Clinical usefulness of indoor life-space assessment in community-dwelling older adults certified as needing support or care

Factors associated with life-space mobility restriction in home-care older adults receiving home-visit rehabilitation: A cross-sectional multi-center study in Japan

AIM

Life-space mobility (LSM) restriction is a serious issue among older adults using home-visit rehabilitation (HR). This study evaluated physical function, transportation, and other factors not comprehensively tested in previous studies and examined factors associated with the restriction of LSM among older adults using HR.

METHODS

This cross-sectional multi-center study recruited 88 HR users (49 men, 39 women, mean age 79.0 [±7.8] years) living in urban and rural areas from August to October 2020. We administered the Life-Space Assessment (LSA), the Self-Efficacy Scale on Going out among community-dwelling Elderly (SEGE), grip strength, a 30-s chair stand test, Bedside Mobility Scale, Functional Independence Measure, Frenchay Activities Index (FAI), Ikigai-9, and Home and Community Environment (HACE) test. Participants were divided into two groups based on the cut-off value of the LSA scores. In the logistic regression analysis, the dependent variable was LSA scores ≤30, and the independent variables were measured based on objective evaluation items and adjusted for confounding factors (age, sex, and frequency of use of day-care services).

RESULTS

Restriction of LSM was significantly associated with FAI (odds ratio [OR] = 0.817, 95% confidence interval [CI] = 0.706-0.945), HACE facilitators (OR = 1.558, 95% CI = 1.168-2.079), and living alone (OR = 12.822, 95% CI = 1.202-136.716).

CONCLUSION

Restriction of LSM is associated with environmental factors, such as assistive devices and household composition, and ability to engage in instrumental activities of daily living. Our findings indicate a great need for focusing on these factors among home-care older adults receiving HR. Geriatr Gerontol Int 2023; 23: 722-728.

Assessing life-space mobility : A systematic review of questionnaires and their psychometric properties

BACKGROUND

Life-space mobility (LSM), as the extent of mobility within one's environment, is a key for successful aging and has become a relevant concept in gerontology and geriatric research. Adequate assessment instruments are needed to identify older persons with LSM restrictions, and to initiate, adapt or evaluate intervention strategies.

OBJECTIVE

To systematically identify, describe and analyze the psychometric properties of LSM questionnaires, with a special focus on their availability in the German language.

METHODS

A systematic literature search was conducted in PubMed, PsycINFO, Cochrane Library, CINAHL, and Web of Science. Studies that examined at least one psychometric property of LSM questionnaires published up to August 2021 were included and evaluated based on the consensus-based standards for the selection of health measurement instruments (COSMIN) guidelines.

RESULTS

This study included 37 validation studies describing 13 different LSM questionnaires. Methodological quality and comprehensiveness of validations were heterogeneous. Based on comprehensive and high-quality results, four LSM questionnaires stood out: the University of Alabama at Birmingham life-space assessment (UAB-LSA), life-space assessment in persons with cognitive impairment (LSA-CI), interview-based and proxy-based versions of the life-space assessment in institutionalized settings (LSA-IS), all of them available in the German language.

CONCLUSION

This systematic review provides a concise overview of available LSM questionnaires and their psychometric properties to facilitate the selection for use in clinical practice and research. The UAB-LSA and LSA-CI for community settings and the interview-based or proxy-based LSA-IS for institutional settings were found to be the most appropriate LSM questionnaires.

An Overview of Social Participation in Older Adults: Concepts and Assessments

In older adults, social participation is an important component of rehabilitation and health promotion. Several studies have attempted to describe the definition and concepts of social participation, and there were many outcomes to measure social participation. This overview provides information about representative social participation and related concepts that have been defined in the literature. A standardized definition of social participation has not been developed; commonly, recognition for social participation was proposed as focused on involvement in social activities that provide interaction with others in a society or community. Many instruments assess the various aspects of social participation. Because of operational definition and diversity in social participation, performance in social participation was adopted as an aspect of assessment. Further discussions are needed to clarify the definition of social participation and evaluate the instruments used to assess social participation for it to be useful for rehabilitation and health promotion. In doing so, determining and developing assessment and intervention based on the purpose or perspective of social participation in older adults with and without disabilities is important.

Life-space and Related Factors for the Elderly in a Geriatric Health Service Facility

Objective

To investigate (1) the concurrent validity of the Nursing Home Life-Space Diameter (NHLSD) and the Home-based Life-Space Assessment (Hb-LSA), (2) the correlated factors of life-space, and (3) the factors that affected the NHLSD score for the elderly in a geriatric health service facility, or Roken.

Methods

This cross-sectional study included 32 participants in a Roken. Staff members, who had received essential guidance for assessment, examined the cognitive function, physical function, mood, communication ability, objective quality of life, vitality, and daily behavior of the participants. Correlation analysis between NHLSD and other measurements and multiple regression analysis with NHLSD as a dependent variable were conducted.

Results

NHLSD and Hb-LSA were significantly correlated (r=0.710, P<0.01). NHLSD was significantly correlated with more measurements than Hb-LSA was; i.e., NHLSD was significantly correlated with communication ability, independence of daily living (Barthel Index; BI), maximum knee extension strength, grip strength, function in daily living, and three QOL measurements: positive affects, ability to communicate, and spontaneity and activity. A stepwise multiple regression analysis indicated that the BI total score, the maximum knee extension strength, and spontaneity and activity (one of the QOL items) were significantly correlated with the NHLSD score.

Conclusions

NHLSD can measure the mobility levels of elderly persons in Roken. In addition to physical conditions and dependence of ADLs, spontaneity (or low levels of apathy) may be an important factor for promoting physical activity in Roken.