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…

Mobility Modification Alleviates Environmental Influence on Incident Mobility Difficulty among Community-Dwelling Older People: A Two-Year Follow-Up Study

Background Environmental barriers increase risk for mobility difficulties in old age. Mobility difficulty is preceded by a phase where people try to postpone a difficulty through mobility modification. We studied whether perceived environmental mobility barriers outdoors correlate with mobility modification and mobility difficulty, predict development of mobility difficulty over a two-year follow-up, and whether mobility modification alleviates the risk for difficulty. Methods At baseline, 848 people aged 75–90 were interviewed face-to-face. Telephone follow-up interviews were conducted one (n = 816) and two years (n = 761) later. Environmental barriers to mobility were self-reported using …

Do Associations Between Perceived Environmental and Individual Characteristics and Walking Limitations Depend on Lower Extremity Performance Level?

Objective: The aim of this study was to analyze whether the associations between perceived environmental and individual characteristics and perceived walking limitations in older people differ between those with intact and those with poorer lower extremity performance. Method: Persons aged 75 to 90 ( N = 834) participated in interviews and performance tests in their homes. Standard questionnaires were used to obtain walking difficulties; environmental barriers to and, facilitators of, mobility; and perceived individual hindrances to outdoor mobility. Lower extremity performance was tested using Short Physical Performance Battery (SPPB). Results: Among those with poorer lower extremity perf…

Life-space mobility and quality of life in community-dwelling older people

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

Background: Life-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. Methods: Community-dwelling older men and women in cent ral Finland aged 75-90 y ears 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 “ Lif…

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 co…

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. DESIGN: Cross-sectional. SETTING: Community and research center. PARTICIPANTS: Five hundred eighty-nine, community-dwelling people aged 75 to 81 took part in face-to-face home-interviews and examinations in the research center. MEASUREMENTS: QoL was assessed using the LEIPAD questionnaire. Environmental barriers were studied based on self-reports of lack of resting places or long distances (distances), noisy traffic or dangerous crossroads (traffic), and…

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 cha…

Perceived and objective entrance-related environmental barriers and daily out-of-home mobility in community-dwelling older people

Abstract Purpose We studied whether entrance-related environmental barriers, perceived and objectively recorded, were associated with moving out-of-home daily in older people with and without limitations in lower extremity performance. Methods Cross-sectional analyses of the “Life-space mobility in old age” cohort including 848 community-dwelling 75–90-year-old of central Finland. Participants reported their frequency of moving out-of-home (daily vs. 0–6 times/week) and perceived entrance-related environmental barriers (yes/no). Lower extremity performance was assessed (Short Physical Performance Battery) and categorized as poorer (score 0–9) or good (score 10–12). Environmental barriers at…

Life-Space Mobility in Parkinson's Disease: Associations with Motor and Non-Motor Symptoms.

Background To describe life-space mobility and explore associations of motor and non-motor symptoms with life-space mobility in people with Parkinson’s disease (PD). Methods About 164 community-dwelling persons with PD (mean age 71.6 years, 64.6% men) received a postal survey and a subsequent home visit. Motor assessments included perceived walking difficulties (Walk-12G), mobility (Timed Up and Go test), motor symptoms (UPDRS-III), and freezing of gait (item 3, FOG-Qsa). Non-motor symptoms included depressive symptoms (GDS-15), pain, fatigue (NHP-EN), and global cognition (MoCA). Life-space mobility was assessed with the life-space assessment (LSA). Calculations included composite score (r…

Task Modifications in Walking Postpone Decline in Life-Space Mobility Among Community-Dwelling Older People: A 2-year Follow-up Study

Background Task modification refers to performing a task differently than before. While task modification in walking may be a sign of looming walking difficulty, it may also be adaptive in and postpone the decline in life-space mobility. However, this has not been studied. This study examined whether changes in life-space mobility over a 2-year period differ between people who at baseline report no walking difficulty and no task modification, those who report no walking difficulty but task modification, and those who report walking difficulty. Methods Community-dwelling people aged 75–90 years were interviewed face-to-face at baseline (N = 848), and over phone one (n = 816) and two (n = 761…

Perceived environmental barriers to outdoor mobility and feelings of loneliness among community-dwelling older people

We examined the association between perceived environmental barriers to outdoor mobility and loneliness among community-dwelling older people. In addition, we studied whether walking difficulties and autonomy in participation outdoors affected this association.Cross-sectional analyses of face-to-face home interview data with 848 people aged 75-90 years (mean age: 80.1 years; 62% women) gathered within the "Life-Space Mobility in Old Age" (LISPE) project. Self-reports of loneliness, environmental barriers to outdoor mobility, and difficulties in walking 2 km were obtained with structured questionnaires. Autonomy in participation outdoors was assessed with the "Impact on Participation and Aut…

Exploring Associations of Housing, Relocation, and Active and Healthy Aging in Sweden : Protocol for a Prospective Longitudinal Mixed Methods Study

Background: While housing and neighborhood features have the potential to impact opportunities for active aging, there is a lack of knowledge related to how older people reason regarding their housing situation and how housing and fulfillment of relocation are associated with active and healthy aging. Objective: The objectives of Prospective RELOC-AGE are to study housing choices and relocation and explore effects on active and healthy aging among men and women aged 55 years and older in Sweden considering relocation. Methods: The estimated sample (2800) will include people aged 55 years and older being listed for relocation at either of two housing companies: a local public housing company…

Perceived environmental barriers to outdoor mobility and changes in sense of autonomy in participation outdoors among older people: a prospective two-year cohort study.

Objective: The aim was to study whether perceived environmental barriers to outdoor mobility affect changes in sense of autonomy in participation outdoors among community-dwelling older people over a two-year period. Methods: Community-dwelling people aged 75–90 years (n = 848) in central Finland were interviewed on two occasions, face-to-face at baseline and over the telephone two years later. Perceived environmental barriers to outdoor mobility were assessed using a 15-item structured questionnaire, and the sum scores categorized into tertiles (0, 1 and 2 or more barriers). Autonomy in participation outdoors was assessed with the ‘Impact on Participation and Autonomy’ (IPA) questionnaire …

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. DESIGN: Observational prospective cohort study and cross-sectional analyses. SETTING: Community and research center. PARTICIPANTS: Seven hundred twenty-seven community-living people aged 75 to 81 were interviewed at baseline, of whom 314 took part in a 3.5-year follow-up. MEASUREMENTS: Fear of moving outdoors and its potential individual and environmental correlates were assessed at baseline. Perceived difficulties in walking 0.5 km and 2 km were assessed twice a year over a 3.5-year period. RE…

Changes in life-space mobility and quality of life among community-dwelling older people: a 2-year follow-up study

Purpose Life-space mobility refers to the spatial area in which a person moves in daily life, taking into account distance, frequency and assistance needed. The aim was to examine how changes in life-space mobility are associated with changes in quality of life (QOL) over a 2-year period. Methods Community-dwelling people aged 75–90 years (n = 848) were interviewed face-to-face in their homes and followed up annually for 2 years. QOL was assessed with the short version of the World Health Organization QOL assessment (range 0–130, higher scores indicate better QOL). Life-space mobility was assessed with the Life-Space Assessment (range 0–120, higher scores indicate better life-space mobility…

Environmental barriers, person-environment fit and mortality among community-dwelling very old people

Background. Environmental barriers are associated with disability-related outcomes in older people but little is known of the effect of environmental barriers on mortality. The aim of this study was to examine whether objectively measured barriers in the outdoor, entrance and indoor environments are associated with mortality among community-dwelling 80- to 89-year-old single-living people. Methods. This longitudinal study is based on a sample of 397 people who were single-living in ordinary housing in Sweden. Participants were interviewed during 2002–2003, and 393 were followed up for mortality until May 15, 2012. Environmental barriers and functional limitations were assessed with the Hous…

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% …

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 one's level of physical activity is inadequate and thus distinct from the recommended amount of physical activity) over a 2-year follow-up. DESIGN Observational prospective cohort study and cross-sectional analyses. SETTING Community and research center. PARTICIPANTS A total of 643 community-living ambulatory people aged 75 to 81 took part in face-to-face interviews and examinations at baseline and 314 at the 2-year follow-up. MEASUREMENTS Unmet physical activity need and its potential individual and…