Nancy Ambrose Gallagher

Influences on neighborhood walking in older adults.

The purpose of this cross-sectional survey study was to examine the influence of self-efficacy, outcome expectations, and environment on neighborhood walking in older adults with (n = 163, mean age = 78.7, SD = 7.96 years) and without (n = 163, mean age = 73.6, SD = 7.93 years) mobility limitations, controlling for demographic characteristics. Multiple regression revealed that in mobility-limited older adults, demographic characteristics, self-efficacy, and outcome expectations explained 17.4% of variance in neighborhood walking, while environment (neighborhood destinations and design) explained 9.4%. Destinations, self-efficacy, sex, and outcome expectations influenced walking. In those without mobility limitations, demographic characteristics, self-efficacy, and outcome expectations explained 15.6% of the variance, while environment explained 5.6%. Self-efficacy, sex, and design influenced walking. Neighborhood walking interventions for older adults should include self-efficacy strategies tailored to mobility status and neighborhood characteristics.

The Impact of Weather on Mobility and Participation in Older US Adults

OBJECTIVES We examined the impact of weather on the daily lives of US adults to understand which populations are most vulnerable to various weather conditions. METHODS Data came from a 2013 supplement to the University of Michigan-Thomson Reuters Surveys of Consumers, a nationally representative telephone survey of 502 adults in the contiguous United States. We used logistic regressions to assess the odds of mobility difficulty and participation restriction during different weather conditions, as well as age group differences. RESULTS Ice was most likely to change the way respondents got around (reported by 47%). In icy conditions, participants had difficulty leaving home (40%) and driving (35%). Facing ice, older adults (≥ 65 years) had twice the odds of having great difficulty leaving home (odds ratio [OR] = 2.22; 95% confidence interval [CI] = 1.12, 4.42) and curtailing work or volunteer activities (OR = 2.01; 95% CI = 1.01, 4.06), and 3 times the odds of difficulty driving (OR = 3.33; 95% CI = 1.62, 6.86) as younger respondents. We also found significant differences in mobility and participation by gender and region of residence. CONCLUSIONS Weather can affect social isolation, health, well-being, and mortality among older US adults.

Gender Differences in Neighborhood Walking in Older Adults

Objective: This study examined mobility, self-efficacy, outcome expectations, neighborhood (density, destinations, and design), and neighborhood walking in older men (n = 106, 60-99 years, M = 76.78, SD = 8.12) and women (n = 216, 60-99 years, M = 75.81, SD = 8.46). Method/Results: In hierarchical regression, the variables explained 32% of the variance in neighborhood walking in men (p < .001) and 27% of the variance in women (p < .01). Self-efficacy (β = .49, p < .01), density (β= .22, p < .05), and design (β= .21, p = .05) were associated with walking in men. Significant design characteristics included sidewalks (β= .25, p < .05) and crime (β= .36, p < .01). In women, self-efficacy (β= .48, p < .001) and destinations (β= .15, p < .05) were associated with walking. Walking was associated with self-efficacy for walking despite individual barriers in women (β= .38, p < .001) and neighborhood barriers in men (β= .30, p < .05). Conclusion: Walking interventions targeting older women should incorporate local destinations. In older men, interventions should consider neighborhood sidewalk design and crime. Walking interventions for all older adults should include enhancement of self-efficacy, but gender differences may exist in the types of self-efficacy on which to focus.

Self-Efficacy, Neighborhood Walking, and Fall History in Older Adults

This cross-sectional study examined the association of self-efficacy with neighborhood walking in older adult (mean age = 76.1, SD = 8.34) fallers (n = 108) and nonfallers (n = 217) while controlling for demographic characteristics and mobility. Hierarchical multiple regression indicated that the full model explained 39% of the variance in neighborhood walking in fallers (P < .001) and 24% in nonfallers (P < .001). Self-efficacy explained 23% of the variance in fallers (P < .001) and 11% in nonfallers (P < .001). Neighborhood walking was significantly associated with self-efficacy for individual barriers in both groups. Self-efficacy for neighborhood barriers trended toward significance in fallers (β = .18, P = .06). Fall history did not moderate the relationship between self-efficacy and neighborhood walking. Walking interventions for older adults should address self-efficacy in overcoming individual walking barriers. Those targeting fallers should consider addressing self-efficacy for overcoming neighborhood barriers.

Trajectories of Outdoor Mobility in Vulnerable Community-Dwelling Elderly The Role of Individual and Environmental Factors

Objective: Outdoor mobility is critical for healthy aging, yet little is known about the factors influencing mobility in the frail elderly. We investigated the role of individual and community risk factors on trajectories of mobility in a population of vulnerable community-dwelling elderly. Method: Using data from 1,188 older adults in Detroit, MI, who qualify for federally funded home care, a latent class growth analysis was used to model the frequency of going outside over a 15-month period. Results: Four latent trajectories were found: those with a low, high, and declining frequency of going outdoors over time, and those who do not go outdoors on a regular basis. Risk factors for membership in the homebound and infrequent mobility groups were older age, more severe mobility impairment, and fear of falling. Barriers at the entry to the home were associated with being homebound. Discussion: Declining health status and functional limitations are risk factors that pose a threat to outdoor mobility in the frail elderly, while housing barriers and community accessibility also merit attention.

Using Mobile, Wearable, Technology to Understand the Role of Built Environment Demand for Outdoor Mobility:

Walking outdoors requires navigating a complex environment. However, no studies have evaluated how environmental barriers affect outdoor mobility in real time. We assessed the impact of the built environment on outdoor mobility, using mobile, wearable inertial measurement units. Data come from a convenience sample of 23 community-dwelling adults in Southeast Michigan. Participants walked a defined outdoor route where gait metrics were captured over a real-world urban environment with varying challenges. Street segments were classified as high versus low environmental demand using the Senior Walking Environmental Assessment Tool. Participants ranged in age from 22 to 74 years (mean age of 47 years). Outdoor gait speed was 0.3 m/s slower, and gait variability almost doubled, over the high- versus low-demand environments (coefficient of variability = 10.6% vs. 5.6%, respectively). This is the first study to demonstrate the feasibility of using wearable motion sensors to gather real-time mobility data in response to outdoor environmental demand. Findings contribute to the understanding of outdoor mobility by quantifying how real-world environmental challenges influence mobility in real time.