Johanna Eronen

Individual and environmental factors underlying life space of older people – study protocol and design of a cohort study on life-space mobility in old age (LISPE)

BackgroundA crucial issue for the sustainability of societies is how to maintain health and functioning in older people. With increasing age, losses in vision, hearing, balance, mobility and cognitive capacity render older people particularly exposed to environmental barriers. A central building block of human functioning is walking. Walking difficulties may start to develop in midlife and become increasingly prevalent with age. Life-space mobility reflects actual mobility performance by taking into account the balance between older adults internal physiologic capacity and the external challenges they encounter in daily life. The aim of the Life-Space Mobility in Old Age (LISPE) project is to examine how home and neighborhood characteristics influence people’s health, functioning, disability, quality of life and life-space mobility in the context of aging. In addition, examine whether a person’s health and function influence life-space mobility.DesignThis paper describes the study protocol of the LISPE project, which is a 2-year prospective cohort study of community-dwelling older people aged 75 to 90 (n = 848). The data consists of a baseline survey including face-to-face interviews, objective observation of the home environment and a physical performance test in the participant’s home. All the baseline participants will be interviewed over the phone one and two years after baseline to collect data on life-space mobility, disability and participation restriction. Additional home interviews and environmental evaluations will be conducted for those who relocate during the study period. Data on mortality and health service use will be collected from national registers. In a substudy on walking activity and life space, 358 participants kept a 7-day diary and, in addition, 176 participants also wore an accelerometer.DiscussionOur study, which includes extensive data collection with a large sample, provides a unique opportunity to study topics of importance for aging societies. A novel approach is employed which enables us to study the interactions of environmental features and individual characteristics underlying the life-space of older people. Potentially, the results of this study will contribute to improvements in strategies to postpone or prevent progression to disability and loss of independence.

The association between objectively measured physical activity and life‐space mobility among older people

The purpose of this cross‐sectional study was to investigate the association between objectively measured physical activity and life‐space mobility in community‐dwelling older people. Life‐space refers to the spatial area a person purposefully moves through in daily life (bedroom, home, yard, neighborhood, town, and beyond) and life‐space mobility to the frequency of travel and the help needed when moving through different life‐space areas. The study population comprised community‐living 75‐ to 90‐year‐old people {n = 174; median age 79.7 [interquartile range (IQR) 7.1]}, participating in the accelerometer substudy of Life‐Space Mobility in Old Age (LISPE) project. Step counts and activity time were measured by an accelerometer (Hookie “AM20 Activity Meter”) for 7 days. Life‐space mobility was assessed with Life‐Space Assessment (LSA) questionnaire. Altogether, 16% had a life‐space area restricted to the neighborhood when moving independently. Participants with a restricted life space were less physically active and about 70% of them had exceptionally low values in daily step counts (≤ 615 steps) and moderate activity time (≤ 6.8 min). Higher step counts and activity time correlated positively with life‐space mobility. Prospective studies are needed to clarify the temporal order of low physical activity level and restriction in life‐space mobility.

Barriers to outdoor physical activity and unmet physical activity need in older adults

OBJECTIVE To profile participants based on reported outdoor physical activity barriers using a data-driven approach, describe the profiles and study their association with unmet physical activity need. METHOD Cross-sectional analyses of 848 community-dwelling men and women aged 75-90 living in Central Finland in 2012. Barriers to outdoor physical activity and unmet physical activity need were enquired with a questionnaire. The latent profiles were identified by profiling participants into latent groups using a mixture modeling technique on the multivariate set of indicators of outdoor physical activity barriers. A path model was used to study the associations of the profiles with unmet physical activity need. RESULTS Five barrier profiles were identified. Profile A was characterized with minor barriers, profile B with weather barriers, profile C with health and weather barriers, profile D with barriers concerning insecurity, health and weather; and profile E with mobility and health barriers. The participants in the profiles differed in the proportion of individual and environmental barriers. The risk for unmet physical activity need was highest among people whose severe mobility difficulties restricted their outdoor physical activity. CONCLUSION Outdoor physical activity barriers reflect the imbalance in person-environment fit among older people, manifested as unmet physical activity need.

Mobility Limitation and Changes in Personal Goals Among Older Women

OBJECTIVES Several theoretical viewpoints suggest that older adults need to modify their personal goals in the face of functional decline. The aim of this study was to investigate longitudinally the association of mobility limitation with changes in personal goals among older women. METHOD Eight-year follow-up of 205 women aged 66-78 years at baseline. RESULTS Health-related goals were the most common at both measurements. Goals related to independent living almost doubled and goals related to exercise and to cultural activities substantially decreased during the follow-up. Higher age decreased the likelihood for engaging in new goals related to cultural activities and disengaging from goals related to independent living. Women who had developed mobility limitation during the follow-up were less likely to engage in new goals related to exercise and more likely to disengage from goals related to cultural activities and to health and functioning. DISCUSSION The results of this study support theories suggesting that age-related losses such as mobility limitation may result in older adults modifying or disengaging from personal goals.

Associations Between Reasons to Go Outdoors and Objectively-Measured Walking Activity in Various Life-Space Areas Among Older People

This cross-sectional study investigated associations between reasons to go outdoors and objectively-measured walking activity in various life-space areas among older people. During the study, 174 community-dwelling older people aged 75-90 from central Finland wore an accelerometer over seven days and recorded their reasons to go outdoors in an activity diary. The most common reasons for going outdoors were shopping, walking for exercise, social visits, and running errands. Activities done in multiple life-space areas contributed more to daily step counts than those done in the neighborhood or town and beyond. Those who went shopping or walked for exercise accumulated higher daily step counts than those who did not go outdoors for these reasons. These results show that shopping and walking for exercise are common reasons to go outdoors for community-dwelling older people and may facilitate walking activity in older age. Future studies on how individual trips contribute to the accumulation of steps are warranted.

Personal goals and changes in life-space mobility among older people

OBJECTIVE Life-space mobility - the spatial extent of mobility in daily life - is associated with quality of life and physical functioning but may also be influenced by future orientation expressed in personal goals. The aim of this study was to explore how different personal goals predict changes in older peoples life-space mobility. METHODS This prospective cohort study with a 2-year follow-up included 824 community-dwelling people aged 75 to 90 years from the municipalities of Jyväskylä and Muurame in Central Finland. As part of the Life-Space Mobility in Old Age study (LISPE), which was conducted between 2012 and 2014, the participants responded to the Life-Space Assessment and Personal Project Analysis in addition to questions on socio-demographics and health. Data were analyzed using generalized estimation equation models. RESULTS The results showed that goals indicating a desire to be active in daily life, to stay mentally alert, and to exercise were associated with higher life-space mobility, and that the associations remained over the follow-up years. Goals related to maintaining functioning predicted higher life-space mobility at the 2-year follow-up. In contrast, goals reflecting improvement of poor physical functioning predicted lower life-space mobility. The results remained significant even when adjusted for indicators of health and functioning. CONCLUSIONS This study indicates that supporting older people in striving for relevant personal goals in their lives might contribute to a larger life-space and thus also to improved quality of life in old age.

The Temporal Association Between Executive Function and Life-Space Mobility in Old Age

Background Life-space mobility, an indicator of community mobility, describes persons movements in terms of the distance from home, the frequency of movement, and the need of assistance for movement. Executive function (EF) is a higher-order cognitive function that supervises motor control and plays a key role in a persons ability to function independently. Cognitive impairment often co-occurs with restricted life-space mobility; however, the direction of the longitudinal associations between EF and life-space mobility is unclear. The aim of this study was to investigate the temporal associations between EF and life-space mobility among community-dwelling older people. Methods One hundred eight community-dwelling persons aged 76 to 91 years participated in the 2 year follow-up study. EF was measured with the Trail Making Test. The Life-Space Assessment (range 0-120, higher scores indicate more mobility) was used to assess life-space mobility. Cross-lagged model design was used to examine longitudinal relationship between EF and life-space mobility. The model was adjusted for age and gender. Results Average age of participants at baseline was 82.2 (SD 4.1) years and 59% were women. Better EF at baseline predicted higher life-space mobility at follow-up (path coefficient = 3.81, 95% confidential interval; 0.84, 6.78, p = .012), whereas baseline life-space mobility did not predict EF at follow-up. Conclusion EF was a determinant of life-space mobility. Supporting EF may enhance maintaining independence and active participation in old age.

Accumulation of disparity in physical activity in old age

Background and aims: The level of physical activity often declines in old age, although many older people would like to be more active than what they are capable of. This leads to unmet physical activity need, the feeling that one’s level of physical activity is inadequate, which is a manifestation of disparity in physical activity in old age. The accumulation of risk factors, including mobility limitations, low socioeconomic status (SES) and lack of social support may increase disparity in physical activity. The aim of this study was to investigate how the accumulation of risk factors is associated with unmet physical activity need in older community-living people. Methods: The study was based on cross-sectional analyses of an observational study with 632 participants. Unmet physical activity need, SES, mobility limitations and availability of social support were self-reported by standardized questionnaires. Results: Having mobility limitations increased the risk of unmet physical activity need almost four-fold compared to those with no mobility limitations; having mobility limitations and either low SES or not having social support increased the risk over four-fold and having mobility limitations, low SES and no social support further increased the risk over seven-fold. Conclusions: We found that accumulation of risk factors increases disparity in physical activity.

Executive function and life-space mobility in old age

BackgroundLife-space assessment incorporates all movements in terms of the distance from home, the frequency of movement and the need of assistance for movement. Executive function (EF) is an important higher order cognitive ability that controls and guides people’s goal-directed actions. We examined the cross-sectional and longitudinal associations between EF and life-space mobility, and investigated if perceived walking difficulties, lower extremity performance, and transportation difficulties explain the association.Methods157 community-dwelling persons aged 76–91 years participated in the study at the baseline, and 103 of them in 2-year follow-up study. Based on the distribution on the Trail Making Test participants were categorized into tertiles of EF. Life-space mobility was assessed using the Life-Space Assessment (range 0–120). Perceived walking difficulties and transportation difficulties were self-reported, and lower extremity performance was assessed with the short physical performance battery (SPPB). Adjustments were made for gender, age, number of chronic conditions, and years of education.ResultsAverage age of participants at the baseline was 82.6 (SD 4.2) years and 61% were women. Individuals with poor EF had lower life-space mobility compared to those with good EF. SPPB and transportation difficulties explained the association. Over the 2-year follow-up, those with poor EF at the baseline showed steeper decline but the difference did not quite reach statistical significance (p = 0.068).ConclusionsPeople with better executive function had higher life-space mobility. This was explained by better lower extremity performance and absence of transportation difficulties. Cognitive decline may hinder access to community amenities, which in turn may further accelerate cognitive decline.

Life resources and personal goals in old age

It has been theorized that life resources influence goal engagement. The aim of the present study was to examine whether personal characteristics, and socio-economic, social and health resources are associated with personal goal content in old age. The participants were 824 community-dwelling people aged 75–90 from the Life-Space Mobility in Old Age project. Personal goals were elicited using a revised version of the Personal Project Analysis in a structured interview. Cross-sectional bi- and multivariate analyses using logistic regression modelling were conducted. The results showed that the most commonly reported goals were health maintenance related. People with better health resources were more likely to report goals related to leisure-time, social and physical activities and less likely to report goals related to recovery of health. Those with poor social resources were at risk for having no personal goals in their lives. The results are in line with theorizing on the influence of life resources on goal setting in old age. Further longitudinal studies are needed on whether resource loss precedes goal modification, and how goal setting strategies influence both mental and physical well-being in old age.