Life-Space Assessment Scores Research Articles

Factors related to the life space of daycare center users

We examined the factors related to life space and changes in the care level after one year in daycare center users. The participants were 83 older adults (age, > 65 years; mean age, 79.5±6.8 years) with MMSE scores of ≥20, who could walk independently, who needed support (1-2) or care (1), and who underwent rehabilitation at a daycare center. The life space was evaluated by the Life Space Assessment (LSA). The subjects' basic information (i.e., age, medical history.) was collected, and their physical function (i.e., grip strength, timed up and go test [TUG]), mental function (i.e., vitality, fear of falls), and social function (i.e., friends, hobbies, public transportation) were assessed to investigate the factors associated with their LSA scores. In addition, a follow-up survey was conducted on the care level at approximately one year later. A multiple regression analysis indicated that TUG scores (β=-0.33), hobbies (β=0.30), friends (β=0.29), public transportation (β=0.26), and grip strength (β=0.24) were related to the life space. Next, the participants were divided into LSA-high and LSA-low groups, and changes in the care level (improvement, maintenance, deterioration) at approximately one year after the initial assessment were examined using a chi-squared test. A significant difference was observed in the distribution of the groups (p=0.03). Multiple factors were related to the life space. Moreover, it is possible that improvements in the level of care may be achieved by improving the life space.

Life-Space Mobility and Cognitive Decline Among Mexican Americans Aged 75 Years and Older.

To examine the association between life-space mobility and cognitive decline over a five-year period among older Mexican Americans. Longitudinal study. Hispanic Established Population for the Epidemiologic Study of the Elderly survey conducted in the southwestern of United States (Texas, Colorado, Arizona, New Mexico, and California). Four hundred thirty-two Mexican Americans aged 75 and older with normal or high cognitive function at baseline. Socio-demographic factors, living arrangement, type of household, social support, financial strain, self-reported medical conditions, Mini-Mental State Examination (MMSE), depressive symptoms, activities of daily living (ADLs), and Short Physical Performance Battery. Life-space assessment (LSA) during the past 4 weeks was assessed during in-home interview. Scores ranged from 0 (daily restriction to the bedroom) to 120 (daily trips outside of their own town without assistance) and categorized as 0 to 20, 21 to 40, 41 to 60, 61 to 80, and 81 to 120. Because of the small sample size in the category of 81 to 120, the two highest categories were combined into a single group. The mean LSA score and MMSE score of participants at baseline was 44.6 (Standard Deviation [SD], 20.7) and 25.7 (SD, 3.2), respectively. Mixed Model analyses showed that participants in the highest life-space category (≥61) experienced slower rates of cognitive decline over time compared to participants in the lowest category (0 to 20) (β = 1.03, Standard Error [SE] = 0.29, P = 0.0004), after adjusting for all covariates. Greater life-space mobility at baseline was predictor of slower rates of cognitive decline over 5 years in older Mexican Americans.

Life-Space Assessment Predicts Hospital Readmission in Home-Limited Adults.

To describe the association between restricted life-space and characteristics of community-dwelling adults hospitalized for congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD), to estimate the effect of hospitalization on postdischarge mobility, and to determine whether baseline restricted life-space predicts hospital readmission. Observational. Urban academic hospital that serves as a safety net for urban and rural populations with low resources and serves central and northern Alabama. Individuals with CHF or COPD hospitalized from home (N = 478). The Life-Space Assessment (LSA) measures mobility by asking about movement in situations ranging from within one's dwelling to beyond one's town. LSA scores below 60 correspond to "restricted life-space." Baseline LSA scores before admission were measured during an index hospitalization; follow-up LSA scores were determined over the telephone at 90 days. Participant characteristics were examined according to baseline restricted life-space using the chi-square test and Student's t-test. Each characteristic's association with restricted life-space was estimated uisng logistic regression. Of the participants, 372 (77.8%) were classified as having baseline restricted life-space. Baseline restricted life-space was associated with older age (odds ratio (OR) = 1.29 per decade, 95% confidence interval (CI) = 1.17-1.42, P = .001), female sex (OR = 2.69, 95% CI = 1.69-4.29, P < .001), African-American race (OR = 1.55, 95% CI = 1.00-2.41, P = .05), and having inadequate financial resources (OR = 2.03, 95% CI = 1.22-3.38, P = .006). In the baseline unrestricted life-space group, 49.5% (n = 49) had restricted life-space at 90-day follow-up. Baseline restricted life-space was associated with greater odds of 90-day hospital readmission (unadjusted OR = 1.64, 95% CI = 1.00-2.70, P = .05; adjusted OR = 1.72, 95% CI = 1.04-2.85, P = .03). Baseline restricted life-space was associated with greater risk of hospital readmission within 90 days after hospital discharge. These findings suggest a need to customize the management of individuals hospitalized with CHF or COPD based on baseline life-space level.

Concurrent validity of the Swedish version of the life-space assessment questionnaire.

BackgroundThe Life-Space Assessment (LSA), developed in the USA, is an instrument focusing on mobility with respect to reaching different areas defined as life-spaces, extending from the room where the person sleeps to mobility outside one’s hometown. A newly translated Swedish version of the LSA (LSA-S) has been tested for test-retest reliability, but the validity remains to be tested. The purpose of the present study was to examine the concurrent validity of the LSA-S, by comparing and correlating the LSA scores to other measures of mobility.MethodThe LSA was included in a population-based study of health, functioning and mobility among older persons in Sweden, and the present analysis comprised 312 community-dwelling participants. To test the concurrent validity, the LSA scores were compared to a number of other mobility-related variables, including the Short Physical Performance Battery (SPPB) as well as “stair climbing”, “transfers”, “transportation”, “food shopping”, “travel for pleasure” and “community activities”. The LSA total mean scores for different levels of the other mobility-related variables, and measures of correlation were calculated.ResultsHigher LSA total mean scores were observed with higher levels of all the other mobility related variables. Most of the correlations between the LSA and the other mobility variables were large (r = 0.5–1.0) and significant at the 0.01 level. The LSA total score, as well as independent life-space and assistive life-space correlated with transportation (0.63, 0.66, 0.64) and food shopping (0.55, 0.58, 0.55). Assistive life-space also correlated with SPPB (0.47). With respect to maximal life-space, the correlations with the mobility-related variables were generally lower (below 0.5), probably since this aspect of life-space mobility is highly influenced by social support and is not so dependent on the individual’s own physical function.ConclusionLSA was shown to be a valid measure of mobility when using the LSA total, independent LS or assistive LSA.

Effects of Intradialytic Resistance Exercise on Protein Energy Wasting, Physical Performance and Physical Activity in Ambulatory Patients on Dialysis: A Single-Center Preliminary Study in a Japanese Dialysis Facility.

Patients under hemodialysis present protein-energy wasting (PEW), which is related with higher mortality rates. The study aimed to determine whether intradialytic resistance exercise training could improve physical performance, physical activity, and PEW in hemodialysis patients. In single center study, 75 hemodialysis patients were enrolled in an intradialytic resistance exercise training consisting of 20 min of adapted leg press, with a gymnastic ball, 3 days/week, during 9 months on the same day of hemodialysis therapy. Physical performance by short physical performance battery (SPPB), physical activity by life space assessment (LSA), and PEW score based on the nomenclature proposed by the International Society of Renal Nutrition and Metabolism in 2008 were assessed at baseline and after 9 months. Intradialytic resistance exercise training significantly improved SPPB score, LSA score, and PEW score (all, P < 0.05). In addition, intradialytic resistance exercise training improved SPPB score in patients with moderate and severe PEW subgroups (P < 0.05), associated with reduced prevalence of the patients with moderate to severe PEW (53% vs. 36%, P < 0.05). Intradialytic resistance exercise training was safe and effective to improve physical performance, physical activity, and PEW in hemodialysis patients.

Comparison of Posthospitalization Function and Community Mobility in Hospital Mobility Program and Usual Care Patients: A Randomized Clinical Trial.

Low mobility is common during hospitalization and associated with loss or declines in ability to perform activities of daily living (ADL) and limitations in community mobility. To examine the effect of an in-hospital mobility program (MP) on posthospitalization function and community mobility. This single-blind randomized clinical trial used masked assessors to compare a MP with usual care (UC). Patients admitted to the medical wards of the Birmingham Veterans Affairs Medical Center from January 12, 2010, through June 29, 2011, were followed up throughout hospitalization with 1-month posthospitalization telephone follow-up. One hundred hospitalized patients 65 years or older were randomly assigned to the MP or UC groups. Patients were cognitively intact and able to walk 2 weeks before hospitalization. Data analysis was performed from November 21, 2012, to March 14, 2016. Patients in the MP group were assisted with ambulation up to twice daily, and a behavioral strategy was used to encourage mobility. Patients in the UC group received twice-daily visits. Changes in self-reported ADL and community mobility were assessed using the Katz ADL scale and the University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA), respectively. The LSA measures community mobility based on the distance through which a person reports moving during the preceding 4 weeks. Of 100 patients, 8 did not complete the study (6 in the MP group and 2 in the UC group). Patients (mean age, 73.9 years; 97 male [97.0%]; and 19 black [19.0%]) had a median length of stay of 3 days. No significant differences were found between groups at baseline. For all periods, groups were similar in ability to perform ADL; however, at 1-month after hospitalization, the LSA score was significantly higher in the MP (LSA score, 52.5) compared with the UC group (LSA score, 41.6) (P = .02). For the MP group, the 1-month posthospitalization LSA score was similar to the LSA score measured at admission. For the UC group, the LSA score decreased by approximately 10 points. A simple MP intervention had no effect on ADL function. However, the MP intervention enabled patients to maintain their prehospitalization community mobility, whereas those in the UC group experienced clinically significant declines. Lower life-space mobility is associated with increased risk of death, nursing home admission, and functional decline, suggesting that declines such as those observed in the UC group would be of great clinical importance. clinicaltrials.gov Identifier: NCT00715962.

Impact of Emergency Department Visits and Hospitalization on Mobility Among Community-Dwelling Older Adults

PurposeThe study purpose was to assess the effects of emergency department visits on mobility as measured by Life-Space Assessment (LSA) scores and to compare life-space trajectories associated with emergency department visit only, hospitalization, and no event. MethodsA total of 410 community-dwelling adults aged ≥75 years who were living in the community, were able to communicate by telephone, could schedule an in-home interview, and could answer questions independently were followed from June 2010 to August 2014. In-home baseline and monthly telephone follow-up interviews collected data on LSA scores, emergency department use, and hospitalizations. Life-space is measured using a validated patient-reported tool reflecting community mobility and quality of life. Trajectories of LSA before and after an emergency department visit or hospitalization were compared with no event occurrence. ResultsMean age of participants was 81.7 years (standard deviation, 4.8); 57% were female, and 35% were African American. During 3 years of follow-up, 83 persons (20%) had an emergency department visit without subsequent hospitalization and 164 persons (40%) were hospitalized. Although baseline LSA scores were similar, in the month after an emergency department visit, adjusted LSA scores decreased by 6.1 points (P = .01) in comparison with hospitalized participants who experienced an average decrease of 18.0 points (P < .0001). Neither those with an emergency department visit only nor those with hospitalization recovered to their prior level of community mobility. Moreover, those with an emergency department visit showed no significant improvement in LSA scores up to 1 year later. ConclusionsOlder adults who experienced an emergency department visit or hospitalization had an associated decrease in community mobility without significant recovery.

Life Space Assessment in Spinal Cord Injury.

Objectives: To examine the Life Space Assessment (LSA) in persons with spinal cord injury (SCI), exploring its psychometric properties, differences between persons with cervical versus thoracolumbar injuries, and cutoff score differentiating a restricted from an unrestricted life space. Method: We conducted a test-retest reliability study in a community setting involving 50 persons with SCI (25 injured above C7, 25 injured below T1). Data were collected in 2 phone interviews approximately 9 days apart using the LSA. Results: Mean LSA scores were 66 ± 25 (n = 50): 62 ± 23 for the cervical group, and 70 ± 25 for the thoracolumbar group. Scores were not significantly different between phone interviews [t(49) = 0.379, p = .706] or between groups [t(48) = -1.214, p = .231]. Test-retest reliability intraclass correlation coefficient (ICC) was 0.876 (95% CI, 0.792-0.928). Spearman's rho correlations between the LSA and Reintegration to Normal Living Index total and subscores ranged from .509 to .538 (p < .001). LSA scores were normally distributed. The minimum detectable change was approximately 23 points. A cutoff score of 78.5 (sensitivity 76.9%, specificity 81.1%) differentiated between persons with a restricted from an unrestricted life space if equipment and personal assistance were not needed for mobility. If equipment was needed, the cutoff score was found to be 49 (sensitivity of 90%, specificity of 90%). Conclusions: The LSA is a reliable and valid measure of life space in persons with SCI and can be used to identify persons with a restricted life space who may be at increased risk of mobility disability.

Identification of Older People at Risk of ADL Disability Using the Life-Space Assessment: A Longitudinal Cohort Study

ObjectivesLife-space mobility, assessed with the Life-Space Assessment (LSA), reflects an individual's mobility in terms of the spatial area, frequency, and need for assistance. The aims were to study associations between life-space mobility and disability status in activities of daily living (ADL), and to define cutoff scores for baseline LSA and LSA change over time identifying individuals who developed ADL inability during 2 years of follow-up. Robustness of the cutoff scores was tested accounting for potential confounders. DesignLongitudinal analyses of the “Life-space mobility in old age” cohort study. SettingHome-based interviews at baseline and phone interviews 2 years later. ParticipantsA total of 755 community-dwelling 75- to 90-year-old people living in Central Finland. MeasurementsLSA score (range 0–120) and ADL disability status (no difficulty, difficulty in ≥1 tasks, or inability in ≥1 tasks) were determined based on self-reports. ResultsParticipants who developed difficulty or inability in ADL over time presented lower LSA scores at baseline and larger declines compared to those who remained without task difficulty or inability during the follow-up, respectively. Sensitivity and specificity analyses showed that baseline LSA ≤52.3 (0.86 and 0.74, respectively) and LSA decline of >11.7 (0.76 and 0.71, respectively) identified participants who developed ADL inability over the follow-up. Multinomial regression showed that, after adjustment for potential confounders, these cutoff scores increased the odds to develop new difficulty in ADL tasks, and the odds to develop ADL inability among those with baseline difficulty. ConclusionOur results suggest that restrictions and declines in life-space mobility may be early signs of increasing vulnerability to disability in old age. These longitudinally defined cutoff points may help to find clinical applications for the LSA.

Effectiveness of a Wheelchair Skills Training Program for Powered Wheelchair Users: A Randomized Controlled Trial

ObjectivesTo test the hypothesis that powered wheelchair users who receive the Wheelchair Skills Training Program (WSTP) improve their wheelchair skills in comparison with a control group that receives standard care, and secondarily to assess goal achievement, satisfaction with training, retention, injury rate, confidence with wheelchair use, and participation. DesignRandomized controlled trial. SettingRehabilitation centers and communities. ParticipantsPowered wheelchair users (N=116). InterventionFive 30-minute WSTP training sessions. Main Outcome MeasuresAssessments were done at baseline (t1), posttraining (t2), and 3 months posttraining (t3) using the Wheelchair Skills Test Questionnaire (WST-Q version 4.1), Goal Attainment Score (GAS), Satisfaction Questionnaire, injury rate, Wheelchair Use Confidence Scale for Power Wheelchair Users (WheelCon), and Life Space Assessment (LSA). ResultsThere was no significant t2–t1 difference between the groups for WST-Q capacity scores (P=.600), but the difference for WST-Q performance scores was significant (P=.016) with a relative (t2/t1 × 100%) improvement of the median score for the intervention group of 10.8%. The mean GAS ± SD for the intervention group after training was 92.8%±11.4%, and satisfaction with training was high. The WST-Q gain was not retained at t3. There was no clinically significant difference between the groups in injury rate and no statistically significant differences in WheelCon or LSA scores at t3. ConclusionsPowered wheelchair users who receive formal wheelchair skills training demonstrate modest, transient posttraining improvements in their WST-Q performance scores, have substantial improvements on individualized goals, and are positive about training.

Factors affecting the coefficient of variation of stride time of the elderly without falling history: a prospective study.

[Purpose] The purpose of this study was to investigate the factors affecting the coefficient of variation (CV) of stride time in an exercise intervention for the elderly without falling history. [Subjects and Methods] The subjects were 42 elderly women who had participated in a care prevention program for 12 weeks. Stride time CV, motor function, movement ability, balance, Modified Falls Efficacy Scale (MFES) score, and Life-space Assessment (LSA) score before and after the intervention were examined for significant differences using the paired t-test. Multiple regression analysis was used to determine the factors that changed in the stride time CV. [Results] There were significant differences in muscle strength, sit-and-reach flexibility, the one-leg standing time (eyes open), the maximum walking speed, local stability of trunk acceleration, The Timed Up and Go Test (TUG-T), the MFES score, and the LSA score between the pre-intervention and post-intervention. Stepwise multiple regression analysis revealed that improvement of quadriceps muscle strength, sit-and-reach flexibility, the one-leg standing time, TUG-T, local stability of trunk acceleration (vertical direction) and MFES score were independent variables explaining the reduction in stride time CV. [Conclusion] The results was suggested that it might be possible to reduce the stride time CV by improving strength, flexibility and dynamic balance, and reducing fear of falls through interventions.

Higher mobility scores in patients with cystic fibrosis are associated with better lung function.

Objective. The purpose of this study was to determine whether mobility and physical activity were associated with lung function in adults with cystic fibrosis (CF). Design. This was a prospective cohort observational study in an urban, academic, specialized care center. Participants were ambulatory, nonhospitalized adults with CF. Main Outcome Measures. Mobility was assessed monthly by the Life-Space Assessment (LSA) questionnaire and quarterly by pedometer. Lung function was assessed by spirometry. Results. Twenty-seven subjects participated. Subjects recorded mean pedometer steps of 20,213 ± 11,331 over three days and FEV1% predicted of 77.48% ± 22.60% over one year. The LSA score at enrollment was correlated with initial pedometer steps (r = 0.42 and P = 0.03), and mean LSA score over one year was correlated with mean number of steps (r = 0.51 and P = 0.007). LSA mobility and pedometer scores were correlated with FEV1% predicted at enrollment and throughout the study. Conclusions. Mobility and physical activity measured by LSA questionnaire and pedometer are positively associated with lung function in adults with CF. This study confirms the importance of mobility and physical activity and supports the utility of a simple office-based questionnaire as a measure of mobility in adults with CF.

Associations between environmental characteristics and life-space mobility in community-dwelling older people.

To examine the association between perceived environmental barriers to and facilitators for outdoor mobility with life-space among older people. Community-dwelling, 75- to 90-year-old people (n = 848) were interviewed face-to-face using standard questionnaires. The Life-Space Assessment (LSA), indicating distance and frequency of moving and assistance needed in moving (range 0-120), was used. Environmental barriers and facilitators outdoors were self-reported. Altogether, 41% (n = 348) of the participants had restricted life-space (LSA score < 60). Those reporting one or more environmental barriers had more than double the odds for restricted life-space compared with those reporting no barriers after adjustments for ill health, functioning, and socioeconomic status (SES) differences. Similarly, those reporting four to seven facilitators had lower odds for restricted life-space compared with those reporting three or fewer facilitators. Perceptions of one's environment may either constrain or extend older people's life-space. Longitudinal studies are needed to study the causality of the findings.

Severity of Spatial Neglect During Acute Inpatient Rehabilitation Predicts Community Mobility After Stroke

To examine whether stroke survivors with more severe spatial neglect duringtheir acute inpatient rehabilitation had poorer mobility after returning to their communities. A prospective observational study. Acute inpatient rehabilitation and follow-up in the community. Thirty-one consecutive stroke survivors with right-brain damage (women, n= 15 [48.4%]), with the mean (standard deviation) age of 60 ± 11.5 years, were included in the study if they demonstrated spatial neglect within 2 months after stroke. Spatial neglect was assessed with the Behavioral Inattention Test (BIT) (range, 0-146 [a lower score indicates more severity]) and the Catherine Bergego Scale (range, 0-30 [a higher score indicates more severity]). A score of the Behavioral Inattention Test<129 or of the Catherine Bergego Scale >0 defined the presence of spatial neglect. The outcome measure is community mobility, defined by the extent and frequency of traveling within the home and in the community, and is assessed with the University of Alabama at Birmingham Study of Aging Life-Space Assessment (range, 0-120 [a lower score indicates less mobile]). This measure was assessed after participants returned home≥6 months after stroke. The covariates were age, gender, functional independence at baseline; follow-up interval; and depressed mood, which may affect the relationship between spatial neglect and community mobility. A lower Behavioral Inattention Test score was a significant predictor of a lower Life-Space Assessment score after controlling for all the covariates (β= 0.009 [95% confidence interval, 0.008-0.017]); P= .020). The proportion of participants unable to travel independently beyond their homes was 0%, 27.3%, and 72.7% for those with mild, moderate, and severe acute neglect, respectively (Catherine Bergego Scale range, 1-10, 11-20, and 21-30, respectively). Our result indicates that acute spatial neglect has a negative impact on regaining of functional mobility in the community. Specific screening and treatment of spatial neglect during acute stroke care may be necessary to improve long-term mobility recovery.

Self-reported Exhaustion is Associated with Small Life Space in Older Adults with Mild Cognitive Impairment.

[Purpose] Older adults experience exhaustion-induced health problems, such as poor physical function and low physical activity levels. The associations between self-reported exhaustion and physical function and activity are not clear in older adults with mild cognitive impairment (MCI). The aim of this study was to investigate the relationships between self-reported exhaustion and physical function and activity in older adults with mild cognitive impairment. [Subjects] A total of 356 older adults with mild cognitive impairment (mean age = 71.6 ± 0.3 years, 50.8% women) were included in this study. [Methods] Self-reported exhaustion was identified by one item from the Study of Osteoporotic Fractures index. Gait speed, gait endurance, and life space were also assessed. [Results] Sixty-two participants reported having exhaustion, giving a 17.4% prevalence of self-reported exhaustion among these individuals. Logistic regression analysis showed that the Life-Space Assessment score was the only parameter significantly independently associated with exhaustion status (adjusted odds ratio 0.97, 95% confidence interval 0.95–0.99). [Conclusion] These results suggest that self-reported exhaustion is associated with life space. Future research is needed to identify ways for older people with MCI to improve their exhaustion status.

Robot-assisted home hazard assessment for fall prevention: a feasibility study

Summary We examined the feasibility of using a remotely manoeuverable robot to make home hazard assessments for fall prevention. We employed use-case simulations to compare robot assessments with in-person assessments. We screened the homes of nine elderly patients (aged 65 years or more) for fall risks using the HEROS screening assessment. We also assessed the participants' perspectives of the remotely-operated robot in a survey. The nine patients had a median Short Blessed Test score of 8 (interquartile range, IQR 2-20) and a median Life-Space Assessment score of 46 (IQR 27-75). Compared to the in-person assessment (mean = 4.2 hazards identified per participant), significantly more home hazards were perceived in the robot video assessment (mean = 7.0). Only two checklist items (adequate bedroom lighting and a clear path from bed to bathroom) had more than 60% agreement between in-person and robot video assessment. Participants were enthusiastic about the robot and did not think it violated their privacy. The study found little agreement between the in-person and robot video hazard assessments. However, it identified several research questions about how to best use remotely-operated robots.

Is the Life Space Assessment Applicable to a Palliative Care Population? Its Relationship to Measures of Performance and Quality of Life

ContextThe spatial environments that palliative care patients frequent for business and leisure constrict as their disease progresses and their physical functioning deteriorates. Measuring a person's movement within his or her own environment is a clinically relevant and patient-centered outcome because it measures function in a way that reflects actual and not theoretical participation. ObjectivesThis exploratory study set out to test whether the Life-Space Assessment (LSA) would correlate with other commonly used palliative care outcome measures of function and quality of life. MethodsThe baseline LSA, Australia-modified Karnofsky Performance Status Scale (AKPS), and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative (EORTC QLQ-C15-PAL) scores from two large clinical trials were used to calculate correlation coefficients between the measures. Convergent validity analysis was undertaken by comparing LSA scores between participants with higher (≥70) and lower (≤60) AKPS scores. ResultsThe LSA was correlated significantly and positively with the AKPS, with a moderate correlation coefficient of 0.54 (P<0.001). There was a significant weak negative correlation between the LSA and the EORTC QLQ-C15-PAL, with a small coefficient of −0.22 (P=0.027), but a strong correlation between the LSA and the EORTC QLQ-C15-PAL item related to independent activities of daily living (r=−0.654, P<0.01). A significant difference in the LSA score between participants with higher (≥70) and lower (≤60) AKPS scores t(97)=−4.35, P<0.001) was found. ConclusionThe LSA appears applicable to palliative care populations given the convergent validity and capacity of this instrument to differentiate a person's ability to move through life-space zones by performance status. Further research is required to validate and apply the LSA within community palliative care populations.

Life-Space Assessment scale to assess mobility: validation in Latin American older women and men

The Life-Space Assessment (LSA) instrument of the University of Alabama and Birmingham study is a useful and innovative measure of mobility in older populations. The purpose of this article was to assess the reliability, construct and convergent validity of the LSA in Latin American older populations. In a cross-sectional study, a total of 150 women and 150 men, aged 65-74 years, were recruited from seniors' community centers in Manizales, Colombia and Natal, Brazil. The LSA questionnaire summarizes where people travel (5 levels from room to places outside of town), how often and any assistance needed. Four LSA variables were obtained according to the maximum life space achieved and the level of independence. As correlates of LSA, education, perception of income sufficiency, depression, cognitive function, and functional measures (objective and subjectively measured) were explored. The possible modifying effect of the city on correlates of LSA was examined. Reliability for the composite LSA score was substantial (ICC = 0.70; 95 % CI 0.49-0.83) in Manizales. Average levels of LSA scores were higher in those with better functional performance and those who reported less mobility difficulties. Low levels of education, insufficient income, depressive symptoms, and low scores of cognitive function were all significantly related to lower LSA scores. Women in both cities were more likely to be restricted to their neighborhood and had lower LSA scores. This study provides evidence for the validity of LSA in two Latin American populations. Our results suggest that LSA is a good measure of mobility that reflects the interplay of physical functioning with gender and the social and physical environment.

Factors associated with life‐space in older adults with amnestic mild cognitive impairment

Restriction of life-space is associated with physical performance and functional decline in older adults. Little is known about the factors associated with life-space in older adults with amnestic mild cognitive impairment (aMCI). The purpose of this study was to identify factors associated with life-space in older adults with aMCI. The study participants were 69 older adults (mean age 74.5 years, males 56.5%) who were identified with aMCI. Life-space mobility was measured using a Japanese translation of the life-space assessment (LSA). Age, sex, cognitive function (general function, executive function and processing speed), physical performance, instrumental activities of daily living status (IADL) and fear of falling (FoF) were measured as potential relevant factors. Univariate analysis showed that the LSA was associated with FoF, sex, physical performance, processing speed and IADL. In the stepwise regression analysis, FoF, processing speed and IADL maintained a significant association with the LSA scores, although sex and physical performance did not reach significance. The results suggest that the restrictions of life-space in older adults with aMCI were more affected by the FoF, slower processing speed and restricted IADL than sex or physical performance.

Life‐Space Mobility in Mexican Americans Aged 75 and Older

To examine the factors associated with life-space mobility in older Mexican Americans. Cross-sectional study involving a population-based survey. Hispanic Established Population for the Epidemiologic Study of the Elderly survey conducted in the southwestern of United States (Texas, Colorado, Arizona, New Mexico, and California). Seven hundred twenty-eight Mexican-American men and women aged 75 and older. Sociodemographic factors, self-reported physician diagnoses of medical conditions (arthritis, diabetes mellitus, heart attack, stroke, hip fracture, and cancer), depressive symptoms, cognitive function, body mass index (BMI), upper and lower extremity muscle strength, Short Physical Performance Battery (SPPB), activities of daily living (ADLs), and the life-space assessment (LSA) were assessed in in-home interviews. The mean age of participants was 84.2 ± 4.2. Sixty-five percent were female. Mean LSA score was 41.7 ± 20.9. Multiple regression analysis showed that older age, being female, limitation in ADLs, stroke, high depressive symptoms, and a BMI index of 35 kg/m(2) and greater were significantly associated with lower LSA scores. Education and better lower extremity function and muscle strength were factors significantly associated with higher LSA scores. Older Mexican Americans had restricted life-space, with approximately 80% limited to their home or neighborhood. Older age, female sex, stroke, high depressive symptoms, BMI of 35 kg/m(2) or greater, and ADL disability were related to less life-space. Future studies are needed to examine the association between life-space and health outcomes and to characterize the trajectory of life-space over time in this population.