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Choi J, Park J. Developing Problematic Performance Value Scores: Binding Routine Activity Performance, Environmental Barriers, and Health Conditions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:764. [PMID: 38929010 PMCID: PMC11203909 DOI: 10.3390/ijerph21060764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Community design features, such as sidewalks and street crossings, present significant challenges for individuals with disabilities, hindering their physical performance and social integration. However, limited research has been conducted on the application of Universal Design (UD) to address these challenges, particularly concerning specific demographic groups and population cohorts. Understanding the influence of environmental features on physical performance is crucial for developing inclusive solutions like UD, which can enhance usability and social integration across diverse populations. OBJECTIVE This study aims to bridge this gap by investigating the complex relationships between environmental barriers, health conditions, and routine activity performance. An index was developed to evaluate users' UD performance based on functional capacity, providing scientifically rigorous and objectively measured evidence of UD effectiveness in creating inclusive built environments. METHOD Using data from the Problematic Activities Survey (PAS) conducted in the U.S., Canada, and Australia and targeting individuals with and without functional limitations, multinomial logit models were employed to estimate the probabilities of encountering performance problems. This analysis led to the development of the Problematic Performance Value (PPV) score. RESULTS The results demonstrated significant disparities in PPVs across various health conditions, particularly concerning curb ramps. Individuals facing mobility issues in their legs/feet, arms/hands, or back/neck encounter more pronounced challenges, especially when curb ramps lack proper design elements. Similarly, individuals with vision impairments face heightened difficulties with traffic signals, particularly due to issues with audible signal systems. These findings underscore the importance of addressing micro-level environmental challenges to accommodate individuals with varying functional capacities effectively. CONCLUSIONS By providing insights into the most problematic daily activities encountered by diverse populations, the PPV score serves as a valuable indicator for guiding environmental design improvements and promoting equitable space usage. This can be used to guide improved UD solutions and decide areas of concentration by providing generalized information on specific environmental features that contribute to user performance.
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Affiliation(s)
- Jimin Choi
- Center for Inclusive Design & Environmental Access, School of Architecture & Planning, University at Buffalo, SUNY, Buffalo, NY 14214, USA;
| | - JiYoung Park
- Department of Urban and Regional Planning, University at Buffalo, SUNY, Buffalo, NY 14214, USA
- MUREPA Korea, Seoul 13640, Republic of Korea
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Kalu ME, Bello-Haas VD, Griffin M, Boamah S, Harris J, Zaide M, Rayner D, Khattab N, Abrahim S. A Scoping Review of Personal, Financial, and Environmental Determinants of Mobility Among Older Adults. Arch Phys Med Rehabil 2023; 104:2147-2168. [PMID: 37119957 DOI: 10.1016/j.apmr.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE To synthesize available evidence of factors comprising the personal, financial, and environmental mobility determinants and their association with older adults' self-reported and performance-based mobility outcomes. DATA SOURCES PubMed, EMBASE, PsychINFO, Web of Science, AgeLine, Sociological Abstract, Allied and Complementary Medicine Database, and Cumulative Index to Nursing and Allied Health Literature databases search for articles published from January 2000 to December 2021. STUDY SECTION Using predefined inclusion and exclusion criteria, multiple reviewers independently screened 27,293 retrieved citations from databases, of which 422 articles underwent full-text screening, and 300 articles were extracted. DATA EXTRACTION The 300 articles' information, including study design, sample characteristics including sample size, mean age and sex, factors within each determinant, and their associations with mobility outcomes, were extracted. DATA SYNTHESIS Because of the heterogeneity of the reported associations, we followed Barnett et al's study protocol and reported associations between factors and mobility outcomes by analyses rather than by article to account for multiple associations generated in 1 article. Qualitative data were synthesized using content analysis. A total of 300 articles were included with 269 quantitative, 22 qualitative, and 9 mixed-method articles representing personal (n=80), and financial (n=1), environmental (n=98), more than 1 factor (n=121). The 278 quantitative and mixed-method articles reported 1270 analyses; 596 (46.9%) were positively and 220 (17.3%) were negatively associated with mobility outcomes among older adults. Personal (65.2%), financial (64.6%), and environmental factors (62.9%) were associated with mobility outcomes, mainly in the expected direction with few exceptions in environmental factors. CONCLUSIONS Gaps exist in understanding the effect of some environmental factors (eg, number and type of street connections) and the role of gender on older adults' walking outcomes. We have provided a comprehensive list of factors with each determinant, allowing the creation of core outcome set for a specific context, population, or other forms of mobility, for example, driving.
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Affiliation(s)
- Michael E Kalu
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
| | - Vanina Dal Bello-Haas
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Meridith Griffin
- Department of Health, Aging & Society, Faculty of Social Science, McMaster University, Hamilton, Canada
| | - Sheila Boamah
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Jocelyn Harris
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Mashal Zaide
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Daniel Rayner
- Department of Health Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Nura Khattab
- Department of Kinesiology, Faculty of Sciences, McMaster University, Hamilton, Canada
| | - Salma Abrahim
- Department of Kinesiology, Faculty of Sciences, McMaster University, Hamilton, Canada
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Nyende A, Ellis-Hill C, Mantzoukas S. A Sense of Control and Wellbeing in Older People Living with Frailty: A Scoping Review. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:1043-1072. [PMID: 37139581 DOI: 10.1080/01634372.2023.2206438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/05/2023]
Abstract
A sense of control is important for supporting older people living with frailty to develop adaptive functioning to optimize wellbeing. This scoping review examined the literature on the sense of control and wellbeing in older people living with frailty within their everyday life and care service use. Nine databases were searched using the timeframe 2000 to 2021 to identify key ideas regarding control and wellbeing in older people with frailty. The review highlighted three major themes: a) Control as conveyed in bodily expressions and daily activities, b) Sense of control and influence of place of residence, and c) Control within health and social care relationships. Maintaining a sense of control is not only an internal feeling but is impacted by physical and social environments. Greater focus is needed on the nature of relationships between older people living with frailty and those who work alongside them, which support control and wellbeing.
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Affiliation(s)
- Adam Nyende
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Caroline Ellis-Hill
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
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Chan JA, Bosma H, Drosinou C, Timmermans EJ, Savelberg H, Schaper N, Schram MT, Stehouwer CDA, Lakerveld J, Koster A. Association of perceived and objective neighborhood walkability with accelerometer-measured physical activity and sedentary time in the Maastricht Study. Scand J Med Sci Sports 2023; 33:2313-2322. [PMID: 37489093 DOI: 10.1111/sms.14455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND We investigated the association of neighborhood walkability with accelerometer-measured physical activity (PA) and sedentary behavior (SB) and examined whether objective and subjective measures of walkability resulted in similar findings. METHODS PA and SB from the first 7689 Maastricht Study participants ages 40-75 from 2010 to 2017 were measured using accelerometers for 7 days. Mean daily step count, light-intensity PA, moderate- to vigorous- intensity PA (MVPA), and SB were calculated. Objective walkability was measured by the 7-component Dutch Walkability Index within 500 m Euclidean buffers around residential addresses of participants. Subjective walkability was obtained from the Abbreviated Neighborhood Environment Walkability Scale. Linear regression models analyzed the associations of walkability with PA and SB, controlling for potential confounders. RESULTS Objective walkability was negatively associated with light intensity PA in the most walkable quartile (b = -14.58, 95% CI = -20.94, -8.23). Compared to participants living in the least walkable neighborhoods, those in the most walkable quartile had statistically significantly higher SB levels (b = 11.64, 95% CI = 4.95, 18.32). For subjective walkability, mean daily step count was significantly higher in the most walkable quartile (b = 509.60, 95% CI = 243.38, 775.81). Higher subjective walkability was positively associated with MVPA (b = 4.40, 95% CI = 2.56, 6.23). CONCLUSION Living in a neighborhood with higher objective walkability was associated with lower levels of PA and higher SB levels while higher subjective walkability was associated with higher levels of PA. These results show discordant findings and thus, the effect of walkability on participant PA and SB within our sample is to be determined.
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Grants
- Cardiovascular Center (CVC, Maastricht, the Netherlands)
- Cardiovascular Research Institute Maastricht (CARIM, Maastricht, the Netherlands)
- Dutch Ministry of Economic Affairs (grant 31O.041)
- European Regional Development Fund
- Health Foundation Limburg (Maastricht, the Netherlands)
- Janssen-Cilag B.V. (Tilburg, the Netherlands)
- Novo Nordisk Farma B.V. (Alphen aan den Rijn, the Netherlands)
- Pearl String Initiative Diabetes (Amsterdam, the Netherlands)
- Province of Limburg
- Sanofi-Aventis Netherlands, B.V. (Gouda, the Netherlands)
- School for Nutrition, Toxicology and Metabolism (NUTRIM, Maastricht, the Netherlands)
- School for Public Health and Primary Care (CAPHRI, Maastricht, the Netherlands)
- Stichting Annadal (Maastricht, the Netherlands)
- Stichting De Weijerhorst (Maastricht, the Netherlands)
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Affiliation(s)
- Jeffrey Alexander Chan
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
- Department of Physical Medicine and Rehabilitation, Northern California VA Healthcare System, Martinez, California, USA
| | - Hans Bosma
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
| | - Connie Drosinou
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
| | - Erik J Timmermans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hans Savelberg
- School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Nicolaas Schaper
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University, Maastricht, The Netherlands
| | - Miranda T Schram
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University, Maastricht, The Netherlands
- Heart and Vascular Centre, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Coen D A Stehouwer
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University, Maastricht, The Netherlands
| | - Jeroen Lakerveld
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annemarie Koster
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
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You Y, Chen Y, Zhang Q, Hu X, Li X, Yang P, Zuo Q, Cao Q. Systematic and meta-based evaluation of the relationship between the built environment and physical activity behaviors among older adults. PeerJ 2023; 11:e16173. [PMID: 37780389 PMCID: PMC10538293 DOI: 10.7717/peerj.16173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/03/2023] [Indexed: 10/03/2023] Open
Abstract
Objectives Existing assertions about the relationship between various factors of the built environment and physical activity behaviors are inconsistent and warrant further exploration and analysis. Methods This study systematically searched PubMed, Embase, Web of Science, Scopus, the Cochrane Library and Google Scholar for the effect of the built environment on the physical activity behaviors of older adults. R software was used to calculate the meta-estimated odds ratio with a 95% confidence interval. Simultaneously, the quality of included studies was evaluated using an observational study quality evaluation standard recommended by American health care quality and research institutions. Results A total of 16 original researches were included in this meta-analysis and eight factors of the built environment were evaluated. These factors which ranked from high to low according to their impact were traffic safety (OR = 1.58, 95% CI [1.14-2.20]), destination accessibility (OR = 1.24, 95% CI [1.06-1.44]), aesthetics of sports venues (OR = 1.21, 95% CI [1.07-1.37]), virescence of sports venues (OR = 1.14, 95% CI [1.06-1.23]), building density (OR = 1.07, 95% CI [1.02-1.13]). Additionally, it seemed that there was no potential association between mixed land use (OR = 1.01, 95% CI [0.92-1.10]), the quality of pedestrian facilities (OR = 1.00, 95% CI [0.92-1.08]) or commercial facilities (OR = 0.94, 95% CI [0.88-1.00]) and physical activity behaviors of older adults. Conclusions The built environment has been found to exhibit a significant relationship with the physical activity behaviors of older adults. It is proposed that factors such as traffic safety, destination accessibility, aesthetics of sports venues, virescence of sports venues, and building density be given more consideration when aiming to promote physical activity levels among older adults.
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Affiliation(s)
- Yanwei You
- Division of Sports Science and Physical Education, Tsinghua University, Bejing, China
- School of Social Sciences, Tsinghua University, Beijing, China
| | - Yuquan Chen
- Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qi Zhang
- Taishan University, Taian, China
| | - Xiaojie Hu
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xingzhong Li
- Zhedong Orthopedic Hospital, Ningbo, China
- Current Affiliation: Orthopedics Department, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Ping Yang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Qun Zuo
- College of Public Health, Hebei University/Hebei Key Laboratory of Public Health Safety, Baoding, China
| | - Qiang Cao
- Department of Earth Sciences, Kunming University of Science and Technology, Kunming, China
- School of Pharmacy, Macau University of Science and Technology, Macau, China
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6
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Encho H, Uchida K, Horibe K, Nakatsuka K, Ono R. Walking and perception of green space among older adults in Japan: subgroup analysis based self-efficacy. Health Promot Int 2023; 38:6974791. [PMID: 36617292 DOI: 10.1093/heapro/daac175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Self-efficacy is the key factor for promoting physical activity. Older adults with low self-efficacy tend to be physical inactive than those with high self-efficacy, and an approach is needed to promote physical activity. Among several approaches, increasing the perception of green space may be an effective approach for low self-efficacy not high self-efficacy, but no study has investigated. This study investigated the association between walking and perception of green space among older adults with high and low self-efficacy, respectively. We conducted a cross-sectional study among 204 community-dwelling older adults (mean age = 78.3 years, 62.3% females). Using the median split, the participants were divided into high and low self-efficacy groups based on the median score of 12. Walking was measured using the International Physical Activity Questionnaire and 'more walking' was defined as ≥150 min of walking time per week. Perception of green space was measured using an 8-item questionnaire. We performed logistic regression analysis to investigate the association between walking and perception of green space adjusted for age, gender, years of education, living with someone and income level. For all participants, 94 participants (46.1%) fell under low self-efficacy. After adjustment, higher perception of green space is associated with more walking among older adults with low self-efficacy [adjusted odds ratio (aOR) = 1.07, 95% confidence interval (CI) = 1.00-1.15], but not among those with high self-efficacy (aOR = 1.09, 95% CI= 0.99-1.20). To increase perception of green space, experts should design/improve green spaces considering beneficiaries' characteristics.
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Affiliation(s)
- Haruhi Encho
- Department of Rehabilitation Sciences, Graduate School of Health Sciences, Kobe University, Kobe, Hyogo, Japan
| | - Kazuaki Uchida
- Department of Rehabilitation Sciences, Graduate School of Health Sciences, Kobe University, Kobe, Hyogo, Japan.,Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Kana Horibe
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Hyogo, Japan
| | - Kiyomasa Nakatsuka
- Department of Rehabilitation Sciences, Graduate School of Health Sciences, Kobe University, Kobe, Hyogo, Japan
| | - Rei Ono
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Hyogo, Japan.,National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
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Mahmood A, Patille R, Lam E, Mora DJ, Gurung S, Bookmyer G, Weldrick R, Chaudhury H, Canham SL. Aging in the Right Place for Older Adults Experiencing Housing Insecurity: An Environmental Assessment of Temporary Housing Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14857. [PMID: 36429576 PMCID: PMC9691151 DOI: 10.3390/ijerph192214857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/23/2022] [Accepted: 10/29/2022] [Indexed: 06/16/2023]
Abstract
Research on programs offering senior-specific housing supports and enabling "aging in the right place" (AIRP) for "older persons with experiences of homelessness" (OPEH) is limited. This paper presents an environmental assessment of a "transitional housing program" (THP) in Metro Vancouver, Canada, for OPEH to AIRP. Data were collected using Aging in the Right Place Environmental (AIRP-ENV) and Secondary Observation (AIRP-ENV-SO) audit tools designed to evaluate multi-unit housing for OPEH. The 241-item AIRP-ENV tool was used to assess the built environmental features of four multi-unit buildings of the THP. The AIRP-ENV-SO tool was used to collect contextual data on the function, safety, and land use of the surrounding neighborhood. Findings identified built environment and urban design features that support THP residents' safety, security, accessibility, functionality, social activity, autonomy, and identity. The THP buildings were rated 'Good' for accessibility, functionality, autonomy and identity, while 'Satisfactory' or 'Poor' for safety, security, and social activity. Findings point to the built environmental features (e.g., size and layout of spaces) required in the THP to create opportunities for increased social engagement among residents and enhanced safety and security. The AIRP-ENV and AIRP-ENV-SO audit tools can help inform programs across the housing continuum to develop supportive built environments that promote AIRP for OPEH.
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Affiliation(s)
- Atiya Mahmood
- Department of Gerontology, Simon Fraser University, 515 West Hastings, Suite 2800, Vancouver, BC V6B 5K3, Canada
| | - Rachelle Patille
- Department of Gerontology, Simon Fraser University, 515 West Hastings, Suite 2800, Vancouver, BC V6B 5K3, Canada
| | - Emily Lam
- Faculty of Health Sciences, Simon Fraser University, 8888 University Dr, Burnaby, BC V5A 1S6, Canada
| | - Diana Juanita Mora
- Faculty of Health Sciences, Simon Fraser University, 8888 University Dr, Burnaby, BC V5A 1S6, Canada
| | - Shreemouna Gurung
- Department of Gerontology, Simon Fraser University, 515 West Hastings, Suite 2800, Vancouver, BC V6B 5K3, Canada
| | - Gracen Bookmyer
- Department of Gerontology, Simon Fraser University, 515 West Hastings, Suite 2800, Vancouver, BC V6B 5K3, Canada
| | - Rachel Weldrick
- Department of Gerontology, Simon Fraser University, 515 West Hastings, Suite 2800, Vancouver, BC V6B 5K3, Canada
| | - Habib Chaudhury
- Department of Gerontology, Simon Fraser University, 515 West Hastings, Suite 2800, Vancouver, BC V6B 5K3, Canada
| | - Sarah L. Canham
- College of Social Work, University of Utah, 395 S 1500 E, Salt Lake City, UT 84112, USA
- College of Architecture and Planning, 375 1530 E, University of Utah, Salt Lake City, UT 84112, USA
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Guerreiro C, Botelho M, Fernández-Martínez E, Marreiros A, Pais S. Determining the Profile of People with Fall Risk in Community-Living Older People in Algarve Region: A Cross-Sectional, Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042249. [PMID: 35206432 PMCID: PMC8871874 DOI: 10.3390/ijerph19042249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/16/2022]
Abstract
One in three people aged 65 years or older falls every year. Injuries associated with this event among the older population are a major cause of pain, disability, loss of functional autonomy and institutionalization. This study aimed to assess mobility and fall risk (FR) in community-living older people and to determine reliable and independent measures (health, social, environmental and risk factors) that can predict the mobility loss and FR. In total, 192 participants were included, with a mean age of 77.93 ± 8.38. FR was assessed by EASY-Care (EC) Standard 2010, the Tinetti Test and the Modified Falls Efficacy Scale (MFES). An exploratory analysis was conducted using the divisive non-hierarchical cluster method, aiming to identify a differentiator and homogeneous group of subjects (optimal group of variables) and to verify if that group shows differences in fall risk. Individually, the health, social, environmental and risk factor categories were not found to be an optimal group; they do not predict FR. The most significant predictor variables were a mix of the different categories, namely, the presence of pain, osteoarthritis (OA), and female gender. The finding of a profile that allows health professionals to be able to quickly identify people at FR will enable a reduction in injuries and fractures resulting from falls and, consequently, the associated costs.
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Affiliation(s)
- Carla Guerreiro
- Algarve Biomedical Center Research Institute (ABCRI), University of Algarve, 8005-139 Faro, Portugal; (C.G.); (M.B.); (A.M.); (S.P.)
| | - Marta Botelho
- Algarve Biomedical Center Research Institute (ABCRI), University of Algarve, 8005-139 Faro, Portugal; (C.G.); (M.B.); (A.M.); (S.P.)
| | - Elia Fernández-Martínez
- Department of Nursing, University of Huelva, 21004 Huelva, Spain
- Department of Nursing, University of Sevilla, 41009 Sevilla, Spain
- Correspondence:
| | - Ana Marreiros
- Algarve Biomedical Center Research Institute (ABCRI), University of Algarve, 8005-139 Faro, Portugal; (C.G.); (M.B.); (A.M.); (S.P.)
- Faculty of Medicine and Biomedical Sciences, University of Algarve, 8005-139 Faro, Portugal
| | - Sandra Pais
- Algarve Biomedical Center Research Institute (ABCRI), University of Algarve, 8005-139 Faro, Portugal; (C.G.); (M.B.); (A.M.); (S.P.)
- Faculty of Medicine and Biomedical Sciences, University of Algarve, 8005-139 Faro, Portugal
- Comprehensive Health Research Center (CHRC), 1150-082 Lisboa, Portugal
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The Neighborhood Effect on Keeping Non-Commuting Journeys within Compact and Sprawled Districts. LAND 2021. [DOI: 10.3390/land10111245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The neighborhood effect on keeping non-commuting trips inside neighborhoods has not yet been investigated in developing countries. The modeling of non-commuting trips inside neighborhoods helps understand how to avoid unnecessary journeys by car into different parts of the city. This paper, therefore, attempts to clarify (1) the similarities and differences in the socioeconomic characteristics and the perceptions of people in sprawled and compact neighborhoods, (2) correlations between, on the one hand, the choice of destinations of non-commuting trips for shopping and entertainment activities and, on the other, the socioeconomic features, travel behavior, and perceptions of residents in the two large Pakistani cities of Lahore and Rawalpindi, (3) the similarities and differences in the determinants of non-commuting destinations inside neighborhoods in compact and sprawled districts. The paper develops four Binary Logistic (BL) regression models, with two models for each type of neighborhood. The findings show that trips to shopping areas inside compact districts are correlated with a sense of belonging to the neighborhood, frequency of public transport use, residential location, and mode choice of non-commuting trips to destinations both inside and outside the neighborhood. On the other hand, the number of non-commuting trips, mode choice for non-commuting trips outside the neighborhood, frequency of public transport use, the attractiveness of shops, and monthly income (please see the Note) are significant determinants for trips to the shopping area in sprawled districts. Age, gender, possession of a driver’s license, income, number of non-commuting trips, mode choice for non-commuting trips outside of the neighborhood, car ownership, and attractiveness of shops in a neighborhood are correlated with trips to entertainment locations inside the neighborhood in compact districts. Finally, the attractiveness of shops, quality of social and recreational facilities, a sense of belonging to a neighborhood, choice of residential location, gender, age, possession of a driver’s license, number of cars in the household, and income are determinants of trips to entertainment locations in sprawled districts. A chi-square test confirms the differences across gender, daily activity, monthly income, frequency of public transport use, residential location choice, and the quality of social and recreational facilities for sprawled and compact districts in Pakistan.
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Lui CKL, Wong TWL. Associations among Perceived Walkability of Neighborhood Environment, Walking Time, and Functional Mobility by Older Adults: an Exploratory Investigation. AGEING INTERNATIONAL 2021. [DOI: 10.1007/s12126-021-09449-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Peters M, Muellmann S, Christianson L, Stalling I, Bammann K, Drell C, Forberger S. Measuring the association of objective and perceived neighborhood environment with physical activity in older adults: challenges and implications from a systematic review. Int J Health Geogr 2020; 19:47. [PMID: 33168094 PMCID: PMC7654613 DOI: 10.1186/s12942-020-00243-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/30/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND A supportive environment is a key factor in addressing the issue of health among older adults. There is already sufficient evidence that objective and self-reported measures of the neighborhood environment should be taken into account as crucial components of active aging, as they have been shown to influence physical activity; particularly in people aged 60+. Thus, both could inform policies and practices that promote successful aging in place. An increasing number of studies meanwhile consider these exposures in analyzing their impact on physical activity in the elderly. However, there is a wide variety of definitions, measurements and methodological approaches, which complicates the process of obtaining comparable estimates of the effects and pooled results. The aim of this review was to identify and summarize these differences in order to emphasize methodological implications for future reviews and meta analyzes in this field and, thus, to create a sound basis for synthesized evidence. METHODS A systematic literature search across eight databases was conducted to identify peer-reviewed articles examining the association of objective and perceived measures of the neighborhood environment and objectively measured or self-reported physical activity in adults aged ≥ 60 years. Two authors independently screened the articles according to predefined eligibility criteria, extracted data, and assessed study quality. A qualitative synthesis of the findings is provided. RESULTS Of the 2967 records retrieved, 35 studies met the inclusion criteria. Five categories of methodological approaches, numerous measurement instruments to assess the neighborhood environment and physical activity, as well as several clusters of definitions of neighborhood, were identified. CONCLUSIONS The strength of evidence of the associations of specific categories of environmental attributes with physical activity varies across measurement types of the outcome and exposures as well as the physical activity domain observed and the operationalization of neighborhood. The latter being of great importance for the targeted age group. In the light of this, future reviews should consider these variations and stratify their summaries according to the different approaches, measures and definitions. Further, underlying mechanisms should be explored.
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Affiliation(s)
- Manuela Peters
- Leibniz Institute for Prevention Research and Epidemiology–BIPS, Achterstraße 30, 28215 Bremen, Germany
- Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Saskia Muellmann
- Leibniz Institute for Prevention Research and Epidemiology–BIPS, Achterstraße 30, 28215 Bremen, Germany
| | - Lara Christianson
- Leibniz Institute for Prevention Research and Epidemiology–BIPS, Achterstraße 30, 28215 Bremen, Germany
| | - Imke Stalling
- Institute for Public Health and Nursing Research (IPP), Working Group Epidemiology of Demographic Change, University of Bremen, Bremen, Germany
| | - Karin Bammann
- Institute for Public Health and Nursing Research (IPP), Working Group Epidemiology of Demographic Change, University of Bremen, Bremen, Germany
| | - Carina Drell
- Institute for Public Health and Nursing Research (IPP), Working Group Epidemiology of Demographic Change, University of Bremen, Bremen, Germany
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology–BIPS, Achterstraße 30, 28215 Bremen, Germany
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12
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Keskinen KE, Gao Y, Rantakokko M, Rantanen T, Portegijs E. Associations of Environmental Features With Outdoor Physical Activity on Weekdays and Weekend Days: A Cross-Sectional Study Among Older People. Front Public Health 2020; 8:578275. [PMID: 33194978 PMCID: PMC7661781 DOI: 10.3389/fpubh.2020.578275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/05/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Physical activity (PA) of higher intensity and longer duration mainly accumulates from older adults' out-of-home activities. Outdoor PA is influenced by environmental features; however, the day-to-day variability of PA and its associations with environmental features have not been widely studied. This study focused on the associations of environmental features with accelerometer-measured PA in older people on weekdays and weekend days. Methods: The study population comprised 167 community-dwelling older people aged 75-90 years. Accelerometers were worn on 7 consecutive days and a structured interview on physical functioning, health, and socioeconomic factors was administered. A geographic information system (GIS) was used to assess environmental features within a distance of 500 (number of land types, road network slope, intersection, and residential densities) or 1,000 m (habitat diversity within natural and green areas) from participants' homes. Accelerometer-based PA [number of PA bouts >10 min and minutes of moderate to vigorous physical activity (MVPA)] was analyzed for weekdays and weekend days separately. Associations between environmental features and PA were analyzed using linear regression models. Results: Participants accumulated on average 0.60 PA bouts and 34.2 MVPA minutes on weekdays and 0.50 PA bouts and 31.5 MVPA minutes on weekend days. Especially participants with low overall PA were less active at weekends. Habitat diversity in natural and green areas, intersection density, and residential density were positively associated with numbers of PA bouts and MVPA minutes on weekdays. Moreover, more diversity in natural and green areas was associated with more MVPA minutes on weekend days. A higher road network slope was negatively associated with the number of PA bouts throughout the week and with MVPA minutes on weekend days. Conclusions: Environmental features close to home, especially PA-supportive infrastructural features and services, were more strongly associated with weekday than weekend PA. This suggests that older people's out-of-home activities, typically conducted on weekdays, are related to service use. However, greater diversity of natural areas close to home seemed to motivate older adults to engage in higher MVPA throughout the week.
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Affiliation(s)
- Kirsi E Keskinen
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland.,School of Resource Wisdom, University of Jyväskylä, Jyväskylä, Finland
| | - Ying Gao
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland.,Department of Sports Science, College of Education, Zhejiang University, Hangzhou, China
| | - Merja Rantakokko
- School of Health and Social Studies, JAMK University of Applied Sciences, Jyväskylä, Finland
| | - Taina Rantanen
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Erja Portegijs
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
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13
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Black K, Jester DJ. Examining Older Adults' Perspectives on the Built Environment and Correlates of Healthy Aging in an American Age-Friendly Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197056. [PMID: 32992480 PMCID: PMC7578930 DOI: 10.3390/ijerph17197056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 11/16/2022]
Abstract
Population aging has led to an increased focus on the environmental context in which we age. While researchers have identified significant health benefits associated with built community features such as housing, transportation and outdoor spaces and buildings, less attention has focused on the correlates of healthy aging and other characteristics via the perspective of community-dwelling older adults. This study utilized cluster analysis to examine health-related subgroups of older adults (n = 598) in an age-friendly community located in the United States, of which nearly half of its residents are age 60 and older. Linear regression was used to associate the health clusters with perceptions of built environmental features and socio-demographics. Four distinct profiles were identified, with the greatest preference for housing and transportation found among those reporting poorer health compared to those reporting excellent health across multi-dimensional healthy aging measures. Perceptions on the importance of built environmental features were also found to vary by age, income and home accessibility status. Findings suggest that older adults’ perceptions about built environmental features differ across health and home status as well as age and income, underscoring opportunities for public health action to better reach and engage older adults by life-course trajectories in age-friendly communities.
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Affiliation(s)
- Kathy Black
- School of Aging Studies, College of Behavioral and Community Sciences, Sarasota-Manatee Campus, University of South Florida, Sarasota, FL 34243, USA
- Correspondence:
| | - Dylan J. Jester
- School of Aging Studies, University of South Florida, Tampa, FL 33620, USA;
- College of Public Health, University of South Florida, Tampa, FL 33620, USA
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14
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Objective and subjective measures of the neighbourhood environment: Associations with frailty levels. Arch Gerontol Geriatr 2020; 92:104257. [PMID: 32979550 DOI: 10.1016/j.archger.2020.104257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of this study was to investigate whether perceptions of the neighbourhood environment (NE) and objective measures of the NE were associated with frailty in older adults. METHODS A cross-sectional study in Adelaide, Australia, recruited a sample of 115 community-dwelling adults aged ≥60 years. Respondents' perceptions of their NEs were assessed using the Neighbourhood Environment Walkability Scale (NEWS). An objective assessment of these NEWS survey questions was conducted using seven variables: residential density, land use mix diversity, street connectivity, accessibility, seasonal persistent green cover, road crash density and crime rate. Frailty was evaluated using the FRAIL (fatigue, resistance, ambulation, illnesses and loss of weight) scale. Multivariable linear regression analyses were employed to assess the associations between NEWS and frailty, and to assess the associations between objective neighbourhood variables and frailty. RESULTS Frail and pre-frail older adults were more likely to live in areas with lower residential density, lower density of road crashes, and higher accessibility than robust participants. Additionally, a poorer perception of the overall environment, worse land-use mix and accessibility and worse crime safety were associated with frailty and pre-frailty after adjustment of covariates and objective GIS variables. DISCUSSION Neighbourhood characteristics, both objective and perceived, are associated with frailty levels in older adults, and that strategies to tackle frailty must consider the impact of the neighbourhood environment.
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15
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Shi SL. Important Elements and Features of Neighborhood Landscape for Aging in Place: A Study in Hong Kong. Front Public Health 2020; 8:316. [PMID: 33014951 PMCID: PMC7461922 DOI: 10.3389/fpubh.2020.00316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/09/2020] [Indexed: 01/22/2023] Open
Abstract
With rapid growth in the aging population around the world, the promotion of aging in place has become more significant in recent years. Many neighborhood landscape elements and features have been revealed by accumulating research findings to be critical to aging in place. However, they are usually studied separately or in small groups. Little has been done to examine the relative importance of these elements and features when brought together, from the older adult's point of view. In this context, the current study investigated the perceived importance for older adults of 22 selected neighborhood landscape elements and features. A questionnaire survey was conducted in 17 public rental housing estates in Hong Kong with proportions of older residents (aged 65 or above) between 20 and 40%. According to the 426 collected samples, older adults considered as highly important landscape elements and features that contribute to comfort and help them avoid hazards, such as good ventilation, protection from severe sunshine/rain, body support, and good hygiene, while elements were thought to potentially bring hazards while not being necessities for older adults' outdoor experience were considered least important, including portable chairs, outdoor tables, plants that can be touched, closeness to children's playgrounds, small spaces for solitude, water features, and fitness equipment. After integrally interpreting the findings regarding perceived importance with other collected data, some landscape design suggestions are generated to supplement existing guidelines and recommendations concerning older adults' well-being and quality of life. These findings can inspire future research and landscape design that prioritize promoting aging in place.
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Affiliation(s)
- Shu-Lin Shi
- Department of Landscape Architecture, School of Architecture, Tsinghua University, Beijing, China
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16
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Liu Z, Kemperman A, Timmermans H. Location Choice in the Context of Older Adults' Leisure-Time Walking. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134775. [PMID: 32630767 PMCID: PMC7369953 DOI: 10.3390/ijerph17134775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/24/2020] [Accepted: 07/01/2020] [Indexed: 01/10/2023]
Abstract
Leisure-time walking is the most prevalent and preferred form of physical activity of older adults. In order to promote leisure-time walking and enhance the efficiency of using outdoor open spaces, the supply of different types of walking locations should match the needs, interests and preferences of older adults. However, there is limited knowledge on which location types are chosen by which groups of individuals under which conditions. This study therefore examines the effects of socio-demographics, episode participation attributes and neighborhood characteristics on the location choice of older adults for leisure-time walking. A multinomial logit model is estimated based on data collected among 316 respondents aged 60 or older in Dalian, China. The results indicate that older people’s location choices for walking are associated with their socio-demographics, episode participation attributes and neighborhood characteristics. Finally, implications of the results for the planning, design and management of open spaces are identified.
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17
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Emerging evolution trends of studies on age-friendly cities and communities: a scientometric review. AGEING & SOCIETY 2020. [DOI: 10.1017/s0144686x20000562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AbstractPopulation ageing, together with urbanisation, has become one of the greatest challenges throughout the world in the 21st century. Approximately one million people turn 60 each month worldwide. By 2050, more than 20 per cent of the global population is predicted to be 60 years old or above. Thus, an increasing need is evident for age-friendly communities, services and structures. Numerous studies on age-friendly cities and communities (AFCCs) have been conducted over the past decade. The large volume literature makes it necessary to figure out key areas and the evolution trends of studies on AFCCs. Therefore, this paper aims to provide a comprehensive review of existing literature pertaining to AFCCs. A total of 231 collected publications are analysed and visualised by CiteSpace. According to the keywords and document co-citation networks that are generated, the foundation, hot topics and domains of AFCC research are grouped. Three major themes, namely the characteristics of AFCCs, the application of the World Health Organization's framework in urban and rural areas worldwide, and the measurement of cities’ and communities’ age-friendliness, are identified. In addition, a roadmap of AFCC research is developed. The results of this research will therefore benefit researchers and practitioners.
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18
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Cerin E, Van Dyck D, Zhang CJP, Van Cauwenberg J, Lai PC, Barnett A. Urban environments and objectively-assessed physical activity and sedentary time in older Belgian and Chinese community dwellers: potential pathways of influence and the moderating role of physical function. Int J Behav Nutr Phys Act 2020; 17:73. [PMID: 32517790 PMCID: PMC7285720 DOI: 10.1186/s12966-020-00979-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/04/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Many studies have examined neighbourhood environmental correlates of older adults' physical activity (PA) but only a few focused on sedentary time (ST). Only a small proportion of these studies used objective measures of PA/ST, such as accelerometer-assessed PA/ST, and only a couple employed accelerometer cut-points appropriate for older adults. Furthermore, although older adults experience declines in physical function as they age, there is a dearth of information on the impact of the neighbourhood environment on PA/ST in individuals with different levels of physical function. METHODS We used data from two extant cross-sectional studies conducted in Hong Kong (China) and Ghent (Belgium) (N = 829). Participants were recruited from pre-selected administrative units stratified by socio-economic status and walkability. Moderate-to-vigorous PA (MVPA) and ST were assessed for 7 days using accelerometers and cut-points developed for older adults. Objective neighbourhood environmental attributes within 400 m and 1 km buffers surrounding participants' homes were quantified using Geographic Information Systems data. Lower extremity physical function was objectively assessed. Socio-demographic information was collected via interviews. Total, direct and indirect (mediated) effects of environmental attributes on MVPA and ST were estimated using generalised additive mixed models and the joint-significant test. RESULTS Commercial/civic destination density and number of parks within 1 km from home showed positive total and direct effects on MVPA, and public transport density showed negative total and direct effects on ST, which were consistent across cities and physical function levels. The total and direct effects of residential density on MVPA depended on physical function, and those of residential density on ST differed by city. A complex network of potential inconsistent pathways linking all environmental attributes to MVPA and ST in the whole sample or in subgroups of participants was revealed. DISCUSSION Access to parks and commercial/civic destinations appear to support older adults' MVPA in different geographical and cultural contexts and irrespective of their physical function level. By supporting MVPA, these characteristics also contribute to a reduction in ST. The potential effects of public transport, recreational facilities and residential density are less straightforward and point at inconsistent effects that may depend on the geographical context and level of physical function.
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Affiliation(s)
- Ester Cerin
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia. .,School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China. .,Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
| | - Delfien Van Dyck
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium
| | - Casper J P Zhang
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jelle Van Cauwenberg
- Research Foundation Flanders (FWO), Brussels, Belgium.,Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Poh-Chin Lai
- Department of Geography, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Anthony Barnett
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
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19
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Multi-Level Factors Associated with Social Participation among Stroke Survivors: China's Health and Retirement Longitudinal Study (2011-2015). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16245121. [PMID: 31847437 PMCID: PMC6950688 DOI: 10.3390/ijerph16245121] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/06/2019] [Accepted: 12/10/2019] [Indexed: 11/23/2022]
Abstract
Background: This study aims to examine the impact of individual-level and community-based factors on popular social participation activities of Chinese middle-aged and older adults post-stroke. Methods: Sub-samples of survivors of stroke (2011: n = 413, 2013: n = 395, 2015: n = 441) recruited by the China Health and Retirement Longitudinal Study (CHARLS) were included in the analysis. Zero-inflated Poisson and multi-level logistic regression models were used to explore factors associated with social participation. Results: More than half of individuals (55.0%) had no social participation and 23.4% participated in multiple social activities. The most popular social activities that individuals participated in were interacting with friends (32.6%) and going to a community club to play table games (22.7%). Multiple individual-level factors were negatively related to social participation (e.g., depressive symptoms and multiple measures of functional limitations) while the allocation of an outdoor exercise facility in the community/village was positively associated with going to a community club to play table games. Conclusion: Stroke survivors are at high risk of limited social participation. Policymakers and other key stakeholders should consider community design among other potential solutions when identifying ways to link at-risk stroke survivors to both opportunities for rehabilitation (e.g., physical function) and social participation.
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20
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Cognitive Functioning as a Moderator in the Relationship Between the Perceived Neighborhood Physical Environment and Physical Activity in Belgian Older Adults. J Aging Phys Act 2019; 27:890-898. [PMID: 31034319 DOI: 10.1123/japa.2018-0277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: To investigate whether the relationship of neighborhood environmental factors with physical activity (PA) is moderated by cognitive functioning in Belgian older adults. Methods: Seventy-one older adults completed validated questionnaires on PA and environmental perceptions, wore an accelerometer, and completed a computerized assessment of cognitive functioning. Moderated linear regression analyses were conducted in SPSS 24.0. Results: Overall cognitive functioning significantly moderated the associations of traffic safety and street connectivity with PA. Detailed analyses showed that these factors were only positively associated with PA in older adults with lower cognitive functioning. In addition, particularly, performance on tests assessing visuospatial and episodic memory moderated these associations. Discussion: Living in traffic-safe neighborhoods with short and many alternative routes might motivate older adults with lower cognitive functioning to be active. As such, the increase in PA might improve their cognitive abilities. This knowledge is crucial for health practitioners to develop effective PA promotion initiatives.
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21
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Environmental Factors Associated with Older Adult’s Walking Behaviors: A Systematic Review of Quantitative Studies. SUSTAINABILITY 2019. [DOI: 10.3390/su11123253] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The aim of this study is to systematically review the relationship between neighborhood environments and all types of walking behaviors among older adults. Seventy peer-reviewed journal articles which met the selection criteria were examined. Research designs were summarized by geographical location and the associations of environmental characteristics and walking were calculated. Interactions between moderators and environmental characteristics for all types of walking were also categorized. Results have shown that transport walking is the most supported by neighborhood environmental characteristics. The positively related environmental characteristics are walkability, urbanization, land use mix-diversity and accessibility, walking amenities, and bicycle lanes. Total walking was positively associated with walkability and urbanization. Recreational walking was associated with neighborhood employment/income level, nearness to public transport/bus stops, and social cohesion. The most commonly used moderators were age and gender, but inconsistent moderating effects between neighborhood environments and walking were also found. In densely populated environments such as Hong Kong, older adults walked mostly for both transport and recreation. In contrast, American older adults in low density areas walked less for transport and more for recreation. Findings support a strong relationship between neighborhood environments and older adults’ walking. Future research should focus on longitudinal studies and comparison studies by geographic location.
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Cleland C, Reis RS, Ferreira Hino AA, Hunter R, Fermino RC, Koller de Paiva H, Czestschuk B, Ellis G. Built environment correlates of physical activity and sedentary behaviour in older adults: A comparative review between high and low-middle income countries. Health Place 2019; 57:277-304. [PMID: 31132718 DOI: 10.1016/j.healthplace.2019.05.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 04/26/2019] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Claire Cleland
- Queen's University Belfast, Centre for Public Health, Belfast, United Kingdom.
| | - Rodrigo Siqueira Reis
- Washington University in St. Louis, Brown School, Prevention Research Center, St. Louis, MO, United States of America; Pontificia Universidade Catolica Do Parana, Research Group in Physical Activity and Quality of Life, Curitiba, Parana, Brazil; Pontificia Universidade Catolica Do Parana, Graduate Program in Urban Management, Curitiba, Parana, Brazil.
| | - Adriano Akira Ferreira Hino
- Pontificia Universidade Catolica Do Parana, Research Group in Physical Activity and Quality of Life, Curitiba, Parana, Brazil; Federal University of Technology - Parana, Research Group in Environment, Physical Activity and Health, Post-Graduate Program in Physical Education, Curitiba, PR, Brazil.
| | - Ruth Hunter
- Queen's University Belfast, Centre for Public Health, Belfast, United Kingdom; Queen's University Belfast, UKCRC Centre of Excellence for Public Health, Belfast, United Kingdom.
| | - Rogério César Fermino
- Pontificia Universidade Catolica Do Parana, Research Group in Physical Activity and Quality of Life, Curitiba, Parana, Brazil; Federal University of Technology - Parana, Research Group in Environment, Physical Activity and Health, Post-Graduate Program in Physical Education, Curitiba, PR, Brazil.
| | - Hermes Koller de Paiva
- Pontificia Universidade Catolica Do Parana, Research Group in Physical Activity and Quality of Life, Curitiba, Parana, Brazil; Federal University of Parana, Post-Graduate Program in Physical Education, Curitiba, Parana, Brazil.
| | - Bruno Czestschuk
- Pontificia Universidade Catolica Do Parana, Research Group in Physical Activity and Quality of Life, Curitiba, Parana, Brazil; Federal University of Parana, Post-Graduate Program in Physical Education, Curitiba, Parana, Brazil.
| | - Geraint Ellis
- Queen's University Belfast, School of Natural and Built Environment, Belfast, United Kingdom.
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Harada K, Lee S, Lee S, Bae S, Harada K, Suzuki T, Shimada H. Psychological and Environmental Correlates of Moderate-to-Vigorous Physical Activity and Step Counts Among Older Adults With Cognitive Decline. Percept Mot Skills 2019; 126:639-655. [PMID: 31033403 DOI: 10.1177/0031512519846026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Promoting physical activity (PA) among older adults with cognitive decline is important for maintaining and improving their health. Identifying psychological and environmental PA correlates in this population can help develop effective strategies for PA promotion. Since past findings with healthy older adults may not generalize to those with cognitive decline, this study offers data on how self-efficacy, self-regulation, and social-environmental factors were associated with PA among a group of older adults with cognitive decline. We report secondary analysis of baseline data from a randomized control study of 262 older participants (M = 76.2 years) who showed a decline in global cognitive function as defined by Mini-Mental State Examination scores between 21 and 24. The participants' PA was measured by an accelerometer, and participants completed questionnaires measuring self-efficacy, self-regulation, social support, social network, and demographic variables. In this study, we evaluated the participants' neighborhood environment with a geographic information system and found through stepwise multiple regression analyses that self-efficacy, gender, and age were associated with PA variables, while self-regulation and environmental factors were not. Thus, perceived self-efficacy was an important psychological correlate of PA in this group of older adults with cognitive decline. PA promotion interventions for this population should attend to self-efficacy, gender, and age.
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Affiliation(s)
- Kazuhiro Harada
- 1 Graduate School of Human Development and Environment, Kobe University, Kobe, Japan.,2 Department of Preventive Gerontology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Sangyoon Lee
- 2 Department of Preventive Gerontology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Sungchul Lee
- 2 Department of Preventive Gerontology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Seongryu Bae
- 2 Department of Preventive Gerontology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kenji Harada
- 2 Department of Preventive Gerontology, National Center for Geriatrics and Gerontology, Obu, Japan.,3 Graduate School of Health and Sport Science, Chukyo University, Obu, Japan
| | - Takao Suzuki
- 4 Institute for Gerontology, J. F. Oberlin University, Machida, Japan
| | - Hiroyuki Shimada
- 2 Department of Preventive Gerontology, National Center for Geriatrics and Gerontology, Obu, Japan
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Abstract
With support and demand for walkable urban spaces on the rise, there has been growing concern among academics and practitioners of increasing exclusivity, particularly in amenity-rich areas. This study examines equity in neighborhood walkability from the perspective of housing affordability, asking whether more walkable urban neighborhoods have less affordable housing from the viewpoint of both neighborhood residents and households within the encompassing metropolitan region. While considering additional factors that may affect housing affordability, including coastal proximity, crime, rail access, housing age, housing size, and employment accessibility, the results indicate lower housing affordability primarily for renter households already living in walkable neighborhoods, but not for those looking to move to a more walkable neighborhood from within the same metropolitan area. Case studies of three large U.S. urban areas, Charlotte, NC, Pittsburgh, PA, and Portland, OR, highlight local variations in the walkability–housing affordability nexus.
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25
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Huang NC, Kung SF, Hu SC. The Relationship between Urbanization, the Built Environment, and Physical Activity among Older Adults in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E836. [PMID: 29695078 PMCID: PMC5981875 DOI: 10.3390/ijerph15050836] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/20/2018] [Accepted: 04/22/2018] [Indexed: 12/02/2022]
Abstract
Urbanization and ageing are global phenomena and offer unique challenges in different countries. A supportive environment plays a critical role in addressing the issue of behavioral change and health promotion among older adults. Many studies in the U.S., EU, and Australia have considered promoting physical activity in the community based on ecological models, whereas very few Asian studies have examined the relationships among urbanization, the built environment and physical activity in elderly at the ecological level, especially from a multi-level perspective. Due to the prevalence of post-war baby boomers and a very low birth-rate, the older population (aged 65 years old and older) in Taiwan has increased rapidly since 2011 and has exceeded the younger generation (0⁻14 years old) in 2017. Hence, the purpose of this study was first to examine the degree of urbanization in townships and the status of related built environments in Taiwan and then to investigate whether the built environment is associated with recommended amounts of physical activity among older adults. Three national datasets and a multi-level design were used in this research. Data at the individual level was obtained from the 2009 National Health Interview Survey (NHIS) which was taken from June 2009 to February 2010. Ecological data was obtained from the 2006 National Land Use Investigation of the National Geographic Information System and the 2010 Population and Housing Census. The analyses included a descriptive analysis, a bivariate analysis, a multiple logistic regression, and a multi-level analysis, utilizing a mostly hierarchical linear model (HLM). The results showed a significant relationship between factors at the environmental levels and physical activity in older adults. Urbanization, the built environment, and the median income of townships were positively correlated to the physical activity of the older adults. After controlling for individual-level factors, urbanization still exhibited this correlation. Parks and green spaces were associated with achieving the recommended amount of physical activity. However, there was no relationship after controlling for factors at the individual level. Detailed discussions were provided.
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Affiliation(s)
- Nuan-Ching Huang
- Department of Urban Planning, College of Planning & Design, National Cheng Kung University, No.1, University Road, Tainan City 701, Taiwan.
| | - Shiann-Far Kung
- Department of Urban Planning, College of Planning & Design, National Cheng Kung University, No.1, University Road, Tainan City 701, Taiwan.
| | - Susan C Hu
- Department of Public Health, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City 701, Taiwan.
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Keskinen KE, Rantakokko M, Suomi K, Rantanen T, Portegijs E. Nature as a facilitator for physical activity: Defining relationships between the objective and perceived environment and physical activity among community-dwelling older people. Health Place 2018; 49:111-119. [PMID: 29306140 DOI: 10.1016/j.healthplace.2017.12.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 11/14/2017] [Accepted: 12/08/2017] [Indexed: 11/19/2022]
Abstract
The aim was to study the correspondence between the objective and perceived environment and to assess their associations with physical activity (PA) in older people. 848 community-dwelling older people aged 75-90 were interviewed on their difficulties in walking 500m, perceiving nature as a facilitator for outdoor mobility, and PA. The presence of water and landscape diversity were objectively assessed inside 500m and 1000m circular buffers around participants' homes. Using logistic regression, participant data were analyzed together with the objectively assessed environmental features. Our results indicate that higher habitat diversity within natural areas correlates with higher PA among older people without walking difficulties and the presence of water correlates with higher PA among those with walking difficulties.
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Affiliation(s)
- Kirsi E Keskinen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, P.O.Box 35, FI-40014, Finland.
| | - Merja Rantakokko
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, P.O.Box 35, FI-40014, Finland
| | - Kimmo Suomi
- Faculty of Sport and Health Sciences, University of Jyväskylä, P.O.Box 35, FI-40014, Finland
| | - Taina Rantanen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, P.O.Box 35, FI-40014, Finland
| | - Erja Portegijs
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, P.O.Box 35, FI-40014, Finland
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Abstract
Mall walking has been a popular physical activity for decades. However, little is known about why mall managers support these programs or why adults choose to walk. Our study aim was to describe mall walking programs from the perspectives of walkers, managers, and leaders. Twenty-eight walkers, 16 walking program managers, and six walking program leaders from five states participated in a telephone or in-person semi-structured interview (N = 50). Interview guides were developed using a social-ecological model. Interviews were recorded, transcribed verbatim, and analyzed thematically. All informants indicated satisfaction with their program and environmental features. Differences in expectations were noted in that walkers wanted a safe, clean, and social place whereas managers and leaders felt a need to provide programmatic features. Given the favorable walking environments in malls, there is an opportunity for public health professionals, health care organizations, and providers of aging services to partner with malls to promote walking.
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Barnett DW, Barnett A, Nathan A, Van Cauwenberg J, Cerin E. Built environmental correlates of older adults' total physical activity and walking: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2017; 14:103. [PMID: 28784183 PMCID: PMC5547528 DOI: 10.1186/s12966-017-0558-z] [Citation(s) in RCA: 359] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/31/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Identifying attributes of the built environment associated with health-enhancing levels of physical activity (PA) in older adults (≥65 years old) has the potential to inform interventions supporting healthy and active ageing. The aim of this study was to first systematically review and quantify findings on built environmental correlates of older adults' PA, and second, investigate differences by type of PA and environmental attribute measurement. METHODS One hundred articles from peer-reviewed and grey literature examining built environmental attributes related to total PA met inclusion criteria and relevant information was extracted. Findings were meta-analysed and weighted by article quality and sample size and then stratified by PA and environmental measurement method. Associations (p < .05) were found in relation to 26 individual built environmental attributes across six categories (walkability, residential density/urbanisation, street connectivity, access to/availability of destinations and services, infrastructure and streetscape, and safety) and total PA and walking specifically. Reported individual- and environmental-level moderators were also examined. RESULTS Positive environmental correlates of PA, ranked by strength of evidence, were: walkability (p < .001), safety from crime (p < .001), overall access to destinations and services (p < .001), recreational facilities (p < .001), parks/public open space (p = .002) and shops/commercial destinations (p = .006), greenery and aesthetically pleasing scenery (p = .004), walk-friendly infrastructure (p = .009), and access to public transport (p = .016). There were 26 individual differences in the number of significant associations when the type of PA and environmental measurement method was considered. No consistent moderating effects on the association between built environmental attributes and PA were found. CONCLUSIONS Safe, walkable, and aesthetically pleasing neighbourhoods, with access to overall and specific destinations and services positively influenced older adults' PA participation. However, when considering the environmental attributes that were sufficiently studied (i.e., in ≥5 separate findings), the strength of evidence of associations of specific categories of environment attributes with PA differed across PA and environmental measurement types. Future research should be mindful of these differences in findings and identify the underlying mechanisms. Higher quality research is also needed.
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Affiliation(s)
- David W. Barnett
- Institute for Health and Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, VIC 3000 Australia
| | - Anthony Barnett
- Institute for Health and Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, VIC 3000 Australia
| | - Andrea Nathan
- Institute for Health and Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, VIC 3000 Australia
| | - Jelle Van Cauwenberg
- Department of Public Health, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
- Research Foundation Flanders, Egmontstraat 5, 1000 Brussels, Belgium
| | - Ester Cerin
- Institute for Health and Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, VIC 3000 Australia
- School of Public Health, The University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, Special Administrative Region China
- Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004 Australia
| | - on behalf of the Council on Environment and Physical Activity (CEPA) – Older Adults working group
- Institute for Health and Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, VIC 3000 Australia
- Department of Public Health, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
- Research Foundation Flanders, Egmontstraat 5, 1000 Brussels, Belgium
- School of Public Health, The University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, Special Administrative Region China
- Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004 Australia
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Barnett DW, Barnett A, Nathan A, Van Cauwenberg J, Cerin E. Built environmental correlates of older adults' total physical activity and walking: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2017. [PMID: 28784183 DOI: 10.1186/sl2966-017-0558-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Identifying attributes of the built environment associated with health-enhancing levels of physical activity (PA) in older adults (≥65 years old) has the potential to inform interventions supporting healthy and active ageing. The aim of this study was to first systematically review and quantify findings on built environmental correlates of older adults' PA, and second, investigate differences by type of PA and environmental attribute measurement. METHODS One hundred articles from peer-reviewed and grey literature examining built environmental attributes related to total PA met inclusion criteria and relevant information was extracted. Findings were meta-analysed and weighted by article quality and sample size and then stratified by PA and environmental measurement method. Associations (p < .05) were found in relation to 26 individual built environmental attributes across six categories (walkability, residential density/urbanisation, street connectivity, access to/availability of destinations and services, infrastructure and streetscape, and safety) and total PA and walking specifically. Reported individual- and environmental-level moderators were also examined. RESULTS Positive environmental correlates of PA, ranked by strength of evidence, were: walkability (p < .001), safety from crime (p < .001), overall access to destinations and services (p < .001), recreational facilities (p < .001), parks/public open space (p = .002) and shops/commercial destinations (p = .006), greenery and aesthetically pleasing scenery (p = .004), walk-friendly infrastructure (p = .009), and access to public transport (p = .016). There were 26 individual differences in the number of significant associations when the type of PA and environmental measurement method was considered. No consistent moderating effects on the association between built environmental attributes and PA were found. CONCLUSIONS Safe, walkable, and aesthetically pleasing neighbourhoods, with access to overall and specific destinations and services positively influenced older adults' PA participation. However, when considering the environmental attributes that were sufficiently studied (i.e., in ≥5 separate findings), the strength of evidence of associations of specific categories of environment attributes with PA differed across PA and environmental measurement types. Future research should be mindful of these differences in findings and identify the underlying mechanisms. Higher quality research is also needed.
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Affiliation(s)
- David W Barnett
- Institute for Health and Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, VIC, 3000, Australia
| | - Anthony Barnett
- Institute for Health and Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, VIC, 3000, Australia
| | - Andrea Nathan
- Institute for Health and Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, VIC, 3000, Australia
| | - Jelle Van Cauwenberg
- Department of Public Health, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
- Research Foundation Flanders, Egmontstraat 5, 1000, Brussels, Belgium
| | - Ester Cerin
- Institute for Health and Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, VIC, 3000, Australia.
- School of Public Health, The University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, Special Administrative Region, China.
- Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, 3004, Australia.
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Satariano WA, Wang C, Kealey ME, Kurtovich E, Phelan EA. Risk Profiles for Falls among Older Adults: New Directions for Prevention. Front Public Health 2017; 5:142. [PMID: 28824893 PMCID: PMC5539824 DOI: 10.3389/fpubh.2017.00142] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 06/06/2017] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To address whether neighborhood factors, together with older adults' levels of health and functioning, suggest new combinations of risk factors for falls and new directions for prevention. To explore the utility of Grade-of-Membership (GoM) analysis to conduct this descriptive analysis. METHOD This is a cross-sectional, descriptive study of 884 people aged ≥65 years from Alameda County, CA, Cook County, IL, Allegheny County, PA, and Wake and Durham counties, NC. Interviews focused on neighborhood characteristics, physical and cognitive function, walking, and falls and injuries. Four risk profiles (higher order interactions of individual and neighborhood factors) were derived from GoM analysis. RESULTS Profiles 1 and 2 reflect previous results showing that frail older adults are likely to fall indoors (Profile 1); healthy older adults are likely to fall outdoors (Profile 2). Profile 3 identifies the falls risk for older with mild cognitive impairment living in moderately walkable neighborhoods. Profile 4 identifies the risk found for healthy older adults living in neighborhoods with low walkability. DISCUSSION Neighborhood walkability, in combination with levels of health and functioning, is associated with both indoor and outdoor falls. Descriptive results suggest possible research hypotheses and new directions for prevention, based on individual and neighborhood factors.
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Affiliation(s)
- William A. Satariano
- School of Public Health, University of California Berkeley, Berkeley, CA, United States
| | - Constance Wang
- School of Public Health, University of California Berkeley, Berkeley, CA, United States
| | - Melissa E. Kealey
- School of Public Health, University of California Berkeley, Berkeley, CA, United States
| | - Elaine Kurtovich
- School of Public Health, University of California Berkeley, Berkeley, CA, United States
| | - Elizabeth A. Phelan
- Department of Medicine, Division of Gerontology and Geriatric Medicine, School of Public Health, University of Washington, Seattle, WA, United States
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States
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Hirsch JA, Winters M, Sims-Gould J, Clarke PJ, Ste-Marie N, Ashe M, McKay HA. Developing a comprehensive measure of mobility: mobility over varied environments scale (MOVES). BMC Public Health 2017; 17:513. [PMID: 28545433 PMCID: PMC5445376 DOI: 10.1186/s12889-017-4450-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 05/17/2017] [Indexed: 01/01/2023] Open
Abstract
Background While recent work emphasizes the multi-dimensionality of mobility, no current measure incorporates multiple domains of mobility. Using existing conceptual frameworks we identified four domains of mobility (physical, cognitive, social, transportation) to create a “Mobility Over Varied Environments Scale” (MOVES). We then assessed expected patterns of MOVES in the Canadian population. Methods An expert panel identified survey items within each MOVES domain from the Canadian Community Health Survey- Healthy Aging Cycle (2008–2009) for 28,555 (weighted population n = 12,805,067) adults (≥45 years). We refined MOVES using principal components analysis and Cronbach’s alpha and weighted items so each domain was 10 points. Expected mobility trends, as assessed by average MOVES, were examined by sociodemographic and health factors, and by province, using Analysis of Variance (ANOVA). Results MOVES ranged from 0 to 40, where 0 represents individuals who are immobile and 40 those who are fully mobile. Mean MOVES was 29.58 (95% confidence interval (CI) 29.49, 29.67) (10th percentile: 24.17 (95% CI 23.96, 24.38), 90th percentile: 34.70 (CI 34.55, 34.85)). MOVES scores were lower for older, female, and non-white Canadians with worse health and lower socioeconomic status. MOVES was also lower for those who live in less urban areas. Conclusions MOVES is a holistic measure of mobility for characterizing older adult mobility across populations. Future work should examine individual or neighborhood predictors of MOVES and its relationship to broader health outcomes. MOVES holds utility for research, surveillance, evaluation, and interventions around the broad factors influencing mobility in older adults. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4450-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jana A Hirsch
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, USA.,Centre for Hip Health and Mobility, Robert H.N. Ho Research Centre, University of British Columbia, 5th Floor, 2635 Laurel St, Vancouver, BC, Canada
| | - Meghan Winters
- Centre for Hip Health and Mobility, Robert H.N. Ho Research Centre, University of British Columbia, 5th Floor, 2635 Laurel St, Vancouver, BC, Canada. .,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada.
| | - Joanie Sims-Gould
- Centre for Hip Health and Mobility, Robert H.N. Ho Research Centre, University of British Columbia, 5th Floor, 2635 Laurel St, Vancouver, BC, Canada.,Department of Family Practice, University of British Columbia, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, BC, Canada
| | - Philippa J Clarke
- Department of Epidemiology, University of Michigan, 1415 Washington Heights, 4667 SPH I, Ann Arbor, MI, USA.,Institute for Social Research, University of Michigan, P.O. Box 1248, 426 Thompson St, Ann Arbor, MI, USA
| | - Nathalie Ste-Marie
- Division of Orthopaedic Surgery, McGill University Health Centre, 1001 Boulevard Décarie, Montréal, QC, Canada
| | - Maureen Ashe
- Centre for Hip Health and Mobility, Robert H.N. Ho Research Centre, University of British Columbia, 5th Floor, 2635 Laurel St, Vancouver, BC, Canada.,Department of Family Practice, University of British Columbia, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, BC, Canada
| | - Heather A McKay
- Centre for Hip Health and Mobility, Robert H.N. Ho Research Centre, University of British Columbia, 5th Floor, 2635 Laurel St, Vancouver, BC, Canada.,Department of Family Practice, University of British Columbia, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, BC, Canada.,Department of Orthopaedics, University of British Columbia, 3114 - 910 West 10th Avenue, Vancouver, BC, Canada
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Pollard TM, Wagnild JM. Gender differences in walking (for leisure, transport and in total) across adult life: a systematic review. BMC Public Health 2017; 17:341. [PMID: 28427376 PMCID: PMC5397769 DOI: 10.1186/s12889-017-4253-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 04/08/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The aim of this systematic review was to examine gender differences in walking for leisure, transport and in total in adults living in high-income countries, and to assess whether gender differences in walking practices change across the life-course. METHODS A systematic literature search was conducted of publications dated 1995 to 2015. Papers providing quantitative data on participation in walking of both men and women aged at least 18 years in a high-income country were screened for the quality of the data on gender differences in walking. Data were extracted and results were synthesised using forest plots and narrative summary. RESULTS Thirty-six studies were included in the review: 18 reported on walking for leisure, 16 on walking for transport (in total, or for particular purposes), and 14 on total walking. Most (33) studies provided data comparing the proportion of men and women who walked (at all or for a minimum duration) over a defined period, usually one week. There was consistent evidence that more women than men walk for leisure, although effect sizes were small. However, this effect varies by age: more younger women than younger men walk for leisure, but the gender difference diminishes with age and appears to reverse in the oldest age groups. Taking all ages together, there was no consistent gender difference in walking for transport or in total walking, although the small number of studies reporting on walking to undertake errands suggested that more women than men walk for this purpose. CONCLUSIONS While there is little evidence that levels of total walking consistently vary by gender, our findings suggest that there are consistent gender differences in participation in walking for some purposes, including for leisure, and that there are gender differences in the impact of age on walking. We conclude that more research is needed to improve our understanding of how walking fits into the lives of women and men across the life-course, especially in relation to gender differences in the impact of aging on walking. PROSPERO REGISTRATION PROSPERO registration number: CRD42015025961 .
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Affiliation(s)
- Tessa M. Pollard
- Department of Anthropology, Durham University, Dawson Building, South Road, Durham, DH1 3LE UK
| | - Janelle M. Wagnild
- Department of Anthropology, Durham University, Dawson Building, South Road, Durham, DH1 3LE UK
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Hirsch JA, Winters M, Clarke PJ, Ste-Marie N, McKay HA. The influence of walkability on broader mobility for Canadian middle aged and older adults: An examination of Walk Score™ and the Mobility Over Varied Environments Scale (MOVES). Prev Med 2017; 95 Suppl:S60-S67. [PMID: 27702639 PMCID: PMC5292080 DOI: 10.1016/j.ypmed.2016.09.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/30/2016] [Accepted: 09/30/2016] [Indexed: 11/21/2022]
Abstract
Neighborhood built environments may play an important role in shaping mobility and subsequent health outcomes. However, little work includes broader mobility considerations such as cognitive ability to be mobile, social connections with community, or transportation choices. We used a population-based sample of Canadian middle aged and older adults (aged 45 and older) from the Canadian Community Health Survey-Healthy Aging (CCHS-HA, 2008-2009) to create a holistic mobility measure: Mobility over Varied Environments Scale (MOVES). Data from CCHS-HA respondents from British Columbia with MOVES were linked with Street Smart Walk Score™ data by postal code (n=2046). Mean MOVES was estimated across sociodemographic and health characteristics. Linear regression, adjusted for relevant covariates, was used to estimate the association between Street Smart Walk Score™ and the MOVES. The mean MOVES was 30.67 (95% confidence interval (CI) 30.36, 30.99), 5th percentile 23.27 (CI 22.16, 24.38) and 95th percentile was 36.93 (CI 35.98, 37.87). MOVES was higher for those who were younger, married, higher socioeconomic status, and had better health. In unadjusted models, for every 10 point increase in Street Smart Walk Score™, MOVES increased 4.84 points (CI 4.52, 5.15). However, results attenuated after adjustment for sociodemographic covariates: each 10 point increase in Street Smart Walk Score™ was associated with a 0.10 (CI 0.00, 0.20) point increase in MOVES. The modest but important link we observed between walkability and mobility highlights the implication of neighborhood design on the health of middle aged and older adults.
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Affiliation(s)
- Jana A Hirsch
- Department of Epidemiology and Biostatistics, University of South Carolina, USA; Centre for Hip Health and Mobility, University of British Columbia, Canada.
| | - Meghan Winters
- Centre for Hip Health and Mobility, University of British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Canada
| | - Philippa J Clarke
- Department of Epidemiology, University of Michigan, USA; Institute for Social Research, University of Michigan, USA
| | | | - Heather A McKay
- Centre for Hip Health and Mobility, University of British Columbia, Canada; Department of Family Practice, University of British Columbia, Canada; Department of Orthopaedics, University of British Columbia, Canada
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Ory MG, Towne SD, Won J, Forjuoh SN, Lee C. Social and environmental predictors of walking among older adults. BMC Geriatr 2016; 16:155. [PMID: 27553668 PMCID: PMC4995768 DOI: 10.1186/s12877-016-0327-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 08/13/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Regular physical activity (PA) is a major factor in maintaining health in aging populations. This study examines the influences of sociodemographic, health, and environmental characteristics on older adults' walking behaviors, and the role physicians can play in promoting physical activity. METHODS Online and paper surveys (n = 272) were distributed to community-dwelling older (age ≥ 60) adults from a large integrated healthcare system in two counties in Central Texas. Descriptive statistics were utilized to characterize participant's walking behaviors and places. Multivariate logistic regression was employed to predict being: 1) a frequent walker (i.e., walking at least three times a week); and 2) meeting the Centers for Disease Control and Prevention (CDC) PA recommendation through walking (i.e., walking ≥150 min per week), while considering sociodemographic, health, and environmental factors. RESULTS Individuals had a median age of 69 years, were of both genders (50.37 % female), and were primarily non-Hispanic White (84.87 %). While the majority (59.55 %) walked at least three times a week, only 27.86 % walked ≥150 min a week. Factors associated with a lower likelihood of being frequent walkers included experiencing poor mental health in the past month (OR = 0.345, 95 % CI = 0.185-0.645) and residing in areas with low or moderate (versus high) perceived neighborhood cohesion (OR = 0.471, 95 % CI = 0.228-0.974), while those in Census Tracts reflecting populations with a lower median age were more likely to report frequent walking behavior (OR = 1.799, 95 % CI = 1.034-3.131). Factors associated with a lower likelihood of meeting the CDC PA recommendation included being 60-69 years (versus 70 years or older) (OR = 0.538, 95 % CI = 0.290-0.997), experiencing poor mental health in the past month (OR = 0.432, 95 % CI = 0.198-0.944), and lacking social support for walking (OR = 0.383, 95 % CI = 0.154-0.957). CONCLUSION Given the health benefits, PA promotion must be seen as a national responsibility. In particular, physicians have a major role to play in communicating the importance of PA to their older patients and making discussions about strategies for overcoming barriers to walking an integral part of their clinical encounter with these patients.
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Affiliation(s)
- Marcia G. Ory
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center School of Public Health, College Station, Texas, 77843 USA
| | - Samuel D. Towne
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center School of Public Health, College Station, Texas, 77843 USA
| | - Jaewoong Won
- Department of Landscape Architecture and Urban Planning, Texas A&M, College Station, Texas, USA
| | - Samuel N. Forjuoh
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center School of Public Health, College Station, Texas, 77843 USA
- Department of Family & Community Medicine, Texas A&M Health Science Center, College Station, Texas, USA
- Baylor Scott & White Health, Temple, Texas, USA
| | - Chanam Lee
- Department of Landscape Architecture and Urban Planning, Texas A&M, College Station, Texas, USA
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Won J, Lee C, Forjuoh SN, Ory MG. Neighborhood safety factors associated with older adults' health-related outcomes: A systematic literature review. Soc Sci Med 2016; 165:177-186. [PMID: 27484353 DOI: 10.1016/j.socscimed.2016.07.024] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 07/17/2016] [Accepted: 07/21/2016] [Indexed: 01/08/2023]
Abstract
RATIONALE Neighborhood safety is important for older adults' health and wellbeing, but there has not been a synthesis in the literature of what is currently known about this construct. OBJECTIVES This systematic literature review, following the PRISMA guidelines, focuses on identifying neighborhood safety factors associated with health-related outcomes and behaviors of older adults in the U.S. METHODS A search was conducted in 2014 via Academic Search Complete, CINAHL, Embase, MEDLINE, SportDis, and Transportation Databases. Based on our inclusion and exclusion criteria, we identified thirty-two articles for review. RESULTS Sixteen studies examined health outcomes such as health status, mental health, physical function, morbidity/mortality, and obesity; the other sixteen studies focused on health behaviors, such as physical activity and walking. Four domains of neighborhood safety were identified: overall/general neighborhood safety; crime-related safety; traffic-related safety; and proxies for safety (e.g., vandalism, graffiti). Overall/general neighborhood safety appeared most relevant to mental health and physical function. Traffic-related safety was most pertinent to physical activity, while crime-related safety was more consistently associated with mental health and walking. While all safety variables were significantly associated with mental health, no significant associations were found for obesity. We also found that specific measures or constructs of safety were not applied consistently across the examined studies, making it difficult to compare the results. CONCLUSION This review identified several important gaps in the existing studies dealing with neighborhood safety-health relationships among older adults. Further studies are needed that examine the different roles of multidimensional neighborhood safety in promoting the community health, not only in the U.S., but globally.
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Affiliation(s)
- Jaewoong Won
- Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, 3137 TAMU, College Station, TX, 77843-3137, USA.
| | - Chanam Lee
- Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, 3137 TAMU, College Station, TX, 77843-3137, USA.
| | - Samuel N Forjuoh
- Department of Family & Community Medicine, Texas A&M HSC College of Medicine, Baylor Scott & White Health, Santa Fe - Century Square, 1402 West Ave H, Temple, TX 76504-5342, USA; Department of Health Promotion and Community Health Sciences, Texas A&M HSC School of Public Health, TAMU 1266, College Station, TX, 77843-1266, USA.
| | - Marcia G Ory
- Department of Health Promotion and Community Health Sciences, Texas A&M HSC School of Public Health, TAMU 1266, College Station, TX, 77843-1266, USA.
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Van Holle V, Van Cauwenberg J, Gheysen F, Van Dyck D, Deforche B, Van de Weghe N, De Bourdeaudhuij I. The Association between Belgian Older Adults' Physical Functioning and Physical Activity: What Is the Moderating Role of the Physical Environment? PLoS One 2016; 11:e0148398. [PMID: 26872017 PMCID: PMC4752465 DOI: 10.1371/journal.pone.0148398] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 01/17/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Better physical functioning in the elderly may be associated with higher physical activity levels. Since older adults spend a substantial part of the day in their residential neighborhood, the neighborhood physical environment may moderate associations between functioning and older adults' physical activity. The present study investigated the moderating role of the objective and perceived physical environment on associations between Belgian older adults' physical functioning and transport walking, recreational walking, and moderate-to-vigorous physical activity. METHODS Data from 438 older adults were included. Objective physical functioning was assessed using the Short Physical Performance Battery. Potential moderators included objective neighborhood walkability and perceptions of land use mix diversity, access to recreational facilities, access to services, street connectivity, physical barriers for walking, aesthetics, crime-related safety, traffic speeding-related safety, and walking infrastructure. Transport and recreational walking were self-reported, moderate-to-vigorous physical activity was assessed through accelerometers. Multi-level regression analyses were conducted using MLwiN to examine two-way interactions between functioning and the environment on both walking outcomes. Based on a previous study where environment x neighborhood income associations were found for Belgian older adults' moderate-to-vigorous physical activity, three-way functioning x environment x income interactions were examined for moderate-to-vigorous physical activity. RESULTS Objectively-measured walkability moderated the association between functioning and transport walking; this positive association was only present in high-walkable neighborhoods. Moreover, a three-way interaction was observed for moderate-to-vigorous physical activity. Only in high-income, high-walkable neighborhoods, there was a positive association between functioning and moderate-to-vigorous physical activity. No functioning x walkability interactions were observed for recreational walking, and none of the perceived environmental variables moderated the positive association between physical functioning and the physical activity outcomes. CONCLUSIONS For older adults with better physical functioning, living in a high-walkable neighborhood could be beneficial to engage in more transport walking. Living in high-income, high-walkable neighborhoods and having better functioning might also be beneficial for more engagement in moderate-to-vigorous physical activity. This might suggest a protective role of neighborhood walkability for preventing declining physical functioning and consequently decreasing physical activity levels in older adults. However, given the cross-sectional design of the present study, this suggestion needs to be confirmed through longitudinal assessment investigating over-time changes in the observed associations.
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Affiliation(s)
- Veerle Van Holle
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Jelle Van Cauwenberg
- Department of Public Health, Ghent University, Ghent, Belgium
- Department of Human Biometry and Biomechanics, Vrije Universiteit Brussel, Brussels, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Freja Gheysen
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Delfien Van Dyck
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Benedicte Deforche
- Department of Public Health, Ghent University, Ghent, Belgium
- Department of Human Biometry and Biomechanics, Vrije Universiteit Brussel, Brussels, Belgium
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Vandenberg AE, Hunter RH, Anderson LA, Bryant LL, Hooker SP, Satariano WA. Walking and Walkability: Is Wayfinding a Missing Link? Implications for Public Health Practice. J Phys Act Health 2016; 13:189-97. [PMID: 25965057 PMCID: PMC5578416 DOI: 10.1123/jpah.2014-0577] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Research on walking and walkability has yet to focus on wayfinding, the interactive, problem-solving process by which people use environmental information to locate themselves and navigate through various settings. METHODS We reviewed the literature on outdoor pedestrian-oriented wayfinding to examine its relationship to walking and walkability, 2 areas of importance to physical activity promotion. RESULTS Our findings document that wayfinding is cognitively demanding and can compete with other functions, including walking itself. Moreover, features of the environment can either facilitate or impede wayfinding, just as environmental features can influence walking. CONCLUSIONS Although there is still much to be learned about wayfinding and walking behaviors, our review helps frame the issues and lays out the importance of this area of research and practice.
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38
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Ivey SL, Kealey M, Kurtovich E, Hunter RH, Prohaska TR, Bayles CM, Satariano WA. Neighborhood characteristics and depressive symptoms in an older population. Aging Ment Health 2016; 19:713-22. [PMID: 25316114 DOI: 10.1080/13607863.2014.962006] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES We explored relationships between depressive symptoms and neighborhood environment measures including traffic safety, crime, social capital, and density of businesses in community-dwelling older adults from four different regions of the United States. METHOD The Healthy Aging Research Network walking study is a cross-sectional study of 884 adults aged 65+, which included a 10-item Center for Epidemiologic Studies Depression scale of depressive symptoms, demographics, self-reported neighborhood perceptions, and objective neighborhood data. RESULTS After adjusting for individual covariates, reports of neighborhood crime, unsafe traffic, and unwillingness of neighbors to help each other were significantly positively associated with depressive symptoms among participants. CONCLUSION This research suggests an association between self-reported depressive symptoms and the social and built environment; examining causal association requires additional longitudinal research in diverse populations of older adults.
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Affiliation(s)
- Susan L Ivey
- a Community Health and Human Development, School of Public Health , University of California , Berkeley , CA , USA
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Soma Y, Tsunoda K, Kitano N, Jindo T, Tsuji T, Saghazadeh M, Okura T. Relationship between built environment attributes and physical function in Japanese community-dwelling older adults. Geriatr Gerontol Int 2016; 17:382-390. [DOI: 10.1111/ggi.12717] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/16/2015] [Accepted: 11/22/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Yuki Soma
- Graduate School of Comprehensive Human Sciences; University of Tsukuba; Tsukuba Ibaraki Japan
| | - Kenji Tsunoda
- Physical Fitness Research Institute; Meiji Yasuda Life Foundation of Health and Welfare; Hachioji Tokyo Japan
| | - Naruki Kitano
- Sports Research & Development Core; University of Tsukuba; Tsukuba Ibaraki Japan
| | - Takashi Jindo
- Graduate School of Comprehensive Human Sciences; University of Tsukuba; Tsukuba Ibaraki Japan
- Japan Society for the Promotion of Science; Chiyoda Tokyo Japan
| | - Taishi Tsuji
- Center for Preventive Medical Science; Chiba University; Chuoh Chiba Japan
| | - Mahshid Saghazadeh
- Faculty of Health and Sport Sciences; University of Tsukuba; Tsukuba Ibaraki Japan
| | - Tomohiro Okura
- Faculty of Health and Sport Sciences; University of Tsukuba; Tsukuba Ibaraki Japan
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Yan T, Liang LJ, Vassar S, Katz MC, Escarce JJ, Longstreth WTJ, Merkin SS, Brown AF. Neighborhood Characteristics are Associated with Racial and Gender Variation in Walking among Older Adults: the Cardiovascular Health Study. Ethn Dis 2016; 26:17-26. [PMID: 26843792 DOI: 10.18865/ed.26.1.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To examine variation by race and gender in the association between neighborhood socioeconomic status and walking among community-dwelling older adults. DESIGN Cross-sectional. SETTING Cardiovascular Health Study, a longitudinal population-based cohort. PARTICIPANTS 4,849 adults, aged > 65 years. MEASUREMENTS Participants reported the number of city blocks walked in the prior week. Neighborhood socioeconomic status (NSES) was measured at the level of the census tract. Negative binominal regression models were constructed to test the association between NSES and blocks walked. In the fully adjusted models, we included two-way and three-way interaction terms among race, gender, and NSES. RESULTS In adjusted analyses, among White residents in the lowest NSES quartile (most disadvantaged), men walked 64% more than women (P<.001), while in the highest NSES (most advantaged), men walked 43% more than women (P<.001). Among African American residents in the lowest NSES quartile, men walked 196% more blocks than women (P<.001). CONCLUSIONS Female gender is more strongly associated with walking for African Americans than for Whites in low SES neighborhoods but had a similar association with walking for both African Americans and Whites in high SES neighborhoods.
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Affiliation(s)
| | - Li-Jung Liang
- UCLA Geffen School of Medicine, Department of Medicine, Division of General Internal Medicine and Health Services Research
| | - Stefanie Vassar
- UCLA Geffen School of Medicine, Department of Medicine, Division of General Internal Medicine and Health Services Research
| | | | - Jose J Escarce
- UCLA Geffen School of Medicine, Department of Medicine, Division of General Internal Medicine and Health Services Research
| | | | | | - Arleen F Brown
- UCLA Geffen School of Medicine, Department of Medicine, Division of General Internal Medicine and Health Services Research
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Cerin E, Sit CHP, Zhang CJP, Barnett A, Cheung MMC, Lai PC, Johnston JM, Lee RSY. Neighbourhood environment, physical activity, quality of life and depressive symptoms in Hong Kong older adults: a protocol for an observational study. BMJ Open 2016; 6:e010384. [PMID: 26733574 PMCID: PMC4716248 DOI: 10.1136/bmjopen-2015-010384] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The neighbourhood environment can assist the adoption and maintenance of an active lifestyle and affect the physical and mental well-being of older adults. The psychosocial and behavioural mechanisms through which the environment may affect physical and mental well-being are currently poorly understood. AIM This observational study aims to examine associations between the physical and social neighbourhood environments, physical activity, quality of life and depressive symptoms in Chinese Hong Kong older adults. METHODS AND ANALYSES An observational study of the associations of measures of the physical and social neighbourhood environment, and psychosocial factors, with physical activity, quality of life and depressive symptoms in 900 Hong Kong older adults aged 65+ years is being conducted in 2012-2016. The study involves two assessments taken 6 months apart. Neighbourhood walkability and access to destinations are objectively measured using Geographic Information Systems and environmental audits. Demographics, socioeconomic status, walking for different purposes, perceived neighbourhood and home environments, psychosocial factors, health status, social networks, depressive symptoms and quality of life are being assessed using validated interviewer-administered self-report measures and medical records. Physical functionality is being assessed using the Short Physical Performance Battery. Physical activity and sedentary behaviours are also being objectively measured in approximately 45% of participants using accelerometers over a week. Physical activity, sedentary behaviours, quality of life and depressive symptoms are being assessed twice (6 months apart) to examine seasonality effects on behaviours and their associations with quality of life and depressive symptoms. ETHICS AND DISSEMINATION The study received ethical approval from the University of Hong Kong Human Research Ethics Committee for Non-Clinical Faculties (EA270211) and the Department of Health (Hong Kong SAR). Data are stored in a password-protected secure database for 10 years, accessible only to the named researchers. Findings will be submitted for publication in peer-reviewed journals.
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Affiliation(s)
- Ester Cerin
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Cindy H P Sit
- Department of Sports Science and Physical Education, Faculty of Education, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Casper J P Zhang
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Anthony Barnett
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
- Institute for Health & Ageing, Australian Catholic University, Melbourne, Victoria, Australia
| | - Martin M C Cheung
- Elderly Health Service, Department of Health, The Government of Hong Kong Special Administrative Region, Hong Kong, China
| | - Poh-chin Lai
- Department of Geography, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Janice M Johnston
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Ruby S Y Lee
- Elderly Health Service, Department of Health, The Government of Hong Kong Special Administrative Region, Hong Kong, China
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Smith AR, Chen C, Clarke P, Gallagher NA. Trajectories of Outdoor Mobility in Vulnerable Community-Dwelling Elderly: The Role of Individual and Environmental Factors. J Aging Health 2015; 28:796-811. [PMID: 26486782 DOI: 10.1177/0898264315611665] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Outdoor mobility is critical for healthy aging, yet little is known about the factors influencing mobility in the frail elderly. We investigated the role of individual and community risk factors on trajectories of mobility in a population of vulnerable community-dwelling elderly. METHOD Using data from 1,188 older adults in Detroit, MI, who qualify for federally funded home care, a latent class growth analysis was used to model the frequency of going outside over a 15-month period. RESULTS Four latent trajectories were found: those with a low, high, and declining frequency of going outdoors over time, and those who do not go outdoors on a regular basis. Risk factors for membership in the homebound and infrequent mobility groups were older age, more severe mobility impairment, and fear of falling. Barriers at the entry to the home were associated with being homebound. DISCUSSION Declining health status and functional limitations are risk factors that pose a threat to outdoor mobility in the frail elderly, while housing barriers and community accessibility also merit attention.
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Farren L, Belza B, Allen P, Brolliar S, Brown DR, Cormier ML, Janicek S, Jones DL, King DK, Marquez DX, Rosenberg DE. Mall Walking Program Environments, Features, and Participants: A Scoping Review. Prev Chronic Dis 2015; 12:E129. [PMID: 26270743 PMCID: PMC4552141 DOI: 10.5888/pcd12.150027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Walking is a preferred and recommended physical activity for middle-aged and older adults, but many barriers exist, including concerns about safety (ie, personal security), falling, and inclement weather. Mall walking programs may overcome these barriers. The purpose of this study was to summarize the evidence on the health-related value of mall walking and mall walking programs. METHODS We conducted a scoping review of the literature to determine the features, environments, and benefits of mall walking programs using the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance). The inclusion criteria were articles that involved adults aged 45 years or older who walked in indoor or outdoor shopping malls. Exclusion criteria were articles that used malls as laboratory settings or focused on the mechanics of walking. We included published research studies, dissertations, theses, conference abstracts, syntheses, nonresearch articles, theoretical papers, editorials, reports, policy briefs, standards and guidelines, and nonresearch conference abstracts and proposals. Websites and articles written in a language other than English were excluded. RESULTS We located 254 articles on mall walking; 32 articles met our inclusion criteria. We found that malls provided safe, accessible, and affordable exercise environments for middle-aged and older adults. Programmatic features such as program leaders, blood pressure checks, and warm-up exercises facilitated participation. Individual benefits of mall walking programs included improvements in physical, social, and emotional well-being. Limited transportation to the mall was a barrier to participation. CONCLUSION We found the potential for mall walking programs to be implemented in various communities as a health promotion measure. However, the research on mall walking programs is limited and has weak study designs. More rigorous research is needed to define best practices for mall walking programs' reach, effectiveness, adoption, implementation, and maintenance.
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Affiliation(s)
- Laura Farren
- Health Promotion Research Center, University of Washington, 1107 NE 45th St, Suite 200, Box 354804, Seattle, WA 98105. . Ms Farren is now affiliated with the Mailman School of Public Health, Columbia University, New York, New York
| | - Basia Belza
- Health Promotion Research Center, University of Washington, Seattle, Washington
| | - Peg Allen
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Sarah Brolliar
- Health Promotion Research Center, University of Washington, Seattle, Washington
| | - David R Brown
- Centers for Disease Control and Prevention; Atlanta, Georgia
| | - Marc L Cormier
- Department of Orthopaedics, Division of Physical Therapy, and Injury Control Research Center, West Virginia University. Dr Cormier is now affiliated with the Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky
| | - Sarah Janicek
- University of Illinois at Chicago, Chicago, Illinois
| | - Dina L Jones
- Department of Orthopaedics, Division of Physical Therapy, and Injury Control Research Center, West Virginia University
| | - Diane K King
- Center for Behavioral Health Research and Services, University of Alaska Anchorage
| | | | - Dori E Rosenberg
- Health Promotion Research Center, University of Washington, Seattle, Washington
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Safe, Affordable, Convenient: Environmental Features of Malls and Other Public Spaces Used by Older Adults for Walking. J Phys Act Health 2015; 13:289-95. [PMID: 26181907 DOI: 10.1123/jpah.2015-0118] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Midlife and older adults use shopping malls for walking, but little research has examined mall characteristics that contribute to their walkability. METHODS We used modified versions of the Centers for Disease Control and Prevention (CDC)-Healthy Aging Research Network (HAN) Environmental Audit and the System for Observing Play and Recreation in Communities (SOPARC) tool to systematically observe 443 walkers in 10 shopping malls. We also observed 87 walkers in 6 community-based nonmall/nongym venues where older adults routinely walked for physical activity. RESULTS All venues had public transit stops and accessible parking. All malls and 67% of nonmalls had wayfinding aids, and most venues (81%) had an established circuitous walking route and clean, well-maintained public restrooms (94%). All venues had level floor surfaces, and one-half had benches along the walking route. Venues varied in hours of access, programming, tripping hazards, traffic control near entrances, and lighting. CONCLUSIONS Despite diversity in location, size, and purpose, the mall and nonmall venues audited shared numerous environmental features known to promote walking in older adults and few barriers to walking. Future research should consider programmatic features and outreach strategies to expand the use of malls and other suitable public spaces for walking.
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Gell NM, Rosenberg DE, Carlson J, Kerr J, Belza B. Built environment attributes related to GPS measured active trips in mid-life and older adults with mobility disabilities. Disabil Health J 2014; 8:290-5. [PMID: 25637503 DOI: 10.1016/j.dhjo.2014.12.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 10/27/2014] [Accepted: 12/15/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Understanding factors which may promote walking in mid-life and older adults with mobility impairments is key given the association between physical activity and positive health outcomes. OBJECTIVE To examine the relationship between active trips and objective measures of the home neighborhood built environment. METHODS Global positioning systems (GPS) data collected on 28 adults age 50+ with mobility disabilities were analyzed for active trips from home. Objective and geographic information systems (GIS) derived measures included Walk Score, population density, street connectivity, crime rates, and slope within the home neighborhood. For this cross-sectional observational study, we conducted mean comparisons between participants who took active trips from home and those who did not for the objective measures. Effect sizes were calculated to assess the magnitude of group differences. RESULTS Nine participants (32%) took active trips from home. Walking in the home neighborhood was significantly associated with GIS derived measures (Walk Score, population density, and street density; effect sizes 0.9-1.2). Participants who used the home neighborhood for active trips had less slope within 1 km of home but the difference was not significant (73.5 m ± 22 vs. 100.8 m ± 38.1, p = 0.06, d = 0.8). There were no statistically significant differences in mean scores for crime rates between those with active trips from home and those without. CONCLUSIONS The findings provide preliminary evidence that more walkable environments promote active mobility among mid-life and older adults with mobility disabilities. The data suggest that this population can and does use active transportation modes when the built environment is supportive.
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Affiliation(s)
- Nancy M Gell
- Group Health Research Institute, Seattle, WA, USA.
| | - Dori E Rosenberg
- Group Health Research Institute, Seattle, WA, USA; Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Jordan Carlson
- Family and Preventive Medicine, University of California, San Diego, CA, USA
| | - Jacqueline Kerr
- Family and Preventive Medicine, University of California, San Diego, CA, USA; Center for Wireless & Population Health Systems, University of California, San Diego, CA, USA
| | - Basia Belza
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA; Health Promotion Research Center, Department of Health Services, University of Washington, Seattle, WA, USA; Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA
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Yen IH, Fandel Flood J, Thompson H, Anderson LA, Wong G. How design of places promotes or inhibits mobility of older adults: realist synthesis of 20 years of research. J Aging Health 2014; 26:1340-72. [PMID: 24788714 PMCID: PMC4535337 DOI: 10.1177/0898264314527610] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this study was to determine the environmental features that best support aging in place. METHOD We conducted a realist synthesis, a theory-driven interpretive method of evidence synthesis, of 120+ articles (published 1991-2011) that attempts to explain how place may influence older adults' decisions about mobility (e.g., physical activity). We developed an initial program theory, reviewed the literature, identified outcomes, analyzed and synthesized patterns, and created a final program theory. RESULTS Safety was a central mechanism, serving as one of the bridges between environmental components (e.g., connectivity, aesthetics, retail and services) and decisions about mobility. Population density, sidewalk presence, and park proximity did not emerge as key factors. DISCUSSION Safety considerations are one of the most prominent influences of older adults' decisions about mobility. Street connectivity, pedestrian access and transit, and retail and services were also important. These factors are amenable to change and can help promote mobility for older adults.
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Affiliation(s)
- Irene H Yen
- University of California, San Francisco, USA
| | | | | | - Lynda A Anderson
- Centers for Disease Control and Prevention, Atlanta, GA, USA Rollins School of Public Health, Atlanta, GA, USA
| | - Geoff Wong
- Barts and the London School of Medicine and Dentistry, London, UK
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Satariano WA, Kealey M, Hubbard A, Kurtovich E, Ivey SL, Bayles CM, Hunter RH, Prohaska TR. Mobility Disability in Older Adults: At the Intersection of People and Places. THE GERONTOLOGIST 2014; 56:525-34. [PMID: 25326342 DOI: 10.1093/geront/gnu094] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 09/08/2014] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Mobility disability is associated with poor lower body function among older adults. This study examines whether specific types of neighborhood characteristics moderate that association. DESIGN AND METHODS This study is based on a cross-sectional sample of 884 people aged ≥ 65 years identified through service organizations in Alameda County, CA; Cook County, IL; Allegheny County, PA; and Wake and Durham counties, NC. In-person interviews focus on neighborhood characteristics, physical and cognitive function, depression, and walking. Functional capacity is tested using objective measures of lower body strength, balance, and walking speed. Mobility disability, the main study outcome, is measured as self-reported level of difficulty in walking 2-3 neighborhood blocks. Estimates of main and interactive effects are derived from logistic regression models. RESULTS Among older adults with poor lower body function, those who report less proximity to goods and services and barriers to walking report more mobility disability than other older adults. In contrast, among older adults with good lower body function, there is a low prevalence of mobility disability and little association between perceptions of the neighborhood and mobility disability. IMPLICATIONS In addition to more refined longitudinal studies, this research provides a foundation for innovative place-based rehabilitation and hospital discharge programs for older adults newly diagnosed and treated for chronic health conditions.
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Affiliation(s)
| | - Melissa Kealey
- School of Public Health, University of California, Berkeley
| | - Alan Hubbard
- School of Public Health, University of California, Berkeley
| | | | - Susan L Ivey
- School of Public Health, University of California, Berkeley
| | - Constance M Bayles
- Center for Social and Urban Research, University of Pittsburgh, Pennsylvania
| | - Rebecca H Hunter
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill
| | - Thomas R Prohaska
- College of Health and Human Services, George Mason University, Fairfax, Virginia
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Rantakokko M, Iwarsson S, Portegijs E, Viljanen A, Rantanen T. Associations between environmental characteristics and life-space mobility in community-dwelling older people. J Aging Health 2014; 27:606-21. [PMID: 25326130 DOI: 10.1177/0898264314555328] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Gong Y, Gallacher J, Palmer S, Fone D. Neighbourhood green space, physical function and participation in physical activities among elderly men: the Caerphilly Prospective study. Int J Behav Nutr Phys Act 2014; 11:40. [PMID: 24646136 PMCID: PMC3994572 DOI: 10.1186/1479-5868-11-40] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 03/05/2014] [Indexed: 11/12/2022] Open
Abstract
Background The built environment in which older people live plays an important role in promoting or inhibiting physical activity. Most work on this complex relationship between physical activity and the environment has excluded people with reduced physical function or ignored the difference between groups with different levels of physical function. This study aims to explore the role of neighbourhood green space in determining levels of participation in physical activity among elderly men with different levels of lower extremity physical function. Method Using data collected from the Caerphilly Prospective Study (CaPS) and green space data collected from high resolution Landmap true colour aerial photography, we first investigated the effect of the quantity of neighbourhood green space and the variation in neighbourhood vegetation on participation in physical activity for 1,010 men aged 66 and over in Caerphilly county borough, Wales, UK. Second, we explored whether neighbourhood green space affects groups with different levels of lower extremity physical function in different ways. Results Increasing percentage of green space within a 400 meters radius buffer around the home was significantly associated with more participation in physical activity after adjusting for lower extremity physical function, psychological distress, general health, car ownership, age group, marital status, social class, education level and other environmental factors (OR = 1.21, 95% CI 1.05, 1.41). A statistically significant interaction between the variation in neighbourhood vegetation and lower extremity physical function was observed (OR = 1.92, 95% CI 1.12, 3.28). Conclusion Elderly men living in neighbourhoods with more green space have higher levels of participation in regular physical activity. The association between variation in neighbourhood vegetation and regular physical activity varied according to lower extremity physical function. Subjects reporting poor lower extremity physical function living in neighbourhoods with more homogeneous vegetation (i.e. low variation) were more likely to participate in regular physical activity than those living in neighbourhoods with less homogeneous vegetation (i.e. high variation). Good lower extremity physical function reduced the adverse effect of high variation vegetation on participation in regular physical activity. This provides a basis for the future development of novel interventions that aim to increase levels of physical activity in later life, and has implications for planning policy to design, preserve, facilitate and encourage the use of green space near home.
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Affiliation(s)
- Yi Gong
- Sustainable Places Research Institute, Cardiff University, Cardiff, Wales, UK.
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Garin N, Olaya B, Miret M, Ayuso-Mateos JL, Power M, Bucciarelli P, Haro JM. Built environment and elderly population health: a comprehensive literature review. Clin Pract Epidemiol Ment Health 2014; 10:103-15. [PMID: 25356084 PMCID: PMC4211137 DOI: 10.2174/1745017901410010103] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 07/17/2014] [Accepted: 08/02/2014] [Indexed: 04/15/2023]
Abstract
Global population aging over recent years has been linked to poorer health outcomes and higher healthcare expenditure. Policies focusing on healthy aging are currently being developed but a complete understanding of health determinants is needed to guide these efforts. The built environment and other external factors have been added to the International Classification of Functioning as important determinants of health and disability. Although the relationship between the built environment and health has been widely examined in working age adults, research focusing on elderly people is relatively recent. In this review, we provide a comprehensive synthesis of the evidence on the built environment and health in the elderly.
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Affiliation(s)
- Noe Garin
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona. Dr Antoni Pujades, 42, 08830, Sant Boi de Llobregat, Bar-celona, Spain
- Fundació Sant Joan de Déu. Santa Rosa, 39-57, 08950. Esplugues de Llobregat, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM. Monforte de Lemos 3-5. Pabellón 11. 28029 Madrid, Spain
| | - Beatriz Olaya
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona. Dr Antoni Pujades, 42, 08830, Sant Boi de Llobregat, Bar-celona, Spain
- Fundació Sant Joan de Déu. Santa Rosa, 39-57, 08950. Esplugues de Llobregat, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM. Monforte de Lemos 3-5. Pabellón 11. 28029 Madrid, Spain
| | - Marta Miret
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM. Monforte de Lemos 3-5. Pabellón 11. 28029 Madrid, Spain
- Department of Psychiatry, Universidad Autónoma de Madrid. Arzobispo Morcillo s/n 28029 Madrid, Spain
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP). Diego de León, 62, 28006. Madrid, Spain
| | - Jose Luis Ayuso-Mateos
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM. Monforte de Lemos 3-5. Pabellón 11. 28029 Madrid, Spain
- Department of Psychiatry, Universidad Autónoma de Madrid. Arzobispo Morcillo s/n 28029 Madrid, Spain
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP). Diego de León, 62, 28006. Madrid, Spain
| | - Michael Power
- Instituto de Salud Carlos III; Department of Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Paola Bucciarelli
- Scientific Directorate, Neurological Institute Carlo Besta, Milan, Via Celoria 11, Italy
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona. Dr Antoni Pujades, 42, 08830, Sant Boi de Llobregat, Bar-celona, Spain
- Fundació Sant Joan de Déu. Santa Rosa, 39-57, 08950. Esplugues de Llobregat, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM. Monforte de Lemos 3-5. Pabellón 11. 28029 Madrid, Spain
- Address correspondence to this author at the Parc Sanitari Sant Joan de Déu, Universitat de Barcelona. Dr Antoni Pujades, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain; Tel: +34 936406350; Fax: +34 935569674;
E-mail:
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