Elke Voss

Out-of-Home Behavior and Cognitive Impairment in Older Adults Findings of the SenTra Project

This study explores differences in the out-of-home behavior of community-dwelling older adults with different cognitive impairment. Three levels of complexity of out-of-home behavior were distinguished: (a) mostly automatized walking behavior (low complexity), (b) global out-of-home mobility (medium complexity), and (c) defined units of concrete out-of-home activities, particularly cognitively demanding activities (high complexity). A sample of 257 older adults aged 59 to 91 years (M = 72.9 years, SD = 6.4 years) included 35 persons with early-stage Alzheimer’s disease (AD), 76 persons with mild cognitive impairment (MCI), and 146 cognitively healthy persons (CH). Mobility data were gathered by using a GPS tracking device as well as by questionnaire. Predicting cognitive impairment status by out-of-home behavior and a range of confounders by means of multinomial logistic regression revealed that only cognitively demanding activities showed at least a marginally significant difference between MCI and CH and were highly significant between AD and CH.

The Use of Tracking Technologies for the Analysis of Outdoor Mobility in the Face of Dementia: First Steps into a Project and Some Illustrative Findings From Germany

As people age in place, cognitive impairment is a major threat to maintaining out-of-home mobility. The SenTra project measures outdoor mobility by taking advantage of tracking technology in an interdisciplinary project involving researchers from geography, social work, gerontology, psychology, and medicine disciplines. The project assesses mobility patterns of urban-dwelling demented and mildly cognitively impaired elders and cognitively intact persons over a period of 3 years in Israel and Germany. The main objectives are to learn more about out-of-home mobility by means of global positioning system/geographical information system technology, to analyze the relationships between cognitive functioning, mobility behavior, and well-being, to examine the ethical implications of the use of advanced tracking technologies in this population, and to assess the potential of tracking technologies in the diagnosis of various types of cognitive impairment. The article presents preliminary findings to illustrate the potential of interdisciplinary data analyses to be performed later in the project. Pilot data were drawn from a combined psychiatric, psycho-social, and tracking data assessment of a group of 19 men and women between 63 and 80 years of age (7 who were healthy, 6 who were mildly cognitive impaired, 6 who were demented) living in Germany. The findings revealed that healthy participants have better health and higher levels of well-being and smaller networks compared to elders who are cognitively impaired. Examples of daily outdoor trips indicate meaningful mobility patterns and the need to combine psycho-social and geographical data to understand the relationships between outdoor mobility, socio-structural dimensions, behavior patterns, and well-being. By achieving its aims, the project will be able to make a substantial contribution to basic, applied, and clinical knowledge gaps in the area of mobility and cognitive impairment research.

Daily Mood and Out-of-Home Mobility in Older Adults Does Cognitive Impairment Matter?

This study explores the relationship between out-of-home behavior and daily mood of community-dwelling older adults with different levels of cognitive impairment across four consecutive weeks. The sample included 16 persons with early stage Alzheimer’s disease (AD), 30 persons with mild cognitive impairment (MCI), and 95 cognitively healthy persons (CH). Using a multi-method approach, GPS tracking and daily-diary data were combined on a day-to-day basis. AD and MCI adults showed lower mood than the CH group. Whereas stronger positive links between mood and out-of-home behavior were found for AD compared to the total sample on an aggregate level, predicting daily mood by person (i.e., cognition) and occasion-specific characteristics (i.e., mobility and weekday), using multilevel regression analysis revealed no corresponding effect. In conclusion, cognitive status in old age appears to impact on mobility and mood as such, rather than on the mood and out-of-home behavior connection.

Interplay of Cognitive and Motivational Resources for Out-of-Home Behavior in a Sample of Cognitively Heterogeneous Older Adults: Findings of the SenTra Project

OBJECTIVES We examined in this study the hypothesis that cognitive resources are more closely linked with out-of-home behavior than motivational resources. METHOD A cognitively heterogeneous sample of 222 older adults aged 59-91 years (M = 72.7; SD = 6.2), including 146 cognitively healthy persons and 76 persons with mild cognitive impairment-recruited in the German and Israeli arm of the SenTra project-was used for the analysis. Out-of-home behavior was assessed by means of global positioning system technology (time out of home; number of nodes visited) as well as by questionnaire (out-of-home activities). Mini-Mental State Examination and trail-making tests A and B were used to assess cognitive resources. Well-being, depression, and environmental mastery were assessed as motivational resources. RESULTS Findings at the zero-order and latent variable levels confirmed that cognitive resources were more closely linked with out-of-home behavior than motivational resources. DISCUSSION Findings support the view that well-being-related motivations to exert out-of-home behavior may become less important in old age because of the increasing cognitive resources required by such behavior.