Abstract
BackgroundTime out-of-home has been linked with numerous health outcomes, including cognitive decline, poor physical ability and low emotional state. Comprehensive characterization of this important health metric would potentially enable objective monitoring of key health outcomes. The objective of this study is to determine the relationship between time out-of-home and cognitive status, physical ability and emotional state.Methods and FindingsParticipants included 85 independent older adults, age 65–96 years (M = 86.36; SD = 6.79) who lived alone, from the Intelligent Systems for Assessing Aging Changes (ISAAC) and the ORCATECH Life Laboratory cohorts. Factors hypothesized to affect time out-of-home were assessed on three different temporal levels: yearly (cognitive status, loneliness, clinical walking speed), weekly (pain and mood) or daily (time out-of-home, in-home walking speed, weather, and season). Subject characteristics including age, race, and gender were assessed at baseline. Total daily time out-of-home in hours was assessed objectively and unobtrusively for up to one year using an in-home activity sensor platform. A longitudinal tobit mixed effects regression model was used to relate daily time out-of-home to cognitive status, physical ability and emotional state. More hours spend outside the home was associated with better cognitive function as assessed using the Clinical Dementia Rating (CDR) Scale, where higher scores indicate lower cognitive function (β CDR = -1.69, p<0.001). More hours outside the home was also associated with superior physical ability (β Pain = -0.123, p<0.001) and improved emotional state (β Lonely = -0.046, p<0.001; β Low mood = -0.520, p<0.001). Weather, season, and weekday also affected the daily time out-of-home.ConclusionsThese results suggest that objective longitudinal monitoring of time out-of-home may enable unobtrusive assessment of cognitive, physical and emotional state. In addition, these results indicate that the factors affecting out-of-home behavior are complex, with factors such as living environment, weather and season significantly affecting time out-of-home. Studies investigating the relationship between time out-of-home and health outcomes may be optimized by taking into account the environment and life factors presented here.
Highlights
The time an individual spends outside their residence, commonly referred to as “time out-ofhome” is critical to quality of life, independence and overall health among older adults [1]
Season, and weekday affected the daily time out-of-home. These results suggest that objective longitudinal monitoring of time out-of-home may enable unobtrusive assessment of cognitive, physical and emotional state
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
Summary
The time an individual spends outside their residence, commonly referred to as “time out-ofhome” is critical to quality of life, independence and overall health among older adults [1]. Spending time outside the home is a complex activity, requiring navigation, way finding, and physical capability [3]. Individuals with mild cognitive impairment (MCI) have been shown to spend less overall time out of the home [7], and do not travel as far from the home as compared to healthy controls [8,9,10,11], perhaps due to the cognitive demands involved in leaving the home. Time out-of-home has been linked with numerous health outcomes, including cognitive decline, poor physical ability and low emotional state. Comprehensive characterization of this important health metric would potentially enable objective monitoring of key health outcomes. The objective of this study is to determine the relationship between time out-ofhome and cognitive status, physical ability and emotional state
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