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Background The usual accelerometry-based measures of physical activity (PA) are dependent on physical performance. We investigated the associations between PA relative to walking performance and the prevalence and incidence of early and advanced walking difficulties compared to generally used measures of PA. Methods Perceived walking difficulty was evaluated in 994 community-dwelling participants at baseline (age 75, 80, or 85 years) and 2 years later over 2 km (early difficulty) and 500 m (advanced difficulty). We used a thigh-mounted accelerometer to assess moderate-to-vigorous PA, daily mean acceleration, and relative PA as movement beyond the intensity of preferred walking speed in a 6-minute walking test (PArel). Self-reported PA was assessed using questionnaires. Results The prevalence and incidence were 36.2% and 18.9% for early and 22.4% and 14.9% for advanced walking difficulty, respectively. PArel was lower in participants with prevalent (mean 42 [SD 45] vs 69 [91] min/week, p < .001) but not incident early walking difficulty (53 [75] vs 72 [96] min/week, p = .15) compared to those without difficulty. The associations between absolute measures of PA and incident walking difficulty were attenuated when adjusted for preferred walking speed. Conclusions The variation in habitual PA may not explain the differences in the development of new walking difficulty. Differences in physical performance explain a meaningful part of the association of PA with incident walking difficulty. Scaling of accelerometry to preferred walking speed demonstrated independence on physical performance and warrants future study as a promising indicator of PA in observational studies among older adults.

Background Older people with limited health literacy may encounter difficulties in finding relevant information on COVID-19, understanding its relevance, and complying with recommended protective measures. Complying with such recommendations has required older as well as younger persons to change their daily lives in ways that have reduced their opportunities for engaging in many activities meaningful to them. Aims To find out from what sources older people have obtained information on protective measures, the level of their coronavirus-related health literacy (CHL), and whether CHL is associated with their perceptions of the restrictiveness of coronavirus-related protective measures. Methods 696 Finnish men and women aged over 77 answered a mailed questionnaire on their CHL, sources of information and perceptions of the restrictiveness of the recommended protective measures. The association of CHL with perceived restrictiveness was studied using multinomial logistic regression analysis. Results Television and newspapers were the most frequently reported sources of information. Reporting high confidence in the ability to assess how one’s behavior influences coronavirus infection risk was associated with higher odds of perceiving the protective measures to be highly restrictive, when controlling for age, gender, and difficulty in using digital devices (OR 3.21, 95% CI 1.09, 9.46). Discussion Participants who reported being highly confident about their ability to appraise the influence of their behavior on their susceptibility to coronavirus infection were more likely to perceive that the recommended protective measures had restricted their daily lives. Conclusions Health literacy plays a role in complying with recommended restrictions.

Background Walking forms a large portion of physical activity (PA) of older adults. We assessed free-living PA using acceleration corresponding to preferred walking speed as a relative cut-point and studied how it relates to age. We compared the relative cut-point to a common absolute cut-point of moderate-to-vigorous physical activity (MVPA). Method Four hundred forty-four community-dwelling adults aged 75, 80, and 85 years wore an accelerometer on the thigh during a PA surveillance period and a modified 6-minute walking test (6MWT) at preferred speed. Each individual’s mean acceleration (g) during the 6MWT was used as a cut-point for relative PA. Acceleration corresponding to three metabolic equivalents (METs) was used as the cut-point for absolute MVPA. Results When using the acceleration of preferred walking speed as a cut-point, 62 (SD 82) minutes a week of relative PA was detected, compared to 228 (163) minutes of absolute MVPA. For 96% of the participants, the acceleration generated by their preferred walking speed exceeded the common absolute cut-point for MVPA. Absolute MVPA was lower in the older age groups, and 6MWT speed explained 22% of its variation (p < .001), whereas relative PA was independent of walking speed and age. Conclusions Preferred walking speed was a significant contributor to absolute MVPA and those who walked the slowest accumulated the least MVPA. Assessing relative PA using the intensity of preferred walking speed as a cut-point eliminated the dependency of PA on age and walking speed, and may be a feasible scaling option to evaluate relative PA among older people.

Objectives: To validate the Finnish version of the 42-item Scales of Psychological Well-Being among community-dwelling older people. The study also examined the test–retest reliability and usability, i.e. user experience, of the scales in this age group. Method: The 42-item version of the SPWB was administered as part of a face-to-face interview among 968 men and women aged 75, 80 or 85 years. The subsample for test–retest analyses comprised 42 participants, who in addition to 11 interviewers also answered questions concerning the usability of the scales. Exploratory and confirmatory factor analyses, Cronbach’s alpha coefficients, Pearson and intra-class correlation coefficients, and Kendal’s Tau B were used in the analyses. Results: The factor analyses did not support the theory-based six-factor structure of the scales. The Cronbach’s alphas showed high internal consistency reliability for the total scale, but modest for the subscales. The intercorrelations between the subscales were moderate. The total score and the subscale scores of the SPWB correlated positively with quality of life and life satisfaction, and negatively with depressive symptoms. The interviewers reported that while most of the participants responded to the scales without marked difficulties, others could only answer after clarifications of some statements. Discussion: The reliability of the 42-item version of the SPWB was modest. The factor structure was inconsistent among the three age groups studied, but the scales were feasible to use. The current results call for further methodological consideration to optimize assessment of eudaimonic well-being in old age. peerReviewed

Social distancing during the COVID-19 pandemic decreased older people’s opportunities to lead an active life. The purpose of this study was to investigate whether walking difficulties predict changes in leading an active life during the COVID-19 social distancing recommendation compared to 2 years before, and whether self-rated resilience moderates this association among older people. Data were collected during social distancing recommendation in May and June 2020 and 2 years before (2017–18) among community-living AGNES study participants initially aged 75, 80, or 85 years (n = 809). Leading an active life was assessed with the University of Jyväskylä Active Aging Scale (UJACAS; total score range 0–272) and resilience with the 10-item Connor-Davidson Resilience Scale (0–40). Self-reported walking difficulties over a 2 km distance were categorized into no difficulty, difficulty, and unable to walk. The total UJACAS score declined 24.9 points (SD 23.5) among those without walking difficulty, 27.0 (SD 25.0) among those reporting walking difficulty and 19.5 (SD 31.2) among those unable to walk 2 km. When adjusted for baseline UJACAS score, those unable to walk 2 km demonstrated the greatest decline. Baseline resilience moderated this association: Higher resilience was associated with less declines in UJACAS scores among persons with or without walking difficulty, and with more declines among persons unable to walk 2 km. When opportunities for leading an active life are compromised, those with less physical and psychological resources become particularly vulnerable to further declines in activity.

This study examined equity in physical activity (PA) by investigating whether perceived opportunity for PA was associated with willingness to be more active. Among community residents (75, 80, or 85 years old, n = 962) perceived opportunity for PA (poor and good), willingness to be more active (not at all, a bit, and a lot), and level of PA (low, moderate, and high) were assessed via questionnaires. Multinomial logistic regression showed that physical activity moderated the association between poor opportunity and willingness to increase PA. Among those with moderate PA, poor opportunity for PA increased the odds of willingness to be a lot more active (multinomial odds ratio, mOR 3.90, 95% confidence interval 2.21–6.87) than not wanting to be more active compared to those perceiving good opportunities. Associations were similar at high PA levels (p &lt, 0.001), but were not found at low PA levels. Those with moderate or high PA wish to increase their activity particularly when the perceived opportunities for activity are not optimal. Among those with low PA, perceived opportunities are not associated with a perceived need to increase physical activity. Increasing equity in physical activity in old age requires provision of support and opportunities at every level of physical activity.

Background The current study aims to compare correlations between a range of measures of physical performance and physical activity assessing the same underlying construct in different settings, that is, in a home versus a highly standardized setting of the research center or accelerometer recording. We also evaluated the selective attrition of participants related to these different settings and how selective attrition affects the associations between variables and indicators of health, functioning and overall activity. Methods Cross-sectional analyses comprising population-based samples of people aged 75, 80, and 85 years living independently in Jyväskylä, Finland. The AGNES study protocol involved the following phases: 1) phone interview (n = 1886), 2) face-to-face at-home interview (n = 1018), 3) assessments in the research center (n = 910), and 4) accelerometry (n = 496). Phase 2 and 3 included walking and handgrip strength tests, and phase 4 a chest-worn and thigh-worn accelerometer estimating physical activity and assessing posture, respectively, for 3–10 days in free-living conditions. Results Older people with poorer health and functioning more likely refrained from subsequent study phases, each requiring more effort or commitment from participants. Paired measures of walking speed (R = 0.69), handgrip strength (R = 0.85), time in physical activity of at least moderate intensity (R = 0.42), and time in upright posture (R = 0.30) assessed in different settings correlated with each other, and they correlated with indicators of health, functioning and overall activity. Associations were robust regardless of limitations in health and functioning, and low overall activity. Conclusions Correlational analyses did not clearly reveal one superior setting for assessing physical performance or physical activity. Inclusion of older people with early declines in health, functioning and overall activity in studies on physical performance and physical activity is feasible in terms of study outcomes, but challenging for recruitment.

Objectives: Assimilative and accommodative coping strategies have hardly been studied in relation to leisure activities in old age. We investigated whether tenacious goal pursuit (TGP) and flexible goal adjustment (FGA) influence the association between physical performance and participation in leisure activities. Methods: A cross-sectional analysis was conducted among 187 community-dwelling people aged 79 to 93 years. TGP, FGA, and leisure activity participation were asked with questionnaires. Physical performance was assessed with the Short Physical Performance Battery (SPPB). Results: TGP moderated the relationship between physical performance and leisure activity participation. Despite low physical performance, people with high TGP had close to mean level of leisure activity participation, whereas low TGP was associated with very little activity. Most notably, people without high TGP had fewer outdoor activities and group activities outside home. Similar effects were not found for FGA. Discussion: Persistency, rather than flexibility, in goal pursuit appears to help older people be active in their leisure time.

Aims: This study examined the feasibility of the HLS-EU-Q16 (in Finnish) for use among older Finns and whether the health literacy score correlates with indicators of health and functioning. Methods: To determine the feasibility of the instrument, we first conducted a focus group discussion with nine participants. For the quantitative analyses, we used data from the AGNES cohort study, collected between October 2017 and April 2018 at the University of Jyväskylä in Finland. 292 75-year-old Finnish men and women were interviewed face-to-face in their homes. Health literacy was measured with the HLS-EU-Q16 and health literacy score, ranging from 0 to 50, computed. The reproducibility of the instrument was test-retested. Chi-square tests were used to compare health literacy scores between participants by different socioeconomic variables, and Spearman correlation coefficients were calculated to study the associations of health literacy with cognition, depressive symptoms, chronic conditions, life-space mobility and physical performance. Results: The mean health literacy score for all participants was 35.05 (SD 6.32). Participants who rated their financial situation and self-rated health as very good had the highest health literacy scores (38.85, SD 5.09 and 39.22, SD 6.77, respectively). Better health literacy was associated with better cognitive status, fewer depressive symptoms and chronic conditions, higher life-space mobility and better physical performance. Conclusions: The HLS-EU-Q16 is a feasible measure for research purposes among older Finns. The associations between health literacy and indicators of health and functioning need to be more closely investigated in larger samples with a wider age-range. peerReviewed

The authors examined whether accelerometer-based free-living walking differs between those reporting walking modifications or perceiving walking difficulty versus those with no difficulty. Community-dwelling 75-, 80-, or 85-year-old people (N = 479) wore accelerometers continuously for 3–7 days, and reported whether they perceived no difficulties, used walking modifications, or perceived difficulties walking 2 km. Daily walking minutes, walking bouts, walking bout intensity and duration, and activity fragmentation were calculated from accelerometer recordings, and cut points for increased risk for perceiving walking difficulties were calculated using receiver operating characteristic analysis. The authors’ analyses showed that accumulating ≤83.1 daily walking minutes and walking bouts duration ≤47.8 s increased the likelihood of reporting walking modifications and difficulties. Accumulating walking bouts ≤99.4 per day, having walking bouts ≤0.119 g intensity, and ≥0.257 active to sedentary transition probability fragmented activity pattern were associated only with perceiving walking difficulties. The findings suggest that older people’s accelerometer-based free-living walking reflects their self-reported walking capability.

Background Outdoor mobility enables participation in essential out-of-home activities in old age. Aim To compare changes in different aspects of outdoor mobility during COVID-19 restrictions versus two years before according to self-reported walking. Methods Community-dwelling participants of AGNES study (2017–2018, initial age 75–85) responded to AGNES-COVID-19 postal survey in spring 2020 (N = 809). Life-space mobility, autonomy in participation outdoors, and self-reported physical activity were assessed at both time points and differences according to self-reported walking modifications and difficulty vs. intact walking at baseline were analyzed. Results Life-space mobility and autonomy in participation outdoors had declined (mean changes -11.4, SD 21.3; and 6.7, SD 5.3, respectively), whereas physical activity had increased (5.5 min/day, SD 25.1) at follow-up. Participants perceiving walking difficulty reported the poorest baseline outdoor mobility, a steeper decline in life-space mobility (p = 0.001), a smaller increase in physical activity (p p = 0.017) than those with intact walking. Those with walking modifications also reported lower baseline life-space mobility and physical activity, a steeper decline in life-space mobility and a smaller increase in physical activity those with intact walking (p Discussion Participants reporting walking modifications remained the intermediate group in outdoor mobility over time, whereas those with walking difficulty showed the steepest decline in outdoor mobility and hence potential risk for accelerated further functional decline. Conclusion Interventions should target older people perceiving walking difficulty, as they may be at the risk for becoming homebound when environmental facilitators for outdoor mobility are removed.

nonPeerReviewed

Older adults with lower limb osteoarthritis (LLOA) are highly dependent on their physical and social environment for being physically active. Longitudinal data from 2286 older adults (M age = 73.8 years; 50.3% female) in six European countries were analyzed using cross-lagged Structural Equation Modeling (SEM) and multi-group SEM. In cross-sectional analyses, neighborhood resources were associated with physical activity (r = 0.26;p

Objectives: To study associations between perceived neighborhood resources and time spent by older adults in active travel. Methods: Respondents in six European countries, aged 65–85 years, reported on the perceived presence of neighborhood resources (parks, places to sit, public transportation, and facilities) with response options “a lot,” “some,” and “not at all.” Daily active travel time (total minutes of transport-related walking and cycling) was self-reported at the baseline (n = 2,695) and 12–18 months later (n = 2,189). Results: Reporting a lot of any of the separate resources (range B’s = 0.19–0.29) and some or a lot for all four resources (B = 0.22, 95% confidence interval [0.09, 0.35]) was associated with longer active travel time than reporting none or fewer resources. Associations remained over the follow-up, but the changes in travel time were similar, regardless of the neighborhood resources. Discussion: Perceiving multiple neighborhood resources may support older adults’ active travel. Potential interventions, for example, the provision of new resources or increasing awareness of existing resources, require further study.

Background Social distancing, that is, avoiding places with other people and staying at home, was recommended to prevent viral transmission during the COVID-19 pandemic. Potentially, reduced out-of-home mobility and lower activity levels among older people may lower their quality of life (QOL). We studied cross-sectional and longitudinal associations of and changes in life-space mobility, active aging, and QOL during COVID-19 social distancing compared to 2 years before. Methods Altogether 809 community-living participants initially aged 75, 80, or 85 years of our active aging study (AGNES) conducted in 2017–2018 took part in the current AGNES-COVID-19 survey in May and June 2020. Outdoor mobility was assessed with the Life-Space Assessment (range 0–120). Active approach to life was assessed with the University of Jyväskylä Active Aging Scale (range 0–272), and QOL with the shortened Older People’s Quality of Life Questionnaire (range13–65; higher scores better for all). Data were analyzed with General Estimating Equations, General Linear Models, and One-way analysis of variance. Results Life-space mobility (B −10.8, SE 0.75, p < .001), the active aging score (B −24.1, SE 0.88, p < .001), and the QOL score (B −1.65, SE 0.21, p < .001) were lower during COVID-19 social distancing versus 2 years before. Concurrent life-space mobility and active aging scores, age, and sex explained 48% of QOL at the baseline and 42% during social distancing. Longitudinally, steeper declines in all 3 variables coincided. Conclusion The observed declines indicate compliance with social distancing recommendation, but underline the importance of participation in meaningful life situations as a factor underlying good QOL also during the COVID-19 pandemic.

Background Although depressive symptoms are more common among older than younger age groups, life satisfaction tends to remain stable over the life course, possibly because the underlying factors or processes differ. Aim To study whether the factors that increase the likelihood of high life satisfaction also decrease the likelihood of depressive symptoms among older people. Methods The data were a population-based probability sample drawn from community-dwelling people aged 75, 80, and 85 years (n = 1021). Participants’ life satisfaction was measured with the Satisfaction with Life Scale and depressive symptoms with the Centre for Epidemiologic Studies Depression Scale (CES-D). Physical performance, perceived financial situation, executive functions, loneliness, self-acceptance, and having interests in one’s life were studied as explanatory variables. The data were analyzed using cross-sectional bivariate linear modeling. Results Better physical performance, not perceiving loneliness, having special interests in one’s life, and higher self-acceptance were associated with higher life satisfaction and fewer depressive symptoms. Better financial situation was related only to life satisfaction. Executive functions were not associated with either of the outcomes. Discussion The opposite ends of the same factors underlie positive and negative dimensions of mental well-being. Conclusion Further studies are warranted to better understand how people maintain life satisfaction with aging when many resources may diminish and depressive symptoms become more prevalent.

Objective To evaluate cohort differences in cognitive performance in older men and women born and assessed 28 years apart. Methods Data in this study were drawn from two age-homogeneous cohorts measured in the same laboratory using the same standardized cognitive performance tests. Participants in the first cohort were born in 1910 and 1914 and assessed in 1989–1990 (Evergreen project, n = 500). Participants in the second cohort were born in 1938 or 1939 and 1942 or 1943 and assessed in 2017–2018 (Evergreen II, n = 726). Participants in both cohorts were assessed at age 75 and 80 years and were recruited from the population register. Cognitive performance was measured using the Digit Span test from the Wechsler Memory Scale (WMS), Digit Symbol test from the Wechsler Adult Intelligence Scale (WAIS) and phonemic Verbal Fluency test from the Schaie-Thurstone Adult Mental Abilities Test. Reaction time assessing motor and mental responses was measured with a simple finger movement task, followed by a complex finger movement task. T-tests were used to study cohort differences and linear regression models to study possible factors underlying differences. Results We found statistically significant cohort differences in all the cognitive performance tests, except for the digit span test and simple movement task in men, the later-born cohort performing better in all the measured outcomes. Conclusions The results of this study provide strong evidence that cognitive performance is better in more recent cohorts of older people compared to their counterparts measured 28 years earlier.

Objectives: The aim of this study is to evaluate the effects of multicomponent rehabilitation on physical activity, sedentary behavior, and mobility in older people recently discharged from hospital. Design: Randomized controlled trial. Setting: Home and community. Participants: Community-dwelling people aged ⩾60 years recovering from a lower limb or back musculoskeletal injury, surgery, or disorder were recruited from local health center hospitals and randomly assigned into an intervention ( n = 59) or a control (standard care, n = 58) group. Intervention: The six-month intervention consisted of a motivational interview, goal attainment process, guidance for safe walking, a progressive home exercise program, physical activity counseling, and standard care. Measurements: Physical activity and sedentary time were assessed using an accelerometer and a single question. Mobility was evaluated with the Short Physical Performance Battery, self-reported use of a walking aid, and ability to negotiate stairs and walk outdoors. Intervention effects were analyzed with generalized estimating equations. Results: Daily physical activity was 127 ± 78 minutes/day and 121 ± 70 at baseline and 167 ± 81 and 164 ± 72 at six months in the intervention and control group, respectively; mean difference of 3.4 minutes (95% confidence interval (CI) = −20.3 to 27.1). In addition, no significant between-group differences were shown in physical performance. Conclusion: The rehabilitation program was not superior to standard care for increasing physical activity or improving physical performance. Mobility-limited older people who had recently returned home from hospital would have needed a longer and more frequently monitored comprehensive geriatric intervention.

Background Fatigue related to task standardized by duration and intensity, termed fatigability, could manifest as shortening of activity bouts throughout the day causing daily activity to accumulate in a more fragmented pattern. Our purpose was to study the association of activity fragmentation with physical and mental dimensions of fatigability. Methods A cross-sectional study of 485 community-dwelling 75-, 80-, and 85-year-old people using a thigh-worn accelerometer for 3–7 days. Activity fragmentation was studied as Active-to-Sedentary Transition Probability for 2 operational definitions of physical activity: accelerations equivalent to at least light physical activity and for upright posture. Physical fatigability was assessed as perceived exertion fatigability, performance fatigability severity, and with the Physical Fatigue Subscale of the Situational Fatigue Scale. Mental fatigability was assessed with the Mental Fatigue Subscale of the Situational Fatigue Scale and as a decrease in perceived mental alertness after a 6-minute walk test. Results Higher activity fragmentation was associated with higher self-reported physical fatigability, perceived exertion fatigability, and performance fatigability severity, independent of total activity minutes (β = 0.13–0.33, p < .05 for all). Higher activity fragmentation was not associated with mental fatigability in the fully adjusted models. The associations with fatigability indices were similar for both activity fragmentation indicators. Associations of activity fragmentation and performance fatigability severity were similar also among those with the highest intensity-based physical activity volume. Conclusions The findings provide support that studying fragmented activity patterns can be useful in identifying those at risk for high fatigability, even among those with relatively high physical activity level.

Background: Many older people report a willingness to increase outdoor physical activity (PA), but no opportunities for it, a situation termed as unmet PA need. The authors studied whether lower neighborhood mobility and PA precede the development of unmet PA need. Methods: Community-dwelling 75- to 90-year-old people (n = 700) were interviewed annually for 2 years. Unmet PA need, neighborhood mobility, and PA were self-reported. In addition, accelerometer-based step counts were assessed among a subgroup (n = 156). Results: Logistic regression analyses revealed that lower baseline neighborhood mobility (odds ratio 3.02, 95% confidence interval [1.86, 4.90] vs. daily) and PA (odds ratio 4.37, 95% confidence interval [2.62, 7.29] vs. high) were associated with the development of unmet PA need over 2 years. The participants with higher step counts had a lower risk for unmet PA need (odds ratio 0.68, 95% confidence interval, [0.54, 0.87]). Conclusion: Maintaining higher PA levels and finding solutions for daily outdoor mobility, especially for those with declines in health, may protect from the development of unmet PA need.

Accelerometer-derived estimates of physical activity (PA) and sedentary time have been an important methodological focus. However, little is known about the daily activities among older people during their normal lives. Furthermore, some older individuals would like to be more active, yet experience an unmet PA need, which is defined as the desire to engage in more PA but without the opportunity to act on the desire. This study examined the intensity of daily PA and sedentary behavior measured with accelerometers among older people, and whether PA differs between weekdays and weekends and those with and without the experience of unmet PA need, measured with self-reports. A total of 174 community-dwelling older people (64% female) aged 75 to 90 years used an accelerometer for 7 consecutive days during waking hours, and the results were classified for sedentary behavior (thresholds of 0.0167 g), light activity (0.091 g), and moderate-to-vigorous activity (MVPA, 0.414 g) based on mean amplitude deviation (g). We found that during weekdays, older people engaged slightly more in light activity and had less sedentary time than during weekends. In total, 7.6% of the participants perceived an unmet PA need. Accordingly, those with unmet PA needs spent less time in MVPA, especially during weekdays, and they might benefit from PA-enabling interventions.

Background Whether increased life expectancy is accompanied by increased functional capacity in older people at specific ages is unclear. We compared similar validated measures of maximal physical performance in 2 population-based older cohorts born and assessed 28 years apart. Method Participants in the first cohort were born in 1910 and 1914 and were assessed at age 75 and 80 years, respectively (N = 500, participation rate 77%). Participants in the second cohort were born in 1938 or 1939 and 1942 or 1943 and were assessed at age 75 and 80 years, respectively (N = 726, participation rate 40%). Participants were recruited using a population register and all community-dwelling persons in the target area were eligible. Both cohorts were interviewed at home and were examined at the research center with identical protocols. Maximal walking speed, maximal isometric grip and knee extension strength, forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were assessed. Data on non-participation were systematically collected. Results Walking speed was on average 0.2–0.4 m/s faster in the later than earlier cohort. In grip strength, the improvements were 5%–25%, and in knee extension strength 20%–47%. In FVC, the improvements were 14–21% and in FEV1, 0–14%. Conclusions The later cohort showed markedly and meaningfully higher results in the maximal functional capacity tests, suggesting that currently 75- and 80-year-old people in Finland are living to older ages nowadays with better physical functioning.

Objectives: To examine associations of perceived outdoor environment with the prevalence and development of adaptive (e.g., slower pace) and maladaptive (e.g., avoiding walking) modifications in walking 2 km among older people. Methods: Community-dwelling 75–90 -year-old persons ( N = 848) reported environmental outdoor mobility facilitators and barriers at baseline. Modifications in walking 2 km (adaptive, maladaptive, or no) were assessed at baseline and one and two years later. Results: Outdoor mobility facilitators were more often reported by those not using modifications or using adaptive versus maladaptive walking modifications. Differences in health and physical capacity explained most of the associations between outdoor mobility barriers and walking modifications. Perceived outdoor environment did not systematically predict future adaptive or maladaptive walking modifications. Discussion: Facilitators may compensate the declined physical capacity and alleviate the strain of walking longer distances by enabling the use of adaptive walking modifications, while lack of such facilitators fuels avoidance of walking longer distances.

Background: Meaningful activities can be done in or around home, but opportunities for participation and active aging decrease when moving in smaller areas. Active aging refers to having an active approach to life in line with one's goals, ability and opportunities. In adults over 75 years with different baseline neighborhood mobility levels, we studied active aging scores two years prior to and amid COVID-19, when governments restricted mobility of residents to slow the COVID-19 outbreak. Methods: AGNES cohort data were collected in 2017-2018 and spring 2020. Individuals were queried about their will, ability, and opportunity, and extent of doing 17 activities, and subsequently, item, composite and sub-scores of active aging were computed. Neighborhood mobility was assessed as frequency of moving in or beyond own neighborhood (limited, regular, daily=reference). Associations were studied using Generalized Linear Models (cross-sectionally, n=1007) and General Estimating Equations (prospectively, n=774). Results: Participants with limited baseline neighborhood mobility had lower active aging scores than those with daily mobility, but the decline over time was similar. Some item scores on opportunity to act and extent of doing, e.g. for making one's day more interesting and advancing matters of faith or worldview, were better retained amid COVID-19 by those with limited mobility, attenuating group differences. Conclusions: Active aging scores were somewhat compromised in individuals with limited neighborhood mobility, but opportunities for and engagement in several activities seemed to be better retained amid COVID-19 than for those with daily mobility. Thus, active aging may be possible despite mobility restriction. peerReviewed

Background As people age, functional losses may limit the potential to get outside the home and participate in desired activities and community life. Coping with age-related losses has been reported to be important for psychological well-being. Hitherto is not known whether active use of coping strategies also helps maintain out-of-home mobility. Aims We investigated how two coping strategies, tenacious goal pursuit (TGP; persistency in reaching one’s goals) and flexible goal adjustment (FGA; adjusting one’s goals to changed circumstances), are associated with life-space mobility and perceived autonomy in participation outdoors among community-dwelling older people. Methods Participants (n = 186) were aged 79–93 years. TGP and FGA were self-reported using separate scales. Perceived autonomy in participation was assessed with the Impact on Participation and Autonomy Outdoors-subscale, and life-space mobility with the Life-Space Assessment. Two-step cluster analysis was used to create data-driven coping profiles of TGP and FGA. Results General linear model analyses showed that the profile including highly tenacious and flexible older people had the highest life-space mobility and perceived autonomy outdoors, whereas the profile including people with low TGP and low FGA showed the lowest scores. Depressive symptoms attenuated the associations. Conclusions Active use of both TGP and FGA is favorable for out-of-home mobility and enables more active participation in society in later life. Electronic supplementary material The online version of this article (10.1007/s40520-018-1074-y) contains supplementary material, which is available to authorized users.

Objective: To develop an assessment method of active aging for research on older people. Method: A multiphase process that included drafting by an expert panel, a pilot study for item analysis and scale validity, a feedback study with focus groups and questionnaire respondents, and a test–retest study. Altogether 235 people aged 60 to 94 years provided responses and/or feedback. Results: We developed a 17-item University of Jyvaskyla Active Aging Scale with four aspects in each item (goals, ability, opportunity, and activity; range 0-272). The psychometric and item properties are good and the scale assesses a unidimensional latent construct of active aging. Discussion: Our scale assesses older people’s striving for well-being through activities pertaining to their goals, abilities, and opportunities. The University of Jyvaskyla Active Aging Scale provides a quantifiable measure of active aging that may be used in postal questionnaires or interviews in research and practice. peerReviewed

Background We studied the combined effects of cognitive performance and lower extremity function on self-reported walking modifications and walking difficulty and on self-reported walking difficulty incidence over a 2-year follow-up. Methods A total of 848 community-dwelling older people aged 75-90 years participated at baseline, 816 at the 1-year follow-up, and 761 at the 2-year follow-up. Baseline lower extremity function was measured with the Short Physical Performance Battery (

Objectives: To examine the association between perceived benefit from hearing aid (HA) use and life-space mobility among older adults. Method: Cross-sectional analysis of 76- to 91-year-old community-dwelling adults ( n = 702). Data on perceived hearing with and without a HA were obtained via postal questionnaire and data on life-space mobility (Life-Space Assessment, range = 0-120) via phone interview. Results: Participants who perceived more benefit from HA use, had a better life-space mobility score ( M = 65, SD = 2.6) than participants who had less benefit from using a HA ( M = 55, SD = 3.2). Participants who benefitted more from HA use did not differ from those who did not have a HA ( M = 63, SD = 0.9) in their life-space mobility score. Discussion: Perceived benefit from HA use is associated with higher life-space mobility among community-dwelling older adults. Future studies are needed to examine whether use of an appropriate HA promotes life-space mobility among those with difficulties in hearing.

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 500 m, perceiving nature as a facilitator for outdoor mobility, and PA. The presence of water and landscape diversity were objectively assessed inside 500 m and 1000 m 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. peerReviewed

Background The research aim was to study the associations of nature diversity with quality of life (QoL) and depressive symptoms among older people, and whether physical activity explains the associations. Methods Community-dwelling people aged 75–90 years (n = 848) living in Central Finland were interviewed in their homes. QoL was assessed with a short version of the World Health Organization Quality-of-Life Assessment (range 0–130, higher score indicates better QoL) and depressive symptoms with the Centre for Epidemiologic Studies Depression Scale (range 0–30, higher scores indicate more depressive symptoms). Self-reported physical activity was assessed by intensity and duration using a single question with seven response options ranging from mostly resting to competitive sports. Nature diversity (Shannon Diversity Index) was assessed objectively within a 500-m buffer around participants’ homes using a geographic information system (GIS). Results Mean QoL was 100.3 (SD 11.8) and mean CES-D 9.6 (SD 6.8). Those in the highest nature diversity tertile had better QoL than those in the lowest tertile (p = .022). Physical activity did not explain the association between nature diversity and QoL. Adjustment for health indicators did not change the results. Nature diversity was not associated with depressive symptoms. Conclusion A diverse environment, especially when this includes elements of nature, is associated with better QoL. Good quality of the green infrastructure and adding natural elements to residential areas may enhance well-being among community-dwelling older people. peerReviewed

Purpose We studied whether entrance-related environmental barriers, perceived and objectively recorded, were associated with moving out-of-home daily in older people with and without limitations in lower extremity performance. Methods Cross-sectional analyses of the “Life-space mobility in old age” cohort including 848 community-dwelling 75–90-year-old of central Finland. Participants reported their frequency of moving out-of-home (daily vs. 0–6 times/week) and perceived entrance-related environmental barriers (yes/no). Lower extremity performance was assessed (Short Physical Performance Battery) and categorized as poorer (score 0–9) or good (score 10–12). Environmental barriers at entrances and in exterior surroundings were objectively registered (Housing Enabler screening tool) and divided into tertiles. Logistic regression analyses were adjusted for age, sex, number of chronic diseases, cognitive function, month of assessment, type of neighborhood, and years lived in the current home. Results At home entrances a median of 6 and in the exterior surroundings 5 environmental barriers were objectively recorded, and 20% of the participants perceived entrance-related barriers. The odds for moving out-of-home less than daily increased when participants perceived entrance-related barrier(s) or when they lived in homes with higher numbers of objectively recorded environmental barriers at entrances. Participants with limitations in lower extremity performance were more susceptible to these environmental barriers. Objectively recorded environmental barriers in the exterior surroundings did not compromise out-of-home mobility. Conclusion Entrance-related environmental barriers may hinder community-dwelling older people to move out-of-home daily especially when their functional capacity is compromised. Potentially, reducing entrance-related barriers may help to prevent confinement to the home.

The authors studied associations of nature- and infrastructure-based features with physical activity (PA) in different urban neighborhood types; 848 community-dwelling people aged 75–90 years reported PA and three perceived nature-based destinations and seven infrastructure-based features as outdoor mobility facilitators. Neighborhood type was defined using a geographic information system based on proximity to central service areas and residential density (city center, subcenter, and dense and dispersed areas outside centers). PA was higher in dense areas and the city center. Binary logistic regression showed that perceiving nature-based destinations increased the odds for higher PA in the city center and areas outside centers. In dispersed areas, perceived infrastructure-based facilitators were especially associated with higher PA. Environmental features were not associated with PA in subcenters. Higher residential density, as a proxy for a higher amount of infrastructure, rather than center proximity, may underlie older adults’ PA. The spatial context should be acknowledged in studies on environment–PA associations.

From the individual viewpoint, active aging refers to the ability of older persons, depending on their goals, functional capacity and opportunities, to engage in desired activities. This study investigated the role of health literacy in active aging among persons differing in their number of chronic conditions. Data were collected from 948 individuals, 57% women, aged 75, 80 and 85 in 2017–2018 in the city of Jyväskylä in Central Finland. Health literacy was assessed with the 16-question version of the European Health Literacy Survey (HLS-EU-Q16), active aging with the University of Jyväskylä Active Aging Scale (UJACAS) and self-reported physician-diagnosed chronic conditions. Both health literacy (r = 0.40) and number of chronic conditions (r = −0.21) correlated with the active aging score. Linear regression models revealed that health literacy was a stronger predictor than chronic conditions of active aging (β 0.18, p < 0.001 vs. β −0.06, p = 0.030) and that its predictive value remained statistically significant after adjustment for cognitive capacity, number of depressive symptoms, physical performance and length of education. Higher health literacy can enable older persons, including those with multiple chronic conditions, to maintain higher levels of active aging. As more people are projected to live with chronic conditions to older ages, health literacy may help them to cope with illnesses and functional limitations and lead a fulfilling life. These cross-sectional findings lay a foundation for future prospective and experimental studies on health literacy and active aging. peerReviewed

The aim is to determine concurrent validity of a single self-report habitual physical activity (PA) question against accelerometer-based PA and mobility variables, and corresponding changes in self-reported PA and mobility. Cross-sectional and longitudinal data of the "Life-space mobility in old age" (LISPE) cohort and its substudy on PA were utilized. At baseline, 848 community-dwelling, 75- to 90-year-old people living independently in central Finland participated in home-based interviews. One and 2 years later, 816 and 761 of them were reassessed by phone, respectively. Tri-axial accelerometer data over 7 days were collected following the baseline assessments in a subsample of 174. Self-reported habitual PA was assessed based on intensity and duration using a single question with seven response options (range: mostly resting to competitive sports). Mobility variables were as follows: life-space mobility, walking difficulty over 500 m, and short physical performance battery. Statistically significant correlations were found between self-reported habitual PA and mobility (Spearman correlation coefficient Rs = 0.40-0.61) and accelerometer-based PA variables [step counts (Rs = 0.49), time in moderate (Rs = 0.49) and low intensity (Rs = 0.40) PA, and time in sedentary behavior (Rs = -0.28)]. A decline in self-reported habitual PA over time was associated with 5-10p decline in life-space mobility (PA improvement with 0-3p increase) and with developing a higher degree of walking difficulty (in 35-44% of participants). In conclusion, based on these results, the self-report question to assess habitual PA is valid and responsive to change and thus useful for epidemiological research in community-dwelling older people, also in follow-up studies.© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Language: en

Objectives Hearing loss is a common health concern in older people, and the prevalence of hearing loss increases with aging. Poor hearing may cause difficulties in everyday life situations and reduce quality of life (QoL). The aim of this study was to assess the associations between different domains of QoL (physical, psychological, social, and environmental), perceived hearing difficulties in various everyday situations, and audiometrically measured hearing level among community-dwelling older adults. Method Cross-sectional analysis of 76- to 91-year-old community-dwelling adults. Data on QoL (WHO Quality of Life Assessment short version) and perceived hearing difficulties were gathered via postal questionnaires (n = 706) and screening pure-tone audiometry was performed at the participants' homes for a random subsample (n = 161). Data were analyzed with linear regression models. Results Factor analysis on the perceived hearing difficulties questionnaire identified three dimensions: speech hearing, socioemotional effects, and spatial hearing. All the perceived hearing difficulty factors, but not the pure-tone audiometry results, were significantly associated with poorer values in all the QoL domains and the total QoL score. Discussion Perceived hearing difficulties in various everyday life situations are more strongly associated with older adults' QoL than audiometrically assessed hearing impairment.

Background: essential aspects of independence in community mobility among older people concern the control over where, when and how to participate (perceived autonomy), and actual mobility (life-space mobility; frequency, distance and need of assistance). We studied relationships between frailty and life-space mobility and perceived autonomy in participation outdoors among community-dwelling 75–90 years old people. Methods: longitudinal analyses of the ‘Life-space mobility in old age’ cohort study (n = 753). Life-space mobility (Life-Space Assessment, range 0–120) and perceived autonomy in participation outdoors (Impact on Participation and Autonomy subscale ‘autonomy outdoors’, range 0–20) were assessed at baseline and 2 years later. Baseline frailty indicators were unintentional weight loss (self-report), weakness (5 times chair rise), exhaustion (self-report), slowness (2.44 m walk) and low physical activity (self-report). Results: in total, 53% had no frailty, 43% pre-frailty (1–2 frailty indicators) and 4% frailty (≥3 indicators). Generalised estimation equation models showed that life-space mobility was lower among those with frailty and pre-frailty compared with those without frailty and, in addition, declined at a faster pace. Perceived autonomy in participation outdoors was more restricted among those with frailty and pre-frailty compared with those without frailty, but the rate of decline did not differ. Conclusion: frailty was associated with more restricted life-space mobility and poorer perceived autonomy in the decision-making concerning community mobility. Over the follow-up, frailty predicted a steeper decline in life-space mobility but not in perceived autonomy. Further study is warranted to determine whether compensation strategies or changes in the valuation of activities underlie this discrepancy. peerReviewed

Objective: The aim of this study was to analyze whether the associations between perceived environmental and individual characteristics and perceived walking limitations in older people differ between those with intact and those with poorer lower extremity performance. Method: Persons aged 75 to 90 ( N = 834) participated in interviews and performance tests in their homes. Standard questionnaires were used to obtain walking difficulties; environmental barriers to and, facilitators of, mobility; and perceived individual hindrances to outdoor mobility. Lower extremity performance was tested using Short Physical Performance Battery (SPPB). Results: Among those with poorer lower extremity performance, the likelihood for advanced walking limitations was, in particular, related to perceived poor safety in the environment, and among those with intact performance to perceived social issues, such as lack of company, as well as to long distances. Discussion: The environmental correlates of walking limitations seem to depend on the level of lower extremity performance.

Background Our aim was to study the relationship between objectively measured physical activity and subsequent changes in life-space mobility over 2 years among older people. Life-space mobility refers to the area a person moves through in daily life, taking into account frequency, and need of assistance. Life-space mobility and physical activity correlate, but whether different intensities of objectively assessed physical activity predicts decline in life-space mobility is not known. Methods Prospective cohort study of the "Life-space Mobility in Old Age" (LISPE) project accelerometer substudy. Participants were community-dwelling older people aged 75-90 (n = 164). Life-space mobility was measured with the Life-Space Assessment at baseline face-to-face home interview and telephone follow-up interviews 1 and 2 years after baseline. Physical activity (step count and time spent in moderate activity, low activity, and sedentary behavior) was measured by a tri-axial accelerometer (Hookie "AM20 Activity Meter") for 7 days at baseline. Generalized estimating equations (GEE models) were used to compare changes in life-space mobility between participants categorized according to the baseline physical activity measures. Results Median age of the participants was 79.5 (IQR 6.7) and 64% were women. Over the 2 years, life-space mobility declined significantly among those with lower step counts and less time spent in moderate activity measured at baseline. Time spent in low activity and sedentary behavior did not predict changes in life-space mobility. Conclusions In old age, more time spent walking outdoors and accumulation of moderate-intensity physical activity may help to maintain higher life-space mobility, a correlate of good quality of life.

Objectives Life-space mobility, assessed with the Life-Space Assessment (LSA), reflects an individual's mobility in terms of the spatial area, frequency, and need for assistance. The aims were to study associations between life-space mobility and disability status in activities of daily living (ADL), and to define cutoff scores for baseline LSA and LSA change over time identifying individuals who developed ADL inability during 2 years of follow-up. Robustness of the cutoff scores was tested accounting for potential confounders. Design Longitudinal analyses of the “Life-space mobility in old age” cohort study. Setting Home-based interviews at baseline and phone interviews 2 years later. Participants A total of 755 community-dwelling 75- to 90-year-old people living in Central Finland. Measurements LSA score (range 0–120) and ADL disability status (no difficulty, difficulty in ≥1 tasks, or inability in ≥1 tasks) were determined based on self-reports. Results Participants who developed difficulty or inability in ADL over time presented lower LSA scores at baseline and larger declines compared to those who remained without task difficulty or inability during the follow-up, respectively. Sensitivity and specificity analyses showed that baseline LSA ≤52.3 (0.86 and 0.74, respectively) and LSA decline of >11.7 (0.76 and 0.71, respectively) identified participants who developed ADL inability over the follow-up. Multinomial regression showed that, after adjustment for potential confounders, these cutoff scores increased the odds to develop new difficulty in ADL tasks, and the odds to develop ADL inability among those with baseline difficulty. Conclusion Our results suggest that restrictions and declines in life-space mobility may be early signs of increasing vulnerability to disability in old age. These longitudinally defined cutoff points may help to find clinical applications for the LSA.

Transportation walking represents a promising target for physical activity promotion in older adults. Perceived characteristics of the neighbourhood physical environment may affect older adults’ choice of transportation mode for a routine activity such as walking to the grocery store. To (1) evaluate associations between older adults’ perception of parks and trails as outdoor mobility facilitators and transportation walking, specifically to the grocery store; and (2) explore whether the spatial relationship between people’s home, perceived facilitator and store was relevant for their transportation choice. Cross-sectional data were collected in a subsample of the ‘Life-space mobility in old age’ cohort. Multivariable logistic regression analysis on the binary outcome ‘transportation walking’ (vs. ‘motorized transportation’) was used to evaluate the association with perceived mobility facilitators in the neighborhood; in step (1) without and in step (2) with taking spatial relationships into account. Perceiving a park as facilitator increased the odds of walking (N = 179; Odds Ratio 9.89; 95% Confidence interval 3.11–31.50). Spatial relationships did not affect transportation choice. Reporting a trail as facilitator was not significantly associated with walking. Our findings suggest that the perception of environmental characteristics in the neighbourhood has an influence on older people’s transportation choices. Taking environmental measures or informing older adults on their options in the neighbourhood might be possible ways to increase older adults’ transportation walking on a population level.

Background: The purpose of the study was to explore the single and combined contributions of body mass index (BMI) and lower extremity performance as modifiable physical factors, and the influence of use of a private car as an environmental factor on prevalent and incident life-space restriction in community-dwelling older people. Methods: Community-dwelling people aged 75–90 years (n = 823) participated in the Life-Space Mobility in Old Age (LISPE) two-year follow-up study. Participants who reported that the largest life-space area they had attained, without aid from any device or another person, was the neighborhood or less were considered to have life-space restriction. Incident life-space restriction was the endpoint of Cox’s proportional hazard model. BMI, lower extremity performance (Short Physical Performance Battery, SPPB), and use of a private car were predictors. Results: At baseline, people who had both obesity (BMI ≥30.0) and impaired lower extremity performance (SPPB 0–9) had a higher prevalence of life-space restriction (prevalence ratio 3.6, 95% confidence interval, CI, 2.0–6.3) compared to those with normal weight (BMI 23.0–24.9) and intact physical performance (SPPB 10–12). The 581 people without life-space restriction at the baseline contributed 1033 person-years during the twoyear follow-up. Incident life-space restrictions were reported by 28.3% participants. A higher hazard ratio (HR) for incident life-space restriction was observed in subjects having both obesity and impaired lower extremity performance (HR 3.6, 95% CI, 1.7–7.4), impaired lower extremity performance only (HR 1.9, 95% CI 0.9–4.1), and obesity only (HR 1.8, 95% CI, 0.9–3.5) compared to those with normal weight and intact performance. Private car passengers (HR 2.0, 95% CI, 1.3–3.0) compared to car drivers had a higher risk of life-space restriction. All models were adjusted for age, sex, chronic diseases, and education. Conclusions: Older people with impaired lower extremity performance have an increased risk of incident life-space restriction especially if combined with obesity. Also, not driving a car renders older people vulnerable to life-space restriction. peerReviewed

Life-space assessment incorporates all movements in terms of the distance from home, the frequency of movement and the need of assistance for movement. Executive function (EF) is an important higher order cognitive ability that controls and guides people’s goal-directed actions. We examined the cross-sectional and longitudinal associations between EF and life-space mobility, and investigated if perceived walking difficulties, lower extremity performance, and transportation difficulties explain the association. Methods 157 community-dwelling persons aged 76–91 years participated in the study at the baseline, and 103 of them in 2-year follow-up study. Based on the distribution on the Trail Making Test participants were categorized into tertiles of EF. Life-space mobility was assessed using the Life-Space Assessment (range 0–120). Perceived walking difficulties and transportation difficulties were self-reported, and lower extremity performance was assessed with the short physical performance battery (SPPB). Adjustments were made for gender, age, number of chronic conditions, and years of education. Results Average age of participants at the baseline was 82.6 (SD 4.2) years and 61% were women. Individuals with poor EF had lower life-space mobility compared to those with good EF. SPPB and transportation difficulties explained the association. Over the 2-year follow-up, those with poor EF at the baseline showed steeper decline but the difference did not quite reach statistical significance (p = 0.068). Conclusions People with better executive function had higher life-space mobility. This was explained by better lower extremity performance and absence of transportation difficulties. Cognitive decline may hinder access to community amenities, which in turn may further accelerate cognitive decline. peerReviewed

Objective: The objective of this study is to study the associations of objectively defined hilliness with the prevalence and incidence of walking difficulties among community-dwelling older adults, and to explore whether behavioral, health, or socioeconomic factors would fully or partially explain these associations. Method: Baseline interviews ( n = 848, 75-90 years) on difficulties in walking 500 m, frequency of moving through the neighborhood, and perceived hilliness as a barrier to outdoor mobility were conducted. Two-year follow-up interviews ( n = 551) on difficulties in walking 500 m were conducted among participants without baseline walking difficulties. Hilliness objectively defined as the mean slope in 500-m road network. Results: Logistic regression showed that hilliness was associated with incident walking difficulties at the 2-year follow-up (odds ratio [OR] = 1.66, 95% confidence interval [CI] = [1.09, 2.51]) but not with the prevalence of walking difficulties at baseline. Adding behavioral, health, or socioeconomic factors to the models did not markedly change the results. Discussion: Greater hilliness should be considered a risk factor for developing walking difficulties among older adults.

Background Life-space mobility, an indicator of community mobility, describes person’s movements in terms of the distance from home, the frequency of movement, and the need of assistance for movement. Executive function (EF) is a higher-order cognitive function that supervises motor control and plays a key role in a person’s ability to function independently. Cognitive impairment often co-occurs with restricted life-space mobility; however, the direction of the longitudinal associations between EF and life-space mobility is unclear. The aim of this study was to investigate the temporal associations between EF and life-space mobility among community-dwelling older people. Methods One hundred eight community-dwelling persons aged 76 to 91 years participated in the 2 year follow-up study. EF was measured with the Trail Making Test. The Life-Space Assessment (range 0–120, higher scores indicate more mobility) was used to assess life-space mobility. Cross-lagged model design was used to examine longitudinal relationship between EF and life-space mobility. The model was adjusted for age and gender. Results Average age of participants at baseline was 82.2 (SD 4.1) years and 59% were women. Better EF at baseline predicted higher life-space mobility at follow-up (path coefficient = 3.81, 95% confidential interval; 0.84, 6.78, p = .012), whereas baseline life-space mobility did not predict EF at follow-up. Conclusion EF was a determinant of life-space mobility. Supporting EF may enhance maintaining independence and active participation in old age. peerReviewed

Purpose Life-space mobility refers to the spatial area in which a person moves in daily life, taking into account distance, frequency and assistance needed. The aim was to examine how changes in life-space mobility are associated with changes in quality of life (QOL) over a 2-year period. Methods Community-dwelling people aged 75–90 years (n = 848) were interviewed face-to-face in their homes and followed up annually for 2 years. QOL was assessed with the short version of the World Health Organization QOL assessment (range 0–130, higher scores indicate better QOL). Life-space mobility was assessed with the Life-Space Assessment (range 0–120, higher scores indicate better life-space mobility). Lower extremity performance was objectively measured with the Short Physical Performance Battery (SPPB). Cognitive impairment was assessed using the Mini-Mental State Examination. Chronic conditions and years of education were self-reported. Data were analyzed with generalized estimation equation models. Results The mean life-space score at baseline was 63.9 ± SD 20.6 and mean QOL score 100.3 ± 11.8. Over the follow-up, the QOL score decreased to 95.0 ± 13.8 across the total study sample. The decrease in QOL score was somewhat higher among those whose life-space mobility score declined >10 points during the follow-up compared to those whose life-space remained stable or improved, even after adjustment for age, gender, number of chronic conditions, cognitive impairment, SPPB and education. Conclusions Decline in life-space mobility is associated with decline in QOL. The results highlight the importance of ensuring continuous possibilities for out-of-home mobility in maintaining QOL among older people. peerReviewed

Aim The aim was to assess the level of lower body pain among people with previous femoral neck fracture, and whether the type of surgery was associated with pain and physical function a mean of 2 years after surgery. Methods The study included 115 community-dwelling older adults aged 60 years and older with previous femoral neck fracture, and 31 reference subjects without previous lower limb injuries. A total of 30 patients had internal fixation surgery, 70 had hemiarthroplasty and 15 had total hip replacement. All patients had surgery in the same hospital and received typical inpatient rehabilitation. From 1.6 months to 7.5 years after the fracture, the patients underwent examination including clinical evaluation, measurements of pain in the lower body (visual analog scale), physical function (maximal walking speed, Timed Up & Go, Berg Balance Scale) and self-reported walking difficulties. Results Hip fracture patients reported more pain (81 ± 88 mm) compared with the reference group (25 ± 39 mm, P = 0.004). Patients with internal fixation reported significantly more pain than the other study groups. Significantly more patients with internal fixation (53%) reported walking difficulties compared with patients who had hemiarthroplasty (29%, P = 0.028) or total hip replacement (13%, P = 0.018). No significant difference was observed in performance-based physical function between the fracture groups, but participants in the reference group had better physical function than any of the fracture groups. Conclusions Hip fracture patients treated with internal fixation experienced more pain and walking difficulties than the hemiarthroplasty and total hip replacement groups. Different types of surgical fixation might require different rehabilitation and pain management strategies after hip fracture. Geriatr Gerontol Int 2015; ●●: ●●–●●.

BACKGROUND: Poor hearing is common in older adults and it may have negative consequences which extend beyond communication. OBJECTIVES: To explore the associations of self-reported hearing problems with physical performance and self-reported difficulties in mobility and activities of daily living (ADL) in community-dwelling older adults. DESIGN: Cross-sectional cohort study SETTING: Community PARTICIPANTS: 848 men and women aged 75-90 years MEASUREMENTS: Structured face-to-face interviews to assess perceived hearing problems in the presence of noise, mobility difficulties (moving indoors, stair-climbing, 0.5 km walk and 2 km walk) and difficulties in ADLs and instrumental ADLs. The Short Physical Performance Battery (SPPB) test was administered. Age, years of education, cognitive functioning, and self-reported cardiac, circulatory, and locomotor diseases were used as covariates. RESULTS: Compared to persons who reported good hearing, persons who reported major hearing problems had a lower SPPB total score indicating poorer performance (mean 9.8 vs. 10.9, p=0.009) and more difficulties in ADLs (mean 1.8 vs. 1.4, p=0.002) and IADLs (mean 4.6 vs. 3.4, p=0.002) after controlling for covariates. They also had higher odds for more difficulty in stair-climbing (OR 2.8, p

Background:An individual’s ability to live independently is commonly measured in health research interested in identifying risk factors associated with disablement processes. In order to inform clinical practice, population research has attempted to identify the contraction of “lived-space” by using various survey instruments.Problem:Studies assessing habitual movements over the environment with the Life-Space Assessment (LSA) survey instrument should carefully consider how the LSA Composite Score (LSA-CS) is computed. Until now, no publication has carefully delineated the assumptions guiding the internal logic used in the computation of the LSA-CS.Core argument:Because the internal logic of the LSA may need further justification, a non-data-editing scoring algorithm should be considered.Solution:Compute LSA-CS by only using non-edited data.Specific aim:Paper first delineates the logic guiding the algorithm used in the formation of the LSA-CS and explains how the scoring creates and changes participant re...

Mobility is important for maintaining independence and active participation in old age. Life-space mobility assessment incorporates the extent of mobility in terms of the distance from home, the frequency of mobility and the need of assistance for mobility. Executive function (EF) is one of the most important higher-order cognitive abilities that control and guide goal-directed actions. The aim of the study was to examine the association between EF and life-space mobility.

Physical activity (PA) decreases during hospitalization. In particular, the amount of PA engaged in by older people who are hospitalized following musculoskeletal injury is likely to be limited for months after discharge home. Given the importance of an active lifestyle for their recovery and the prevention of future adverse outcomes, there is clearly a need for interventions to increase PA. This article describes the protocol of a randomized controlled trial set up to investigate the effects of a physical activity oriented home rehabilitation program (ProPA) on PA and the restoration of mobility in community-dwelling older people. Men and women aged 60 years or older hospitalized due to a musculoskeletal injury or disorder in the back or lower limbs are recruited. After discharge from hospital to home, participants are randomized into a six-month ProPA program or a standard care (control) group. The ProPA program consists of a motivational interview, goal attainment process, guidance for safe walking, a progressive home exercise program and physical activity counseling. In addition, frail participants who are not able to go outdoors alone receive support from volunteers. Primary outcomes are PA measured using a 3-dimentional accelerometer, and mobility assessed by the Short Physical Performance Battery and self-reports. Secondary outcomes are life space mobility, participation restriction, fear of falling, pain, mood, and grip strength. Information on barriers to and enablers of PA participation are also collected. Data on mortality and use of health services are collected from the national register. In this 6-month intervention, all participants are assessed in their homes at baseline and after three and six months, and at 12 months after randomization they will receive a follow-up questionnaire. This study investigates the effects of a rehabilitation program on PA and mobility among older people at risk for increased sedentary time and mobility problems. If positive effects are observed, the program can be considered for incorporation into the health care system and thereby contribute to the rehabilitation of older people who have recently been discharged from hospital. ISRCTN13461584 . Registered 27 January 2016.