Assessing mobility in older adults: the UAB Study of Aging Life-Space Assessment. Mobility Limitations and Cognitive Deficits as Predictors of Institutionalization among Community-Dwelling Older People The dynamic nature of mobility disability in older persons. Effect of a multifactorial interdisciplinary intervention on mobility-related disability in frail older people: randomised controlled trial A randomized controlled trial of a home exercise programme for elderly people with poor mobility. Mobility Is a Key Predictor of Change in Well-Being Among Older Adults Who Experience Falls: Evidence From the Vancouver Falls Prevention Clinic Cohort. Translating weight loss and physical activity programs into the community to preserve mobility in older, obese adults in poor cardiovascular health. Improved functional ability and independence in activities of daily living for older adults at high risk of hospital readmission: a randomized controlled trial. Effects of a programme of multifactorial home visits on falls and mobility impairments in elderly people at risk: randomised controlled trial Can the control of bodily orientation be significantly improved in a group of older adults with a history of falls? Onset of mobility disability among community-dwelling old men and women. The role of tiredness in daily activities. Association of visual impairment with mobility and physical function. Mobility difficulties and physical activity as predictors of mortality and loss of independence in the community-living older population. Socioeconomic position and incident mobility impairment in the Cardiovascular Health Study Measuring life-space mobility in community-dwelling older adults. Does functionally based activity make a difference to health status and mobility? A randomised controlled trial in residential care facilities (The Promoting Independent Living Study; PILS). Instrumental activities of daily living related to impairments and functional limitations in 70-year-olds and changes between 70 and 76 years of age.
BACKGROUND AND PURPOSE The University of Alabama at Birmingham ( UAB ) Study of Aging Life-Space Assessment ( LSA ) is a relatively new instrument to measure mobility . The purpose of this report is to describe the relationships between LSA and traditional measures of physical function , sociodemographic characteristics , depression , and cognitive status . SUBJECTS Subjects were a stratified r and om sample of 998 Medicare beneficiaries aged > or = 65 years . The sample was 50 % African American , 50 % male , and 50 % from rural ( versus urban ) counties . METHODS In-home interviews were conducted . Mobility was measured using the LSA , which documents where and how often subjects  travel and any assistance needed during the 4 weeks prior to the assessment . Basic activities of daily living ( ADL ) and instrumental activities of daily living ( IADL ) , cognitive status , income level , presence of depressive symptoms , and transportation re sources were determined . The  Short Physical Performance Battery ( SPPB ) was used to assess physical performance . RESULTS Simple bivariate correlations indicated a significant relationship between LSA and all variables except residence ( rural versus urban ) . In a regression model , physical function ( ADL , IADL ) and physical performance ( SPPB ) accounted for 45.5 % of the variance in LSA scores . An additional 12.7 % of the variance was explained by sociodemographic variables , and less than 1 % was explained by cognition and depressive symptoms . DISCUSSION AND CONCLUSION The LSA can be used to document patients ' mobility within their home and community . The LSA scores are associated with a person 's physical capacity and other factors that may limit mobility . These scores can be used in combination with other tests and measures to generate clinical hypotheses to explain mobility deficits and to plan appropriate interventions to address these deficits Purpose : Mobility limitations and cognitive disorders have often been observed as risks for institutionalization . However , their combined effects on risk of institutionalization among initially community-dwelling older people have been less well reported . Design : A prospect i ve cohort study with 10-year surveillance on institutionalization . Subjects : Study population ( n = 476 ) consisted of 75- and 80-year-old people who were community-dwelling , had not been diagnosed with dementia , and participated in tests on walking speed and cognitive capacity at a research centre . Measures : Cognitive capacity was measured with three vali date d psychometric tests that were from the Wechsler Adult Intelligence Scale , Wechsler Memory Scale and Schaie- Thurstone Adult Mental Abilities Test .  Mobility  was measured with walking speed over a 10-m distance . Exclusive distribution based study groups were formed with cut-offs at the lowest third as follows : no limitation , solely mobility limitation , solely cognitive deficits , and combined mobility limitation and cognitive deficits . Cox proportional hazards model was used to determine the relative risks of institutionalization for the study groups . Results : Eleven percent of the participants were institutionalized during the 10-year surveillance . The risk for institutionalization was 4.9 times greater ( 95 % confidence interval : 2.1–11.2 ) for those who had co-existing mobility limitations and cognitive deficits than for those with no limitations . Conclusions : The findings show that the accumulation of limitations in physical and cognitive performance substantially decreases the possibility for a person remaining at home . This might be due to a decreased reserve capacity and ineffective compensatory strategies . Therefore , interventions targeted to improve even one limitation , or prevent accumulation of these risk factors , could significantly reduce the risk of institutionalization OBJECTIVES To determine the rates of clinical ly meaningful transitions in mobility disability ; evaluate how these transitions differ according to age , sex , and physical frailty ; and depict the duration of the result ing episodes of mobility disability . DESIGN Prospect i ve cohort study . SETTING General community in greater New Haven , Connecticut , from March 1998 to October 2004 . PARTICIPANTS Seven hundred fifty-four community-living older persons , aged 70 and older , who were nondisabled ( i.e. , required no personal assistance ) in four activities of daily living . MEASUREMENTS  Mobility disability , defined as the inability to  walk  one quarter of a mile and to  climb a flight of stairs , respectively without personal assistance  , was assessed every month for up to 5 years . RESULTS For both mobility tasks , rates per 1,000 person-months were higher for transitions from no disability to intermittent disability ( 34.7 for walking one quarter of a mile and 17.4 for climbing a flight of stairs ) , intermittent to continuous disability ( 52.0 and 42.5 ) , continuous to intermittent disability ( 35.4 and 31.5 ) , and intermittent to no disability ( 68.6 and 85.4 ) than for other transitions . Older age , female sex , and physical frailty were associated with greater likelihood of transition to states of greater disability and lower likelihood of regaining independent mobility . CONCLUSION Mobility disability in older persons is a highly dynamic process , characterized by frequent transitions between states of independence and disability . Programs design ed to enhance independent mobility should focus not only on the prevention of mobility disability but also on the restoration and maintenance of independent mobility in older persons who become disabled Background Interventions that enhance mobility in frail older people are needed to maintain health and independence , yet definitive evidence of effective interventions is lacking . Our objective was to assess the impact of a multifactorial intervention on mobility-related disability in frail older people . Methods We conducted a r and omised , controlled trial with 241 frail community-dwelling older people in Sydney , Australia . Participants were classified as frail using the Cardiovascular Health Study definition , did not have severe cognitive impairment and were recently discharged from an aged care and rehabilitation service . The experimental group received a 12 month multifactorial , interdisciplinary intervention targeting identified frailty components . Two physiotherapists delivered a home exercise program targeting mobility , and coordinated management of psychological and medical conditions with other health professionals . The control group received usual care .  Disability in the mobility domain was measured at baseline and at 3 and 12 months using the International Classification of Functioning , Disability and Health framework . Participation ( involvement in life situations ) was assessed using the Life Space Assessment and the Goal Attainment Scale . Activity ( execution of mobility tasks ) was measured using the 4-metre walk and self-report measures . Results The mean age of participants was 83.3 years ( SD : 5.9 years ) . Of the participants recruited , 216 ( 90 % ) were followed-up at 12 months . At this time point , the intervention group had significantly better scores than the control group on the Goal Attainment Scale ( odds ratio 2.1 ; 95 % confidence interval ( CI ) 1.3 to 3.3 , P = 0.004 ) and Life Space Assessment ( 4.68 points , 95 % CI 1.4 to 9.9 , P = 0.005 ) . There was no difference between groups on the global measure of participation or satisfaction with ability to get out of the house . At the activity level , the intervention group walked 0.05 m/s faster over 4 m ( 95 % CI 0.0004 to 0.1 , P = 0.048 ) than the control group , and scored higher on the Activity Measure for Post Acute Care ( P < 0.001 ) . Conclusions The intervention reduced mobility-related disability in frail older people . The benefit was evident at both the participation and activity levels of mobility-related disability . Trial registration Australia and New Zeal and Clinical Trials Register ( ANZCTR ) : ANZCTRN12608000507381 Eighty-six elderly people with limited mobility and dependence in at least one activity of daily living were recruited to a home exercise study . The subjects ( mean age 82 years ) were allocated at r and om to either a strength exercise group , a mobility exercise group or a health education group . Subjects were visited for 30 minutes every 3 - 4 weeks by a physiotherapist who gave both verbal and written instruction . Sixty-nine of the original 86 completed the 6-month study , with five drop-outs from the strength group , ten drop-outs from the mobility group , and two drop-outs from the health education group . By the end of the study , there were no significant differences between the groups with regard to changes in outcome variables . The results showed a trend towards improvement in both the exercise groups in both Sit to St and and Timed Get Up and Go tests , but this failed to attain statistical significance . Further work is required to identify the optimal exercise intervention for this subgroup of the elderly population OBJECTIVE To determine the factors that predict change in well-being over time in older men and women presenting to the falls prevention clinic . DESIGN Prospect i ve cohort study . SETTING Falls prevention clinic . PARTICIPANTS Community-dwelling older adults who were referred to the clinic after sustaining a fall ( between N=244 and N=255 , depending on the analysis ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES The ICEpop CAPability measure for Older people , a measure of well-being or quality of life , was administered at baseline , 6 months , and 12 months . We constructed linear mixed models to determine whether baseline predictor variables were related to baseline well-being and /or changes in well-being over time . In addition , we included interactions with sex to investigate the difference between men and women . Baseline predictors included 2 measures of mobility -- Short Performance Physical Battery and timed Up and Go test-- and a measure of global cognitive function -- Montreal Cognitive Assessment .  RESULTS All 3 predictors were associated with well-being at baseline ( P<.05 ) . Furthermore , both the Short Performance Physical Battery and the timed Up and Go test interacted with sex ( P<.05 ) to predict changes in well-being over time . Follow-up analyses suggested that better mobility was protective against decline in well-being in men but was generally unrelated to changes in well-being in women . CONCLUSIONS We found that 2 valid and reliable measures of mobility interacted with sex to predict changes in well-being over time . This is a critical research area to develop in order to appropriately tailor future intervention strategies targeting well-being in older fallers , a population at high risk of functional decline BACKGROUND Limitations in mobility are common among older adults with cardiovascular and cardiometabolic disorders and have profound effects on health and well-being . With the growing population of older adults in the United States , effective and scalable public health approaches are needed to address this problem . Our goal was to determine the effects of a physical activity and weight loss intervention on 18-month change in mobility among overweight or obese older adults in poor cardiovascular health . METHODS The study design was a translational , r and omized controlled trial of physical activity ( PA ) and weight loss ( WL ) on mobility in overweight or obese older adults with cardiovascular disease ( CVD ) or at risk for CVD . The study was conducted within the community infrastructure of Cooperative Extension Centers . Participants were r and omized to 1 of 3 interventions : PA , WL + PA , or a successful aging ( SA ) education control arm . The primary outcome was time to complete a 400-m walk in seconds ( 400MWT ) . RESULTS A significant treatment effect ( P = .002 ) and follow-up testing revealed that the WL + PA group improved their 400MWT ( adjusted mean [ SE ] , 323.3 [ 3.7 ] seconds ) compared with both PA ( 336.3 [ 3.9 ] seconds ; P = .02 ) and SA ( 341.3 [ 3.9 ] seconds ; P < .001 ) . Participants with poorer mobility at baseline benefited the most ( P < .001 ) . CONCLUSION Existing community infrastructures can be effective in delivering lifestyle interventions to enhance mobility in older adults in poor cardiovascular health with deficits in mobility ; attention should be given to intervening on both weight and sedentary behavior since weight loss is critical to long-term improvement in mobility . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00119795 OBJECTIVE During hospitalization older people often experience functional decline which impacts on their future independence . The objective of this study was to evaluate a multifaceted transitional care intervention including home-based exercise strategies for at-risk older people on functional status , independence in activities of daily living ( ADLs ) and walking ability . METHODS A r and omized controlled trial was undertaken in a metropolitan hospital in Australia with 128 patients ( 64 intervention , 64 control ) aged over 65 years with an acute medical admission and at least one risk factor for hospital readmission . The intervention group received an individually tailored programme for exercise and follow-up care which was commenced in hospital and included regular visits in hospital by a physiotherapist and a registered nurse , a home visit following discharge and regular telephone follow-up for 24 weeks following discharge . The programme was design ed to improve health-promoting behaviours , strength , stability , endurance and mobility . Data were collected at baseline , then 4 , 12 and 24 weeks following discharge using the Index of ADL , Instrumental Activities of Daily Living ( IADL ) and the Walking Impairment Question naire ( WIQ ; modified ) . RESULTS Significant improvements were found in the intervention group in IADL scores ( P < 0.001 ) , ADL scores ( P < 0.001 ) and WIQ scale scores ( P < 0.001 ) in comparison to the control group . The greatest improvements were found in the first 4 weeks following discharge . CONCLUSIONS Early introduction of a transitional model of care incorporating a tailored exercise programme and regular telephone follow-up for hospitalized at-risk older adults can improve independence and functional ability Abstract Objective : To evaluate whether a programme of multifactorial home visits reduces falls and impairments in mobility in elderly people living in the community . Design : R and omised controlled trial with 18 months of follow up . Setting : Six general practice s in Hoensbroek , the Netherl and s. Participants : 316 people aged 70 and over living in the community , with moderate impairments in mobility or a history of recent falls . Intervention : Five home visits by a community nurse over a period of one year . Visits consisted of screening for medical , environmental , and behavioural factors causing falls and impairments in mobility , followed by specific advice , referrals , and other actions aim ed at dealing with the observed hazards . Main outcome measures : Falls and impairments in mobility . Results : No differences were found in falls and mobility outcomes between the intervention and usual care groups . Conclusion : Multifactorial home visits had no effects on falls and impairments in mobility in elderly people at risk who were living in the community . Because falls and impairments in mobility remain a serious problem among elderly people , alternative strategies should be developed and evaluated OBJECTIVE To determine the short-term effectiveness of a biofeedback-based , computerized intervention that applied the principles of the ecological theory of perception and control of bodily orientation to the rehabilitation of older adults with a history of falling . PARTICIPANTS Forty-five older adults ( X = 78.5 years ) with a history of falls were assigned to either a control ( n = 21 ) or intervention group ( n = 24 ) . DESIGN A 2 x 2 ( Group x Time ) mixed factorial design with repeated measures on the second factor . SETTING A motor control research laboratory in a university setting . MEASUREMENT Impairments in multiple dimensions of balance ( i.e. , dynamic postural control and sensory organization ) were measured before and after an 8-week balance intervention using the 100 % Limits of Stability Test and Sensory Organization Test . More functional limitations in balance and /or mobility were measured using two clinical tests : Berg Balance Scale and Timed Up and Go test . MAIN RESULTS Repeated measures multivariate analyses and follow-up testing indicated significant improvements in the dynamic balance and sensory integration capabilities in the case of the intervention group only ( P < .03 ) . Significant improvements were also observed in the two clinical measures of balance and mobility evaluated before and after the intervention for the intervention group only . CONCLUSIONS Theory-driven rehabilitation programs that focus on manipulating individual , task , and environmental constraints concurrently can significantly improve the control of bodily orientation of older adults with a previous history of falls in both static and dynamic action environments . Moreover , the significant improvements in functional performance observed for the intervention group suggest that interventions emphasizing task-specific practice are not the only means by which an older adult 's ability to perform daily activities requiring postural control can be improved BACKGROUND in the primary prevention of disability among older adults it might be useful to identify individuals at high risk for functional decline before it occurs . OBJECTIVE to examine whether  tiredness in daily activities  is an independent determinant of onset of mobility disability at 1 1/2-year follow-up among non-disabled older men and women . DESIGN a prospect i ve study with 1 1/2-year follow-up . SETTING 34 communities in four counties in Denmark . SUBJECTS 1396 older non-disabled adults ( 74 - 75 and 80 years old ) living in 17 of the participating communities . METHODS question naire surveys at baseline and at 1 1/2-year follow-up . Tiredness in daily activities  was measured by questions about tiredness in six mobility activities . Onset of mobility disability was measured as onset of need for help in one to six mobility activities . RESULTS men and women who felt tired in their daily activities at baseline had a higher risk of onset of mobility disability at 1 1/2-year follow-up , when adjusted by the covariates . In addition , low social participation , poor psychological function , and physical inactivity were independent risk factors of onset of mobility disability among men , and home help , low sense of coherence and physical inactivity were independent risk factors of onset of mobility disability among women . CONCLUSION older people who complain about tiredness are at higher risk of becoming disabled than others . This highlights the need for alertness and management of this early sign of functional decline in a preventive perspective OBJECTIVE To examine the association of distant vision and physical function in the population of older adults . DESIGN Cross-sectional and cohort study . PARTICIPANTS 5143 older residents of three communities ( Established Population s for the Epidemiologic Studies of the Elderly ) who were interviewed in 1988 - 89 , including residents of two communities who were re-interviewed 15 months later ( n = 3133 , 97 % of those eligible ) . MEASURES  Visual acuity screening , self-reported activities of daily living and mobility , and objective physical performance measures of balance , walking , and rising from a chair .  RESULTS Limitations in mobility , activities of daily living , and physical performance were associated with worse visual function . In prospect i ve analyses controlling for potential confounders , participants with severe visual impairment had 3-fold higher odds of incident mobility and activity of daily living limitations than those with acuity of 20/40 or better ( P < 0.001 ) . In prospect i ve analyses investigating the relationship of vision with improvement in function , those with poor vision were about half as likely to improve as those with better acuity , but this relationship was only statistically significant for improvement in mobility limitations . CONCLUSIONS Distant visual function appears to play an important role in physical function , particularly for mobility . An intervention to improve vision  in at-risk elders might preserve function and prevent disability ; this warrants further investigation OBJECTIVE In older people , mobility impairments and physical inactivity are risk factors for further disability and death . We studied the interaction of physical activity and mobility impairment as a predictor of dependence and mortality . DESIGN A population -based , prospect i ve study . The data were collected in structured interviews in the year 1988 and 8 years later in the year 1996 as part of the Evergreen Project . PARTICIPANTS Subjects were 1109 independently living , at baseline 65- to 84-year-old people in the city of Jyvaskyla , in central Finl and . METHODS Participants were ranked into four groups : ( 1 ) Intact mobility and physically active ( Mobile-Active ) , ( 2 ) Intact mobility and sedentary ( Mobile-Sedentary ) , ( 3 ) Impaired mobility and physically active ( Impaired-Active ) , and ( 4 ) Impaired mobility and sedentary ( Impaired-Sedentary ) . The confounders adjusted for in the models included age , marital status , education , chronic conditions , smoking , and physical exercise earlier in life . RESULTS In men and women , the relative risk of death was two times greater in Impaired-Active and three times greater in Impaired-Sedentary groups than the risk of death in Mobile-Active groups . However , the risk of death did not differ between Mobile-Active and Mobile-Sedentary groups . The odds ratio for dependency ( 95 % confidence interval ) in Impaired-Sedentary men was 5.21 ( 1.44 - 18.70 ) and in Impaired-Sedentary women was 2.92 ( 1.52 - 5.60 ) compared to Mobile-Active groups . The risk of dependence did not differ significantly between Mobile-Active , Mobile-Sedentary , and Impaired-Active groups . CONCLUSIONS Mobility impairments predicted mortality and dependence . However , among people with impaired mobility , physical activity was associated with lower risks , whereas the risk did not differ according to activity level among those with intact mobility . Despite of their overall greater risk , mobility-impaired people may be able to prevent further disability and mortality by physical exercise Background We investigated if personal socioeconomic position ( SEP ) factors and neighborhood characteristics were associated with incident mobility impairment in the elderly . Methods We used data from the Cardiovascular Health Study , a longitudinal , population -based examination of coronary heart disease and stroke among persons aged 65 and older in the United States . Results Among 3,684 persons without baseline mobility impairment , lower baseline SEP was associated with increased risk of incident mobility disability during the 10-year follow-up period , although the strengths of these associations varied by socioeconomic indicator and race/sex group . Conclusion Among independent-living elderly , SEP affected development of mobility impairment into later life . Particular effort should be made to prevent or delay its onset among the elderly with low income , education , and /or who live in economically disadvantaged neighborhoods OBJECTIVES To evaluate the validity and reliability of a st and ardized approach for assessing life-space mobility ( the University of Alabama at Birmingham Study of Aging Life-Space Assessment ( LSA ) ) and its ability to detect changes in life-space over time in community-dwelling older adults . DESIGN Prospect i ve , observational cohort study . SETTING Five counties ( three rural and two urban ) in central Alabama . PARTICIPANTS Community-dwelling Medicare beneficiaries ( N=306 ; 46 % male , 43 % African American ) who completed in-home baseline interviews and 2-week and 6-month telephone follow-up interviews . MEASUREMENTS The LSA assessed the range , independence , and frequency of movement over the 4 weeks preceding assessment s. Correlations between the baseline LSA and measures of physical and mental health ( physical performance , activities of daily living , instrumental activities of daily living , a global measure of health ( the short form-12 question survey ) , the Geriatric Depression Scale , and comorbidities ) established validity . Follow-up LSA scores established short-term test-retest reliability and the ability of the LSA to detect change . RESULTS For all LSA scoring methods , baseline and 2-week follow-up LSA correlations were greater than 0.86 ( 95 % confidence interval=0.82 - 0.97 ) . Highest correlations with measures of physical performance and function were noted for the LSA scoring method considering all attributes of mobility . The LSA showed both increases and decreases at 6 months . DISCUSSION Life-space correlated with observed physical performance and self-reported function . It was stable over a 2-week period yet showed changes at 6 months OBJECTIVES to determine whether a repetitive activities of daily living ( ADL ) activity programme improves health status , life satisfaction and mobility for older people living in residential care . DESIGN cluster r and omised controlled trial . SETTING five low-level dependency residential care homes in Auckl and , New Zeal and . PARTICIPANTS one hundred and forty-nine older residents ( mean age 84.7 years ) . INTERVENTION trained research staff worked with residents in intervention wards to set a goal and complete a functional assessment for each resident . They then design ed an individualised activity programme based on ADL and worked with residential care home staff to implement the programme into daily activities of residents . MEASUREMENTS mobility : timed-up- and -go ( TUG ) ; life satisfaction : late life satisfaction index ( LSI-Z ) ; and health status : SF-36 were assessed at baseline , 3- and 6-months follow-up . RESULTS in the intervention group the SF-36 total physical component summary ( PCS ) score improved at 3 months in comparison with the control group . There was no difference between groups on mobility measures at any time , nor any measures at 6-months follow-up . Significant contamination is likely to have affected the 6-month follow-up measures . CONCLUSIONS a repetitive ADL exercise programme may improve health status in the short term in a group of frail older people living in residential care . Further research is needed to establish sustainability of change The aim of this study was to analyse in particular dependence in instrumental daily life activities ( I-ADLs ) and its association with physical impairments and functional limitations in the elderly . The study was based on cross-sectional data on 70-year-olds ( n = 602 ) and longitudinal data on subjects followed up to the age of 76 ( n = 371 ) . Persons dependent in ADL  had lower values in maximum walking speed , grip strength , knee extensor strength , stair climbing capacity and in forward reach , compared with those who were independent in ADL .  Walking speed in both women and men and sight impairment in men had the greatest influence on dependence in ADL . Possible critical levels for disability in ADL are discussed , as persons who developed dependence between 70 and 76 already had a lower capacity in walking speed and knee extensor strength at age 70 than persons who retained their independence in ADL
Commonly measured constructs of mobility included walking , climbing stairs , and lower extremity function .
There was heterogeneity in ways of defining and measuring mobility limitation in older adults living in the community .
Mobility is critical in maintaining independence in older adults .
This study aims to systematic ally review the scientific literature to identify measures of mobility limitation for community-dwelling older adults .