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.

Risk Factors for Mobility Decline in Community-Dwelling Older Adults: A Systematic Literature Review

Mobility is essential to maintaining independence for older adults. This systematic review aimed to summarize evidence about self-reported risk factors for self-reported mobility decline; and to provide an overview of published prognostic models for self-reported mobility decline among community-dwelling older adults. Databases were searched from inception to June 2, 2020. Studies were screened by two independent reviewers who extracted data and assessed study quality. Sixty-one studies (45,187 participants) were included, providing information on 107 risk factors. High-quality evidence and moderate/large effect sizes for the association with mobility decline were found for older age beyond 75 years, the presence of widespread pain, and mobility modifications. Moderate-high quality evidence and small effect sizes were found for a further 21 factors. Three model development studies demonstrated acceptable model performance, limited by high risk of bias. These findings should be considered in intervention development, and in developing a prediction instrument for practical application.

Testing a two step nursing intervention focused on decreasing rehospitalizations and nursing home admission post discharge from acute care

Older adults are at high risk of readmission on discharge from the Acute Medical and Emergency Department (ED). This study examines the effect of a two-stage nursing assessment and intervention to address older adults' uncompensated problems and thus intend to prevent readmission and functional decline. A randomized controlled study was conducted. Included were 271 patients aged 70 and over admitted to an ED. A brief standardized nursing assessment and intervention was carried out after discharge and at follow-up. No effect was found on readmission to hospital, admission to nursing home, or death but the intervention group was less likely to be at risk of depression after 180 days. Whether this method can be recommended needs further study as well as knowledge is needed as to the organization and to reveal older adults' experiences on follow-up after ED stay.

Fatigue in older adults: an early indicator of the aging process?

The aim of this paper is to give an overview of research on fatigue in older adults, with a focus on fatigue as an early indicator of the aging process. Fatigue is a strong predictor of functional limitations, disability, mortality, and other adverse outcomes in young-old and old-old populations, between men and women, and in different geographic localities. Several biological, physiological and social explanations are proposed: fatigue may be seen not only as a self-reported indicator of frailty, defined as a physiologic state of increased vulnerability to stressors, which results from decreased physiologic reserves and even dysregulation of multiple physiologic systems, but also this state may be accelerated because of the cumulative impact of social, mental and biological factors throughout life.

Functional ability at age 75: is there an impact of physical inactivity from middle age to early old age?

The aim of this study is to analyze the impact of physical inactivity from middle age to early old age on functional ability at age 75. Physical activity is measured both as cumulated activity from age 50 to 60 to 70 and at three separate points in time. Three hundred eighty-seven men and women born in 1914 and living in seven municipalities in the western part of the County of Copenhagen were followed for 25 years with examinations in 1964, 1974, 1984 and 1989. Analyses were conducted with physical inactivity as an independent variable (accumulated and separately for each point in time) and smoking, sex, school education, household composition, chronic disease at baseline and functional ability at age 70 as possible confounders. There was a strong association between physical inactivity at age 70 and disability at age 75. However, the analyses showed no effect of cumulated physical inactivity from age 50 to 60 to 70 on disability at age 75 when adjusting for functional ability at age 70. Physical inactivity is a risk factor for disability among old people. Thus, old people should be encouraged to take up and maintain physical training throughout the aging process.

Physical and mental function and incident low back pain in seniors: a population-based two-year prospective study of 1387 Danish Twins aged 70 to 100 years

STUDY DESIGN

Prospective cohort study.

OBJECTIVES

To investigate whether physical performance, grip strength, cognitive function, and depression symptomatology are risk factors for incident low back pain (LBP) over a 2-year period in seniors.

SUMMARY OF BACKGROUND DATA

LBP is common in the older age groups, but little is known about predictors of LBP in this age group.

METHODS

Data from the 2001 and 2003 data collection from the population-based Longitudinal Study of Aging Danish Twins formed the basis of this analysis. Participants free from LBP at baseline (no LBP during the past month, N = 1387) were included and interview data on overall physical function, and assessment of grip strength, overall cognitive function, and depression at baseline were obtained. LBP status at follow-up was assessed using a modified version of the Standardized Nordic Questionnaire. Logistic regression was used to assess the associations between the baseline risk factors and LBP at follow-up.

RESULTS

A total of 1387 persons 70 to 100 years of age at baseline were included in the analyses. Of the initially LBP-free individuals, 7% had experienced LBP more than 30 days out of the past year, 7% had altered or decreased their physical activities due to LBP, and 11% had received treatment for LBP at follow-up. Good overall physical function (being among the top 50%) at baseline was protective for LBP of more than 30 days duration and for diminishing physical activities due to LBP and for care seeking due to LBP. High depression scores (being among the top 25%) were strongly associated with altering or decreasing daily activities because of LBP. Grip strength and overall cognitive performance at baseline were associated with lower incidence of LBP and decreasing activities due to LBP at follow-up; however, these associations were not statistically significant.

CONCLUSION

Poor overall physical function and depression symptomatology are associated with LBP and consequences of LBP in persons 70 years of age and older.

Stability and change in physical activity in old age: the role of changes in disability

The objective was to examine whether stability and change in physical activity in older men and women are influenced by (1) changes in disability and by (2) social relations and psychological well-being. The study is based on baseline, 3 and 4.5 year follow-up data on 917 older men and women. Changes in physical activity were measured through self-reported frequencies of vigorous physical activity at the three measurement points. The analyses were carried out for two outcomes-decline in physical activity versus sustained high level of physical activity (from high to low) and sustained low physical activity versus improvement in physical activity (from low to high). The main results were: older adults with onset of tiredness or continuous tiredness in daily activities during 4.5 years are more likely to have a concurrent decline in their physical activities during the same period. Older adults with onset of need of help and sustained need of help are more likely to have a decline in physical activities or to sustain a low level of physical activities during the same period. The associations between the psychosocial factors and change in physical activity are attenuated by the concurrent changes in disability. The present study supports that health promotion projects should be aware that development of tiredness and continuous tiredness are strongly related to a decline in physical activity and that onset of and sustained need of help are strongly associated with both a decline in and sustained low physical activity.

Functional decline from age 80 to 85: influence of preceding changes in tiredness in daily activities

OBJECTIVE

To analyze whether functional decline from age 80 to 85 is influenced by changes in self-reported tiredness in daily activities in the preceding 5-year period.

METHOD

A prospective study of 226 75-year-old men and women with 5- and 10-year follow-up in the Western part of Copenhagen County. Tiredness in daily activities was measured at age 75 and 80 by a validated scale. Changes in tiredness from age 75 to 80: 1) Sustained no tiredness, 2) not tired-tired, 3) tired-not tired, 4) sustained tiredness. Functional decline from age 80 to 85:1) Sustained no need of help; 2) need of help at age 85, alive; 3) need of help at age 85 or dead; 4) dead.

RESULTS

The analyses among the survivors showed a slight tendency to an association between having sustained tiredness or development of tiredness from age 75 to 80 and functional decline from age 80 to 85. Persons with sustained tiredness from age 75 to 80 were at significantly larger risk of functional decline and mortality from age 80 to 85. These results were not attenuated when adjusted by the covariates.

CONCLUSION

The results in the present study indicate that it is important to take continuous complaints about tiredness in daily activities seriously, because this is an early sign of functional decline.

Qigong as a psychosocial intervention for depressed elderly with chronic physical illnesses

Literature uncovers that depression is common in elderly people. The problem is more serious in elderly with chronic physical illnesses. Although the relationship between physical problems and depression is well documented, the underlying mechanism is basically unknown. This article proposed after a comprehensive literature review that depression in elderly with chronic physical illnesses results from disability and a reduction in psychosocial resources. If depression is left untreated, suicide may be a consequence. In view of this, various forms of psychosocial interventions are developed based on mainstream western medicine. The authors argue that qigong, a form of Chinese therapeutics, has the effect of alleviating clinical depression and thus improves quality of life. A simple form of dynamic qigong, namely the Eight-Section Brocades, is suggested to serve the purpose. A theory which explains the psychosocial effect of qigong is hypothesized.

Tiredness in daily activities among nondisabled old people as determinant of onset of disability

The purpose of this article was to examine whether self-reported tiredness in daily activities at age 75 is an independent determinant of onset of disability at 5-year follow-up. The investigation is based on two subgroups of nondisabled participants of 75 year olds who survived and participated in the follow-up study 5 years later (n = 510 and 429). Persons who felt tired in their daily activities had a larger risk of becoming disabled in mobility (OR = 3.2, 95% CI = 1.4-7.6) and in daily activities (OR = 2.1, 95% CI = 1.0-4.2) compared to persons without tiredness. In addition, persons with poor cognitive function, little diversity in social relations and no physical activity had an independent risk of onset of disability. The results indicate that it is important to take it seriously when older people complain about tiredness in daily activities, as these people are at higher risk of becoming disabled than others.

Dissemination and Implementation of “Aging Well and Healthily”: A Health-Education and Exercise Program for Older Adults

The article describes the dissemination and implementation of the Aging Well and Healthily (AWH) program in the Netherlands. In the period 1997–1999 this process was monitored by means of telephone interviews with 263 participants, 28 peer educators, and 13 organizers. The program participants were mainly physically active and relatively healthy people in their mid 70s. The peer educators were in their late 50s. The overall satisfaction with the content and delivery of the AWH program was good; 13% of the participants enrolled in related local sports activities. In total, the AWH program was run 57 times, which did not meet the target of 50 times a year. Different factors could have negatively influenced dissemination. In the first place, the organization of the program was perceived to be complex and not compatible with the values of the organizations that were to implement the program. Also, 3 national implementation partners had organizational problems of their own. The results were used to design a new social marketing strategy, which appears to be successful.