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The Journals of Gerontology. Series B,... Jan 2021This study compares estimates and determinants of within-individual changes in mobility across surveys of older U.S. adults.
OBJECTIVES
This study compares estimates and determinants of within-individual changes in mobility across surveys of older U.S. adults.
METHODS
Data come from the Health and Retirement Study (HRS) and the Midlife in the United States (MIDUS) study. Measures of mobility comprise self-reported level of difficulty with walking several blocks, going up several flights of stairs, lifting and carrying 10 pounds, and stooping. Predictors include sociodemographic characteristics and indicators of health and health behaviors. We pool the datasets and estimate weighted lagged dependent variable logistic regression models for each activity, assessing cross-study differences using interaction terms between a survey indicator and relevant variables.
RESULTS
Estimates of declines in mobility differ substantially across surveys for walking, lifting and carrying, and stooping, but there are no between-survey differences in the probability of (not) recovering from a limitation. With the exception of age, determinants of change are similar between studies. For lifting/carrying and stooping, the age-related increase in developing limitations is less steep at younger ages for HRS respondents than MIDUS respondents, but steeper at older ages.
DISCUSSION
To compare estimates of mobility change across surveys, mobility measures would need to be harmonized. Determinants of mobility change, however, are more comparable.
Topics: Adult; Age Factors; Aged; Aging; Cross-Sectional Studies; Female; Humans; Longitudinal Studies; Male; Middle Aged; Mobility Limitation; Motor Activity; Risk Factors; United States
PubMed: 31362309
DOI: 10.1093/geronb/gbz091 -
Archives of Gerontology and Geriatrics Sep 2023Clinical interpretability of the gait speed and 5-times sit-to-stand (5-STS) tests is commonly established by comparing older adults with and without self-reported...
Estimating cutpoints of gait speed and sit-to-stand test values for self-reported mobility limitations in a cohort of community-dwelling older adults from Singapore: comparing receiver operating characteristic (ROC) analysis with adjusted predictive modelling.
OBJECTIVES
Clinical interpretability of the gait speed and 5-times sit-to-stand (5-STS) tests is commonly established by comparing older adults with and without self-reported mobility limitations (SRML) on gait speed and 5-STS performance, and estimating clinical cutpoints for SRML using the receiver operating characteristics (ROC) method. Accumulating evidence, however, suggests that the adjusted predictive modeling (APM) method may be more appropriate to estimate these interpretational cutpoints. Thus, we aimed to compare, in community-dwelling older adults, gait speed and 5-STS cutpoints estimated using the ROC and APM methods.
DESIGN
Cross-sectional study.
SETTING AND PARTICIPANTS
This study analyzed data from 955 community-dwelling independently walking older adults (73%women) aged ≥60 years (mean, 68; range, 60-88).
METHODS
Participants completed the 10-metre gait speed and 5-STS tests. Participants were classified as having SRML if they responded "Yes" to either of the 2 questions regarding walking and stair climbing difficulty. Cutpoints for SRML and its component questions were estimated using ROC analysis with Youden criterion and the APM method.
RESULTS
The proportions of participants with self-reported walking difficulty, self-reported stair climbing difficulty, and SRML were 10%, 19%, and 22%, respectively. Gait speed and 5-STS time were moderately correlated with each other (r=-0.56) and with the self-reported measures (absolute r-values, 0.39-0.44). ROC-based gait speed cutpoints were 0.14 to 0.16 m/s greater than APM-based cutpoints (P < 0.05) whilst ROC-based 5-STS time cutpoints were 0.8 to 3.3 s lower than APM-based cutpoints (P < 0.05 for walking difficulty). Compared with ROC-based cutpoints, APM-based cutptoints were more precise and they varied monotonically with self-reported walking difficulty, self-reported stair climbing difficulty, and SRML.
CONCLUSIONS AND IMPLICATIONS
In a sample of 955 older adults, our findings of precise and biologically plausible gait speed and 5-STS cutpoints for SRML estimated using the APM method indicate that this promising method could potentially complement or even replace traditional ROC methods.
Topics: Aged; Humans; Female; Independent Living; Walking Speed; ROC Curve; Mobility Limitation; Self Report; Cross-Sectional Studies; Singapore; Geriatric Assessment; Walking; Gait
PubMed: 37075584
DOI: 10.1016/j.archger.2023.105036 -
Disability and Rehabilitation.... Feb 2019Low ridership of public transit buses among wheeled mobility device users suggests the need to identify vehicle design conditions that are either particularly...
BACKGROUND
Low ridership of public transit buses among wheeled mobility device users suggests the need to identify vehicle design conditions that are either particularly accommodating or challenging. The objective of this study was to determine the effects of low-floor bus interior seating configuration and passenger load on wheeled mobility device user-reported difficulty, overall acceptability and design preference.
METHODS
Forty-eight wheeled mobility users evaluated three interior design layouts at two levels of passenger load (high vs. low) after simulating boarding and disembarking tasks on a static full-scale low-floor bus mockup.
RESULTS
User self-reports of task difficulty, acceptability and design preference were analyzed across the different test conditions. Ramp ascent was the most difficult task for manual wheelchair users relative to other tasks. The most difficult tasks for users of power wheelchairs and scooters were related to interior circulation, including moving to the securement area, entry and positioning in the securement area and exiting the securement area. Boarding and disembarking at the rear doorway was significantly more acceptable and preferred compared to the layouts with front doorways.
CONCLUSION
Understanding transit usability barriers, perceptions and preferences among wheeled mobility users is an important consideration for clinicians who recommend mobility-related device interventions to those who use public transportation. Implications for Rehabilitation In order to maximize community participation opportunities for wheeled mobility users, clinicians should consider potential public transit barriers during the processes of wheelchair device selection and skills training. Usability barriers experienced by wheeled mobility device users on transit vehicles differ by mobility device type and vehicle configurations. Full-scale environment simulations are an effective means of identifying usability barriers and design needs in people with mobility impairments and may provide an alternative model for determining readiness for using fixed route buses or eligibility for paratransit.
Topics: Adult; Aged; Architectural Accessibility; Disabled Persons; Equipment Design; Female; Humans; Male; Middle Aged; Mobility Limitation; Motor Vehicles; Self Report; Self-Help Devices; Task Performance and Analysis; Wheelchairs
PubMed: 29130752
DOI: 10.1080/17483107.2017.1401128 -
The Netherlands Journal of Medicine Sep 2014
Topics: Aged; Arterial Occlusive Diseases; Brain Ischemia; Dizziness; Dysarthria; Female; Giant Cell Arteritis; Humans; Magnetic Resonance Imaging; Mobility Limitation; Vertebral Artery
PubMed: 25178774
DOI: No ID Found -
American Journal of Public Health Feb 2015
Topics: Disabled Persons; Female; Humans; Male; Mobility Limitation; Smoking; Smoking Cessation
PubMed: 25574698
DOI: 10.2105/AJPH.2014.302528 -
International Journal of Older People... Sep 2020To identify the current state of knowledge about the use of the sit-to-stand intervention with older people and to identify implications for further research. (Review)
Review
AIMS AND OBJECTIVES
To identify the current state of knowledge about the use of the sit-to-stand intervention with older people and to identify implications for further research.
BACKGROUND
Many older people experience mobility challenges which can negatively affect their well-being. Physical activities are vital to improving or maintaining mobility. Although there is evidence that mobility challenged older people benefit from the sit-to-stand intervention, there is a need to systematically examine the state of knowledge about this intervention.
DESIGN
Scoping review using Arksey and O'Malley's methodological framework.
METHODS
A systematic search of three databases was completed. Abstracts were evaluated for relevance using predetermined inclusion criteria. Studies that met the inclusion criteria had data extracted and were appraised for internal and external validity. Narrative synthesis was based on methods described by Popay and colleagues.
RESULTS
Of 3,041 papers, six studies met the inclusion criteria. Publications provided a range of sit-to-stand interventions with durations varying from four weeks to six months. The frequency of each intervention fluctuated from three to seven times/week with a duration of 15-45 min. Different professionals prompted the activity. Three themes were identified the following: (a) sit-to-stand activity as an intervention; (b) generalisability of findings; and (c) sustainability.
CONCLUSIONS
Most of the studies reviewed indicated improvements in performance of the sit-to-stand activity and in motor function. However, issues with studies rigour do not allow us to make generalisations. Further research is needed to confirm the effectiveness of the intervention.
IMPLICATIONS FOR PRACTICE
Healthcare providers are expected to offer evidence-based patient care. This review details current knowledge about the sit-to-stand intervention with older people.
Topics: Activities of Daily Living; Aged; Aged, 80 and over; Humans; Mobility Limitation; Quality of Life; Sitting Position; Standing Position; Vulnerable Populations
PubMed: 32500976
DOI: 10.1111/opn.12319 -
BMC Geriatrics Apr 2022Projections of the development of mobility limitations of older adults are needed for evidence-based policy making. The aim of this study was to generate projections of...
BACKGROUND
Projections of the development of mobility limitations of older adults are needed for evidence-based policy making. The aim of this study was to generate projections of mobility limitations among older people in the United States, England, and Finland.
METHODS
We applied multiple imputation modelling with bootstrapping to generate projections of stair climbing and walking limitations until 2026. A physical activity intervention producing a beneficial effect on self-reported activities of daily living measures was identified in a comprehensive literature search and incorporated in the scenarios used in the projections. We utilised the harmonised longitudinal survey data from the Ageing Trajectories of Health - Longitudinal Opportunities and Synergies (ATHLOS) project (N = 24,982).
RESULTS
Based on the scenarios from 2012 to 2026, the prevalence of walking limitations will decrease from 9.4 to 6.4%. A physical activity intervention would decrease the prevalence of stair climbing limitations compared with no intervention from 28.9 to 18.9% between 2012 and 2026.
CONCLUSIONS
A physical activity intervention implemented on older population seems to have a positive effect on maintaining mobility in the future. Our method provides an interesting option for generating projections by incorporating intervention-based scenarios.
Topics: Activities of Daily Living; Aged; Exercise; Healthy Aging; Humans; Mobility Limitation; Walking
PubMed: 35397525
DOI: 10.1186/s12877-022-03008-4 -
Journal of Physiological Anthropology Oct 2016This study aimed to examine the association of walking difficulty with bone mass or bone turnover among community-dwelling Japanese people aged 40 years and older.
BACKGROUND
This study aimed to examine the association of walking difficulty with bone mass or bone turnover among community-dwelling Japanese people aged 40 years and older.
METHODS
We studied 1097 community-dwelling Japanese people aged 40 years and older (379 men and 718 women) who were invited to participate in periodic health examinations in 2006-2009. Walking difficulty was defined as having difficulty walking 100 m on a level surface (self-administered questionnaire). Calcaneal stiffness index (bone mass) was measured by quantitative ultrasound. Spot urine samples were collected, and urinary N-terminal cross-linking telopeptide of type I collagen (NTx) was measured. Values were corrected for creatinine (Cre) concentration.
RESULTS
The prevalence of walking difficulty was significantly higher in women than in men (7.4 vs. 3.4 %, p = 0.011) and significantly increased with age in men (p for trend = 0.02) and women (p for trend <0.001). In univariate analysis, men and women with walking difficulty were older (p < 0.001) and had a lower stiffness index (p < 0.001), compared with those without walking difficulty. Among women, individuals with walking difficulty had significantly higher urinary NTx/Cre than those without walking difficulty (p < 0.001); however, this was not so among men (p = 0.39). Multiple regression analysis adjusted for age, weight, and menopausal status showed a significant association between walking difficulty and lower stiffness index in men (p = 0.004) and women (p = 0.005). In women, walking difficulty was significantly associated with higher NTx/Cre (p = 0.001), but not in men (p = 0.35).
CONCLUSIONS
Walking difficulty may contribute to low bone mass in both sexes but might cause high bone turnover in women only.
Topics: Adult; Aged; Aged, 80 and over; Aging; Biomarkers; Bone Density; Bone Resorption; Female; Humans; Male; Middle Aged; Mobility Limitation; Walking
PubMed: 27729080
DOI: 10.1186/s40101-016-0114-6 -
American Journal of Physical Medicine &... Feb 2018Mobility activity modifications indicate early functional losses that act as precursors to future declines among community-dwelling older adults. However, there is...
OBJECTIVES
Mobility activity modifications indicate early functional losses that act as precursors to future declines among community-dwelling older adults. However, there is scarce evidence on whether activity modifications indicate poorer physical health among adults with symptomatic osteoarthritis, a major cause of disability. Our purpose was to investigate whether patient-reported mobility activity modifications indicated poorer physical health among adults with symptomatic knee osteoarthritis.
DESIGN
Secondary cross-sectional analysis of randomized trial data was performed. Preclinical Disability Questionnaire was used to group participants into the following three categories: difficulty, modified, and no difficulty walking/stair climbing. Kruskal Wallis and χ tests were used to compare clinical factors across groups.
RESULTS
Among 121 participants (median age = 60 yrs; 73% female; 60% white), less than 10% had modified walking/stair climbing. Compared with those with no walking difficulty, participants with modified walking had significantly less balance (P = 0.01) and global health (P = 0.01) as well as greater knee pain (P = 0.05) and physical disability (P = 0.04). Those with modified stair climbing had significantly smaller walking distances (P = 0.03) compared with those with no difficulty stair climbing.
CONCLUSIONS
Activity modifications may signal early impairments in physical health among people with symptomatic knee osteoarthritis. If confirmed, patient-reported activity modifications may enhance symptom evaluation in osteoarthritis and enable a better understanding of the disablement process.
Topics: Adult; Chi-Square Distribution; Cross-Sectional Studies; Disability Evaluation; Exercise; Female; Humans; Knee Joint; Male; Middle Aged; Mobility Limitation; Osteoarthritis, Knee; Physical Therapy Modalities; Postural Balance; Randomized Controlled Trials as Topic; Range of Motion, Articular; Single-Blind Method; Statistics, Nonparametric; Tai Ji; Walking
PubMed: 28763325
DOI: 10.1097/PHM.0000000000000802 -
American Journal of Kidney Diseases :... Apr 2022For older adults, maintaining mobility is a major priority, especially for those with advanced chronic diseases like kidney failure. However, our understanding of the...
RATIONALE & OBJECTIVE
For older adults, maintaining mobility is a major priority, especially for those with advanced chronic diseases like kidney failure. However, our understanding of the factors affecting mobility in older adults receiving maintenance hemodialysis is limited.
STUDY DESIGN
Descriptive qualitative study.
SETTING & PARTICIPANTS
Using purposive sampling, we recruited (1) persons aged≥60 years receiving maintenance hemodialysis; and (2) care partners (≥18 years) providing regular support to an older adult receiving hemodialysis. During a single in-person home visit, we assessed mobility using the Short Physical Performance Battery (SPPB) and conducted individual one-on-one interviews regarding important personal factors related to mobility.
ANALYTICAL APPROACH
Descriptive statistics were used for demographic and SPPB data. Transcripts underwent thematic coding, informed by the International Classification of Function framework of mobility. We used conceptual content analysis to inductively extract themes and subthemes.
RESULTS
We enrolled 31 older adults receiving hemodialysis (42% female, 68% Black) with a mean age of 73±8 years and mean dialysis vintage of 4.6±3.5 years; their mean SPPB score was 3.6±2.8 points. Among 12 care partners (75% female, 33% Black), the mean age was 54±16 years and mean SPPB score was 10.1±2.4 points. Major themes extracted were (1) mobility represents independence; (2) mobility is precarious; (3) limitations in mobility cause distress; (4) sources of encouragement and motivation are critical; and (5) adaptability is key.
LIMITATIONS
Modest sample from single geographic area.
CONCLUSIONS
For older adults receiving hemodialysis, mobility is severely limited and is often precarious in nature, causing distress. Older adults receiving hemodialysis and their care partners have identified sources of encouragement and motivation for mobility, and cite an adaptable mindset as important. Future studies should conceptualize mobility as a variable condition and build on this outlook of adaptability in the development of interventions.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Mobility Limitation; Qualitative Research; Renal Dialysis
PubMed: 34419517
DOI: 10.1053/j.ajkd.2021.07.010