood levels of socioeconomic status. In this study, ecological factors did not appear to be significant predictors of dropout, whereas certain individual and study-related variables were predictive. Future studies should consider these factors during program planning to mobilize and keep subjects in the program.

Experiences of stroke survivors and measurement of post stroke participation and activity across seasons-A mixed methods approach

Participation and activity post stroke can be limited due to adverse weather conditions. This study aimed to: Quantify and compare summer and winter participation and activity, and explore how community dwelling people with stroke describe their feelings about their level of participation and activity by season. This embedded mixed-methods observational study took place in a city with weather extremes. Community dwelling individuals at least one year post-stroke, able to walk ≥50 metres +/- a walking aide were included. Evaluations and interviews occurred at participants’ homes in two seasons: Reintegration to Normal living Index (RNL), Activities-specific Balance Confidence (ABC) and descriptive outcomes. Participants wore activity monitors for one week each season. Analysis included descriptive statistics, non-parametric tests and an inductive approach to content analysis. Thirteen individuals participated in quantitative evaluation with eight interviewed. Mean age 61.5 years, 62% female and mean 6.2 years post-stroke. No differences between winter-summer values of RNL, ABC, or activity monitor outcomes. However, participants felt they could do more and were more independent in summer. The winter conditions such as ice, snow, cold and wind restricted participation and limited activities. Nonetheless, many participants were active and participated despite the winter challenges by finding other ways to be active, and relying on social supports and personal motivation. The qualitative findings explained unexpected quantitative results. Participants described many challenges with winter weather, but also ways they had discovered to participate and be active despite these challenges. Changes to future studies into seasonal differences are suggested.

Analysis of Intersection Traffic Safety in the City of San Antonio, 2013–2017

An understanding of the contributing factors to severe intersection crashes is crucial for developing countermeasures to reduce crash numbers and severity at high-risk crash locations. This study examined the variables affecting crash incidence and crash severity at intersections in San Antonio over a five-year period (2013–2017) and identified high-risk locations based on crash frequency and injury severity using data from the Texas Crash Record and Information System database. Bivariate analysis and binary logistic regression, along with respective odds ratios, were used to identify the most significant variables contributing to severe intersection crashes by quantifying their association with crash severity. Intersection crashes were predominantly clustered in the downtown area with relatively less severe crashes. Males and older drivers, weekend driving, nighttime driving, dark lighting conditions, grade and hillcrest road alignment, and crosswalk, divider and marked lanes used as traffic control significantly increased crash severity risk at intersections. Prioritizing resource allocation to high-risk intersections, separating bicycle lanes and sidewalks from the roadway, improving lighting facilities, increasing law enforcement activity during the late night hours of weekend, and introducing roundabouts at intersections with stops and signals as traffic controls are recommended countermeasures.

Associations of Neighborhood Walkability and Walking Behaviors by Cognitive Trajectory in Older Adults

BACKGROUND AND OBJECTIVES

Lawton's Ecological Model of Aging suggests that associations between environment and mobility differ based on individual factors such as cognitive decline.

RESEARCH DESIGN AND METHODS

Virtual walkability audits were conducted within 1/8 mile of residences of older adults (n = 545; average age = 82; 57% female; 33% Black) who had been enrolled in the Health, Aging, and Body Composition (Health ABC) cohort for 10 years. The primary outcome was self-reported walking in past week and the secondary was mobility disability, self-reported difficulty to walk ¼ mile. Linear mixed models of general cognitive function over the prior 10 years calculated participant-specific slopes; those below 0 were cognitive decliners. Logistic regression models, adjusted for demographics and neighborhood socioeconomic status, tested associations between each walkability variable and each mobility outcome. Interaction terms between walkability and cognitive status were tested and walkability analyses stratified on cognitive status where p for interaction < .2.

RESULTS

In the sample, 57.4% reported walking, 24.2% reported mobility disability, and 51% were cognitive decliners. Sidewalk quality was related to walking in cognitive maintainers; slope was related in decliners. Mixed land use (odds ratio [OR] = 1.61; 95% confidence interval [CI]: 1.12, 2.30) and senior residence (OR = 2.14; 95% CI: 1.27, 3.60) were related to greater walking, regardless of cognitive status. Mixed land use was related to less mobility disability in decliners and abandoned properties were related to greater mobility disability in maintainers.

DISCUSSION AND IMPLICATIONS

Policy-level interventions targeted at walkability, including improved sidewalk quality and increasing mixed land use could support walking in older adults, regardless of cognitive status.

Reducing fall risk for home care workers with slip resistant winter footwear

Falls on icy surfaces are the leading cause of occupational injuries for workers exposed to outdoor winter conditions. Slip resistant footwear has been shown to reduce the risk of falls for indoor workers but until recently, there was no accepted standard for evaluating the slip resistance of winter footwear on icy surfaces. Our team recently developed a lab-based testing protocol for measuring footwear slip resistance. This protocol, called the Maximum Achievable Angle (MAA) test, measures the steepest ice-covered slope that participants can walk up and down without experiencing a slip in a simulated winter environment. This lab-based protocol has found there is wide variability in the performance of commercially available winter footwear. In particular, we have found that a new generation of footwear that incorporates composite materials in the outsole, performs much better than most other footwear. The objective of this project was to investigate whether the footwear that performed well in our lab-based testing would reduce the risk of slips and/or falls in real-world winter conditions. One hundred and ten home healthcare workers from SE Health were recruited for this study and were asked to report their exposure to icy surfaces along with the numbers of slips and numbers of falls they experienced each week using online surveys over eight weeks in the winter. Fifty participants (the intervention group) were provided winter footwear that were among the best performing in the MAA test. The remaining sixty participants (the control group) wore their own footwear for the duration of the study. A total of 563 slips and 36 falls were reported over the eight-week data collection period. The intervention group consistently reported fewer slips (127 vs 436) and fewer falls (6 vs 30) compared to the control group. We found the slip rate in the intervention group was between 68.0% and 68.7% lower than the control group. Similarly, the fall rate was between 78.5% and 81.5% lower in the intervention group compared to the control group. These findings demonstrate that footwear that performs well in the MAA test can reduce the risk of both slips and falls in real-world winter conditions.

Weather Woes? Exploring Potential Links between Precipitation and Age-Related Cognitive Decline

Rain, snow, or ice may discourage older adults from leaving their homes with potential consequences for social isolation, decreased physical activity, and cognitive decline. This study is the first to examine potential links between annual precipitation exposure and cognitive function in a large population-based cohort of older Americans. We examined the association between precipitation (percent of days with snow or rain in the past year) and cognitive function in 25,320 individuals aged 45+ from the Reasons for Geographic and Racial Differences in Stroke Study. Linear mixed models assessed the relationship between precipitation and cognitive function, as well as rates of change in cognitive function with age. We found a non-linear relationship between precipitation and cognitive function. Compared to those exposed to infrequent precipitation (less than 20% of days with rain/snow in the past year), cognitive function was higher among older adults experiencing moderately frequent precipitation (20–40% of annual days with precipitation). However, beyond more than about 45% of days with precipitation in the past year, there was a negative association between precipitation and cognitive function, with faster rates of cognitive decline with age. These exploratory findings motivate further research to better understand the complex role of precipitation for late-life cognitive function.

Planning for Supportive Green Spaces in the Winter City of China: Linking Exercise of Elderly Residents and Exercise Prescription for Cardiovascular Health

The elderly population have a high incidence of cardiovascular disease and are the main users of green spaces, such as city parks. Creating supportive green spaces for exercise for the elderly is of great significance to promote their cardiovascular health. The winter cities have a severely cold climate and high incidence of cardiovascular disease, while the elderly, especially those with cardiovascular disease, face more challenges when participating in exercise in the green spaces. In the context of the winter cities, the kinds of exercise the elderly participate in are more conducive to their cardiovascular health, and determining the factors of the green spaces that are supportive for exercise for cardiovascular health in the winter are of particular interest. Taking Harbin, a typical winter city in China, as an example, this study aims to identify the exercise characteristics of elderly residents in the green spaces in winter, to link them with the principles and contents of exercise prescription for cardiovascular health, to identify the deficient factors of the green spaces in supporting exercise for cardiovascular health, and to put forward optimization design implications. Mixed qualitative methods including interviews, a questionnaire, and field observation were used to identify special behavioral characteristics and spatial factors involving winter exercise in the green spaces among the elderly. The results showed that: (1) about 42.4% of the participants had a gap with the principles of exercise prescription for cardiovascular health. Their exercise items were generally consistent with the principle of low-intensity exercise, but some of them had the problems regarding early exercise time and insufficient exercise duration and frequency. (2) Insufficient supportive factors of the green spaces mainly included facilities allocation, comfort, safety, accessibility, and air quality. Facilities allocation involved walking paths, rehabilitation facilities, auxiliary facilities, and guidance facilities; comfort involved sunlight conditions of the exercise areas; safety involved slippery roads and sites with ice and snow and medical accidents; accessibility involved the proximity, the safety of connecting roads, and the movement of the elderly; air quality involved the planting of evergreen trees. Accordingly, the design implications were given in order to bridge the supportive gap of the green spaces for exercise for cardiovascular health in the elderly population.

Winter Mobility and Community Participation Among People Who Use Mobility Devices: A Scoping Review

OBJECTIVE

To identify the knowledge, products, and strategies for individuals with mobility-related disabilities used to address challenging winter conditions.

DATA SOURCES

AgeLine, OVID, Scopus, and CIHAHL were searched for studies that met the inclusion criteria, from inception to April 2018. Sources for gray literature, or information outside commercial publishing, included ProQUEST, government websites, and manufacturers, vendors, and consumer organization websites.

SOURCE SELECTION

Population of people with limited or reduced mobility or mobility device users involved in winter-related environmental conditions; aim was to increase activity, participation, or safety.

DATA EXTRACTION

Two reviewers independently applied the inclusion criteria to select eligible sources. Two reviewers independently extracted the data from each source.

DATA SYNTHESIS

Twenty-three published peer-reviewed papers were located. Study populations were predominantly those who used wheelchairs (mixed wheelchair type, n=7; power, n=4; manual, n=2), canes (n=3), or specialized winter footwear (n=2). The primary focus of these papers was determined to be tool or device (n=10), recommendations (n=9), strategy (n=2), or resource (n=2). Civic policy documents were variable in citizen responsibility for snow clearing. Limited winter-related supports were identified on consumer organization websites. Although some winter-specific products exist, very few studies have examined the effectiveness of any of these products.

CONCLUSIONS

Despite the common experience of challenging winter conditions, a paucity of winter-specific research and innovation relevant for individuals who use mobility devices exists. Researchers, consumers, and industry need to partner to develop novel tools, strategies, resources, and evidence-based recommendations.

Older Adults' Expectations about Mortality, Driving Life and Years Left without Driving

People are living and driving longer than ever before, with little preparation for transitioning to being non-drivers. We investigated driving expectations among drivers age 65 and older, including sociodemographic and driving context predictors. Cross-sectional data from 349 older drivers were explored to determine variation in how many years they expected to continue driving. General linear models examined predictors of both expectations. In this predominantly Black/African American sample, 76% of older drivers (mean age = 73 ± 5.7 years) expected a non-driving future, forecasting living an average of 5.75 ± 7.29 years after driving cessation. Regression models on years left of driving life and years left to live post-driving cessation predicted nearly half of the variance in older drivers' expectations with five significant predictors: income, current age, age expected to live to, self-limiting driving to nearby places and difficulty, visualizing being a non-driver. Many older drivers expect to stop driving before end of life.

Risk of a feedback loop between climatic warming and human mobility

Human behaviours alter-and are altered by-climate. Might the impacts of warming on human behaviours amplify anthropogenic contributions to climate change? Here, we show that warmer temperatures substantially increase transportation use in the USA. To do so, we combine meteorological data with data on vehicle miles travelled (VMT) and public transit trips (PTT) between 2002 and 2018. Moving from freezing temperatures up to 30°C increases VMT by over 10% and amplifies use of public transit by nearly 15%. Temperatures beyond 30°C exert little influence on either outcome. We then examine climate model projections to highlight the possible transportation impacts of future climatic changes. We project that warming over the coming century may add over one trillion cumulative VMT and six billion PTT in the USA alone, presenting the risk of a novel feedback loop in the human-environmental system.

Winter City Urbanism: Enabling All Year Connectivity for Soft Mobility

This study explores connectivity for soft mobility in the winter season. Working with residents from the sub-arctic city of Luleå, Sweden, the research examines how the interaction between the built environment and winter season affects people's use of the outdoor environment. The research questions for this study are (1) How do residents perceive the effects of winter on an areas spatial structure and pattern of streets and pathways? and (2) What enablers and barriers impact resident soft mobility choices and use of the public realm in winter? Methods used were mental mapping and photo elicitation exercises. These were used to gain a better understanding of people's perception of soft mobility in winter. The results were analysed to identify how soft mobility is influenced by the winter season. The discussion highlights that at the neighbourhood scale, residents perceive that the winter alters an areas spatial structure and pattern of streets and pathways. It was also seen to reduce ease of understanding of the public realm and townscape. In conclusion, it is argued that new and re-tooled town planning strategies, such as extending blue/ green infrastructure planning to include white space could help better enable all year outdoor activity in winter cities.

The impact of weather on summer and winter exercise behaviors

BACKGROUND

Outdoor exercise is an enjoyable way for individuals to improve fitness, but it is dependent on weather conditions. This study examines the association between weather conditions and outdoor exercise after adjustment for age, sex, race, and socioeconomic status.

METHODS

We used data representative of American adults from the University of Michigan/Thomson Reuters June 2013 surveys of consumers (core and supplement) to investigate self-reported exercise behavior in summer and winter. Multivariate multinomial logistic regression models estimated the odds of delayed or indoor exercise compared with outdoor exercise.

RESULTS

Of the 502 respondents, 16.3% did not regularly exercise outdoors (i.e., at least once a week), and many would delay exercise both in summer (51.8%) and winter (43.9%). Individuals listing rain as the predominant adverse weather condition had 3.33 times higher odds of exercising indoors (95% confidence interval (CI): 1.34-8.28) and 3.49 times higher odds of delaying exercise (95%CI: 1.69-7.21) compared with those mentioning heat as the predominant adverse condition. Individuals for whom ice or snow was an adverse winter weather condition were more likely to delay exercise (odds ratio (OR) = 3.34; 95%CI: 1.19-9.36), compared with those concerned with cold.

CONCLUSION

This study found that race, age, and education exacerbate the negative effects of adverse weather conditions on the decision to exercise outdoors. Accordingly, any recommendation for an individual to exercise outdoors should be combined with an evaluation of the individual's outdoor environment along with strategies for the individual to continue exercising, indoors or outdoors, when adverse weather is present.

Qualitative longitudinal study of episodic disability experiences of older women living with HIV in Ontario, Canada

OBJECTIVES

To examine the episodic disability experiences of older women living with HIV over time.

DESIGN

Qualitative longitudinal study, conducting semistructured in-depth interviews on four occasions over a 20-month time frame. Inductive thematic analyses were conducted cross-sectionally and longitudinally.

SETTING

Participants were recruited from HIV community organisations in Canada.

PARTICIPANTS

10 women aged 50 years or older living with HIV for more than 6 years.

RESULTS

Two major themes related to the episodic nature of the women's disability. Women were living with multiple and complex sources of uncertainty over time including: unpredictable health challenges, worrying about cognition, unreliable weather, fearing stigma and the effects of disclosure, maintaining housing and adequate finances, and fulfilling gendered and family roles. Women describe strategies to deal with uncertainty over time including withdrawing and limiting activities and participation and engaging in meaningful activities.

CONCLUSIONS

This longitudinal study highlighted the disabling effects of HIV over time in which unpredictable fluctuations in illness and health resulted in uncertainty and worrying about the future. Environmental factors, such as stigma and weather, may put older women living with HIV at a greater risk for social isolation. Strategies to promote dealing with uncertainty and building resilience are warranted.

For everything a season? A month-by-month analysis of social network resources in later life

It is widely acknowledged that informal social ties provide older persons with many resources that serve to protect and improve their levels of health and well-being. Most studies on this topic, however, ignore the month or season of the year during which data was accumulated. This study proposes two hypotheses to explain seniors' social network resources over the calendar year: the "fluctuation hypothesis", which proposes that seasonal variation, in the form of weather fluctuations, institutional calendars, and holidays, might influence the social lives and resources of older persons, and the "network stability" perspective, which, informed by tenets of convoy theory and socioemotional selectivity theory, emphasizes the increasing importance of close network ties as individuals age and the stability of these ties. Using two waves (2005-2006 and 2010-2011) of the National Social Life, Health, and Aging Project (NSHAP), a nationally representative sample of community-dwelling older adults aged 57-85 in the United States, we examine a diverse set of nine social connectedness outcomes. Results, overall, support the network stability perspective, as the only social connectedness outcome found to significantly vary by month of year was average closeness with network members. We conclude by suggesting some methodological considerations for survey research and by noting how these findings complement the growing literature on inter-year fluctuation in social networks and social support. Changes in older adults' networks, while frequently observable over the course of years, do not seem to be seasonally patterned.

Social participation and heat-related behavior in older adults during heat waves and on other days

BACKGROUND

High indoor temperatures require behavioral adaptation, especially among vulnerable older adults. There are uncertainties as to the degree to which people adapt to these challenging conditions.

OBJECTIVE

The aim of this study was to describe the degree of adaptation of social participation and other heat-related behavior with respect to higher indoor temperatures.

METHODS

In this study 81 residents from 10 sheltered living facilities (84% women, mean age 80.9 years) were visited every 4 weeks from May to October 2015 and additionally during 2 heat waves in July and August 2015. The indoor temperature, drinking and clothing and social participation were documented. Baseline documentation of gait speed and residential area were used to create subgroups of people with high or low gait speed and with facility location in a garden city/suburb or city/city center.

RESULTS

Social participation and clothing decreased with -4.53 in the World Health Organization participation score units (95% confidence interval CI -5.32; -3.74) and -0.41 for clothing units (95% CI -0.46; -0.37) and volume of drinking increased (0.65 l/day; 95% CI 0.52; 0.77) per increase of indoor temperature by 10 °C. The negative association between indoor temperature and social life participation was stronger if functional capacity was low or if the facility was located in the city/city center. Not all older adults displayed temperature-related adaptive behavior.

CONCLUSION

For older adults the negative association between indoor temperature and social life participation was stronger in the city/city center or if their functional capacity was low. Frequent personal contact and motivation of those who are frail might be helpful to support their adaptive behavior of drinking and clothing during heat stress.

Citizen science applied to building healthier community environments: advancing the field through shared construct and measurement development

BACKGROUND

Physical inactivity across the lifespan remains a public health issue for many developed countries. Inactivity has contributed considerably to the pervasiveness of lifestyle diseases. Government, national and local agencies and organizations have been unable to systematically, and in a coordinated way, translate behavioral research into practice that makes a difference at a population level. One approach for mobilizing multi-level efforts to improve the environment for physical activity is to engage in a process of citizen science. Citizen Science here is defined as a participatory research approach involving members of the public working closely with research investigators to initiate and advance scientific research projects. However, there are no common measures or protocols to guide citizen science research at the local community setting.

OBJECTIVES

We describe overarching categories of constructs that can be considered when designing citizen science projects expected to yield multi-level interventions, and provide an example of the citizen science approach to promoting PA. We also recommend potential measures across different levels of impact.

DISCUSSION

Encouraging some consistency in measurement across studies will potentially accelerate the efficiency with which citizen science participatory research provides new insights into and solutions to the behaviorally-based public health issues that drive most of morbidity and mortality. The measures described in this paper abide by four fundamental principles specifically selected for inclusion in citizen science projects: feasibility, accuracy, propriety, and utility. The choice of measures will take into account the potential resources available for outcome and process evaluation. Our intent is to emphasize the importance for all citizen science participatory projects to follow an evidence-based approach and ensure that they incorporate an appropriate assessment protocol.

CONCLUSIONS

We provided the rationale for and a list of contextual factors along with specific examples of measures to encourage consistency among studies that plan to use a citizen science participatory approach. The potential of this approach to promote health and wellbeing in communities is high and we hope that we have provided the tools needed to optimally promote synergistic gains in knowledge across a range of Citizen Science participatory projects.

The role of environmental factors for the onset of restricted mobility outside the home among older adults with osteoarthritis: a prospective cohort study

OBJECTIVES

The study examines how environmental factors contribute to the onset of restricted mobility outside the home among older adults with osteoarthritis.

METHODS

This is a prospective cohort study of adults aged 50 years and older with osteoarthritis (n=1802). Logistic regression tested the association between the onset of restricted mobility outside the home and health, sociodemographic and perceived environmental barriers (hills and steep slopes, inaccessible public buildings, poor pavement condition, lack of access to public parks or sport facilities, heavy traffic or speeding cars and poor weather). The potential moderating role of environmental barriers on the association between health factors and onset was examined using interaction terms and stratified analysis.

RESULTS

Of 1802 participants, 13.5% (n=243) reported the onset of restricted mobility outside the home at 3-year follow-up. Walking disability, anxiety, depression, cognitive impairment and obesity and all environmental barriers were associated with onset after adjustment for confounders. Environmental barriers had an added contribution to the effect of the health conditions on onset of restricted mobility, which was attenuated when adjusted for confounders. The added contribution remained only for walking disability and the presence of hills and steep slopes; in the presence of both, the association with onset of restricted mobility was stronger (OR 7.66, 95% CI 4.64 to 12.64) than in the presence of walking disability (3.60, 2.43 to 5.32) or the presence of hills and steep slopes alone (4.55, 2.89 to 7.16).

CONCLUSION

For older adults with osteoarthritis, environmental barriers are associated and add a contribution to that of morbidities and walking disability on the onset of restricted mobility outside the home. Awareness of environmental barriers is important when aiming to maintain mobility and activities outside the home despite health conditions in older adults.

Snow and Rain Modify Neighbourhood Walkability for Older Adults

The literature has documented a positive relationship between walkable built environments and outdoor mobility in older adults. Yet, surprisingly absent is any consideration of how weather conditions modify the impact of neighbourhood walkability. Using archived weather data linked to survey data collected from a sample of older adults in Vancouver, Canada, we found that car-dependent neighbourhoods (featuring longer block lengths, fewer intersections, and greater distance to amenities) became inaccessible in snow. Even older adults who lived in very walkable neighbourhoods walked to 25 per cent fewer destinations in snow. It is crucial to consider the impact of weather in the relationship between neighbourhood walkability and older adult mobility.

How Different Forms of Health Matter to Political Participation

Physical and mental health is known to have wide influence over most aspects of social life-be it schooling and employment or marriage and broader social engagement-but has received limited attention in explaining different forms of political participation. We analyze a unique dataset with a rich array of objective measures of cognitive and physical well-being and two objective measures of political participation, voting and contributing money to campaigns and parties. For voting, each aspect of health has a powerful effect on par with traditional predictors of participation such as education. In contrast, health has little to no effect on making campaign contributions. We recommend additional attention to the multifaceted affects of health on different forms of political participation.