Abstract
Background: Older adults spend a considerable amount of time inside their residences; however, most research investigates out-of-home mobility and its health correlates. We measured indoor mobility using room-to-room transitions, tested their psychometric properties, and correlated indoor mobility with cognitive and functional status.Materials and Methods: Community-dwelling older adults living alone (n = 139; age = 78.1 ± 8.6 years) from the Oregon Center for Aging & Technology (ORCATECH) and Minority Aging Research Study (MARS) were included in the study. Two indoor mobility features were developed using non-parametric parameters (frequency; stability): Indoor mobility frequency (room-to-room transitions/day) was detected using passive infrared (PIR) motion sensors fixed on the walls in four geographic locations (bathroom; bedroom; kitchen; living room) and using door contact sensors attached to the egress door in the entrance. Indoor mobility stability was estimated by variances of number of room-to-room transitions over a week. Test-retest reliability (Intra-class coefficient, ICC) and the minimal clinically important difference (MCID) defined as the standard error of measurement (SEM) were generated. Generalized estimating equations models related mobility features with mild cognitive impairment (MCI) and functional status (gait speed).Results: An average of 206 days (±127) of sensor data were analyzed per individual. Indoor mobility frequency and stability showed good to excellent test-retest reliability (ICCs = 0.91[0.88–0.94]; 0.59[0.48–0.70]). The MCIDs of mobility frequency and mobility stability were 18 and 0.09, respectively. On average, a higher indoor mobility frequency was associated with faster gait speed (β = 0.53, p = 0.04), suggesting an increase of 5.3 room-to-room transitions per day was associated with an increase of 10 cm/s gait speed. A decrease in mobility stability was associated with MCI (β = −0.04, p = 0.03).Discussion: Mobility frequency and stability in the home are clinically meaningful and reliable features. Pervasive-sensing systems deployed in homes can objectively reveal cognitive and functional status in older adults who live alone.
Highlights
Mobility, the ability to move about in one’s environment, is fundamental to sustaining independence and well-being
There was a significant difference in the indoor mobility stability between mild cognitive impairment (MCI) and non-MCI groups (Cohen’s d = 1, t = 3.32, p < 0.01, Table 1), suggesting that 84% of the MCI individuals scored below the mean of the non-MCI group
We found that a higher indoor mobility frequency was associated with faster gait speed
Summary
The ability to move about in one’s environment, is fundamental to sustaining independence and well-being. The proportion of time spent beyond the home becomes more susceptible to cognitive and functional changes [4,5,6,7,8,9]. Individuals carry out different activities of daily living (ADL) when moving around indoors (bathing, preparing meals, using a computer) vs time spent out of the home (shopping, visiting friends, driving). Assessing indoor mobility and identifying its cognitive and functional correlates may aid in early detection of health changes [9, 14], especially for those with impairment who either live alone or do not have care partners. Older adults spend a considerable amount of time inside their residences; most research investigates out-of-home mobility and its health correlates. We measured indoor mobility using room-to-room transitions, tested their psychometric properties, and correlated indoor mobility with cognitive and functional status
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