Abstract
BackgroundStudies on life-space (LS) and its determinants have previously been limited to community-dwelling subjects but are lacking in institutionalized older persons. The purpose of this study was to provide an advanced descriptive analysis of LS in nursing home residents and to identify associated factors based on an established theoretical framework, using an objective, sensor-based assessment with a high spatiotemporal resolution.MethodsCross-sectional study in two nursing homes in Heidelberg, Germany (n = 65; mean age: 82.9 years; 2/3 female). Changes of location in the nursing home (Transits) as well as time spent away from the private room (TAFR) were assessed using a wireless sensor network. Measures of physical, psychosocial, cognitive, socio-demographic, and environmental factors were assessed via established motor performance tests, interviews, and proxy-reports.ResultsLS of residents was largely restricted to the private room and the surrounding living unit (90%); 10% of daytime was spent outside the living unit and/or the facility. On average, TAFR was 5.1 h per day (±2.3; Range: 0–8); seven Transits (6.9 ± 3.2; Range: 0–18) were performed per day. Linear regression analyses revealed being male, lower gait speed, higher cognitive status, and lower apathy to be associated with more Transits; higher gait speed, lower cognitive status, and less depressive symptoms were associated with more TAFR. LS was significantly increased during institutional routines (mealtimes) as compared to the rest of the day.ConclusionsThe sensor-based LS assessment provided new, objective insights into LS of institutionalized persons living in nursing homes. It revealed that residents’ LS was severely limited to private rooms and adjacent living units, and that in institutional settings, daily routines such as meal times seem to be the major determinant of LS utilization. Gait speed, apathy, and depressive symptoms as well as institutional meal routines were the only modifiable predictors of Transits and/or TAFR, and thus have greatest potential to lead to an enhancement of LS when targeted with interventions.Trial registrationCurrent Controlled Trials ISRCTN96090441 (retrospectively registered).
Highlights
Studies on life-space (LS) and its determinants have previously been limited to community-dwelling subjects but are lacking in institutionalized older persons
Descriptive life-space statistics According to the s-net® measurement protocol, approximately 62,400 position reports were received during the study, which is equal to 480 observations of each nursing home residents (NHR)’s position per day [62,400 / (65 NHR × 2 days)]
Results of the LS measures Time spent away from the private room (TAFR), Transits, and the average duration of stay in the four LS-zones on both days show that LS of residents was to a very large extent restricted to the private room and the immediate area around it
Summary
Studies on life-space (LS) and its determinants have previously been limited to community-dwelling subjects but are lacking in institutionalized older persons. A measure that has been positively associated with physical activity as well as social participation in community-dwelling older adults [5, 6] and NHR [7] is life-space (LS). The model has found partial empirical support in previous research which has demonstrated associations between LS mobility and physical performance [8, 12, 13], global cognitive functioning [14], and psycho-social factors including depression [12, 13, 15], concerns about falling [16], and apathy [13] in community-dwelling older persons
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