Merja Rantakokko

Fear of moving outdoors and development of outdoor walking difficulty in older people

OBJECTIVES: To study which individual characteristics and environmental factors correlate with fear of moving outdoors and whether fear of moving outdoors predicts development of mobility limitation.

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.

Mobility decline in old age

Mobility is important for community independence. With increasing age, underlying pathologies, genetic vulnerabilities, physiological and sensory impairments, and environmental barriers increase the risk for mobility decline. Understanding how mobility declines is paramount to finding ways to promote mobility in old age.

Quality of Life and Barriers in the Urban Outdoor Environment in Old Age

OBJECTIVES: To examine the association between barriers in the outdoor environment and perceived quality of life (QoL) in old age and to assess whether fear of moving outdoors and unmet physical activity need contribute to this association.

Unmet Physical Activity Need in Old Age

OBJECTIVES: To examine which individual and environmental factors correlate with unmet physical activity need in old age and predict development of unmet physical activity need (the feeling that ones level of physical activity is inadequate and thus distinct from the recommended amount of physical activity) over a 2‐year follow‐up.

Fear of Falling and Coexisting Sensory Difficulties As Predictors of Mobility Decline in Older Women

BACKGROUND Mobility decline, the coexistence of several sensory difficulties and fear of falling (FOF) are all common concerns in older people; however, knowledge about the combined effect of FOF and coexisting sensory difficulties on mobility is lacking. METHODS Data on self-reported FOF, difficulties in hearing, vision, balance, and walking 2 km were gathered with a structured questionnaire among 434 women aged 63-76 years at baseline and after a 3-year follow-up. Logistic regression models were used for analyses. RESULTS Every third participant reported difficulties in walking 2 km at baseline. In cross-sectional analysis, the odds ratio for difficulties in walking 2 km was higher among persons who reported FOF compared with persons without FOF and the odds increased with the increasing number of sensory difficulties. Persons who reported FOF and who had three sensory difficulties had almost fivefold odds (odds ratio = 4.7, 95% confidence interval = 1.9-11.7) for walking difficulties compared with those who reported no FOF and no sensory difficulties. Among the 290 women without walking difficulties at baseline, 54 participants developed difficulty in walking 2 km during the 3-year follow-up. Odds ratio for incident walking difficulty was 3.5 (95% confidence interval = 1.6-7.8) in participants with FOF and with 2-3 sensory difficulties compared with persons without FOF and with at most one sensory difficulty at baseline. CONCLUSIONS Older women who have several coexisting sensory difficulties combined with FOF are particularly vulnerable to mobility decline. Avoidance of walking as a result of FOF is likely to be reinforced when multiple sensory difficulties hinder reception of accurate information about the environment, resulting in accelerated decline in walking ability.

Perceived barriers in the outdoor environment and development of walking difficulties in older people

SIR—Older people with mobility limitations often report more barriers in their outdoor environment than people with intact mobility [1]. However, it is uncertain whether older people perceive their environment as problematic because of their mobility limitations or whether the environmental barriers precede incident mobility limitation, as most studies have been limited to cross-sectional analyses [2–5]. Only a few longitudinal studies have shown that barriers in the outdoor environment, such as poor street conditions, poor lighting and heavy traffic, increase the risk for overall functional loss [6, 7] and decrease physical activity participation [8]. More knowledge is needed about the characteristics of outdoor environments that threaten the mobility of older people [9]. The aim of the study reported in this letter was to explore whether perceived barriers in the outdoor environment predict development of difficulties in advanced and basic mobility among community-dwelling people who did not have walking difficulties at baseline. (Less)

association Between Physical Performance and Sense of Autonomy in Outdoor Activities and Life-space Mobility in Community-dwelling Older People

To study the relationship between physical performance and sense of autonomy in outdoor activities with life‐space mobility—the spatial area a person purposefully moves through in daily life—in community‐dwelling older people.

Life-space mobility assessment in older people in Finland; measurement properties in winter and spring

BackgroundLife-space mobility refers to the spatial area an individual moves through, the frequency and need for assistance. Based on the assumption that measurement scale properties are context-specific, we tested the scale distribution, responsiveness, and reproducibility of the 15-item University of Alabama at Birmingham Study of Aging Life-Space Assessment in older people in Finland, specifically accounting for season.MethodsCommunity-dwelling older men and women in central Finland aged 75-90 years were interviewed to determine life-space mobility (score range 0-120). Baseline (January-June 2012) and one-year follow-up data (January-June 2013; n = 806) from the cohort study “Life-space mobility in old age” were used to investigate the scale distribution and responsiveness over a period of one year. In addition, with a sub-sample in conjunction with the one-year follow-up, we collected data to study the two-week test-retest reproducibility (n = 18 winter and n = 21 spring 2013).ResultsThe median life-space mobility score at baseline was 64. The median change in score over the one-year follow-up was zero. However, participants reporting a decline in health (repeated measures ANOVA p = .016) or mobility (p = .002) status demonstrated a significantly larger decrease in life-space mobility score than those reporting no or positive changes over the year. The two-week intra-class correlation (ICC) coefficient was .72. Lower ICC was found in the winter than in the spring sample and for items that represent higher life-space levels.ConclusionsThe test-retest reproducibility of the Life-Space Assessment was fair but somewhat compromised in the winter. Mobility of older people at the life-space levels of “town” and “beyond town” may be more variable. Life-space mobility was responsive to change, regardless of season. Further study is warranted to obtain insight in the factors contributing to seasonal effects.

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.