Exploring the relationship between the urban built environment and elderly pedestrian mobility in South Asian cities

Cities in South Asia have traditionally been dominated by pedestrians for their daily trips. As the elderly population is increasing in the last two decades, the dynamics of designing appropriate walkways to serve elderly people are getting more attention from urban planning scholars and policymakers alike. However, few studies in planning in the context of southern cities have considered the significant issue of elderly mobility and walkability in cities in South Asia beyond the realm of large metropolitan cities. In this paper, we attempt to understand the challenges encountered by elderly pedestrians in existing street conditions and summarizes information that may be useful for enhancing elderly mobility. Using cases of Rourkela in India and Khulna city in Bangladesh, we have collected both primary and secondary information by conducting a structured questionnaire survey in both cities at a similar period. Further to this, we analyzed statistical models to understand relationships among built environment and mobility issues based on subjective evaluation (i.e., infrastructure, street design, lighting, overcrowding condition, and encroachment). Most of the elderly pedestrians surveyed in both cities demand improvement of micro-scale urban design features and planning guidelines that they assume are absent in the statutory planning documents. This study may be employed as a useful document for city-level planning taking into account elderly perception about the built environment and their mobility concerns in future policy and planning projects. Consequently, a more comprehensive study may be incorporated highlighting elderly pedestrian’s mobility within the formal/informal transportation planning system.

A Study on Appearance Acceptance Appraisal of Elderly Mobility Assists

Given the low birth rate and the rapid aging of the population in Taiwan, the issues such as long-term care, high dependency ratio, and labor shortage are no longer avertible. The mobility assists shall play a significant role in helping the elder community to live independently with dignity, and the appearance of the mobility assists should make them feel comfortable as well. Hence this study recommends the development of assistive devices, barrier-free environments, and other solutions that allows the elderly to remain independent. This study explores the influencing factors of the willingness to use exoskeleton mobility assists on the psychological aspects. The purpose of this study is to explore the key factors of the willingness to use Wearable Robotic Exoskeleton. By sorting the style of the assistive devices based on various appreciation levels, the semantic difference scale was used to investigate the influence on the appearance of the assistive device on the wearing acceptance. Lastly, this study aims to acquire the factors that affect the style of the model and the influencing factors on the wearing acceptance, providing a reference for future assistive device design and developers to increase user’s willingness to accept the product.

Hubungan Kemampuan Mobilisasi dengan Risiko Jatuh pada Lansia Hipertensi

Hypertensive elderly influences body balance that affects their ability to mobilize. Therefore, this condition can improve a risk for falling. The aimed of this study was to analyzed the relationship between mobilization ability and risk for fall among elderly with hypertension in Tresna Werdha Social Services (PSTW) Bondowoso. A cross sectional design was conducted among 47 elderly using total sampling. A self-administered questionnaire was used to measure sociodemographic of elderly, while Elderly Mobility Scale (EMS) was performed to measure mobilization ability and Morse Falls Scale was performed to measure risk for fall. The relationship mobilization ability and risk for fall was analysed using Chi Square test. The result showed that among 47 elderly were 49,8% of independent and 46,8% of low risk for falling. There were significantly relationship between mobilization ability and risk for fall (X2 = 14,674; p = 0.001). The conclusion of this study, there is a relationship between mobilization ability and risk of fall among elderly. Therefore, elderly should be active in physical activities to reduce the risk of falling.

STRONG FAMILY VALUES AND PHYSICAL ENVIRONMENT OF NEIGHBORHOOD: MALAYSIAN ELDERS ASPIRATIONS AND PREFERENCES FOR LIVING

There is inevitable aging. By 2030, the steady rise of the elderly will make Malaysia an aging country. Malaysians historically practice the custom where the elderly co-reside with their kids. The strong family values among family members make older people strongly believe that in the elderly their family will take on filial responsibilities and take care of them. Nevertheless, the social characteristics of Malaysians have also steadily changed in tandem with increased urbanisation and modernisation. This research is therefore aimed at researching the housing aspirations of the elderly in Malaysia. Elderly people's perspectives are varied. Therefore, recognizing the diversity of different ways involves a thorough study of the elderly. This article uses qualitative approaches, adopts library-based research, and, by content analysis of documents, applies the literature review approach. The literature highlights the views and perspectives of researchers in the study who have raised the subject and problems. The research used was therefore focused on the content analysis on the previous academic studies carried out on the housing options preferred by elderly people, the potential elderly mobility reasons for them to move from current housing, and the types of houses and location of future housing preferred by the elderly. The results of these studies show that most elderly people in Malaysia have shown a preference for living close to their children, indicating the strong family values and physical environment of neighborhood as the preferences and aspirations among them.

132 Physical Function Comparison of Acutely Unwell COVID-Negative Older Adults Pre-Pandemic and Through-Pandemic; “Covid-Protected”

Introduction The risk of severe morbidity after COVID-19 infection is high in older adults (Lithander et al, 2020). Subsequent responsive UK Government guidance for older adults included self-isolation during the pandemic. It is therefore hypothesised that during the pandemic older adults are inadvertently deconditioned due to iatrogenic factors such as inactivity, social isolation, hospital-avoidance and malnutrition, and present with reduced resilience to illness and lower levels of function. The OPU continued to admit COVID-negative, or recently termed “COVID-protected”, patients throughout the pandemic. Data captured prior to, and during the COVID-19 pandemic has been compared to explore the implications on older adults, and elicit whether they are protected from the consequences of the pandemic? Method Demographic and physical function data (average 6 m gait-speed, Elderly Mobility Scale) were captured pre- and through-pandemic for all patients admitted to a COVID-negative OPU ward over a one month period. Ethical review was provided through local Trust governance process. Results Pre-pandemic 2019 (n = 67, mean(±SD) age 82.7(±8.2) years, 61%, hospital length-of-stay (LOS) 7.9(±7.3) days, hospital mortality-rate 7.2%) and through-pandemic 2020 (n = 73, 83.1(±8.3) years, 59%♀, LOS 9.0(±9.1) days, hospital mortality-rate 7.5%) data were captured during July 2019 and May 2020 respectively. There were no between-group differences in age [t(−.313) = 138, p = 0.755], gender [X2, 1 df, p = 0.782], LOS [t(0.78) = 134, p = 0.44], or hospital mortality-rate [X2 1 df, p = 0.96]. Through-pandemic patients had a significantly slower 6 m gait-speed (0.11(±0.05) m.s-1) than pre-pandemic (0.16(±0.24) m.s-1); [t(2.74) = 93, p = 0.007] and lower median (IQR) Elderly Mobility Scale (4(6 IQR) vs 9 (12 IQR) [u = 866, p = 0.015]). Conclusion Our data indicates this relatively short period of self-isolation might have significant implications on the physical function of older adults. The likely mechanism is iatrogenic deconditioning. Critical Public Health and policy responses are required to mitigate these unforeseen risks by deploying prehabilitative counter-measures and accurately targeted hospital and community rehabilitation.

142 Improving Functional Outcomes During Covid-19 for Both COVID-19 and Non COVID-19 Positive Older Adults Through the Introduction

Purpose To improve the functional outcomes of older adults presenting to the Health and Ageing wards during the COVID-19 pandemic through a focussed rehabilitation list. The intended benefits to the older adult and service were for: 1. Daily rehabilitation input for older adults. 2. Older adults to spend less time immobile. 3. Ongoing rehabilitation intervention while awaiting medical clearance for discharge. 4. Increased staff satisfaction 5. Better outcomes on discharge. 6. Rehabilitation ethos on the Health and Ageing wards. Methods The quality improvement project was carried out using the Plan, Do, Study, Act (PDSA) cycle. Three iterative PDSA cycles were carried out over the course of the project to deliver proactive interventions as a result of analysis of baseline data and stakeholder involvement. These interventions were aimed at developing communication around the rehabilitation list within the team and sustainability of this list. Results The project resulted in better functional outcomes for older adults and increased staff morale. Between May 2020–June 2020, a total of 56 patients were seen on the rehabilitation list, with 84% of these patients seeing improvements in their Elderly Mobility Scores (EMS). 27% of patients on the rehabilitation list saw a change to their initial discharge plan, either needing reduced packages of care or reduced need for ongoing rehabilitation in an external setting. Conclusions The quality improvement project found that with focussed rehabilitation older adult inpatients with or without COVID-19 can make significant functional gains. These gains have wider effects on their outcomes on discharge and also for the service through increased morale and job satisfaction. Due to demand and capacity issues in the acute setting, older adults who would often benefit from ongoing input are not always reviewed regularly. This project demonstrates that with focussed rehabilitation older adults can improve and achieve better functional outcomes.

Prevalence of sarcopenia and the association of sarcopenia, premorbid factors, early functional outcome and 1-year mortality in Hong Kong Chinese fragility hip fracture patients

Background/purpose: Sarcopenia is a predictor of fall, which is a leading cause of fragility hip fractures (FHF). Dual energy X-ray absorptiometry (DXA) is a costly measurement method for sarcopenia. Rehabilitation and prognosis can be determined by early functional outcomes. Meanwhile, 1-year mortality of FHF patients is high. Aims: (i) To report the prevalence of sarcopenia. (ii) To investigate the relationships of sarcopenia, premorbid factors, early functional outcomes and 1-year mortality in Hong Kong Chinese FHF patients. Methods: FHF patients admitted to Queen Elizabeth Hospital in Hong Kong from April 2016 to March 2017 were reviewed, including outcomes of relative appendicular skeletal muscle mass index (RASM), handgrip strength (HGS), New Mobility Score (NMS), Modified Functional Ambulation Classification (MFAC), Modified Barthel Index (MBI), Cumulated Ambulation Score (CAS), Elderly Mobility Scale (EMS) and 1-year mortality. Results: One hundred sixty nine FHF patients, aged 82.68 ± 7.32 years, were reviewed. Prevalence of sarcopenia in male and female were 71.4% and 37.7%, respectively. RASM was correlated with HGS of both dominant ( r = 0.366, p < 0.001) and non-dominant side ( r = 0.383, p < 0.001), NMS ( rs = 0.239, p < 0.001), MFAC ( rs = 0.192, p = 0.013), MBI ( rs = 0.182, p = 0.018) and CAS ( rs = 0.183, p = 0.019). RASM was not significantly correlated with EMS-1 ( rs = 0.050, p = 0.525) and EMS-DC ( rs = 0.092, p = 0.249). There was significant correlation between Sarcopenia and EMS-DC ( rrb = −0.226, p = 0.004). Sarcopenia was marginally not associated with 1-year mortality ( χ 2 = 3.745, p = 0.053). One-year mortality of FHF patients with Sarcopenia and without Sarcopenia were 16.5% and 7.1%, respectively. FHF patients with Sarcopenia were not statistically significant to be more likely to face mortality within 1 year ( R 2 = 0.030, OR = 2.638, p = 0.060). Conclusions: Prevalence of sarcopenia was high in FHF patients and RASM was correlated with HGS and NMS, which can be easily administered as screening tools. Sarcopenia was correlated with early functional outcome but not with 1-year mortality. Early detection of Sarcopenia is crucial for early implementation of rehabilitation and treatment.