Community Mobility In Older Adults Research Articles

DESIGN NEEDS AND PERCEPTIONS OF OLDER ADULTS REGARDING SHARED-USE AUTOMATED VEHICLES

Abstract Many communities struggle to provide safe, accessible, and reliable transportation services for older adults due to high demand, rising costs, driver shortages, and other evolving challenges. Innovative transportation solutions are needed to support the current and future populations of older adults. Low-speed, shared-use, driverless shuttles present an exciting development in automated vehicle (AV) technology with potential to meet mobility needs of older adults in their community. Understanding older adults’ perceptions about and willingness to consider using these emerging modes of transportation is vital to realizing the full potential of these technologies. This presentation summarizes an in-person study conducted with 12 older (average: 66 +/- 4 years of age, range: 60 to 80 years) and 10 younger (average: 44 +/- 11 years) adults that evaluated a stationary, proof-of-concept shared-use AV retrofitted with accessibility features. We will present findings on perceptions regarding accessibility, safety, and willingness to use driverless AVs along with human factors design recommendations. While questionnaire-based studies have been the dominant approach to understanding older adults’ perceptions about shared-use AVs, in-person evaluations even with prototype AVs as described here, provide opportunities to identify goals, needs and preferences of older adults concerning usability and safety in early design stages, and through hands-on exploration help older adults develop good mental models, i.e., understand AV capabilities and limitations, towards building trust and acceptance for these emerging modes of transportation. Research and policy implications will be discussed towards enabling emerging driverless shared-use AV technologies that support safe and independent community mobility for older adults.

ESPO AND HEALTH SCIENCES SECTION SYMPOSIUM: BUILDING BRIDGES: LEVERAGING SOCIAL CONNECTIONS AND ENVIRONMENTS TO IMPROVE HEALTH IN LATER LIFE

Abstract The COVID-19 pandemic has renewed focus on social connections as fundamental contributors to health across the lifespan. Social connections have been studied in numerous ways (e.g., social network size, daily social interactions, engagement in social activities) and may facilitate health via multiple, dynamic biopsychosocial mechanisms. In line with this year’s theme, we review novel insights from early-career scholars into how “building bridges” with others throughout life may promote mental and cognitive health in later life. Further, we emphasize how bridging disciplines (e.g., social and neurocognitive sciences) is vital to understanding how social environments may “get under the skin” to impact health. Presentations will span multiple social-ecological levels (community, institutional, interpersonal). Beginning at the community/institutional level, Dr. Moored will discuss how the quantity of neighborhood social destinations contributes to GPS measures of community mobility in older adults. Dr. Britt will then describe how religious participation, a specific social institutional activity, is associated with an inflammatory biomarker predictive of cognitive impairments. The remaining talks will then report on daily social experiences. Dr. Ng will highlight links between daily support exchanges and life satisfaction in older adults and how these relationships differ by marital status. Extending to the caregiving context, Dr. Puga will present on how role captivity and daily changes in social isolation contribute to mood symptoms in family caregivers of individuals living with dementia. Our Discussant, Dr. Cudjoe, will provide a critical review in the context of new directions for research on social connections and environments.

Enhancing Physical and Community MoBility in OLDEr Adults with Health Inequities Using CommuNity Co-Design (EMBOLDEN): Results of an Environmental Scan.

Using the comparatively new environmental scan methodology, a protocol was developed and conducted to inform the co-design and implementation of a novel intervention to promote mobility among older adults in Hamilton, Ontario, Canada. The EMBOLDEN program seeks to promote physical and community mobility in adults 55 years and older who face barriers accessing community programs and who reside in areas of high inequity in Hamilton, and to address the following areas of focus: physical activity, nutrition, social participation, and system navigation supports. The environmental scan protocol was developed using existing models and drew insights from census data, a review of existing services, organizational representative interviews, windshield surveys of selected high-priority neighbourhoods, and Geographic Information System (GIS) mapping. A total of 98 programs for older adults from 50 different organizations were identified, with the majority (92) supporting mobility, physical activity, nutrition, social participation, and system navigation. The analysis of census tract data identified eight high-priority neighbourhoods characterized by large shares of older adults, high material deprivation, low income, and high proportion of immigrants. These populations can be hard to reach and face multiple barriers to participation in community-based activities. The scan also revealed the nature and types of services geared toward older adults in each neighbourhood, with each priority neighbourhood having at least one school and park. Most areas had a range of services and supports (i.e., health care, housing, stores, religious options), although there was a lack of diverse ethnic community centres and income-diverse activities specific to older adults in most neighbourhoods. Neighbourhoods also differed in the geographic distribution number of services, along with the number of recreational services specific to older adults. Barriers included financial and physical accessibility, lack of ethnically diverse community centres, and food deserts. Scan results will inform the co-design and implementation of the Enhancing physical and community MoBility in OLDEr adults with health inequities using commuNity co-design intervention-EMBOLDEN.

COMMUNITY MOBILITY PATTERNS OF OLDER ADULTS DURING THE COVID-19 PANDEMIC

Abstract The COVID-19 pandemic has had appreciative impacts on the lives of older adults. At various times during the pandemic, Canadian provinces put in place public health measures to prevent the spread of the virus, including closures of non-essential businesses and services. The Candrive Driving Cessation sub-study is a 12-year, mixed methods, longitudinal study. During the COVID-19 pandemic, participants from four sites (n=124, mean age=85.5 years) were asked to report how their community mobility patterns during the pandemic compared with before the pandemic. They also completed the COVID-19 Anxiety Syndrome Scale and the Assessment of Readiness for Mobility Transition (ARMT) tool. The results indicated that during the pandemic, participants were less likely to drive (χ2=7.11, p=.004) or ride a public bus (χ2=20.05, p<.001) when leaving their home. During the pandemic, they reported fewer trips to the supermarket (χ2=99.00, p<.001) and fewer visits with family (χ2=68.00, p=.001). We observed a statistically significant relationship between COVID-19 Anxiety Syndrome Scale scores and ARMT (Anticipatory Anxiety subscale; r= .810, p<.001), such that higher COVID-19-related anxiety was associated with greater anxiety related to anticipating changes in mobility. These results emphasize the impacts of the COVID-19 pandemic on the mobility patterns of older adults. Promoting community mobility for older adults alongside preventative public health measures is essential.

Using GPS Technologies to Examine Community Mobility in OlderAdults.

Objective measures of community mobility are advantageous for capturing movement outside the home. Compared with subjective, self-reported techniques, global positioning system (GPS) technologies leverage passive, real-time location data to reduce recall bias and increase measurement precision. We developed methods to quantify community mobility among community-dwelling older adults and assessed how GPS-derived indicators relate to clinical measures of physical and cognitive performance. Participants (n=149; M ± standard deviation [SD]=77.1±6.5years) from the program to improve mobility in aging (PRIMA) study, a physical therapy intervention to improve walking ability, carried a GPS device for 7days. Community mobility was characterized by assessing activity space, shape, duration, and distance. Associations between GPS-derived indicators and cognition and physical function were evaluated using Spearman correlations. In adjusted models, a larger activity space, greater duration (eg, time out-of-home), and greater distance traveled from home were correlated with better 6-Minute Walk Test performance (ρ=0.17-0.23, p's < .05). Amore circular activity shape was related to poorer performance on the Trail Making Test, Part A(ρ=0.18, p < .05). More time out-of-home and a larger activity space were correlated with faster times on the Trail Making Test, Part B (ρ=-0.18 to -0.24, p's < .05). Community mobility measures were not associated with global cognition, skilled walking, or usual gait speed. GPS-derived community mobility indicators capture real-world activity among older adults and were correlated with clinical measures of executive function and walking endurance. These findings will guide the design of future interventions to promote community mobility.

The EMBOLDEN study: Using intervention co-design to enhance physical and community mobility in older adults

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

Community Mobility in Older Adults: Novel Methodologies, Risk Factors, and Interventions

Community mobility is an individual’s movement outside the home. It is essential for the completion of many instrumental activities of daily living, such as shopping and healthcare, and promotes physical function, social engagement, independent living, and quality of life. Mobility research often focuses on gait speed measured in clinical settings, a critical but not sufficient determinant of community mobility. Here we present four talks that assess community mobility and its determinants using novel methodologies to enhance our understanding of how to maintain independence in older ages. First, Andrea Rosso presents characteristics of individuals with the strongest associations between environmental walkability, as assessed by virtual audits, and walking. Second, Kyle Moored demonstrates associations of self-reported fatigability with life space among older men, independent of their physical functioning. Breanna Crane introduces GPS-based objective measures of community mobility and their associations with cognitive and physical function of older adults. Finally, Pam Dunlap presents results of a randomized clinical trial of a physical therapy intervention to improve walking in older adults on subjective and objective measures of life space. These talks will provide a better understanding of the factors related to community mobility, introduce attendees to novel methodologies in the assessment of both community mobility and risk factors associated with the loss of community mobility, and demonstrate approaches to improve community mobility in at-risk older adults. The discussant, Jana Hirsch, will provide perspectives on how these data inform our current view of community mobility and will lead a discussion with the audience.

Methods and Rationale for Using GPS-Derived Objective Technologies to Examine Community Mobility in Older Adults

Objective measures of community mobility are advantageous for capturing life-space activity. In contrast to subjective, self-reported approaches, GPS-derived objective measures leverage passive, real-time data collection techniques to mitigate recall bias and minimize participant burden. We present methods to quantify community mobility among a sample of 164 community-dwelling older adults (Mean age=77.3±6.5) from a physical therapy intervention aimed at improving walking ability. We characterized community mobility using activity space metrics (e.g., standard deviation ellipse (SDE) area), timing (e.g., time outside home), and shape (e.g., SDE compactness). We will discuss challenges and solutions to generating these metrics as well as their associations with physical and cognitive performance. Time outside of home and SDE area, but not SDE compactness, were correlated with better performance on the 6-Minute Walking Test and Trail-Making Test (Part B) (ρ=.20-.23, p’s<.05). These findings will aid in understanding which community mobility measures are associated with functional capacity.

The EMBOLDEN study: Enhancing physical and community mobility in older adults with health inequities using community co-design

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

Validation of the German Life-Space Assessment (LSA-D): cross-sectional validation study in urban and rural community-dwelling older adults

ObjectivesTo develop a German version of the original University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA-D) for measurement of community mobility in older adults within the past...

Linking people and activities through community mobility: an international comparison of the mobility patterns of older drivers and non-drivers

AbstractCommunity mobility using private and public transportation is important for maintaining health, social participation and living well in later life. This international cross-sectional cohort study (N = 246) reported on the health and driving status of older adults from seven countries where the mobility patterns of drivers and non-drivers were compared in terms of city and rural areas, weather, as well as their respective differences in the number of out-of-home places accessed and quality of life. Older adults participated in a semi-structured interview and completed four standardised instruments: the EQ-5D-5L, modified PULSES health profile, modified Transportation Questionnaire, and the Transport – Participation in Activities and Places Outside the Home. Results suggested inclement weather and place of residence negatively impacted out-of-home activities but did not increase use of public transportation. Drivers accessed more out-of-home activities than non-drivers, suggesting higher community participation among this group, and quality of life was generally high among all participants, but slightly higher for drivers. Findings indicate that a complex myriad of factors can influence community mobility in older adults and further investigations are needed to understand patterns of transport in later life, particularly with regard to those factors that promote and maintain transport mobility, and relationships between transport mobility, community participation and quality of life.

Re-thinking community mobility for older adults amid a revolution in automotive technology

Re-thinking community mobility for older adults amid a revolution in automotive technology

ReadySteady intervention to promote physical activity in older adults with Parkinson's disease: Study design and methods

The main motor impairments of gait and balance experienced by people with Parkinson's disease (PD) contribute to a sedentary lifestyle, resulting in poor physical conditioning, loss of functional independence, and reduced quality of life. Despite the known benefits of physical activity in PD, the majority of older adults with PD are insufficiently active. Few studies incorporate behavioral change approaches to promoting physical activity in PD. The main goal of this research is to foster community mobility in older adults with PD by promoting physical activity and improving gait patterns using a theory-based behavioral change intervention. The ReadySteady intervention combines wellness motivation theory with polestriding physical activity, which has been shown to be beneficial for people with PD. The intervention will be tested using a randomized controlled design, including inactive older adults diagnosed with PD. Participants will be randomly assigned the 12-week ReadySteady intervention, 12-week polestriding, and education intervention, or 12-week education intervention. Thirty-six older adults with PD will participate in each of the interventions. Level of physical activity, clinical scores, quantitative measures of gait and balance control, and motivational variables for each intervention will be measured at three time points: pre-intervention, post-intervention (12 weeks), and follow-up (24 weeks). If the intervention is beneficial, it may serve as a sustainable addition to current practice in health promotion efforts serving the PD population.

Accessible Design of Low-Speed Automated Shuttles: A Brief Review of Lessons Learned from Public Transit

Low-speed, driverless automated shuttles have the potential to significantly improve community mobility for older adults and people with disabilities who are otherwise unable or ineligible to drive. However, accessibility and inclusive design of these shuttles to accommodate the spectrum of human abilities and impairments is impeded by the lack of accessible design regulations, standards, and information tools specific to automated vehicles. In light of the scarce accessibility research on automated shuttles, a literature review on public transit was performed. A total of 66 documents were identified addressing components of the public transit travel chain involving older adults and people with disabilities. This paper reviewed 11 of the documents pertaining to onboard circulation. Findings highlight the importance of vehicle interior design on accessibility and usability for people with impairments, the inadequacy of existing accessibility standards when designing beyond minimum requirements, and a lack of evidence-based design tools and information to support designing for accessibility. An interactive web-based repository for transportation accessibility research is introduced to inform the accessible design of LSAS, along with directions for future research.

Research Opportunities in the Area of Driving and Community Mobility for Older Adults

The American Occupational Therapy Association (AOTA) Evidence-Based Practice Project has developed a table summarizing the research opportunities in the area of driving and community mobility for older adults. The table provides an overview of the state of current available evidence on interventions within the scope of occupational therapy practice and is based on the systematic reviews from the AOTA Practice Guidelines Series. Researchers, students, and clinicians can use this information in developing innovative research to answer important questions within the occupational therapy field.

Care partner dyad strategies to support participation in community mobility

ABSTRACTBackground Factors supporting continued community mobility for older adults warrant attention due to the relationship between mobility, health, and social participation. Although community mobility is typically considered from the perspective of individual functional abilities, care partnerships represent a situation in which maintaining community mobility has implications for the well-being of all members. Aim The aim of this research was to explore and describe strategies used by older adult care partner dyads to support and maintain participation in community mobility. Methods Ethnographic case studies of three care partner dyads were conducted using in-depth interviews, participant observation, photographs, and reciprocal data analysis. An inductive, constant comparative data analysis resulted in thematic descriptions of strategies employed by the care partner dyads. Results Three strategies were identified in collaboration with care partners: (i) Acting in accordance with the values of the relationship, (ii) Finding and using available assistive technology and (iii) Relying on social networks. Conclusion and significance Strategies identified by participants were more relational than procedural in nature, indicating the need for occupational therapists working with care partner dyads to consider historical routines, social connectedness, and needs of the care partnership in addition to functional abilities of the care recipient when addressing community mobility.

Associations between neighbourhood characteristics and community mobility in older adults with chronic health conditions

Purpose: To explore associations between perceptions of neighbourhood built and social characteristics and satisfaction with community mobility in older adults with chronic health conditions. Method: Two hundred and thirty-seven community-dwelling adults aged 60 years or more with one or more of arthritis (osteoarthritis or rheumatoid arthritis), chronic obstructive pulmonary disease, diabetes or heart disease completed a cross-sectional, mailed survey. The survey addressed community mobility and 11 neighbourhood characteristics: amenities (three types), problems (six), social cohesion and safety. Analysis involved logistic regression modeling for each neighbourhood characteristic. Results: Satisfaction with community mobility was associated with perception of no traffic problems (OR = 3.0, 95% CI = 1.4–6.2, p ≤ 0.05) and neighbourhood safety (OR = 3.4, 95% CI = 1.2–9.8, p ≤ 0.05), adjusted for age, ability to walk several blocks and depressive symptoms.Conclusion: Satisfaction with community mobility is associated with neighbourhood safety and no traffic problems among older adults with chronic conditions. While further research is needed to explore these neighbourhood characteristics in more detail and to examine causation, addressing these neighbourhood characteristics in health services or community initiatives may help promote community mobility in this population. Implications for RehabilitationCommunity mobility, or the ability to move about one’s community, is a key aspect of participation that enables other aspects of community participation.Good community mobility is associated with perception of no traffic problems and neighbourhood safety among older adults.Considering and addressing a broad range of environmental influences has the potential to improve community mobility in older adults, beyond traditional approaches.Health professionals can work with clients to develop strategies to avoid traffic and safety problems and can work with communities to develop safe spaces within neighbourhoods, to improve community mobility in older adults.

Method for the Systematic Reviews on Occupational Therapy and Driving and Community Mobility for Older Adults

Systematic reviews of literature relevant to driving and community mobility for older adults are important to the practice of occupational therapy. We describe the four questions that served as the focus for the systematic reviews of the effectiveness of occupational therapy assessments and interventions for driving and community mobility for older adults. We include the background for the reviews; the process followed for each question, including search terms and search strategy; the databases searched; and the methods used to summarize and critically appraise the literature. The final number of articles included in each systematic review, a summary of the themes of the results, the strengths and limitations of the findings, and the implications for practice, education, and research are presented.

Occupational therapy and driving and community mobility for older adults.

This special issue of the American Journal of Occupational Therapy includes summaries from a systematic evidence-based literature review of occupational therapy and driving and community mobility for older adults. Since the previous review on this topic in 2008, the cohort of 78 million baby boomers began turning 65 in January 2011. As a group, this cohort is more likely to have longer life expectancy, stay in the workforce longer, and age in place in the community. Is the occupational therapy profession ready for the potential demand for driving rehabilitation services from this generation of older drivers who grew up with the automobile and are dependent on it for access to and participation in their communities?

Occupational Therapy Interventions to Promote Driving and Community Mobility for Older Adults With Low Vision: A Systematic Review

A systematic literature review was conducted to evaluate the effectiveness of interventions within the scope of occupational therapy practice to improve or maintain the driving performance and community mobility of older adults with low vision. The results of this review identified a limited number of articles-eight-that met the inclusion criteria. Identified intervention strategies included the use of bioptics or prisms, multidisciplinary vision rehabilitation for community mobility, driving simulator training, driver education programs, and orientation and mobility training. Evidence is insufficient for the effectiveness of these interventions in improving or maintaining the driving performance or community mobility of older adults with low vision. Key study limitations included heterogeneity of sample characteristics (age, type of vision impairment), lack of standardization of interventions (device type, time, intensity duration), and lack of standardized assessments to measure driving and community mobility. This evidence-based review is informative for discussion of practice, education, and research implications.