Patricia Sawyer Baker

Measuring Life‐Space Mobility in Community‐Dwelling Older Adults

Objectives: To evaluate the validity and reliability of a standardized approach for assessing life‐space mobility (the University of Alabama at Birmingham Study of Aging Life‐Space Assessment (LSA)) and its ability to detect changes in life‐space over time in community‐dwelling older adults.

Prevalence and Correlates of Fecal Incontinence in Community‐Dwelling Older Adults

Objectives: To determine prevalence and correlates of fecal incontinence in older community‐dwelling adults.

Racial Similarities and Differences in Predictors of Mobility Change over Eighteen Months

AbstractOBJECTIVES: To define racial similarities and differences in mobility among community-dwelling older adults and to identify predictors of mobility change. DESIGN: Prospective, observational, cohort study. PARTICIPANTS: Nine hundred and five community-dwelling older adults. MEASURES: Baseline in-home assessments were conducted to assess life-space mobility, sociodemographic variables, disease status, geriatric syndromes, neuropsychological factors, and health behaviors. Disease reports were verified by review of medications, physician questionnaires, or hospital discharge summaries. Telephone interviews defined follow-up life-space mobility at 18 months of follow-up. RESULTS: African Americans had lower baseline life-space (LS-C) than whites (mean 57.0 ± standard deviation [SD] 24.5 vs. 72.7 ± SD 22.6; P<.001). This disparity in mobility was accompanied by significant racial differences in socioeconomic and health status. After 18 months of follow-up, African Americans were less likely to show declines in LS-C than whites. Multivariate analyses showed racial differences in the relative importance and strength of the associations between predictors and LS-C change. Age and diabetes were significant predictors of LS-C decline for both African Americans and whites. Transportation difficulty, kidney disease, dementia, and Parkinson’s disease were significant for African Americans, while low education, arthritis/gout, stroke, neuropathy, depression, and poor appetite were significant for whites. CONCLUSIONS: There are significant disparities in baseline mobility between older African Americans and whites, but declines were more likely in whites. Improving transportation access and diabetes care may be important targets for enhancing mobility and reducing racial disparities in mobility.

The Relationship Between Sociodemographic Factors and Oral Health–Related Quality of Life in Dentate and Edentulous Community‐Dwelling Older Adults

OBJECTIVES: To quantify the associations between sociodemographic factors and oral health–related quality of life (OHRQoL) in dentate and edentulous community‐dwelling older adults.

Bereavement among African American and White older adults.

Purpose: The authors examined epidemiology and sociodemographic predictors of spousal, nonspousal family, and friendship bereavement among African American and White community-dwelling older adults using longitudinal data from 839 participants of the University of Alabama at Birmingham Study of Aging, a prospective cohort study of a random sample of Alabama Medicare beneficiaries. Method: Authors calculated cumulative incidences of each type of loss and used logistic regression to identify factors significantly and independently associated with loss. Results: Of participants, 71% reported at least one loss; 50% reported nonspousal family loss, and 37% reported friendship loss. For married participants, the cumulative incidence of spousal loss was 8.1%. Female sex and income <

The Feminization of Bereavement Among Community-Dwelling Older Adults

12,000 were predictors of spousal loss. Female sex and education ≥ 12 years were predictors of friendship loss. Higher educated African American women were at greater risk of nonspousal family loss. Discussion: Future research should examine bereavement burden and identify health outcomes of multiple losses.

Nonspousal Family Loss among Community-Dwelling Older Adults

ABSTRACT We examined gender differences in frequency and socio-demographic predictors of spousal, non-spousal family, and friendship bereavement events among community-dwelling older adults using data from the UAB Study of Aging. Analysis involved a 30-month observation period of 893 subjects. There were significant differences between women and men for all types of loss. Significant differences were also found in the sociodemographic predictors of loss between and within gender categories. This study revealed the extent to which older women disproportionately bear the burden of loss and points to the need for greater attention to bereavement as a womens issue.

Clock drawing phenotypes in community-dwelling African Americans and Caucasians: Results from the University of Alabama at Birmingham study of aging

We examined the prevalence and correlates of recent nonspousal family loss among older adults using data from the University of Alabama at Birmingham Study of Aging, a stratified random sample of community-dwelling older adults living in central Alabama. Twenty-three percent of participants reported a recent nonspousal family loss. African American ethnicity, education <12th grade, functional difficulty, restricted life-space mobility, depressive symptomology, pain and other somatic symptoms were associated with recent nonspousal family loss. Compared to non-widowed participants, widows with family loss reported a higher proportion of mental health and activity-limiting physical problems as well as restricted life-space. Programs to improve physical function and enhance health and wellbeing in older bereaved spouses should be expanded to include older adults with nonspousal family loss, particularly targeting the mental health needs of previously widowed persons who lose another family member.

Life-Space Assessment composite score rationale:

Background: Two dementia patterns have been described: ‘type 1’ dementia is characterized by executive function impairment and posterior cortical impairment, and ‘type 2’ dementia is characterized by executive impairment and relatively preserved posterior cortical function. The Executive Clock Drawing Task (CLOX) has been used to discriminate between type 1, type 2, and normal cognitive phenotypes. The aim of this study was to describe the prevalence of these phenotypes in community-dwelling African American and Caucasian elders. Methods: 433 African Americans and 477 Caucasians over the age of 65 were recruited. Executive function was assessed using CLOX1, a command-directed clock drawing task. Posterior cortical impairment was assessed using CLOX2, a clock copy task. CLOX scores were combined to estimate the prevalence of type 1 phenotype (those with poor CLOX1 and CLOX2 performance) versus type 2 phenotype (those with only poor CLOX1 performance). Results: 351 (39%) subjects had poor executive performance. Three hundred (33%) subjects had a type 1 phenotype and this pattern was 2.5 times more common among African Americans than Caucasians. One hundred and thirty-seven (15%) subjects had a type 2 phenotype with no significant difference between African Americans and Caucasians. African American ethnicity was independently associated with poor CLOX1 performance after adjusting for sociodemographic factors, posterior cortical function, and global cognition. CLOX2 performance was not associated with ethnicity. Conclusion: The prevalence of poor executive performance in community-dwelling elders is high. African Americans were more likely to have a type 1 phenotype and these ethnic differences were not explained by sociodemographic variables alone.

Declaration of San Antonio, Texas

Life-Space Assessment composite score rationale In his recent manuscript, Siordia1 expressed concerns with the University of Alabama at Birmingham (UAB) Life-Space Assessment (LSA) as a measure of community mobility, suggesting that the logic for the composite score (LSA-CS) is problematic and proposing an alternative scoring method. Siordia indicated that “locating clear instructions for how the LSA-CS should be computed is difficult,” but failed to acknowledge that the authors of the original paper2 validating the LSA-CS invited readers to contact them for LSA instructions and SPSS scoring syntax . In fact Dr. Siordia contacted the authors in May 2013 and received instructions, scoring syntax, and copies of publications relevant to the LSA; he did not subsequently request any additional information. We agree with Dr. Siordia that it is important for “radical clarity” regarding the underlying assumptions of measurement tools and their scoring for clinicians or researchers using the assessments. The LSA was developed based upon the classical sociological perspective of life-space constriction associated with aging as older adults adapt to living with disability3 and was designed to enable researchers or clinicians to assess a person’s usual community mobility during the four weeks before the assessment. In contrast to other self-reported mobility measures that focus on specific mobilityrelated tasks (transferring, walking, or climbing stairs), the LSA reflects community participation by assessing where a person actually went, the frequency of movement, the use of help from others or assistive devices. Rather than assessing the person’s perceived ability to carry out a specific mobility-related task, the LSA obtains information about the person’s actual movement in the environment. Frequency and the independence of movement were incorporated into the LSA to capture important changes in mobility not captured by other assessments. Siordia1 highlighted the value of objective measures of mobility-related tasks such as observed gait speed, and pointed out potential difficulties in self-reported measures such as the LSA. For that reason, the original validation of the LSA included an examination of the correlation of four different scoring LSA methods with a composite measure of physical function that included gait speed, timed chair stands, and an assessment of balance.2 The LSA-CS was the most highly correlated score with observed physical performance and approximated a normal distribution; the test-retest reliability of the LSA-CS had an interclass correlation of 0.96.2 Subsequently, the LSA-CS has been validated as an important clinical measure of community mobility, predicting death, nursing home admissions, cognitive change, incident IADL disability, and as a measure reflecting important changes in mobility after hospitalizations and surgery.4–7 The LSA gives credit for the maximal values of life-space of a person, the greatest extent of the area in which they conduct their lives, while adjusting for person-specific adaptations to independent movement. Such scoring allows the assessment to be used clinically at a single point in time and to assess change in mobility at the individual level, perhaps as a trigger to understand factors amenable to intervention. In contrast to observations that require an in-home or clinic visit, the LSA can be administered by telephone or in person, providing a way to monitor changes in community-mobility in 614295 CRE0010.1177/0269215515614295Clinical RehabilitationBaker et al. research-article2015