Physical and Cognitive Correlates of GPS-Derived Life-Space Characteristics in Older Adults

Abstract Life-space mobility, movement within one’s living environment, is important for functional independence in later life. It is unclear which life-space characteristics (i.e., space, duration, shape) are most affected by physical and cognitive limitations. GPS-derived measures mitigate recall bias and offer novel ways to characterize life-space. We examined associations between physical and cognitive performance and GPS-derived life-space characteristics. Participants were 164 community-dwelling adults (Age: M=77.3±6.5) from baseline data of a clinical trial to improve walking in older adults. Participants carried a portable GPS for 7 days, which passively collected real-time location. Standard deviational ellipses (SDEs) and minimum convex polygons (MCPs) were derived for each day. Area and compactness of these measures quantified activity space and shape, respectively. For each measure, 7-day medians and median absolute deviations (MAD) were computed to capture both central tendency and variability of weekly activity. Activity duration was quantified as percentage of time outside home. Adjusting for age and sex, percent time outside home was associated with lower mobility performance (i.e., 6-minute walk (6MWT), figure 8 walk, ρ’s=.17-.18, p’s<.05) and executive functioning (i.e., Trail Making Test, Part A: ρ=.16, p=.04, Part B: ρ=.19, p=.01). Median MCP and SDE areas, but not compactness, were associated with 6MWT performance (ρ’s=.18-.20, p’s<.05). MCP area MAD was associated with greater global cognition (3MSE, ρ=.15, p=.05). Life-space characteristics were differentially associated with performance measures, suggesting physical and cognitive limitations may constrain life-space mobility via different mechanisms. Variation in these associations by neighborhood walkability and active versus passive travel will also be examined.

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Using Everyday Technology Independently When Living with Forgetfulness: Experiences of Older Adults in Barcelona

Gerontology and Geriatric Medicine ◽

10.1177/2333721421993754 ◽

2021 ◽

Vol 7 ◽

pp. 233372142199375

Author(s):

Samuel Briones ◽

Louise Meijering

Keyword(s):

Older Adults ◽

Qualitative Methodology ◽

Local Community ◽

Phenomenological Study ◽

Later Life ◽

Learning Opportunities ◽

Individual Characteristics ◽

Community Dwelling ◽

Community Dwelling Older Adults ◽

The Capability Approach

Older adults living with forgetfulness encounter difficulties when engaging with changing and dynamic everyday technology (ET). The capability to use ET is important for independence in later life and is affected by the contextual and individual characteristics of older adults. Using the capability approach as a theoretical lens, this phenomenological study aims to explore the experiences of older adults living with forgetfulness, in order to identify contextual and individual factors that facilitate the use of ET in everyday life. A qualitative methodology was used to interview 16 community-dwelling older adults participating in memory and technology workshops at local community centres in Barcelona. Findings show that motivation and openness to learning played a facilitating role in our participants’ use of ET. The presence of social support in the form of “technology experts” and community centres offering learning opportunities were also enhancing factors that encourage independence when engaging with ET. In conclusion, our study demonstrates the importance of expanding intergenerational ET learning opportunities, through the creation of age-friendly spaces.

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Validation of the German Life-Space Assessment (LSA-D): cross-sectional validation study in urban and rural community-dwelling older adults

BMJ Open ◽

10.1136/bmjopen-2021-049926 ◽

2021 ◽

Vol 11 (7) ◽

pp. e049926

Author(s):

Sandra Angelika Mümken ◽

Paul Gellert ◽

Malte Stollwerck ◽

Julie Lorraine O'Sullivan ◽

Joern Kiselev

Keyword(s):

Older Adults ◽

Construct Validity ◽

Outcome Measures ◽

Total Sample ◽

Community Dwelling ◽

Secondary Outcome ◽

Life Space ◽

Cross Sectional ◽

The Past ◽

Community Dwelling Older Adults

ObjectivesTo develop a German version of the original University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA-D) for measurement of community mobility in older adults within the past 4 weeks and to evaluate its construct validity for urban and rural populations of older adults.DesignCross-sectional validation study.SettingTwo study centres in urban and rural German outpatient hospital settings.ParticipantsIn total, N=83 community-dwelling older adults were recruited (n=40 from urban and n=43 from rural areas; mean age was 78.5 years (SD=5.4); 49.4% men).Primary and secondary outcome measuresThe final version of the translated LSA-D was related to limitations in activities and instrumental activities of daily living (ADL/iADL) as primary outcome measure (primary hypothesis); and with sociodemographic factors, functional mobility, self-rated health, balance confidence and history of falls as secondary outcome measures to obtain construct validity. Further descriptive measurements of health included hand grip strength, screening of cognitive function, comorbidities and use of transportation. To assess construct validity, correlations between LSA-D and the primary and secondary outcome measures were examined for the total sample, and urban and rural subsamples using bivariate regression and multiple adjusted regression models. Descriptive analyses of LSA-D included different scoring methods for each region. All parameters were estimated using non-parametric bootstrapping procedure.ResultsIn the multiple adjusted model for the total sample, number of ADL/iADL limitations (β=−0.26; 95% CI=−0.42 to −0.08), Timed Up and Go Test (β=−0.37; 95% CI=−0.68 to −0.14), shared living arrangements (β=0.22; 95% CI=0.01 to 0.44) and history of falls in the past 6 months (β=−0.22; 95% CI=−0.41 to −0.05) showed significant associations with the LSA-D composite score, while living in urban area (β=−0.19; 95% CI=−0.42 to 0.03) and male gender (β=0.15; 95% CI=−0.04 to 0.35) were not significant.ConclusionThe LSA-D is a valid tool for measuring life-space mobility in German community-dwelling older adults within the past 4 weeks in ambulant urban and rural settings.Trial registration numberDRKS00019023.

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Older Adults’ Motivations for Participating in a “Tune-Up” of Their Driving Skills: A Multi-Stakeholder Analysis

Journal of Applied Gerontology ◽

10.1177/0733464820982413 ◽

2020 ◽

pp. 073346482098241

Author(s):

Ruheena Sangrar ◽

Kyung Joon Mun ◽

Lauren E. Griffith ◽

Lori Letts ◽

Brenda Vrkljan

Keyword(s):

Older Adults ◽

Stakeholder Analysis ◽

Later Life ◽

Community Dwelling ◽

Older Drivers ◽

Willingness To Participate ◽

Structured Interviews ◽

Driver Training ◽

Near Misses ◽

Driving Experience

Driver training has the potential to keep older adults safe behind-the-wheel for longer, yet there is limited evidence describing factors that influence their willingness to participate in training. Focus groups with community-dwelling older drivers ( n = 23; 70–90 years) and semi-structured interviews with driving instructors ( n = 6) and occupational therapists ( n = 5) were conducted to identify these factors. Qualitative descriptive analyses highlighted how self-awareness of behind-the-wheel abilities in later life can influence an older adult’s motivation to participate in driver training, as well as their willingness to discuss their behaviors. Collision-involvement and near-misses prompted participants to reflect on their driving abilities and their openness to feedback. Participants’ preferences for learning contexts that use a strengths-based approach and validate the driving experience of older drivers, while providing feedback on behind-the-wheel performance, were raised. Older driver training initiatives that consider the needs of the aging population in their design can promote road safety and community mobility.

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Digital Health Interventions for Healthy Aging: A Qualitative User Evaluation and Ethical Assessment

10.21203/rs.3.rs-121871/v1 ◽

2020 ◽

Author(s):

Marcello Ienca ◽

Christophe Schneble ◽

Reto Kressig ◽

Tenzin Wangmo

Keyword(s):

Older Adults ◽

Older People ◽

Healthy Aging ◽

Ethical Issues ◽

Digital Health ◽

Functional Independence ◽

Community Dwelling ◽

Healthy Ageing ◽

Health Technologies ◽

Community Dwelling Older Adults

Abstract BackgroundDigital health technologies are being increasingly developed with the aim of allowing older adults to maintain functional independence throughout the old age, a process known as healthy ageing. Such digital health technologies for healthy ageing are expected to mitigate the socio-economic effects of population ageing and improve the quality of life of older people. However, little is known regarding the views and needs of older people regarding these technologies. AimThe aim of this study is to explore the views, needs and perceptions of community-dwelling older adults regarding the use of digital health technologies for healthy ageing. MethodFace-to-face, in-depth qualitative interviews were conducted with community-dwelling older adults (median age 79.6 years). The interview process involved both abstract reflections and practical demonstrations. The interviews were transcribed verbatim and analyzed according to inductive content analysis. ResultsThree main themes and twelve sub-themes emerged. The three main themes revolved around the following thematic areas: favorable views and perceptions on technology-assisted living, usability evaluations and ethical considerations. ConclusionsOur study reveals a generally positive attitude towards digital health technologies as participants believed digital tools could positively contribute to improving their overall wellbeing, especially if designed in a patient-centered manner. Safety concerns and ethical issues related to privacy, empowerment and lack of human contact also emerged as key considerations.

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Day-to-Day Variability and Year-to-Year Reproducibility of Accelerometer-Measured Free-Living Sit-to-Stand Transitions Volume and Intensity among Community-Dwelling Older Adults

Sensors ◽

10.3390/s21186068 ◽

2021 ◽

Vol 21 (18) ◽

pp. 6068

Author(s):

Antti Löppönen ◽

Laura Karavirta ◽

Erja Portegijs ◽

Kaisa Koivunen ◽

Taina Rantanen ◽

...

Keyword(s):

Older Adults ◽

Angular Velocity ◽

Functional Disability ◽

Intraclass Correlation ◽

Living Environment ◽

Community Dwelling ◽

Free Living ◽

Sit To Stand ◽

Increased Risk ◽

Community Dwelling Older Adults

(1) Background: The purpose of this study was to evaluate the day-to-day variability and year-to-year reproducibility of an accelerometer-based algorithm for sit-to-stand (STS) transitions in a free-living environment among community-dwelling older adults. (2) Methods: Free-living thigh-worn accelerometry was recorded for three to seven days in 86 (women n = 55) community-dwelling older adults, on two occasions separated by one year, to evaluate the long-term consistency of free-living behavior. (3) Results: Year-to-year intraclass correlation coefficients (ICC) for the number of STS transitions were 0.79 (95% confidence interval, 0.70–0.86, p < 0.001), for mean angular velocity—0.81 (95% ci, 0.72–0.87, p < 0.001), and maximal angular velocity—0.73 (95% ci, 0.61–0.82, p < 0.001), respectively. Day-to-day ICCs were 0.63–0.72 for number of STS transitions (95% ci, 0.49–0.81, p < 0.001) and for mean angular velocity—0.75–0.80 (95% ci, 0.64–0.87, p < 0.001). Minimum detectable change (MDC) was 20.1 transitions/day for volume, 9.7°/s for mean intensity, and 31.7°/s for maximal intensity. (4) Conclusions: The volume and intensity of STS transitions monitored by a thigh-worn accelerometer and a sit-to-stand transitions algorithm are reproducible from day to day and year to year. The accelerometer can be used to reliably study STS transitions in free-living environments, which could add value to identifying individuals at increased risk for functional disability.

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The Association of Mobility Determinants and Life Space Among Older Adults

The Journals of Gerontology Series A ◽

10.1093/gerona/glab268 ◽

2021 ◽

Author(s):

Pamela M Dunlap ◽

Andrea L Rosso ◽

Xiaonan Zhu ◽

Brooke N Klatt ◽

Jennifer S Brach

Keyword(s):

Older Adults ◽

Lower Extremity ◽

Energy Cost ◽

Community Dwelling ◽

Walk Test ◽

Personal Factors ◽

Linear Regression Models ◽

Life Space ◽

Mobility Disability ◽

Energy Cost Of Walking

Abstract Background It is important to understand the factors associated with life space mobility so that mobility disability can be prevented/treated. The purpose of this study was to identify the association between mobility determinants and life space among older adults. Methods This study was a cross-sectional analysis of 249 community-dwelling older adults (mean age=77.4 years, 65.5% female, 88% white) who were recruited for a randomized, controlled, clinical intervention trial. Associations between cognitive, physical, psychosocial, financial, and environmental mobility determinants and the Life Space Assessment (LSA) at baseline were determined using Spearman’s correlation coefficients and one-way analysis of variance. Multivariate analysis was performed using multivariable linear regression models. Results The mean LSA score for the sample was 75.3 (SD=17.8). Personal factors (age, gender, education, comorbidities), cognitive (Trail Making Test A and B), physical (gait speed, lower extremity power, Six Minute Walk Test, Figure of 8 Walk Test, tandem stance, energy cost of walking, and Late Life Function and Disability Function Scale), psychosocial (Modified Gait Efficacy Scale), and financial (neighborhood socio-economic status) domains of mobility were significantly associated with LSA score. In the final regression model, age (β=-0.43), lower extremity power (β=0.03), gait efficacy (β=0.19), and energy cost of walking (β=-57.41) were associated with life space (R 2=0.238). Conclusions Younger age, greater lower extremity power, more confidence in walking, and lower energy cost of walking were associated with greater life space. Clinicians treating individuals with mobility disability should consider personal, physical, and psychosocial factors assessing barriers to life space mobility.

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Reclaiming Social Space: Adapting Neighbourhoods to Support an Ageing Population

10.26686/wgtn.17057993 ◽

2021 ◽

Author(s):

◽

Lisa McClintock

Keyword(s):

Older Adults ◽

Age Structure ◽

Social Space ◽

Later Life ◽

Community Dwelling ◽

Ageing Population ◽

Age In Place ◽

Creative Solutions ◽

Community Dwelling Older Adults ◽

Unique Potential

<p>The age structure of New Zealand’s population is expected to undergo a dramatic change in the next few decades. By 2050, it is thought that approximately one quarter of the population will be aged 65+. Research indicates that the overwhelming preference of older adults is to age in their own homes and communities if possible. However, loneliness among community-dwelling older adults is widespread. Architecture as a discipline has unique potential to critique existing neighbourhood design and generate creative solutions to provide a more socially fulfilling environment for residents to age in place. Architecture for ageing must combat loneliness and enable continued contact in later life. This research explores the sensitive adaptation of inner suburban Wellington neighbourhoods with the aim of empowering inhabitants to age positively in the community.</p>

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THE DIFFERENTIAL INFLUENCE OF REGIONAL CONTEXT ON LATER-LIFE HEALTH AND MORTALITY

Innovation in Aging ◽

10.1093/geroni/igz038.2970 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S806-S806

Author(s):

Alicia Riley

Keyword(s):

Older Adults ◽

Life Course ◽

Health Effect ◽

Later Life ◽

Community Dwelling ◽

Life Course Perspective ◽

The South ◽

Nationally Representative ◽

Health And Mortality ◽

The U.S

Abstract This study examines regional disparities in later life health from a life course perspective. To sort out when and how region influences health over the life course, I focus on the sharp contrast between the South and the rest of the U.S. in health and mortality. I draw on data from the National Life Health and Aging Project (NSHAP), a nationally representative sample of community-dwelling older adults in the U.S., to estimate the differential risk of multiple health outcomes and mortality by regional trajectory. I find that older adults who leave the South are worse off in multiple outcomes than those who stay. I also find evidence of a protective health effect of community cohesion and dense social networks for the Southerners who stay in the South. My results suggest that regional trajectory influences health in later life through its associations with socioeconomic status, access to healthcare, and social rootedness.

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Development and Psychometrics Test of Home Environment Assessment Checklist for Community-Dwelling Older Adults with Dementia

Journal of Alzheimer s Disease ◽

10.3233/jad-200241 ◽

2020 ◽

Vol 77 (4) ◽

pp. 1389-1396

Author(s):

Yi Wang ◽

Liyu Li ◽

Shuangyue Tian ◽

Jie Wu ◽

Zhiwen Wang

Keyword(s):

Older Adults ◽

Home Environment ◽

Visual Cues ◽

Reliability And Validity ◽

Living Environment ◽

Community Dwelling ◽

Rater Reliability ◽

Environment Assessment ◽

People With Dementia ◽

Community Dwelling Older Adults

Background: Home environment is a core domain in the care of community-dwelling older adults with dementia, but there is no suitable instrument to measure it in China. Objective: To develop and psychometrically test the home environment assessment checklist for community-dwelling older adults with dementia. Methods: A three-step process was performed to develop and test this instrument: 1) based on the evidence-based theory, the checklist was summarized as the main points of evidence from living environment settings among older adults with dementia, 2) the draft tool was assigned to an iterative process of evaluation by a panel of examiners consisting of experts from treatment, nursing and caring, people with dementia and their caregivers, 3) inter-rater reliability and internal consistency were calculated with a sample of 348 caregivers of the older adults with dementia. Results: The HEAC consisted of 71 items in domains addressing safety, stability and familiarity, visual cues, and sensory stimulation. Psychometric evaluation showed that this tool demonstrated sound reliability and validity. Content validity was 0.969 which was established by a panel of experts (n = 10). Inter-rater reliability of two researchers was 0.978, and 0.848 for researchers and caregivers. Test-retest reliability was excellent (ICC = 0.757–0.877) in community-dwelling older adults with dementia 2 week apart. Conclusion: The HEAC is a new tool to help collect the reliable information on the barriers and facilitators of home environment for community-dwelling older adults with dementia and to precipitate the home modification process to improve the quality of care for people with dementia and their caregivers in daily life.

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