Promoting mobility in older people Rantanen, Taina
Journal of preventive medicine and public health
46 Suppl 1, Številka:
Suppl 1
Journal Article
Recenzirano
Odprti dostop
Out-of-home mobility is necessary for accessing commodities, making use of neighborhood facilities, and participation in meaningful social, cultural, and physical activities. Mobility also promotes ...healthy aging as it relates to the basic human need of physical movement. Mobility is typically assessed either with standardized performance-based tests or with self-reports of perceived difficulty in carrying out specific mobility tasks. Mobility declines with increasing age, and the most complex and demanding tasks are affected first. Sometimes people cope with declining functional capacity by making changes in their way or frequency of doing these tasks, thus avoiding facing manifest difficulties. From the physiological point of view, walking is an integrated result of the functioning of the musculoskeletal, cardio-respiratory, sensory and neural systems. Studies have shown that interventions aiming to increase muscle strength will also improve mobility. Physical activity counseling, an educational intervention aiming to increase physical activity, may also prevent mobility decline among older people. Sensory deficits, such as poor vision and hearing may increase the risk of mobility decline. Consequently, rehabilitation of sensory functions may prevent falls and decline in mobility. To promote mobility, it is not enough to target only individuals because environmental barriers to mobility may also accelerate mobility decline among older people. Communities need to promote the accessibility of physical environments while also trying to minimize negative or stereotypic attitudes toward the physical activity of older people.
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. Outdoor mobility was assessed with the Life-Space Assessment (range 0–120). Active approach to life was assessed with the University of Jyväskylä Active Aging Scale (range 0–272), and QOL with the shortened Older People’s Quality of Life Questionnaire (range13–65; higher scores better for all). Data were analyzed with General Estimating Equations, General Linear Models, and One-way analysis of variance.
Results
Life-space mobility (B −10.8, SE 0.75, p < .001), the active aging score (B −24.1, SE 0.88, p < .001), and the QOL score (B −1.65, SE 0.21, p < .001) were lower during COVID-19 social distancing versus 2 years before. Concurrent life-space mobility and active aging scores, age, and sex explained 48% of QOL at the baseline and 42% during social distancing. Longitudinally, steeper declines in all 3 variables coincided.
Conclusion
The observed declines indicate compliance with social distancing recommendation, but underline the importance of participation in meaningful life situations as a factor underlying good QOL also during the COVID-19 pandemic.
The current study aims to compare correlations between a range of measures of physical performance and physical activity assessing the same underlying construct in different settings, that is, in a ...home versus a highly standardized setting of the research center or accelerometer recording. We also evaluated the selective attrition of participants related to these different settings and how selective attrition affects the associations between variables and indicators of health, functioning and overall activity.
Cross-sectional analyses comprising population-based samples of people aged 75, 80, and 85 years living independently in Jyväskylä, Finland. The AGNES study protocol involved the following phases: 1) phone interview (n = 1886), 2) face-to-face at-home interview (n = 1018), 3) assessments in the research center (n = 910), and 4) accelerometry (n = 496). Phase 2 and 3 included walking and handgrip strength tests, and phase 4 a chest-worn and thigh-worn accelerometer estimating physical activity and assessing posture, respectively, for 3-10 days in free-living conditions.
Older people with poorer health and functioning more likely refrained from subsequent study phases, each requiring more effort or commitment from participants. Paired measures of walking speed (R = 0.69), handgrip strength (R = 0.85), time in physical activity of at least moderate intensity (R = 0.42), and time in upright posture (R = 0.30) assessed in different settings correlated with each other, and they correlated with indicators of health, functioning and overall activity. Associations were robust regardless of limitations in health and functioning, and low overall activity.
Correlational analyses did not clearly reveal one superior setting for assessing physical performance or physical activity. Inclusion of older people with early declines in health, functioning and overall activity in studies on physical performance and physical activity is feasible in terms of study outcomes, but challenging for recruitment.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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). Lower extremity performance was objectively measured with the Short Physical Performance Battery (SPPB). Cognitive impairment was assessed using the Mini-Mental State Examination. Chronic conditions and years of education were self-reported. Data were analyzed with generalized estimation equation models. Results The mean life-space score at baseline was 63.9 ± SD 20.6 and mean QOL score 100.3 ± 11.8. Over the follow-up, the QOL score decreased to 95.0 ± 13.8 across the total study sample. The decrease in QOL score was somewhat higher among those whose life-space mobility score declined >10 points during the follow-up compared to those whose life-space remained stable or improved, even after adjustment for age, gender, number of chronic conditions, cognitive impairment, SPPB and education. Conclusions Decline in life-space mobility is associated with decline in QOL. The results highlight the importance of ensuring continuous possibilities for out-of-home mobility in maintaining QOL among older people.
Assessment of health literacy among older Finns Eronen, Johanna; Paakkari, Leena; Portegijs, Erja ...
Aging clinical and experimental research,
04/2019, Letnik:
31, Številka:
4
Journal Article
Recenzirano
Odprti dostop
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 instrument was test-retested. Chi-square tests were used to compare health literacy scores between participants by different socioeconomic variables, and Spearman correlation coefficients were calculated to study the associations of health literacy with cognition, depressive symptoms, chronic conditions, life-space mobility and physical performance.
Results
The mean health literacy score for all participants was 35.05 (SD 6.32). Participants who rated their financial situation and self-rated health as very good had the highest health literacy scores (38.85, SD 5.09 and 39.22, SD 6.77, respectively). Better health literacy was associated with better cognitive status, fewer depressive symptoms and chronic conditions, higher life-space mobility and better physical performance.
Conclusions
The HLS-EU-Q16 is a feasible measure for research purposes among older Finns. The associations between health literacy and indicators of health and functioning need to be more closely investigated in larger samples with a wider age-range.
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 categorized all others as having ‘low/moderate’. Perceived restrictiveness of the social distancing recommendations was examined with one item and was categorized as ‘yes’ or ‘no’ restrictiveness.
Results
Better stress-coping ability (OR 1.21, 95% CI 1.14–1.28) and not being lonely (OR 2.67, 95% CI 1.48–4.63) increased the odds for constant high QoL from before to amid social distancing, and the odds did not differ according to the perceived restrictiveness of the social distancing recommendations. Higher walking speed predicted constant high QoL only among those perceiving restrictiveness (OR 1.16, 95% CI 1.07–1.27). Living arrangement did not predict constant high QoL.
Conclusion
During social distancing, psychosocial resources helped to maintain good QoL regardless how restrictive the social distancing recommendations were perceived to be. Better physical capacity was important for constant high QoL only among those perceiving restrictiveness presumably because it enabled replacing blocked activities with open outdoor physical activities.
Objectives
To study the relationship between physical performance and sense of autonomy in outdoor activities with life‐space mobility—the spatial area a person purposefully moves through in daily ...life—in community‐dwelling older people.
Design
Cross‐sectional analyses of baseline data of the Life‐Space Mobility in Old Age cohort study.
Setting
Structured interviews in participants' homes.
Participants
Community‐dwelling people aged 75 to 90 (N = 848).
Measurements
Sense of autonomy outdoors (Impact on Participation and Autonomy questionnaire subscale), life‐space mobility (Life‐Space Assessment; University of Alabama, Birmingham Study of Aging), and Short Physical Performance Battery.
Results
The median score for life‐space mobility was 64.0. In linear regression models, poorer physical performance and more‐limited sense of autonomy were independently associated with more restrictions in life‐space mobility, explaining approximately one‐third of the variation in life‐space mobility. Physical performance also had an indirect effect on life‐space mobility through sense of autonomy outdoors. Subgroup analyses of 5‐year age groups and sex revealed that the associations were somewhat stronger in women and the oldest age group.
Conclusion
Physical performance and sense of autonomy in outdoor activities explained a substantial portion of the variation in life‐space mobility in healthy older people, indicating that physical and psychosocial factors play a role in maintaining mobility in old age.
Life-space mobility, assessed with the Life-Space Assessment (LSA), reflects an individual's mobility in terms of the spatial area, frequency, and need for assistance. The aims were to study ...associations between life-space mobility and disability status in activities of daily living (ADL), and to define cutoff scores for baseline LSA and LSA change over time identifying individuals who developed ADL inability during 2 years of follow-up. Robustness of the cutoff scores was tested accounting for potential confounders.
Longitudinal analyses of the "Life-space mobility in old age" cohort study.
Home-based interviews at baseline and phone interviews 2 years later.
A total of 755 community-dwelling 75- to 90-year-old people living in Central Finland.
LSA score (range 0-120) and ADL disability status (no difficulty, difficulty in ≥1 tasks, or inability in ≥1 tasks) were determined based on self-reports.
Participants who developed difficulty or inability in ADL over time presented lower LSA scores at baseline and larger declines compared to those who remained without task difficulty or inability during the follow-up, respectively. Sensitivity and specificity analyses showed that baseline LSA ≤52.3 (0.86 and 0.74, respectively) and LSA decline of >11.7 (0.76 and 0.71, respectively) identified participants who developed ADL inability over the follow-up. Multinomial regression showed that, after adjustment for potential confounders, these cutoff scores increased the odds to develop new difficulty in ADL tasks, and the odds to develop ADL inability among those with baseline difficulty.
Our results suggest that restrictions and declines in life-space mobility may be early signs of increasing vulnerability to disability in old age. These longitudinally defined cutoff points may help to find clinical applications for the LSA.
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 compared with those reporting no barriers after adjustments for ill health, functioning, and socioeconomic status (SES) differences. Similarly, those reporting four to seven facilitators had lower odds for restricted life-space compared with those reporting three or fewer facilitators. Discussion: Perceptions of one’s environment may either constrain or extend older people’s life-space. Longitudinal studies are needed to study the causality of the findings.
This study investigated the relationships among company average age, company work ability, and company performance by examining (a) the effects of employee average use of selection, optimization, and ...compensation (SOC) personal strategies and high-involvement work practices (HIWPs) on employee work ability; (b) the buffering effects of both employee average use of SOC and HIWPs on the negative relationship between company-level average age of employees and employee work ability; and (c) the link between company average age and company performance as mediated by company work ability. Analysis was conducted on data from 70 Finnish companies in the retail and metal industries and their 889 employees. Results showed that company average age was negatively related to company work ability, which in turn was positively related to company performance assessed by company managers. HIWPs were positively related to company work ability. Employee average use of SOC strategies buffered the negative effect of company average age on company work ability. Theoretical and practical implications of these findings are discussed.
PDF
