Trajectories of everyday mobility at older age

Abstract

Background: This review and exploratory data analysis focuses on everyday mobility at older age; that is, travel outside the house for routine activities. Everyday mobility is an important determinant of health and wellbeing. Although there can be physiological reasons for declines in an individual’s capacity for mobility, trajectories are uneven. A social model of mobility at older age assumes that impairments due to bodily ageing do not inevitably lead to reduced mobility, and that policy and environmental interventions (such as transport provision, quality of built environment) can and should support mobile later lives. We scope the potential for a study of the conditions which foster trajectories of maintained or increased mobility over time, in an equitable way. Aims: With a focus on corporeal mobility in the UK (in particular England), and on social and environmental, rather than physiological factors, our aims were to: 1) scope the existing evidence on trajectories of mobility at older age; 2) assess the English Longitudinal Study of Ageing (ELSA) as a possible source of data on changes in mobility over time; 3) outline the potential for further research through identifying candidate analytical approaches and; draft an initial logic model to inform a study. Literature review findings: Literature on mobility at older age documents physiological, lifecourse, social, and environmental factors that shape trajectories of declining mobility, and the health and wellbeing consequences. There are complex and bidirectional relationships between determinants and consequences of mobility. Points of disruption in the lifecourse are points where mobility practices may change and are therefore potential points for interventions to promote greater mobility. A body of research demonstrates this through the case of concessionary bus travel for older adults in the UK, which both promotes greater mobility and appears to improve health status. There is a more mixed body of research on the environmental factors that can foster greater mobility: more research is needed on how to support mobility in place in the UK, particularly in settings outside urban centres. Compared to research on physiological factors, there is a relative dearth of evidence on population level interventions, with the exception of free bus travel. ELSA summary: The main strength of using the ELSA for understanding what influences trajectories of everyday mobility is that it is an eighteen-year longitudinal study with data collection every two years, focussing on those aged 50 and over. The sample is drawn from across England, detailed contextual information is available via linked geographical identifiers, and longitudinal and cross-sectional weights enable adjustment of the sample for non-response and attrition. The weaknesses (for studies of mobility) are the lack of fine-grained measures of ‘ability’ for many mobility indicators and the potential for reporting biases that intersect with measures of social and cultural capital. In this descriptive analysis, we document six separate measures of everyday mobility that can be derived from ELSA data, and map these to our logic model. Implications: The review identified the potential for studying the conditions for mobility at older age that could help identify and develop population level interventions. Focusing on points of disruption in the lifecourse is a potentially fruitful and tractable area of investigation. We have mapped indicators available from ELSA as a foundation for future study, and as a resource for other researchers. ELSA has some disadvantages for a study, but also many strengths. Given the complexity of causal pathways linking different conditions for maintained or increased mobility, an analysis approach directed specifically at multiple pathways (such as Qualitative Comparative Analysis) could well be fruitful."