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)

Abstract Background A 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) p…

TENACIOUS GOAL PURSUIT AND LIFE-SPACE MOBILITY AMONG OLDER PEOPLE WITH WALKING DIFFICULTIES

Life-space mobility, defined as the spatial extent of movement in daily life, is strongly dependent on functional ability. However, active striving to reach one’s goals might inspire older people to move in a larger life-space regardless of their physical abilities. We aimed to study whether tenacious goal pursuit differs according to walking difficulties and whether it is associated with life-space mobility 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 b…

Terveyden lukutaito – ajankohtainen mutta vähän tutkittu kansalaistaito

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 g…

Health literacy supports active aging

From the individual viewpoint, active aging refers to the ability of older persons, depending on their goals, functional capacity and opportunities, to engage in desired activities. This study investigated the role of health literacy in active aging among persons differing in their number of chronic conditions. Data were collected from 948 individuals, 57% women, aged 75, 80 and 85 in 2017–2018 in the city of Jyväskylä in Central Finland. Health literacy was assessed with the 16-question version of the European Health Literacy Survey (HLS-EU-Q16), active aging with the University of Jyväskylä Active Aging Scale (UJACAS) and self-reported physician-diagnosed chronic conditions. Both health l…

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 count…

Environmental mobility barriers and walking for errands among older people who live alone vs. with others

Background. Walking is the most popular form of physical activity among older people and for community-dwelling older people walking for errands is especially important. The aim of this study is to examine the association between self-reported environmental mobility barriers and amount of walking for errands among older people who live alone compared to those who live with others. Methods. This observational study is based on cross-sectional data on 657 people aged 75–81 living in Jyväskylä, Central Finland. Self-reports of environmental mobility barriers were collected under four categories: Traffic, Terrain, Distances and Entrance. Persons who reported walking for errands ≤ 1.5 km/week or…

Outdoor Mobility and Use of Adaptive or Maladaptive Walking Modifications among Older People

Background. In old age, decline in functioning may cause changes in walking ability. Our aim was to study whether older people who report adaptive, maladaptive or no walking modifications differ in outdoor mobility. Methods. Community-dwelling people aged 75–90 years (N=848) were interviewed at baseline, of whom 761 participated in the 2-year follow-up. Walking modifications were assessed by asking the participants whether they had modified their way of walking 2 kilometers due to their health. Based on the responses, three categories were formed: no walking modifications (reference), adaptive (e.g., walking more slowly, using an aid) and maladaptive walking modifications (reduced frequency…

Supplemental_tables – Supplemental Material for Associations between Perceived Outdoor Environment and Walking Modifications in Community-Dwelling Older People: A Two-Year Follow-Up Study

Supplemental Material, Supplemental_tables for Associations between Perceived Outdoor Environment and Walking Modifications in Community-Dwelling Older People: A Two-Year Follow-Up Study by Heidi Skantz, Taina Rantanen, Timo Rantalainen, Kirsi E. Keskinen, Lotta Palmberg, Erja Portegijs, Johanna Eronen and Merja Rantakokko in Journal of Aging and Health

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

Abstract 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 people's 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 Jyvaskyla 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 an…

FLEXIBLE AND TENACIOUS GOAL PURSUIT IN RELATION TO OUTDOOR MOBILITY IN OLD AGE

Goal pursuit may affect older people’s outdoor mobility, a correlate of quality of life. This study investigated associations of flexible and tenacious goal pursuit with perceived autonomy in participation outdoors and life-space mobility. Participants were community-dwelling older people aged 79–93 years (n=185). Tenacious goal pursuit (TGP) and flexible goal adjustment (FGA) were self-reported with separate scales (ranges 5–25). Perceived autonomy in participation was assessed with the Impact on Participation and Autonomy ‘outdoors’-subscale (range 0–20), and life-space mobility with the Life-Space Assessment (range 0–120). Two-step cluster analysis was used to create data-driven goal pur…

Maintenance of high quality of life as an indicator of resilience during COVID-19 social distancing among community-dwelling older adults in Finland

Abstract Purpose Social distancing during the COVID-19 pandemic reduced possibilities for activities of choice potentially threatening quality of life (QoL). We defined QoL resilience as maintaining high quality of life and studied whether walking speed, absence of loneliness, living arrangement, and stress-coping ability predict QoL resilience among older people. Methods Community-dwelling 75-, 80-, and 85-year-old persons (n = 685) were interviewed and examined in 2017–2018 and were followed up during COVID-19 social distancing in 2020. We assessed QoL using the OPQOL-brief scale and set a cut-off for ‘constant high’ based on staying in the highest baseline quartile over the follow-up and…

Assimilative and Accommodative Coping and Older People’s Leisure Activities

Objectives: Assimilative and accommodative coping strategies have hardly been studied in relation to leisure activities in old age. We investigated whether tenacious goal pursuit (TGP) and flexible goal adjustment (FGA) influence the association between physical performance and participation in leisure activities. Methods: A cross-sectional analysis was conducted among 187 community-dwelling people aged 79 to 93 years. TGP, FGA, and leisure activity participation were asked with questionnaires. Physical performance was assessed with the Short Physical Performance Battery (SPPB). Results: TGP moderated the relationship between physical performance and leisure activity participation. Despite…

Terveyden lukutaito, terveys ja toimintakyky 75-vuotiailla jyväskyläläisillä

Socioeconomic Status and Life-Space Mobility in Old Age.

Life-space mobility describes the extent of community mobility of older persons. The aim of this cross-sectional study was to examine the relationship between socioeconomic status (SES) and life-space mobility and to investigate whether associations might be explained by SES-related disparities in health and functioning. The participants (n = 848) were community-dwelling adults aged 75–90. Education and occupation were used to indicate SES. Life-space assessment (range 0–120) was used to indicate distance and frequency of moving and assistance needed in moving. People with low education had lower life-space mobility scores than those with intermediate or high education: marginal means 63.5,…

Life-Space Mobility and Active Aging as Factors Underlying Quality of Life Among Older People Before and During COVID-19 Lockdown in Finland—A Longitudinal Study

Abstract Background Social distancing, that is, avoiding places with other people and staying at home, was recommended to prevent viral transmission during the COVID-19 pandemic. Potentially, reduced out-of-home mobility and lower activity levels among older people may lower their quality of life (QOL). We studied cross-sectional and longitudinal associations of and changes in life-space mobility, active aging, and QOL during COVID-19 social distancing compared to 2 years before. Methods Altogether 809 community-living participants initially aged 75, 80, or 85 years of our active aging study (AGNES) conducted in 2017–2018 took part in the current AGNES-COVID-19 survey in May and June 2020. …

Impact of mobility restrictions on active aging; cross-sectional associations and longitudinal changes parallel to COVID-19 restrictions

Background: Meaningful activities can be done in or around home, but opportunities for participation and active aging decrease when moving in smaller areas. Active aging refers to having an active approach to life in line with one's goals, ability and opportunities. In adults over 75 years with different baseline neighborhood mobility levels, we studied active aging scores two years prior to and amid COVID-19, when governments restricted mobility of residents to slow the COVID-19 outbreak. Methods: AGNES cohort data were collected in 2017-2018 and spring 2020. Individuals were queried about their will, ability, and opportunity, and extent of doing 17 activities, and subsequently, item, comp…

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

Abstract 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 u…

EXECUTIVE FUNCTION AND LIFE-SPACE MOBILITY IN OLD AGE

Mobility is important for maintaining independence and active participation in old age. Life-space mobility assessment incorporates the extent of mobility in terms of the distance from home, the frequency of mobility and the need of assistance for mobility. Executive function (EF) is one of the most important higher-order cognitive abilities that control and guide goal-directed actions. The aim of the study was to examine the association between EF and life-space mobility.

Executive function and life-space mobility in old age

Life-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. Methods 157 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 Ma…

Association of tenacious goal pursuit and flexible goal adjustment with out-of-home mobility among community-dwelling older people

Background As people age, functional losses may limit the potential to get outside the home and participate in desired activities and community life. Coping with age-related losses has been reported to be important for psychological well-being. Hitherto is not known whether active use of coping strategies also helps maintain out-of-home mobility. Aims We investigated how two coping strategies, tenacious goal pursuit (TGP; persistency in reaching one’s goals) and flexible goal adjustment (FGA; adjusting one’s goals to changed circumstances), are associated with life-space mobility and perceived autonomy in participation outdoors among community-dwelling older people. Methods Participants (n …

Lievää Alzheimerin tautia sairastavien henkilöiden ja heidän omaishoitajiensa sosiaali- ja terveyspalveluiden käyttö ja siihen yhteydessä olevat tekijät

Alzheimerin tauti on yleisin dementiaa aiheuttava sairaus. Alzheimerin tautia sairastavien henkilöiden itsenäinen selviytyminen heikkenee taudin oireiden etenemisen myötä. Omaishoitajan avustuksella moni muistisairas henkilö pystyy asumaan omassa kodissaan vielä siinäkin vaiheessa, kun se yksin olisi mahdotonta. Läheisen ihmisen omaishoitajana toimiminen on raskasta työtä ja moni omaishoitaja kokee olevansa psyykkisesti ja fyysisesti kuormittunut. Omaishoitajan ja muistisairaan henkilön tukena ovat useat sosiaali- ja terveyspalvelut, joiden tarkoituksena on tukea toimintakykyä, mahdollistaa kotona asuminen ja parantaa omaishoitajan jaksamista. Tämän tutkimuksen tarkoituksena on selvittää li…

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 …

Coronavirus-related health literacy and perceived restrictiveness of protective measures among community-dwelling older persons in Finland

Abstract Background Older people with limited health literacy may encounter difficulties in finding relevant information on COVID-19, understanding its relevance, and complying with recommended protective measures. Complying with such recommendations has required older as well as younger persons to change their daily lives in ways that have reduced their opportunities for engaging in many activities meaningful to them. Aims To find out from what sources older people have obtained information on protective measures, the level of their coronavirus-related health literacy (CHL), and whether CHL is associated with their perceptions of the restrictiveness of coronavirus-related protective measur…

Associations between Perceived Outdoor Environment and Walking Modifications in Community-Dwelling Older People: A Two-Year Follow-Up Study

Objectives: To examine associations of perceived outdoor environment with the prevalence and development of adaptive (e.g., slower pace) and maladaptive (e.g., avoiding walking) modifications in walking 2 km among older people. Methods: Community-dwelling 75–90 -year-old persons ( N = 848) reported environmental outdoor mobility facilitators and barriers at baseline. Modifications in walking 2 km (adaptive, maladaptive, or no) were assessed at baseline and one and two years later. Results: Outdoor mobility facilitators were more often reported by those not using modifications or using adaptive versus maladaptive walking modifications. Differences in health and physical capacity explained m…

Assessment of health literacy among older Finns

Aims: This study examined the feasibility of the HLS-EU-Q16 (in Finnish) for use among older Finns and whether the health literacy score correlates with indicators of health and functioning. Methods: To determine the feasibility of the instrument, we first conducted a focus group discussion with nine participants. For the quantitative analyses, we used data from the AGNES cohort study, collected between October 2017 and April 2018 at the University of Jyväskylä in Finland. 292 75-year-old Finnish men and women were interviewed face-to-face in their homes. Health literacy was measured with the HLS-EU-Q16 and health literacy score, ranging from 0 to 50, computed. The reproducibility of the in…

Kaduilla, poluilla ja puutarhoissa : iäkkäiden ihmisten ulkona liikkuminen ja hyvinvointi

Tämän kirjoituksen tarkoituksena on tuoda esiin iäkkäiden ihmisten ulkoilua ja ulkona liikkumista käsitelleitä tutkimuksia ja niiden tuloksia. Lisäksi tarkoituksena on tarkastella, mitä kaikkea hyvinvointi-käsitteen alle sijoitetaan iäkkäiden ulkoilua ja ulkona liikkumista käsittelevässä tutkimuksessa ja käsitellä sitä, miksi juuri ulkona liikkumisen sanotaan olevan iäkkäille ihmisille tärkeää. Mitä on se hyvinvointi, jota ulkoilu ja ulkona liikkuminen tuottavat, mikä rooli ulkona liikkumisen ympäristöllä on, entä mikä on se mekanismi, jolla ulkoilun ajatellaan tuovan hyvinvointia iäkkäälle? peerReviewed

Physical Activity Scaled to Preferred Walking Speed as a Predictor of Walking Difficulty in Older Adults: A 2-Year Follow-up

Abstract Background The usual accelerometry-based measures of physical activity (PA) are dependent on physical performance. We investigated the associations between PA relative to walking performance and the prevalence and incidence of early and advanced walking difficulties compared to generally used measures of PA. Methods Perceived walking difficulty was evaluated in 994 community-dwelling participants at baseline (age 75, 80, or 85 years) and 2 years later over 2 km (early difficulty) and 500 m (advanced difficulty). We used a thigh-mounted accelerometer to assess moderate-to-vigorous PA, daily mean acceleration, and relative PA as movement beyond the intensity of preferred walking spee…

Disparities in physical activity in old age

Perceived Opportunities for Physical Activity and Willingness to Be More Active in Older Adults with Different Physical Activity Levels

This study examined equity in physical activity (PA) by investigating whether perceived opportunity for PA was associated with willingness to be more active. Among community residents (75, 80, or 85 years old, n = 962) perceived opportunity for PA (poor and good), willingness to be more active (not at all, a bit, and a lot), and level of PA (low, moderate, and high) were assessed via questionnaires. Multinomial logistic regression showed that physical activity moderated the association between poor opportunity and willingness to increase PA. Among those with moderate PA, poor opportunity for PA increased the odds of willingness to be a lot more active (multinomial odds ratio, mOR 3.90, 95% …

The temporal association between executive function and life-space mobility in old age

Background Life-space mobility, an indicator of community mobility, describes person’s 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 person’s 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…

Health literacy, socioeconomic status and digital device use among older adults

Daily Physical Activity and Sedentary Time Assessed by Acceleration Based on Mean Amplitude Deviation among Older People

Accelerometer-derived estimates of physical activity (PA) and sedentary time have been an important methodological focus. However, little is known about the daily activities among older people during their normal lives. Furthermore, some older individuals would like to be more active, yet experience an unmet PA need, which is defined as the desire to engage in more PA but without the opportunity to act on the desire. This study examined the intensity of daily PA and sedentary behavior measured with accelerometers among older people, and whether PA differs between weekdays and weekends and those with and without the experience of unmet PA need, measured with self-reports. A total of 174 comm…

Active aging – resilience and external support as modifiers of the disablement outcome: AGNES cohort study protocol

Background: Population aging increases the need for knowledge on positive aspects of aging, and contributions of older people to their own wellbeing and that of others. We defined active aging as an individual’s striving for elements of wellbeing with activities as per their goals, abilities and opportunities. This study examines associations of health, health behaviors, health literacy and functional abilities, environmental and social support with active aging and wellbeing. We will develop and validate assessment methods for physical activity and physical resilience suitable for research on older people, and examine their associations with active aging and wellbeing. We will examine coho…

Environmental facilitators for outdoor walking and development of walking difficulty in community-dwelling older adults

Older adults who report environmental barriers in their neighborhood have a higher risk for walking difficulty. However, environmental facilitators that protect against walking difficulty are not well known. The objective of this study was to identify the effect of environmental facilitators for outdoor walking on development of walking difficulty in community-dwelling older people. This was a prospective study with a 3.5-year follow-up time on 261 community-dwelling people aged 75–81 years, who at baseline were able to walk 0.5 km without difficulty. Environmental facilitators for outdoor walking were self-reported with standardized questionnaires, including having features in one’s home w…