The role of the built environment and assistive devices for outdoor mobility in later life

The Relationship Between Physical Housing Characteristics, Housing Accessibility and Different Aspects of Health Among Community-Dwelling Older People: A Systematic Review

Objectives: To synthesize the evidence on the relationships between physical housing characteristics or housing accessibility and different aspects of health among community-dwelling people 60 years and older. Methods: A systematic review of recent evidence with a narrative synthesis was conducted. Results: We included 15 studies and found three themes covering physical housing characteristics or housing accessibility that are associated with aspects of health among community-dwelling older adults: (1) interventions by home modifications targeting housing features both at entrances and indoors; (2) non-interventions targeting indoor features; (3) non-interventions targeting entrance features, that is, the presence of an elevator or stairs at the entrance. The overall quality of evidence across studies was assessed as very low. Discussion: The findings highlight the need for studies with a stronger research design and higher methodological quality that address the physical housing environment in relation to health among older adults to strengthen the body of evidence.

A Scoping Review of Personal, Financial, and Environmental Determinants of Mobility Among Older Adults

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.

Exploring outdoor activity limitation (OAL) factors among older adults using interpretable machine learning

BACKGROUND

The occurrence of outdoor activity limitation (OAL) among older adults is influenced by multidimensional and confounding factors associated with aging.

AIM

The aim of this study was to apply interpretable machine learning (ML) to develop models for multidimensional aging constraints on OAL and identify the most predictive constraints and dimensions across multidimensional aging data.

METHODS

This study involved 6794 community-dwelling participants older than 65 from the National Health and Aging Trends Study (NHATS). Predictors included related to six dimensions: sociodemographics, health condition, physical capacity, neurological manifestation, daily living habits and abilities, and environmental conditions. Multidimensional interpretable machine learning models were assembled for model construction and analysis.

RESULTS

The multidimensional model demonstrated the best predictive performance (AUC: 0.918) compared to the six sub-dimensional models. Among the six dimensions, physical capacity had the most remarkable prediction (AUC: physical capacity: 0.895, daily habits and abilities: 0.828, physical health: 0.826, neurological performance: 0.789, sociodemographic: 0.773, and environment condition: 0.623). The top-ranked predictors were SPPB score, lifting ability, leg strength, free kneeling, laundry mode, self-rated health, age, attitude toward outdoor recreation, standing time on one foot with eyes open, and fear of falling.

DISCUSSION

Reversible and variable factors, which are higher in the set of high-contribution constraints, should be prioritized as the main contributing group in terms of interventions.

CONCLUSION

The integration of potentially reversible factors, such as neurological performance in addition to physical function into ML models, yields a more accurate assessment of OAL risk, which provides insights for targeted, sequential interventions for older adults with OAL.

Designing environments that contribute to a reduction in the progression of Parkinson's disease; a literature review

Parkinson's Disease (PD), a prevalent neurological disorder, causes physical difficulties like stiffness and impaired walking and affects patients' emotional well-being. Regular exercise and exposure to enriched environments are crucial to managing these symptoms. This review aims to extract evidence from studies regarding built environments' impact on reducing the progression of PD. Keywords from 2005 to 2022 were used in five databases, including PubMed, Clarivate Web of Science, UGA Library, and Google Scholar. Many studies emphasized physiotherapy and training for physical enhancement, often utilizing virtual games and smart devices. Others highlighted the advantages of non-slip flooring and accessible outdoor spaces, with some based on universal design principles. Few studies considered the emotional impact of built environments, showing a considerable gap in the studies simultaneously evaluating psychological and physical perspectives of Parkinson-friendly environments. There needs to be more consistency when considering these aspects of planning. Our findings suggest future research modeling enriched environments and tracking their impact on patients via Virtual Reality to find a comprehensive guideline for the most effective PD management environments.

Safety Concerns in Mobility-Assistive Products for Older Adults: Content Analysis of Online Reviews

BACKGROUND

Older adults who have difficulty moving around are commonly advised to adopt mobility-assistive devices to prevent injuries. However, limited evidence exists on the safety of these devices. Existing data sources such as the National Electronic Injury Surveillance System tend to focus on injury description rather than the underlying context, thus providing little to no actionable information regarding the safety of these devices. Although online reviews are often used by consumers to assess the safety of products, prior studies have not explored consumer-reported injuries and safety concerns within online reviews of mobility-assistive devices.

OBJECTIVE

This study aimed to investigate injury types and contexts stemming from the use of mobility-assistive devices, as reported by older adults or their caregivers in online reviews. It not only identified injury severities and mobility-assistive device failure pathways but also shed light on the development of safety information and protocols for these products.

METHODS

Reviews concerning assistive devices were extracted from the "assistive aid" categories, which are typically intended for older adult use, on Amazon's US website. The extracted reviews were filtered so that only those pertaining to mobility-assistive devices (canes, gait or transfer belts, ramps, walkers or rollators, and wheelchairs or transport chairs) were retained. We conducted large-scale content analysis of these 48,886 retained reviews by coding them according to injury type (no injury, potential future injury, minor injury, and major injury) and injury pathway (device critical component breakage or decoupling; unintended movement; instability; poor, uneven surface handling; and trip hazards). Coding efforts were carried out across 2 separate phases in which the team manually verified all instances coded as minor injury, major injury, or potential future injury and established interrater reliability to validate coding efforts.

RESULTS

The content analysis provided a better understanding of the contexts and conditions leading to user injury, as well as the severity of injuries associated with these mobility-assistive devices. Injury pathways-device critical component failures; unintended device movement; poor, uneven surface handling; instability; and trip hazards-were identified for 5 product types (canes, gait and transfer belts, ramps, walkers and rollators, and wheelchairs and transport chairs). Outcomes were normalized per 10,000 posting counts (online reviews) mentioning minor injury, major injury, or potential future injury by product category. Overall, per 10,000 reviews, 240 (2.4%) described mobility-assistive equipment-related user injuries, whereas 2318 (23.18%) revealed potential future injuries.

CONCLUSIONS

This study highlights mobility-assistive device injury contexts and severities, suggesting that consumers who posted online reviews attribute most serious injuries to a defective item, rather than user misuse. It implies that many mobility-assistive device injuries may be preventable through patient and caregiver education on how to evaluate new and existing equipment for risk of potential future injury.

Using machine learning to examine associations between the built environment and physical function: A feasibility study

Linking geospatial neighbourhood design characteristics to health and behavioural data from population-representative cohorts is limited by data availability and difficulty collecting information on environmental characteristics (e.g. greenery, building setbacks, dwelling structure). As an alternative, this study examined the feasibility of Generative Adversarial Networks (GANs) - machine learning - to measure neighbourhood design using 'street view' and aerial imagery to explore the relationship between the built environment and physical function. This study included 3102 adults aged 45 years and older clustered in 200 neighbourhoods in 2016 from the How Areas in Brisbane Influence Health and Activity (HABITAT) project in Brisbane, Australia. Exposure data were Google Street View and Google Maps images from within the 200 neighbourhoods, and outcome data were self-reported physical function using the PF-10 (a subset of the SF-36). Physical function scores were aggregated to the neighbourhood level, and the highest and lowest 20 neighbourhoods respectively were used in analysis. We found that the aerial imagery retrieved was unable to be used to adequately train the model, meaning that aerial imagery failed to produce meaningful results. Of the street view images, n = 56,330 images were downloaded and used to train the GAN model. Model outputs included augmented street view images between neighbourhoods classed as having high function and low function residents. The GAN model detected differences in neighbourhood design characteristics between neighbourhoods classed as high and low physical function at the aggregate level. Specifically, differences were identified in urban greenery (including tree heights) and dwelling structure (e.g. building height). This study provides important lessons for future work in this field, especially related to the uniqueness, diversity and amount of imagery required for successful applications of deep learning methods.

Neighborhood environmental attributes and walking mobility decline: A longitudinal ecological study of mid-to-older aged Australian adults

OBJECTIVES

Cross-sectional studies have found some built environmental attributes to be associated with residents' lower levels of mobility (functional capacity to walk outside the home). However, less is known about what environmental attributes are related to mobility decline. This longitudinal study examined area-level associations of specific environmental attributes with mid-to-older aged adults' changes in walking mobility.

METHODS

Data collected from 4,088 adults (aged 46-71 years at baseline) who participated in a cohort study in Brisbane, Australia were used. The outcome was the change in self-reported mobility score (SF-36) from 2013 to 2016, which were aggregated at the neighborhood (N = 156) and suburb (N = 99) levels, due to the known lack of sensitivity in SF-36 subscales to individual changes. Linear regression analysis examined associations of mobility change with seven environmental attributes measured at baseline (residential density, intersection density, land use mix, density of walking/bike paths, park density, bus stop density, density of social incivilities), adjusting for confounding variables.

RESULTS

Participants on average reported 4% of mobility decline during the 3-year study period. It was found that greater land use diversity was consistently associated with less decline in walking mobility, while greater density of social incivilities was associated with more decline in walking mobility. The latter finding was significant only at the neighborhood level. No consistent associations were observed for residential density, intersection density, density of walking/bike paths, park density, and bus stop density.

DISCUSSION

Our findings suggest that mid-to-older aged adults who live in areas with lower land use diversity and more social incivilities may be at risk of developing mobility limitations. Recommended policies to slow residents' mobility decline and to achieve aging in place include improving these environmental attributes where needed and advising older adults to relocate to safer, mixed-use neighborhoods.

Mobility impact and well-being in later life: A multidisciplinary systematic review

In modern societies, the understanding of how active mobility affects the elderly's psycho-physical well-being is crucial to design ageing-friendly transport measures. From a multidisciplinary perspective, this systematic review points out the mobility impact on three elements of the EU Active Ageing Index: health, independence and social connectedness. By scanning four databases (Scopus, Web of Science, PubMed, and TRID), 3727 peer-reviewed papers published in the last decade were found, of which 57 met the inclusion criteria. The screening process was conducted following the PRISMA protocol and registered to the database PROSPERO, while the quality assessment was done using the Mixed Methods Appraisal Tool. More than 80% of the papers showed that an active mobility prevents psycho-physical harms, while only few papers study the relation of mobility with independence and social inclusion, to reduce the need for assistance and the related public expenditures. The findings of this review give important information both to transportation researchers and policymakers and companies, underlining the need for further research as well as investments in targeted age-friendly transport systems. The Covid-19 emergency has further underlined the importance of this issue, being the elderly one of the more disadvantaged and frailer social group.

Understanding key home and community environment challenges encountered by older adults undergoing total knee or hip arthroplasty

BACKGROUND AND OBJECTIVES

Older adults undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) experience significant challenges while navigating their homes post-surgery and are at higher risk for falls and injuries. This study explored specific home and community physical environment challenges faced by community-dwelling older adults while performing daily activities and actions taken to modify their homes before surgery.

RESEARCH DESIGN AND METHODS

Using a qualitative descriptive methodology, semi-structured interviews were conducted with 22 older adult-care partner dyads pre- and post-surgery to identify key built environment barriers and facilitators in addition to home modifications made pre-and post-surgery.

RESULTS

Challenges anticipated by participants to perform daily activities pre-surgery varied from those experienced post-surgery. Lack of support along stairs or in bathrooms, flooring material, and transitions were significant concerns raised by participants pre-surgery. Size and layout of home and ergonomics of resting furniture were recognized as issues post-surgery. Modifications ranged from easy fixes like rearranging furniture, removing clutter, installing grab bars to high-cost structural changes like remodeling critical spaces like bathrooms. Although participants agreed on the importance of conducting proactive home assessments and modifications before surgery, perceived costs, and lack of knowledge or services limit older adults from implementing some changes.

DISCUSSION AND IMPLICATIONS

Home modifications must be considered proactively before an event such as a THA or TKA. These should be done within the context of the specific needs, abilities, financial capabilities, and social and physical home environments of the individual and the residential caregivers.

Associations of Neighborhood Walkability and Walking Behaviors by Cognitive Trajectory in Older Adults

BACKGROUND AND OBJECTIVES

Lawton's Ecological Model of Aging suggests that associations between environment and mobility differ based on individual factors such as cognitive decline.

RESEARCH DESIGN AND METHODS

Virtual walkability audits were conducted within 1/8 mile of residences of older adults (n = 545; average age = 82; 57% female; 33% Black) who had been enrolled in the Health, Aging, and Body Composition (Health ABC) cohort for 10 years. The primary outcome was self-reported walking in past week and the secondary was mobility disability, self-reported difficulty to walk ¼ mile. Linear mixed models of general cognitive function over the prior 10 years calculated participant-specific slopes; those below 0 were cognitive decliners. Logistic regression models, adjusted for demographics and neighborhood socioeconomic status, tested associations between each walkability variable and each mobility outcome. Interaction terms between walkability and cognitive status were tested and walkability analyses stratified on cognitive status where p for interaction < .2.

RESULTS

In the sample, 57.4% reported walking, 24.2% reported mobility disability, and 51% were cognitive decliners. Sidewalk quality was related to walking in cognitive maintainers; slope was related in decliners. Mixed land use (odds ratio [OR] = 1.61; 95% confidence interval [CI]: 1.12, 2.30) and senior residence (OR = 2.14; 95% CI: 1.27, 3.60) were related to greater walking, regardless of cognitive status. Mixed land use was related to less mobility disability in decliners and abandoned properties were related to greater mobility disability in maintainers.

DISCUSSION AND IMPLICATIONS

Policy-level interventions targeted at walkability, including improved sidewalk quality and increasing mixed land use could support walking in older adults, regardless of cognitive status.

Walking-friendly built environments and objectively measured physical function in older adults

BACKGROUND

Few studies have examined the associations between urban design attributes and older adults' physical function. Especially, it is not well known how built-environment attributes may influence physical function in Asian cities. The aim of this study was to examine associations between objectively measured environmental attributes of walkability and objectively assessed physical function in a sample of Japanese older adults.

METHODS

Cross-sectional data collected in 2013 from 314 older residents (aged 65-84 years) living in Japan were used. Physical function was estimated from objectively measured upper- and lower-body function, mobility, and balance by a trained research team member. A comprehensive list of built-environment attributes, including population density, availability of destinations, intersection density, and distance to the nearest public transport station, were objectively calculated. Walk Score as a composite measure of neighborhood walkability was also obtained.

RESULTS

Among men, higher population density, availability of destinations, and intersection density were significantly associated with better physical function performance (1-legged stance with eyes open). Higher Walk Score was also marginally associated with better physical function performance (1-legged stance with eyes open). None of the environmental attributes were associated with physical function in elderly women.

CONCLUSION

Our findings indicate that environmental attributes of walkability are associated with the physical function of elderly men in the context of Asia. Walking-friendly neighborhoods can not only promote older adults' active behaviors but can also support their physical function.

Rehabilitation professional and user evaluation of an integrated push-pull lever drive system for wheelchair mobility

Wheeled mobility devices enable persons with limited mobility to maintain an independent lifestyle. Lever-drive propulsion options have been shown to increase wheeled mobility device efficiency while reducing physical strain on users. Despite these benefits, they have not been widely adopted for everyday use. Two novel lever-drive devices (RoScooter and RoTrike) provide an alternative to pushrim propulsion by using an integrated front-and-center push-pull lever mechanism. The objectives of this study were to assess the usability and performance of the lever-drive devices using both rehabilitation professional and user feedback. The study enrolled 17 rehabilitation professionals and 13 users who performed various mobility tasks to rate the performance of the RoScooter and RoTrike for ease of use, stability, safety, appearance, and comfort. Users were graded on their performance using a scoring system based on the Wheelchair Skills Test. Rehabilitation professionals suggested improvements in regard to adjustability, maneuverability, target population, and appearance, preferring the operations of the RoScooter to the RoTrike. Users reported that the devices were entertaining and easy to use, but improvements in adjustability, reversal methods, and operation options to appeal to a wider range of consumers are needed before lever-drive devices are suitable to replace or supplement current wheeled mobility devices.

Trajectories of Homebound Status in Medicare Beneficiaries Aged 65 and Older

BACKGROUND AND OBJECTIVES

The purpose of this study was to examine the trajectories of homebound status in older adults and to investigate the risk factors in shaping the pattern of these trajectories.

RESEARCH DESIGN AND METHODS

The study sample was a nationally representative sample of Medicare beneficiaries aged 65 and older (N = 7,607) from the National Health and Aging Trends Study (Round 1-Round 7). Homebound state was defined as never or rarely went out the home in the last month. Homebound trajectories were identified using an enhanced group-based trajectory modeling that accounted for nonrandom attrition. Multinomial logistic regression was used to examine risk factors of homebound trajectories.

RESULTS

Three trajectory groups were identified: the "never" group (65.5%) remained nonhomebound; the "chronic" group were largely persistently homebound (8.3%); and the "onset" group (26.2%) had a rapid increase in their risk of being homebound over the 7-year period. The following factors increased the relative risk for being on the "onset" and "chronic" versus the "never" trajectory: older age, Hispanic ethnicity, social isolation, past or current smoking, instrumental activities of daily living limitations, probable dementia, and use of a walker or wheelchair. Male sex and living alone were associated with a lower risk of being on the "chronic" trajectory, whereas depression and anxiety symptoms, chronic conditions, and activities of daily living limitations increased the risk.

DISCUSSION AND IMPLICATIONS

The progression of homebound status among community-dwelling older adults followed three distinct trajectories over a 7-year period. Addressing social isolation and other risk factors may prevent or delay the progression to homebound state.

Mobility scooters in urban environments: A research agenda

INTRODUCTION

As our society ages, mobility scooters are a fast-growing mode of transportation. The growing prevalence of mobility scooters as a mode of transportation has the potential to not only affect the lives of older adults who use them but to impact urban environments at large as well as have implications for the safety of pedestrians and of other vehicle users.

GOAL

The goal of this paper is to explore the gaps in the existing literature regarding mobility scooters, laying out key areas for future research.

RESULTS

We propose three areas of research that focus on mobility scooter use by older people: (1) research involving users - impacts on older people employing mobility scooters; (2) studying the impact on urban space - public spaces and passageways used as travel routes, the barriers impeding travel and lack of appropriate parking solutions in the urban environment; and (3) issues of safety - mobility scooter driving and travel regulations and infrastructure design regulations.

DISCUSSION

Addressing these gaps in knowledge has the potential to contribute to the social and physical sustainability of future urban environments as well as to the wellbeing of older adults.

Interrater Reliability of Historical Virtual Audits Using Archived Google Street View Imagery

Impaired mobility occurs in up to half of community-dwelling older adults and is associated with poor health outcomes and high health care costs. Although the built environment impacts mobility, most studies of older adults lack information about environmental-level factors. In-person observational audits can be utilized but cannot assess the historical environment. We applied a 78-item checklist to archived Google Street View imagery to assess historical residence access and neighborhood characteristics. Interrater reliability between two raters was tested on 50 addresses using prevalence-adjusted and bias-adjusted kappa (PABAK). The mean PABAK for all items was .75, with 81% of the items having substantial (PABAK ≥ .61) or almost perfect (PABAK ≥ .81) agreement. Environmental assessment using archived virtual imagery has excellent reliability for factors related to residence access and many neighborhood characteristics. Archived imagery can assess past neighborhood characteristics, facilitating the use of historical environment data within existing cohorts.

Independent living with mobility restrictions: older people's perceptions of their out-of-home mobility

We studied older people's perceptions of how they organise their out-of-home mobility and independent living when they face mobility restrictions, based on seven focus groups with older people (N = 28) from a suburb in Finland. This article provides an everyday life view of how the ability to move outside the home evolves through interdependencies between older people and their neighbourhoods, social relations and societal arrangements. Our findings show that supportive socio-material surroundings can provide older people with new ways to move outside their home despite mobility restrictions and new ways to organise their daily life with decreased mobility. In contrast, restrictive socio-material surroundings can lead to situations in which older people forgo certain out-of-home journeys and activities. The findings contribute to an understanding that organising one's daily life and out-of-home mobility is an act of interdependence. Policies promoting independent living in old age should recognise these fundamental interdependencies and support versatile ways of living rather than overemphasise activity and self-reliance. Based on older people's everyday life perspectives, both sides of the coin need to be considered: how to enable the out-of-home mobility of older people facing mobility restrictions and how to support them in managing and enjoying daily life with decreased mobility.

Social Participation Among Adults Aging With Long-Term Physical Disability: The Role of Socioenvironmental Factors

Objective: This study examined the environmental barriers and facilitators that hinder or promote participation among adults aging with physical disabilities. Method: Data come from an ongoing study of 1,331 individuals aging with long-term physical disability (M = 65 years). Linear regression examined the association between individual and socioenvironmental factors and participation restrictions in work, leisure, and social activities. Results: Pain, fatigue, and physical functional limitations were significant barriers to participation for individuals aging with physical disability. Barriers in the built environment also reduced participation, net of health and functioning. Poor access to buildings was especially problematic for participation among individuals not using any mobility aid to get around. But for those using wheel or walking aids, environmental barriers had no adverse effect on participation. Discussion: These findings highlight the importance of disentangling the role of different environmental factors by distinguishing between assistive technology for mobility and the physical built environment, including their interactive effects.

Lived experiences of people with mobility-related disability using assistive devices

PURPOSE

Assistive devices (ADs) are an essential component for people with disability to achieve functional independence and improved quality of life. The current study explored lived experiences of adults with mobility related disability using ADs, with reference to access to ADs, facilitators and barriers in access, use and adaptation of devices and whether any changes experienced after use of ADs.

MATERIALS AND METHODS

Data were collected through interviews using narrative inquiry approach with 25 individuals having mobility related disabilities and who had experience of using one or more ADs for minimum 12 months. Transcripts were analyzed using thematic analysis procedure.

RESULTS

The analysis resulted in four main themes. The first theme of "access to ADs" revealed apathy of and disappointment towards public health service providers. The second theme "life with ADs" described personal and social adaptation of ADs. Third important theme was "barriers to use of ADs" which brought out physical barriers in public places, lack of home modification, and inaccessible built environment. Major concern was economic dependence, out of pocket expenditure and lack of services for maintenance and upgradation of ADs. The last theme "achieving a better life" described a sense of achievement with ease of mobility, relief of agony and gaining independence.

CONCLUSION

In spite of the challenging experiences of disability, usage of ADs has increased social participation, independence and self-esteem. These major components helped participants to achieve "normalcy" in life.Implications for rehabilitationEarly identification of need of AD is necessary to support disabled individualAvailability, accessibility and affordability of appropriate devices at public health centres will improve rehabilitationRaising awareness and removing stigma about ADs will improve utilization of rehabilitative servicesTimely use and use of appropriate devices are necessary to improve quality of lifeUpgradation and maintenance of devices is a major concern which need to be linked with rehabilitation service provision.

Neighbourhood built environment and physical function among mid-to-older aged adults: A systematic review

This systematic review included 23 quantitative studies that estimated associations between aspects of the neighbourhood built environment and physical function among adults aged ≥45 years. Findings were analysed according to nine aspects of the neighbourhood built environment: walkability, residential density, street connectivity, land use mix, public transport, pedestrian infrastructure, aesthetics, safety and traffic. Evidence was found for a positive association of pedestrian infrastructure and aesthetics with physical function, while weaker evidence was found for land use mix, and safety from crime and traffic. There was an insufficient number of studies for walkability, residential density, street connectivity and access to public transport.

What features of the built environment matter most for mobility? Using wearable sensors to capture real-time outdoor environment demand on gait performance

BACKGROUND

A growing body of research has demonstrated relationships between built environment characteristics and outdoor mobility. However, most of this work has relied on composite scores of the built environment.

RESEARCH QUESTION

Which properties of the outdoor built environment are associated with the greatest change in gait metrics in a real-world setting?

METHODS

25 community-dwelling adults from Southeast Michigan were equipped with mobile inertial measurement units and walked a 1300-meter outdoor course with varying environmental demands. Environmental properties were documented in sections of the course using the Senior Walking Environmental Assessment Tool. Gait speed, left foot cadence, and stride length were used to identify the built environment properties under which mobility was most challenged using linear mixed models. We hypothesized that subjects would adapt to demanding environments by decreasing gait speed, increasing cadence, and shortening stride length.

RESULTS

Properties of the built environment were significantly associated with changes in gait speed, left foot cadence, and stride length. Properties that were most important for predicting gait speed included slope, sidewalk condition, and presence of holes. Sidewalk slope, bumps, and the presence of a curb cut were all significant predictors of left foot cadence. Mean stride length of the outdoor course was significantly associated with the section's condition, slope, holes, bumps, width, and the presence of grooves and bumps at a curb.

SIGNIFICANCE

Associations between environmental properties and gait parameters were differential across the three mobility outcomes. When examining which properties of the built environment are challenging to navigate it is important to understand the relative influence of specific properties on gait metrics. Knowledge of which built environment properties are barriers for walking behavior is critical for the design of inclusive sidewalks and streets.

Examining the relationships between walkability and physical activity among older persons: what about stairs?

BACKGROUND

Walkability is considered an important dimension of healthy communities. However, variable associations between measures of walkability and physical activity have been observed, particularly among older persons. Given the challenges older persons may have navigating stairs on walking routes, the presence of stairs may be an explanatory factor for these mixed associations. The purposes of this scoping review were to determine whether studies examining the relationship between walkability and physical activity included items that assessed stairs and what relationships were found.

METHODS

Systematic reviews were identified by entering search terms into five database search engines. Eligibility criteria were: a) published between 2008 and 2017, b) examined the relationship between walkability and physical activity, c) included a focus on persons aged 65 years and older, and d) written in English. The full articles for all primary studies included in eligible systematic reviews were then retrieved. Duplicates were removed. Information about where the study took place, walkability measures used, types of walkability data obtained (objective and/or subjective) and questions asked about stairs were extracted from the full text articles.

RESULTS

Eleven systematic reviews were identified; seven were eligible. After removing duplicates, 289 primary studies remained for review. Measures of neighborhood walkability were present in 205 studies; a minority (n = 5, 2.4%) included items about stairs. No information was obtained on the structural features of the stairs.

CONCLUSIONS

The presence of stairs may deter older persons (and others) from walking outdoors. Standard measures to document the presence and characteristics of stairs, and sampling approaches to select stairs for assessment are needed. The inclusion of these measures would augment the utility and comparability of studies examining relationships between walkability and physical activity and better inform planning and policy decisions.

Mapping review of accessible pedestrian infrastructures for individuals with physical disabilities

BACKGROUND

Due to the ageing population and higher prevalence of individuals living with physical disabilities, there is a critical need for inclusive practices when designing accessible pedestrian infrastructures for ensuring social participation and equal opportunities.

PURPOSE

Summarize the physical characteristics of current pedestrian infrastructure design for individuals with physical disabilities (IPD - motor, visual and hearing) found in the scientific literature and assess its quality.

MATERIALS AND METHODS

A mapping review of the existing literature on pedestrian infrastructures specifically built for individuals with physical disabilities identifying measurable physical characteristics for their design was done using online databases (Urban Studies Abstracts, Geobase, PubMed, and Cairn and secondary research). Information about accessibility (physical characteristics) of existing pedestrian infrastructures was extracted. The quality of the evidence was assessed using the Guidelines for critical review form - Quantitative studies and Qualitative studies version 2.0 (SAGE Publications, Inc., Thousand Oaks, CA).

RESULTS

Of the 1131 articles identified, forty-one articles examined access to bus stops, curb ramps, lighting, pedestrian crossings, ramps, shared spaces, sidewalks and steps. Six articles reported on more than one physical disability. Quality scores were generally low (quantitative: 2-11/15 and qualitative: 1-22/23). Recommended design features differed for the same infrastructure.

CONCLUSIONS

While there were a fair number of articles (n = 41) documenting accessible design features of pedestrian infrastructures, the quality of the evidence was low. The review identified knowledge gaps. Although specific design solutions exist, they have not yet been tested among individuals with various or multiple types of physical disabilities to ensure access to pedestrian infrastructures by all. Implications for Rehabilitation Pedestrian infrastructures still pose problems to mobility, limiting social participation and quality of life outcomes for individuals with physical disabilities (motor, visual and hearing). The results of this mapping review show that few articles are concerned with the accessibility of pedestrian infrastructures for more than one type physical disability, which might lead to recommendations that are inadequate for individuals with differing disabilities, few recommendations have been compared, most studies have been performed in environments not representative of northern countries and their quality score was generally low. Health professionals and State Parties have a complementary expertise that should be put to use in the determination and implementation of best design solutions to ensure the respect of the needs of individuals with physical disabilities. This review can thus help them have an idea of what has already been done to identify what needs to be achieved to fill the gap of knowledge required to insure access for individuals with motor, visual as well as hearing disabilities. Rehabilitation profesionals should take part in the assessment of the proposed solutions as well as the development of new designs to fill knowledge gaps.

Mobility Device Quality Affects Participation Outcomes for People With Disabilities: A Structural Equation Modeling Analysis

OBJECTIVE

To test the effect that indicators of mobility device quality have on participation outcomes in community-dwelling adults with spinal cord injury, traumatic brain injury, and stroke by using structural equation modeling.

DESIGN

Survey, cross-sectional study, and model testing.

SETTING

Clinical research space at 2 academic medical centers and 1 free-standing rehabilitation hospital.

PARTICIPANTS

Community-dwelling adults (N=250; mean age, 48±14.3y) with spinal cord injury, traumatic brain injury, and stroke.

INTERVENTIONS

Not applicable.

MAIN OUTCOMES MEASURES

The Mobility Device Impact Scale, Patient-Reported Outcomes Measurement Information System Social Function (version 2.0) scale, including Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities, and the 2 Community Participation Indicators' enfranchisement scales. Details about device quality (reparability, reliability, ease of maintenance) and device type were also collected.

RESULTS

Respondents used ambulation aids (30%), manual (34%), and power wheelchairs (30%). Indicators of device quality had a moderating effect on participation outcomes, with 3 device quality variables (repairability, ease of maintenance, device reliability) accounting for 20% of the variance in participation. Wheelchair users reported lower participation enfranchisement than did ambulation aid users.

CONCLUSIONS

Mobility device quality plays an important role in participation outcomes. It is critical that people have access to mobility devices and that these devices be reliable.

Progressive disability in elderly population among tribals of Telangana: a cross sectional study

Background

The tribal population of Telangana, India, lives in remote and difficult conditions. This study was carried out to find out estimate, the prevalence and progression of disability in elderly population among tribals of Khammam District, Telangana state, India.

Methods

A population based cross sectional survey was conducted in villages of Tribal Sub Plan area. Elderly people who are 60 years or older were chosen with a two stage sampling procedure: (1) probability proportion to size was used to select clusters and (2) in each selected cluster households were selected by systematic random sampling. The participants were interviewed with the 36 item Telugu version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) questionnaire. Socio- demographic information, behavioral measurements, health and social benefit indicators were also assessed. Descriptive analytical methods were used for prevalence estimation and logistic regression was used to examine the associations of progressive age over disability among elderly.

Results

A total of 506 elderly people from 1349 households in 20 villages across 31mandals of Khammam were interviewed. Majority of elderly population among tribals were illiterate (men 88.94%; women 99.33%), used tobacco (men 81.25%; women 57.72%), consumed alcohol (men 80.77%; women 47.32%) and were hypertensive (men 53.85%; women 63.42%). The prevalence of disability was higher in women. Maximum disability in the interviewed elderly population was seen in domains of performing house hold activities, and mobility. In comparison with men, women expressed more disability for majority of domains. As age progressed, the disability for self-care domain increased to a maximum of 2.6 times in men and 6.6 times in women and for mobility domain increased to a maximum of 9.7 times in men and 7.2 times in women.

Conclusions

Although present disability modifying mobility Assistive Devices (AD) can help elderly in overcoming disability, these are primarily designed for built environments. As the needs, cultural sensitivities, and living environment of elderly population in tribals are unique, newer innovative assistive devices should be designed and developed.

Effect of uphill and downhill walking on walking performance in geriatric patients using a wheeled walker

BACKGROUND

Wheeled walkers are recommended to improve walking performance in older persons and to encourage and assist participation in daily life. Nevertheless, using a wheeled walker can cause serious problems in the natural environment. This study aimed to compare uphill and downhill walking with walking level in geriatric patients using a wheeled walker. Furthermore, we investigated the effect of using a wheeled walker with respect to dual tasking when walking level.

METHODS

A total of 20 geriatric patients (median age 84.5 years) walked 10 m at their habitual pace along a level surface, uphill and downhill, with and without a standard wheeled walker. Gait speed, stride length and cadence were assessed by wearable sensors and the walk ratio was calculated.

RESULTS

When using a wheeled walker while walking level the walk ratio improved (0.58 m/[steps/min] versus 0.57 m/[steps/min], p = 0.023) but gait speed decreased (1.07 m/s versus 1.12 m/s, p = 0.020) when compared to not using a wheeled walker. With respect to the walk ratio, uphill and downhill walking with a wheeled walker decreased walking performance when compared to level walking (0.54 m/[steps/min] versus 0.58 m/[steps/min], p = 0.023 and 0.55 m/[steps/min] versus 0.58 m/[steps/min], p = 0.001, respectively). At the same time, gait speed decreased (0.079 m/s versus 1.07 m/s, p < 0.0001) or was unaffected.

CONCLUSION

The use of a wheeled walker improved the quality of level walking but the performance of uphill and downhill walking was worse compared to walking level when using a wheeled walker.

Homebound status among middle-aged and older adults with disabilities in ADLs and its associations with clinical, functional, and environmental factors

BACKGROUND

Homebound status is associated with poor health, comorbidity, and mortality and represents a major challenge for health systems. However, its prevalence among people with disabilities in the basic activities of daily living (ADLs) is unknown.

OBJECTIVES

The objectives were to: (1) examine the prevalence of the homebound status among middle-aged and older adults with disabilities in ADLs, and (2) identify its clinical, functional, and environmental determinants.

METHODS

This study included 221 community-dwelling subjects, aged ≥50 years, who applied for long-term care services at the Office for Legal Certification of Long-term Care Need of Coruña (Spain). Each subject had a disability in ADLs and was interviewed by a trained examiner in the subject's home. The participants were considered homebound if they remained inside their home during the previous week.

MEASURES

Demographic, clinical, functional, and environmental factors. Multiple logistic regression was used to determine the factors associated with homebound status.

RESULTS

The prevalence of homebound status was 39.8%. A multivariate analysis revealed that the presence of architectural barriers at the home entrance (stairs [OR: 6.67, p < 0.001] or a heavy door [OR: 2.83, p = 0.023]), walking ability limitations (OR: 3.26, p = 0.006), and higher age (OR: 1.05, p = 0.04) were associated with homebound status.

CONCLUSIONS

Homebound status is a highly prevalent problem among middle-aged and older adults with disabilities in ADLs. Architectural factors in the home and walking ability limitations seem to be important predictors, suggesting that health care interventions should target home adaptations and mobility skills as a means to preventing or decreasing homebound status.

Factors associated with participation frequency and satisfaction among people applying for a housing adaptation grant

BACKGROUND

People applying for a housing adaptation (HA) grant are at great risk of participation restrictions due to declining capacity and environmental barriers.

AIM

To investigate the association of person-, environment-, and activity-related factors with participation frequency and satisfaction among people applying for a housing adaptation grant.

MATERIAL AND METHODS

Baseline cross-sectional data were collected during home visits (n = 128). The association between person-, environment-, and activity-related factors and participation frequency and satisfaction was analysed using logistic regressions.

RESULTS

The main result is that frequency of participation outside the home is strongly associated with dependence in activities of daily living (ADL) and cognitive impairments, while satisfaction with participation outside the home is strongly associated with self-reported health. Moreover, aspects of usability in the home were associated with frequency of participation outside the home and satisfaction with participation in the home and outside the home alone.

CONCLUSION

Dependence in ADL, cognitive impairments, self-rated health, and aspects of usability are important factors contributing to participation frequency and satisfaction among people applying for a housing adaptation grant, particularly outside the home.

SIGNIFICANCE

Our findings indicate that more attention should be directed towards activity-related factors to facilitate participation among HA applicants, inside and outside the home.

Assistive device use and mobility-related factors among adults aged≥65years

INTRODUCTION

Examining how assistive device (cane, walker) use relates to other mobility factors can provide insight into older adults' future mobility needs.

METHODS

Data come from the Second Injury Control and Risk Survey, Phase 2 (ICARIS2-P2), conducted from March 2007 to May 2008. Prevalence estimates were calculated for older adults (aged ≥65) and multivariable logistic regression was used to explore associations between assistive device use and mobility-related characteristics.

RESULT

Compared with non-users, assistive device users were more likely to report a recent fall (AOR 12.0; 95% CI 4.9-29.3), limit walking outside due to concerns about falling (AOR 7.1; 95% CI 2.6-19.1), be unable to walk outside for 10min without resting (AOR 3.3; 95% CI 1.1-9.3), and be no longer driving (AOR 6.7; 95% CI 2.0-22.3).

CONCLUSION

Assistive device users have limited mobility and an increased risk for fall injury compared with non-users.

PRACTICAL APPLICATION

Effective fall prevention interventions, and innovative transportation options, are needed to protect the mobility of this high-risk group.