The association of perceived neighborhood walkability and environmental pollution with frailty among community-dwelling older adults in rural areas

BACKGROUND Community-dwelling older adults living in rural areas are in a less favorable environment for health care compared with urban older adults. We believe that intermittent coaching through wearable devices can help optimize health care for older adults in medically limited environments. OBJECTIVE We aimed to evaluate whether a wearable device and mobile-based intermittent coaching or self-management could increase physical activity and health outcomes of small groups of older adults in rural areas. METHODS To address the above evaluation goal, we carried out the “Smart Walk” program, a health care model wherein a wearable device is used to promote self-exercise particularly among community-dwelling older adults managed by a community health center. We randomly selected older adults who had enrolled in a population-based, prospective cohort study of aging, the Aging Study of Pyeongchang Rural Area. The “Smart Walk” program was a 13-month program conducted from March 2017 to March 2018 and included 6 months of coaching, 1 month of rest, and 6 months of self-management. We evaluated differences in physical activity and health outcomes according to frailty status and conducted pre- and postanalyses of the Smart Walk program. We also performed intergroup analysis according to adherence of wearable devices. RESULTS We recruited 22 participants (11 robust and 11 prefrail older adults). The two groups were similar in most of the variables, except for age, frailty index, and Short Physical Performance Battery score associated with frailty criteria. After a 6-month coaching program, the prefrail group showed significant improvement in usual gait speed (mean 0.73 [SD 0.11] vs mean 0.96 [SD 0.27], P=.02), International Physical Activity Questionnaire scores in kcal (mean 2790.36 [SD 2224.62] vs mean 7589.72 [SD 4452.52], P=.01), and European Quality of Life-5 Dimensions score (mean 0.84 [SD 0.07] vs mean 0.90 [SD 0.07], P=.02), although no significant improvement was found in the robust group. The average total step count was significantly different and was approximately four times higher in the coaching period than in the self-management period (5,584,295.83 vs 1,289,084.66, P<.001). We found that participants in the “long-self” group who used the wearable device for the longest time showed increased body weight and body mass index by mean 0.65 (SD 1.317) and mean 0.097 (SD 0.513), respectively, compared with the other groups. CONCLUSIONS Our “Smart Walk” program improved physical fitness, anthropometric measurements, and geriatric assessment categories in a small group of older adults in rural areas with limited resources for monitoring. Further validation through various rural public health centers and in a large number of rural older adults is required.

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Associations of Neighborhood Walkability with Sedentary Time in Nigerian Older Adults

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16111879 ◽

2019 ◽

Vol 16 (11) ◽

pp. 1879 ◽

Cited By ~ 1

Author(s):

Adewale L. Oyeyemi ◽

Sanda M. Kolo ◽

Adamu A. Rufai ◽

Adetoyeje Y. Oyeyemi ◽

Babatunji A. Omotara ◽

...

Keyword(s):

Older Adults ◽

Traffic Safety ◽

Sedentary Time ◽

Developed Countries ◽

Community Dwelling ◽

Neighborhood Walkability ◽

Walkability Index ◽

Environmental Attributes ◽

Community Dwelling Older Adults

Previous studies have investigated the potential role of neighborhood walkability in reducing sedentary behavior. However, the majority of this research has been conducted in adults and Western developed countries. The purpose of the present study was to examine associations of neighborhood environmental attributes with sedentary time among older adults in Nigeria. Data from 353 randomly-selected community-dwelling older adults (60 years and above) in Maiduguri, Nigeria were analyzed. Perceived attributes of neighborhood environments and self-reported sedentary time were assessed using Nigerian-validated and reliable measures. Outcomes were weekly minutes of total sedentary time, minutes of sitting on a typical weekday, and minutes of sitting on a typical weekend day. In multivariate regression analyses, higher walkability index, proximity to destinations, access to services, traffic safety, and safety from crime were associated with less total sedentary time and sedentary time on both a weekday and a weekend day. Moderation analysis showed that only in men was higher walking infrastructure and safety found to be associated with less sedentary time, and higher street connectivity was associated with more sedentary time. The findings suggest that improving neighborhood walkability may be a mechanism for reducing sedentary time among older adults in Nigeria.

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Comparison of Functional Independence among Community-dwelling Older Adults in Rural Areas in South Korea and the United States

Korean Journal of Adult Nursing ◽

10.7475/kjan.2012.24.5.540 ◽

2012 ◽

Vol 24 (5) ◽

pp. 540-545

Author(s):

Jia Lee

Keyword(s):

United States ◽

Older Adults ◽

South Korea ◽

Rural Areas ◽

The United States ◽

Functional Independence ◽

Community Dwelling ◽

Community Dwelling Older Adults

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Predictors of Physical Functioning Trajectories among Chinese Oldest Old Adults: Rural and Urban Differences

The International Journal of Aging and Human Development ◽

10.2190/ag.69.3.b ◽

2009 ◽

Vol 69 (3) ◽

pp. 181-199 ◽

Cited By ~ 6

Author(s):

Fei Sun ◽

Nan Sook Park ◽

David L. Klemmack ◽

Lucinda L. Roff ◽

Zhihong Li

Keyword(s):

Older Adults ◽

Hierarchical Linear Modeling ◽

Rural Areas ◽

Oldest Old ◽

Community Dwelling ◽

Linear Modeling ◽

Healthy Longevity ◽

Rural And Urban ◽

Rural Sample ◽

Community Dwelling Older Adults

This article examined the differences between rural/urban older adults in their trajectories of activities of daily living (ADL) over a 4-year period. The sample included 2,490 community dwelling older adults who completed three waves (1998, 2000, and 2002) of the Chinese Longitudinal Healthy Longevity Survey. Among them, 63.5% were from rural areas. Hierarchical linear modeling (HLM) was run for the whole sample and separately for rural and urban samples. For both rural and urban samples, older age and involvement in fewer activities predicted increases in ADL difficulties over time. In addition, being female and routinely smoking predicted increases in ADL difficulties for the rural sample. Implications for interventions to slow down ADL decline were discussed.

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Incidence of frailty among community-dwelling older adults: a nationally representative profile in China

BMC Geriatrics ◽

10.1186/s12877-019-1393-7 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Weihao Xu ◽

Ya-Xi Li ◽

Chenkai Wu

Keyword(s):

Older Adults ◽

Incidence Rate ◽

Rural Areas ◽

Geographic Region ◽

Adverse Outcomes ◽

Community Dwelling ◽

Frailty Phenotype ◽

Chinese Older Adults ◽

Nationally Representative ◽

Community Dwelling Older Adults

Abstract Background Frailty is a clinically recognizable state of reduced resilience to stressors and increased vulnerability to adverse outcomes. The majority of studies have focused on the prevalence and risk factors of frailty, while the incidence of frailty has not been well documented, especially in less developed regions including China—a country that has the largest aging population in the world. We investigated the incidence of frailty among non-frail Chinese older adults by sociodemographic characteristics, disease burden, and geographic region. Methods Participants were 4939 adults aged ≥60 years from the China Health and Retirement Longitudinal Study, a cohort study of a nationally representative sample of middle-aged and older community-dwelling adults from 28 provinces in China. Frailty was assessed by an adapted version of the well-validated Fried’s physical frailty phenotype, in which five criteria were included: weakness, slowness, exhaustion, physical inactivity, and shrinking. Results Over an average of 2.1 years of follow-up (10,514.2 person-years), the weighted incidence rate of frailty was 60.6 per 1000 person-years; the incidence rate was 28.8 and 86.6 per 1000 person-years for those who were initially robust and prefrail, respectively. Participants who were older and widowed, had lower education and household income, lived in rural areas, and had higher burden of chronic conditions had higher frailty incidence. Frailty incidence ranged from 44.8 per 1000 person-years in the Southeast to 93.0 per 1000 person-years in the Northwest. Conclusions Incidence rate of frailty was 60.6 per 1000 person-years among community-living Chinese adults aged ≥ 60 years. Substantial sociodemographic and geographical disparities exist in frailty incidence.

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Prevalence of frailty in rural community-dwelling older adults in Kegalle district of Sri Lanka: a population-based cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2018-026314 ◽

2019 ◽

Vol 9 (1) ◽

pp. e026314 ◽

Cited By ~ 13

Author(s):

Dhammika Deepani Siriwardhana ◽

Manuj Chrishantha Weerasinghe ◽

Greta Rait ◽

Milena Falcaro ◽

Shaun Scholes ◽

...

Keyword(s):

Older Adults ◽

Sri Lanka ◽

Rural Community ◽

Rural Areas ◽

Cross Sectional Study ◽

Community Dwelling ◽

Sectional Study ◽

Cross Sectional ◽

Health And Social Care ◽

Community Dwelling Older Adults

ObjectiveOur main objective was to describe the prevalence and associated sociodemographic factors of frailty and pre-frailty in rural community-dwelling older adults in Kegalle district of Sri Lanka.DesignCommunity-based cross-sectional study.SettingThe study was conducted in rural areas of Kegalle district in Sri Lanka.ParticipantsA total of 746 community-dwelling older adults aged ≥60 years were included in the study.ResultsThe prevalence of frailty and pre-frailty in rural Kegalle district was 15.2% (95% CI 12.3% to 18.6%) and 48.5% (95% CI 43.8% to 53.2%), respectively. We found a strong association between age and both frailty and pre-frailty. There were strong associations between longest-held occupation and frailty and education level and pre-frailty.ConclusionsThe prevalence of frailty in this rural Sri Lankan older population was high compared with high-income and upper middle-income countries. The profile of health and social care services in Sri Lanka needs to address frailty and its consequences.

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