Richard M. Allman

Life-space mobility declines associated with incident falls and fractures

To determine the effect of falls and fractures on life‐space mobility in a cohort of community‐dwelling older adults.

Life-Space Mobility Change Predicts 6-Month Mortality.

To examine 6‐month change in life‐space mobility as a predictor of subsequent 6‐month mortality in community‐dwelling older adults.

The Association Between Life-Space and Health Care Utilization in Older Adults with Heart Failure

BACKGROUND Life-space is associated with adverse health outcomes in older adults, but its role in health care utilization among individuals with heart failure is not well understood. We examined the relationship between life-space and both emergency department (ED) utilization and hospitalization. METHODS Participants were community-dwelling older adults with a verified diagnosis of heart failure who completed a baseline in-home assessment and at least one follow-up telephone interview. Life-space was measured at baseline and at follow-up every 6 months for 8.5 years. Poisson models were used to determine the association between life-space, measured at the beginning of each 6-month interval, and health care utilization, defined as ED utilization or hospitalization in the immediate ensuing 6 months, adjusting for sociodemographic and clinical confounders. RESULTS A total of 147 participants contributed 259 total health care utilization events involving an ED visit or a hospital admission. Multivariate analysis demonstrated an inverse association between life-space and health care utilization, where a clinically significant 10-point difference in life-space was independently associated with a 14% higher rate of ED utilization or hospitalization (incidence rate ratio 1.14, 95% CI 1.04-1.26, p = .004). CONCLUSIONS Life-space may be a useful identifier of community-dwelling older adults with heart failure at increased risk of ED visits or hospital admissions in the ensuing 6 months. Life-space may therefore be a potentially important component of intervention programs to reduce health care utilization.

Neighborhood Disadvantage and Life-Space Mobility Are Associated with Incident Falls in Community-Dwelling Older Adults

To determine the relationship between neighborhood‐level socioeconomic characteristics, life‐space mobility, and incident falls in community‐dwelling older adults.

Innovation in a Learning Health Care System: Veteran-Directed Home- and Community-Based Services

A path‐breaking example of the interplay between geriatrics and learning healthcare systems is the Veterans Health Administrations (VHAs) planned roll‐out of a program for providing participant‐directed home‐ and community‐based services to veterans with cognitive and functional limitations. We describe the design of a large‐scale, stepped‐wedge, cluster‐randomized trial of the Veteran‐Directed Home‐ and Community‐Based Services (VD‐HCBS) program. From March 2017 through December 2019, up to 77 Veterans Affairs Medical Centers will be randomized to times to begin offering VD‐HCBS to veterans at risk of nursing home placement. Services will be provided to community‐dwelling participants with support from Aging and Disability Network Agencies. The VHA Partnered Evidence‐based Policy Resource Center (PEPReC) is coordinating the evaluation, which includes collaboration from operational stakeholders from the VHA and Administration for Community Living and interdisciplinary researchers from the Center of Innovation in Long‐Term Services and Supports and the Center for Health Services Research in Primary Care. For older veterans with functional limitations who are eligible for VD‐HCBS, we will evaluate health outcomes (hospitalizations, emergency department visits, nursing home admissions, days at home) and healthcare costs associated with VD‐HCBS availability. Learning healthcare systems facilitate diffusion of innovation while enabling rigorous evaluation of effects on patient outcomes. The VHAs randomized rollout of VD‐HCBS to veterans at risk of nursing home placement is an example of how to achieve these goals simultaneously. PEPReCs experience designing an evaluation with researchers and operations stakeholders may serve as a framework for others seeking to develop rapid, rigorous, large‐scale evaluations of delivery system innovations targeted to older adults.

Comparison of In‐Person and Telephone Administration of the Mini‐Mental State Examination in the University of Alabama at Birmingham Study of Aging

To validate the Mini‐Mental State Examination (MMSE) Telephone (MMSET) against the MMSE.

The Impact of Veteran Status on Life-Space Mobility among Older Black and White Men in the Deep South

OBJECTIVE To examine life-space mobility over 8.5 years among older Black and White male veterans and non-veterans in the Deep South. DESIGN A prospective longitudinal study of community-dwelling Black and White male adults aged >65 years (N=501; mean age=74.9; 50% Black and 50% White) enrolled in the University of Alabama at Birmingham (UAB) Study of Aging. Data from baseline in-home assessments with follow-up telephone assessments of life-space mobility completed every 6 months were used in linear mixed-effects modeling analyses to examine life-space mobility trajectories. MAIN OUTCOME MEASURES Life-space mobility. RESULTS In comparison to veterans, non-veterans were more likely to be Black, single, and live in rural areas. They also reported lower income and education. Veterans had higher baseline life-space (73.7 vs 64.9 for non-veterans; P<.001). Race-veteran subgroup analyses revealed significant differences in demographics, comorbidity, cognition, and physical function. Relative to Black veterans, there were significantly greater declines in life-space trajectories for White non-veterans (P=.009), but not for White veterans (P=.807) nor Black non-veterans (P=.633). Mortality at 8.5 years was 43.5% for veterans and 49.5% for non-veterans (P=.190) with no significant differences by race-veteran status. CONCLUSIONS Veterans had significantly higher baseline life-space mobility. There were significantly greater declines in life-space trajectories for White non-veterans in comparison to other race-veteran subgroups. Black veterans and non-veterans did not have significantly different trajectories.

New Frontiers in Resilient Aging: Resilience in mobility in the context of chronic disease and aging:

Abstract The purpose of this chapter is to provide a conceptual basis for using life-space to assess mobility resilience and maintenance of social participation among community dwelling older adults. The Life-Space Assessment (LSA) measures mobility and the geographic scope of participation in society over one month. It reflects distance, frequency, and use of equipment or personal help while ambulating through the environment. An LSA score of 60 or higher defines an unrestricted life-space – a level of mobility and participation that operationalizes resilience among older adults. After reporting results of a qualitative study examining attitudes toward life-space mobility, we report cross-sectional and prospective data from an observational cohort study of community-dwelling older adults. Significant associations between life-space mobility with social participation, as well as specific correlates and predictors of life-space mobility resilience, are defined. The importance of life-space resilience as a reflection of mobility and social participation among community-dwelling older adults An important aspect of resilience is the ability to maintain function in the context of chronic disease and age-associated physiological changes. Available data suggest that 80 percent of persons over the age of 65 years have at least one chronic condition and 20 percent have four or more such conditions (Chodosh et al ., 2005). Age-associated physiological changes have been well documented in all organ systems (Hazzard et al ., 2003).