Longitudinal changes in life-space mobility and autonomy in participation outdoors among Finnish community-dwelling older adults from pre-COVID-19 to through the pandemic.

BACKGROUND: Among older people, community mobility was reduced at the beginning of the COVID-19 pandemic, but the longer-term changes are unclear. AIMS: To study lower extremity performance and car driving as predictors of changes in older adults' life-space mobility, autonomy in participation outdoors, and the risk of developing restricted life-space mobility from 2017 to 2022. METHODS: Life-space mobility (scoring range 0-120) and autonomy in participation outdoors (scoring range 0-20) were assessed in community-dwelling individuals (n = 657) in 2017-2018 (baseline age 75, 80, or 85 years), during the first wave of COVID-19 in 2020, and in 2021-2022. Lower extremity performance was assessed using the Short Physical Performance Battery, and car driving was self-reported at baseline. Data were analysed using generalized estimating equations and Cox regression. RESULTS: During the first wave of COVID-19 in 2020, life-space mobility decreased on average by 10.3 (SD 21.6) points and partially recovered in 2021-2022 (+ 2.7, SD 21.8). The same pattern was observed for autonomy in participation outdoors. Non-drivers and those with impaired lower extremity performance had a 2.4-to-3.6-fold adjusted risk of developing restricted life-space mobility over the follow-up period compared to drivers with intact lower extremity performance. CONCLUSIONS: For older people, the recovery of community mobility was incomplete after the restrictions stemming from the pandemic were lifted. Older adults with impaired lower extremity performance and who did not drive were particularly vulnerable to developing restricted life-space mobility, a situation that could lead to social isolation and reduced well-being.

Physical Activity Changes From Before to During the First Wave of the COVID-19 Pandemic Among Community-Dwelling Older Adults in Finland.

This study aimed to compare community-dwelling older adults' physical activity (PA) during the COVID-19 restrictions in 2020 to their PA levels 2 years before and investigate associations between earlier physical performance and PA levels over the follow-up. Participants' (n = 809, initial age 75-85 years) self-reported PA was assessed at baseline in 2017-2018 and May/June 2020 as total weekly minutes of walking and vigorous PA. Physical performance was assessed at baseline using the maximal handgrip strength and Short Physical Performance Battery tests. During the first wave of the COVID-19 pandemic, a median change in total weekly minutes of walking and vigorous PA among all participants was + 20.0 (interquartile range: -60.0 to 120.0, p < .001) min per week compared with 2 years earlier. Higher baseline Short Physical Performance Battery total scores were associated with higher total weekly minutes of walking and vigorous PA over the follow-up in men and women, and better handgrip strength in women.

Maintenance of high quality of life as an indicator of resilience during COVID-19 social distancing among community-dwelling older adults in Finland.

PURPOSE: Social distancing during the COVID-19 pandemic reduced possibilities for activities of choice potentially threatening quality of life (QoL). We defined QoL resilience as maintaining high quality of life and studied whether walking speed, absence of loneliness, living arrangement, and stress-coping ability predict QoL resilience among older people. METHODS: Community-dwelling 75-, 80-, and 85-year-old persons (n = 685) were interviewed and examined in 2017-2018 and were followed up during COVID-19 social distancing in 2020. We assessed QoL using the OPQOL-brief scale and set a cut-off for 'constant high' based on staying in the highest baseline quartile over the follow-up and categorized all others as having 'low/moderate'. Perceived restrictiveness of the social distancing recommendations was examined with one item and was categorized as 'yes' or 'no' restrictiveness. RESULTS: Better stress-coping ability (OR 1.21, 95% CI 1.14-1.28) and not being lonely (OR 2.67, 95% CI 1.48-4.63) increased the odds for constant high QoL from before to amid social distancing, and the odds did not differ according to the perceived restrictiveness of the social distancing recommendations. Higher walking speed predicted constant high QoL only among those perceiving restrictiveness (OR 1.16, 95% CI 1.07-1.27). Living arrangement did not predict constant high QoL. CONCLUSION: During social distancing, psychosocial resources helped to maintain good QoL regardless how restrictive the social distancing recommendations were perceived to be. Better physical capacity was important for constant high QoL only among those perceiving restrictiveness presumably because it enabled replacing blocked activities with open outdoor physical activities.

Physical Activity Scaled to Preferred Walking Speed as a Predictor of Walking Difficulty in Older Adults: A 2-Year Follow-up.

BACKGROUND: The usual accelerometry-based measures of physical activity (PA) are dependent on physical performance. We investigated the associations between PA relative to walking performance and the prevalence and incidence of early and advanced walking difficulties compared to generally used measures of PA. METHODS: Perceived walking difficulty was evaluated in 994 community-dwelling participants at baseline (age 75, 80, or 85 years) and 2 years later over 2 km (early difficulty) and 500 m (advanced difficulty). We used a thigh-mounted accelerometer to assess moderate-to-vigorous PA, daily mean acceleration, and relative PA as movement beyond the intensity of preferred walking speed in a 6-minute walking test (PArel). Self-reported PA was assessed using questionnaires. RESULTS: The prevalence and incidence were 36.2% and 18.9% for early and 22.4% and 14.9% for advanced walking difficulty, respectively. PArel was lower in participants with prevalent (mean 42 [SD 45] vs 69 [91] min/week, p < .001) but not incident early walking difficulty (53 [75] vs 72 [96] min/week, p = .15) compared to those without difficulty. The associations between absolute measures of PA and incident walking difficulty were attenuated when adjusted for preferred walking speed. CONCLUSIONS: The variation in habitual PA may not explain the differences in the development of new walking difficulty. Differences in physical performance explain a meaningful part of the association of PA with incident walking difficulty. Scaling of accelerometry to preferred walking speed demonstrated independence on physical performance and warrants future study as a promising indicator of PA in observational studies among older adults.

Impact of mobility restrictions on active aging; cross-sectional associations and longitudinal changes parallel to COVID-19 restrictions.

BACKGROUND: Meaningful activities can be done in or around home, but opportunities for participation and active aging decrease when moving in smaller areas. Active aging refers to having an active approach to life in line with one's goals, ability and opportunities. In adults over 75 years with different baseline neighborhood mobility levels, we studied active aging scores two years prior to and amid COVID-19, when governments restricted mobility of residents to slow the COVID-19 outbreak. METHODS: AGNES cohort data were collected in 2017-2018 and spring 2020. Individuals were queried about their will, ability, and opportunity, and extent of doing 17 activities, and subsequently, item, composite and sub-scores of active aging were computed. Neighborhood mobility was assessed as frequency of moving in or beyond own neighborhood (limited, regular, daily=reference). Associations were studied using Generalized Linear Models (cross-sectionally, n = 1007) and General Estimating Equations (prospectively, n = 774). RESULTS: Participants with limited baseline neighborhood mobility had lower active aging scores than those with daily mobility, but the decline over time was similar. Some item scores on opportunity to act and extent of doing, e.g. for making one's day more interesting and advancing matters of faith or worldview, were better retained amid COVID-19 by those with limited mobility, attenuating group differences. CONCLUSIONS: Active aging scores were somewhat compromised in individuals with limited neighborhood mobility, but opportunities for and engagement in several activities seemed to be better retained amid COVID-19 than for those with daily mobility. Thus, active aging may be possible despite mobility restriction.

Coronavirus-related health literacy and perceived restrictiveness of protective measures among community-dwelling older persons in Finland.

BACKGROUND: Older people with limited health literacy may encounter difficulties in finding relevant information on COVID-19, understanding its relevance, and complying with recommended protective measures. Complying with such recommendations has required older as well as younger persons to change their daily lives in ways that have reduced their opportunities for engaging in many activities meaningful to them. AIMS: To find out from what sources older people have obtained information on protective measures, the level of their coronavirus-related health literacy (CHL), and whether CHL is associated with their perceptions of the restrictiveness of coronavirus-related protective measures. METHODS: 696 Finnish men and women aged over 77 answered a mailed questionnaire on their CHL, sources of information and perceptions of the restrictiveness of the recommended protective measures. The association of CHL with perceived restrictiveness was studied using multinomial logistic regression analysis. RESULTS: Television and newspapers were the most frequently reported sources of information. Reporting high confidence in the ability to assess how one's behavior influences coronavirus infection risk was associated with higher odds of perceiving the protective measures to be highly restrictive, when controlling for age, gender, and difficulty in using digital devices (OR 3.21, 95% CI 1.09, 9.46). DISCUSSION: Participants who reported being highly confident about their ability to appraise the influence of their behavior on their susceptibility to coronavirus infection were more likely to perceive that the recommended protective measures had restricted their daily lives. CONCLUSIONS: Health literacy plays a role in complying with recommended restrictions.

Perceived Opportunities for Physical Activity and Willingness to Be More Active in Older Adults with Different Physical Activity Levels.

This study examined equity in physical activity (PA) by investigating whether perceived opportunity for PA was associated with willingness to be more active. Among community residents (75, 80, or 85 years old, n = 962) perceived opportunity for PA (poor and good), willingness to be more active (not at all, a bit, and a lot), and level of PA (low, moderate, and high) were assessed via questionnaires. Multinomial logistic regression showed that physical activity moderated the association between poor opportunity and willingness to increase PA. Among those with moderate PA, poor opportunity for PA increased the odds of willingness to be a lot more active (multinomial odds ratio, mOR 3.90, 95% confidence interval 2.21-6.87) than not wanting to be more active compared to those perceiving good opportunities. Associations were similar at high PA levels (p < 0.001), but were not found at low PA levels. Those with moderate or high PA wish to increase their activity particularly when the perceived opportunities for activity are not optimal. Among those with low PA, perceived opportunities are not associated with a perceived need to increase physical activity. Increasing equity in physical activity in old age requires provision of support and opportunities at every level of physical activity.

Health literacy supports active aging.

From the individual viewpoint, active aging refers to the ability of older persons, depending on their goals, functional capacity and opportunities, to engage in desired activities. This study investigated the role of health literacy in active aging among persons differing in their number of chronic conditions. Data were collected from 948 individuals, 57% women, aged 75, 80 and 85 in 2017-2018 in the city of Jyväskylä in Central Finland. Health literacy was assessed with the 16-question version of the European Health Literacy Survey (HLS-EU-Q16), active aging with the University of Jyväskylä Active Aging Scale (UJACAS) and self-reported physician-diagnosed chronic conditions. Both health literacy (r = 0.40) and number of chronic conditions (r = -0.21) correlated with the active aging score. Linear regression models revealed that health literacy was a stronger predictor than chronic conditions of active aging (ß 0.18, p < 0.001 vs. ß -0.06, p = 0.030) and that its predictive value remained statistically significant after adjustment for cognitive capacity, number of depressive symptoms, physical performance and length of education. Higher health literacy can enable older persons, including those with multiple chronic conditions, to maintain higher levels of active aging. As more people are projected to live with chronic conditions to older ages, health literacy may help them to cope with illnesses and functional limitations and lead a fulfilling life. These cross-sectional findings lay a foundation for future prospective and experimental studies on health literacy and active aging.

Life-Space Mobility and Active Aging as Factors Underlying Quality of Life Among Older People Before and During COVID-19 Lockdown in Finland-A Longitudinal Study.

BACKGROUND: Social distancing, that is, avoiding places with other people and staying at home, was recommended to prevent viral transmission during the COVID-19 pandemic. Potentially, reduced out-of-home mobility and lower activity levels among older people may lower their quality of life (QOL). We studied cross-sectional and longitudinal associations of and changes in life-space mobility, active aging, and QOL during COVID-19 social distancing compared to 2 years before. METHODS: Altogether 809 community-living participants initially aged 75, 80, or 85 years of our active aging study (AGNES) conducted in 2017-2018 took part in the current AGNES-COVID-19 survey in May and June 2020. Outdoor mobility was assessed with the Life-Space Assessment (range 0-120). Active approach to life was assessed with the University of Jyväskylä Active Aging Scale (range 0-272), and QOL with the shortened Older People's Quality of Life Questionnaire (range13-65; higher scores better for all). Data were analyzed with General Estimating Equations, General Linear Models, and One-way analysis of variance. RESULTS: Life-space mobility (B -10.8, SE 0.75, p < .001), the active aging score (B -24.1, SE 0.88, p < .001), and the QOL score (B -1.65, SE 0.21, p < .001) were lower during COVID-19 social distancing versus 2 years before. Concurrent life-space mobility and active aging scores, age, and sex explained 48% of QOL at the baseline and 42% during social distancing. Longitudinally, steeper declines in all 3 variables coincided. CONCLUSION: The observed declines indicate compliance with social distancing recommendation, but underline the importance of participation in meaningful life situations as a factor underlying good QOL also during the COVID-19 pandemic.

Daily Physical Activity and Sedentary Time Assessed by Acceleration Based on Mean Amplitude Deviation among Older People.

Accelerometer-derived estimates of physical activity (PA) and sedentary time have been an important methodological focus. However, little is known about the daily activities among older people during their normal lives. Furthermore, some older individuals would like to be more active, yet experience an unmet PA need, which is defined as the desire to engage in more PA but without the opportunity to act on the desire. This study examined the intensity of daily PA and sedentary behavior measured with accelerometers among older people, and whether PA differs between weekdays and weekends and those with and without the experience of unmet PA need, measured with self-reports. A total of 174 community-dwelling older people (64% female) aged 75 to 90 years used an accelerometer for 7 consecutive days during waking hours, and the results were classified for sedentary behavior (thresholds of 0.0167 g), light activity (0.091 g), and moderate-to-vigorous activity (MVPA, 0.414 g) based on mean amplitude deviation (g). We found that during weekdays, older people engaged slightly more in light activity and had less sedentary time than during weekends. In total, 7.6% of the participants perceived an unmet PA need. Accordingly, those with unmet PA needs spent less time in MVPA, especially during weekdays, and they might benefit from PA-enabling interventions.

Older Adults' Physical Activity and the Relevance of Distances to Neighborhood Destinations and Barriers to Outdoor Mobility.

Aim: To determine the relevance of features located close to home and further away, our aim was to study associations between older adults' physical activity and self-reported neighborhood destinations and barriers to outdoor mobility categorized by presence and maximal distance from home. Methods: Cross-sectional analyses comprising men and women 79-94 years old (57%) living independently in Central Finland (n = 185). Self-reported physical activity was categorized into lower (≤3 h moderate activity a week) and higher (≥4 h moderate or intense activity a week) activity. Assisted by interviewers, participants located on an interactive map destinations perceived to facilitate and barriers perceived to hinder outdoor mobility in their neighborhood. Participants' home addresses were geolocated. Euclidean distances between home and reported locations were computed, and the maximal distance from home to neighborhood destinations and barriers, respectively, was categorized based using four common buffer distances, i.e., 250 m, 500 m, 750 m, and 1 km. Participants reporting destinations or barriers within and beyond the respective distance were compared with those reporting none. Results: About 80% of participants reported neighborhood destinations and 55% neighborhood barriers to outdoor mobility. Barriers were generally located closer to home than destinations [median 166 m (range 25 m-6.10 km) vs. 492 m (5 m-2.7 km)]. Logistic regression analyses adjusted for age, sex, and physical performance showed that neighborhood destinations increased the odds for higher physical activity when located beyond 500 m from home [OR 2.95, 95% confidence interval (CI) 1.02-8.54], but not when located solely within 500 m (OR 1.70, 95% CI 0.30-9.61), in comparison with when reporting no destinations. In contrast, neighborhood barriers decreased the odds for higher physical activity when solely located within 500 m (OR 0.31, 95% CI 0.14-0.72), but not when any barrier was located beyond 500 m (OR 0.96, 95% CI 0.23-3.99), compared with when reporting no barriers. Associations were similar for 250-m buffer distances, but not robust for 750-m and 1,000-m buffers because of lower prevalence. Conclusion: Neighborhood barriers to outdoor mobility located close to home were associated with lower physical activity of older adults, whereas barriers further away were not. Attractive destinations for outdoor mobility located further away from home correlated with higher physical activity, potentially by motivating one to go out and be physically active. Temporal relationships warrant further study.

Associations between Perceived Outdoor Environment and Walking Modifications in Community-Dwelling Older People: A Two-Year Follow-Up Study.

Objectives: To examine associations of perceived outdoor environment with the prevalence and development of adaptive (e.g., slower pace) and maladaptive (e.g., avoiding walking) modifications in walking 2 km among older people. Methods: Community-dwelling 75-90 -year-old persons (N = 848) reported environmental outdoor mobility facilitators and barriers at baseline. Modifications in walking 2 km (adaptive, maladaptive, or no) were assessed at baseline and one and two years later. Results: Outdoor mobility facilitators were more often reported by those not using modifications or using adaptive versus maladaptive walking modifications. Differences in health and physical capacity explained most of the associations between outdoor mobility barriers and walking modifications. Perceived outdoor environment did not systematically predict future adaptive or maladaptive walking modifications. Discussion: Facilitators may compensate the declined physical capacity and alleviate the strain of walking longer distances by enabling the use of adaptive walking modifications, while lack of such facilitators fuels avoidance of walking longer distances.

Outdoor Mobility and Use of Adaptive or Maladaptive Walking Modifications Among Older People.

BACKGROUND: In old age, decline in functioning may cause changes in walking ability. Our aim was to study whether older people who report adaptive, maladaptive, or no walking modifications differ in outdoor mobility. METHODS: Community-dwelling people aged 75-90 years (N = 848) were interviewed at baseline, of whom 761 participated in the 2-year follow-up. Walking modifications were assessed by asking the participants whether they had modified their way of walking 2 km due to their health. Based on the responses, three categories were formed: no walking modifications (reference), adaptive (eg, walking more slowly, using an aid), and maladaptive walking modifications (reduced frequency of walking, or having given up walking 2 km). Differences between these categories in life-space mobility, autonomy in participation outdoors, and unmet physical activity need were analyzed using generalized estimation equation models. RESULTS: Participants with maladaptive walking modifications (n = 238) reported the most restricted life-space mobility (ß = -9.6, SE = 2.5, p < .001) and autonomy in participation outdoors (ß = 1.7, SE = 0.6, p = .004) and the highest prevalence of unmet physical activity need (odds ratio = 4.3, 95% confidence interval = 1.1-16.5) at baseline and showed a decline in these variables over time. Those with no walking modifications (n = 285) at baseline exhibited the best values in all outdoor mobility variables and no change over time. Although at baseline those with adaptive walking modifications (n = 325) resembled those with no modifications, their outdoor mobility declined over time. CONCLUSION: Adopting adaptive modifications may postpone decline in outdoor mobility, whereas the use of maladaptive modifications has unfavorable consequences for outdoor mobility.

Assimilative and Accommodative Coping and Older People's Leisure Activities.

Objectives: Assimilative and accommodative coping strategies have hardly been studied in relation to leisure activities in old age. We investigated whether tenacious goal pursuit (TGP) and flexible goal adjustment (FGA) influence the association between physical performance and participation in leisure activities. Methods: A cross-sectional analysis was conducted among 187 community-dwelling people aged 79 to 93 years. TGP, FGA, and leisure activity participation were asked with questionnaires. Physical performance was assessed with the Short Physical Performance Battery (SPPB). Results: TGP moderated the relationship between physical performance and leisure activity participation. Despite low physical performance, people with high TGP had close to mean level of leisure activity participation, whereas low TGP was associated with very little activity. Most notably, people without high TGP had fewer outdoor activities and group activities outside home. Similar effects were not found for FGA. Discussion: Persistency, rather than flexibility, in goal pursuit appears to help older people be active in their leisure time.

Perception of parks and trails as mobility facilitators and transportation walking in older adults: a study using digital geographical maps.

BACKGROUND: Transportation walking represents a promising target for physical activity promotion in older adults. Perceived characteristics of the neighbourhood physical environment may affect older adults' choice of transportation mode for a routine activity such as walking to the grocery store. AIMS: To (1) evaluate associations between older adults' perception of parks and trails as outdoor mobility facilitators and transportation walking, specifically to the grocery store; and (2) explore whether the spatial relationship between people's home, perceived facilitator and store was relevant for their transportation choice. METHODS: Cross-sectional data were collected in a subsample of the 'Life-space mobility in old age' cohort. Multivariable logistic regression analysis on the binary outcome 'transportation walking' (vs. 'motorized transportation') was used to evaluate the association with perceived mobility facilitators in the neighborhood; in step (1) without and in step (2) with taking spatial relationships into account. RESULTS: Perceiving a park as facilitator increased the odds of walking (N = 179; Odds Ratio 9.89; 95% Confidence interval 3.11-31.50). Spatial relationships did not affect transportation choice. Reporting a trail as facilitator was not significantly associated with walking. CONCLUSIONS: Our findings suggest that the perception of environmental characteristics in the neighbourhood has an influence on older people's transportation choices. Taking environmental measures or informing older adults on their options in the neighbourhood might be possible ways to increase older adults' transportation walking on a population level.

Association of tenacious goal pursuit and flexible goal adjustment with out-of-home mobility among community-dwelling older people.

BACKGROUND: As people age, functional losses may limit the potential to get outside the home and participate in desired activities and community life. Coping with age-related losses has been reported to be important for psychological well-being. Hitherto is not known whether active use of coping strategies also helps maintain out-of-home mobility. AIMS: We investigated how two coping strategies, tenacious goal pursuit (TGP; persistency in reaching one's goals) and flexible goal adjustment (FGA; adjusting one's goals to changed circumstances), are associated with life-space mobility and perceived autonomy in participation outdoors among community-dwelling older people. METHODS: Participants (n = 186) were aged 79-93 years. TGP and FGA were self-reported using separate scales. Perceived autonomy in participation was assessed with the Impact on Participation and Autonomy Outdoors-subscale, and life-space mobility with the Life-Space Assessment. Two-step cluster analysis was used to create data-driven coping profiles of TGP and FGA. RESULTS: General linear model analyses showed that the profile including highly tenacious and flexible older people had the highest life-space mobility and perceived autonomy outdoors, whereas the profile including people with low TGP and low FGA showed the lowest scores. Depressive symptoms attenuated the associations. CONCLUSIONS: Active use of both TGP and FGA is favorable for out-of-home mobility and enables more active participation in society in later life.

Assessment of health literacy among older Finns.

AIMS: This study examined the feasibility of the HLS-EU-Q16 (in Finnish) for use among older Finns and whether the health literacy score correlates with indicators of health and functioning. METHODS: To determine the feasibility of the instrument, we first conducted a focus group discussion with nine participants. For the quantitative analyses, we used data from the AGNES cohort study, collected between October 2017 and April 2018 at the University of Jyväskylä in Finland. 292 75-year-old Finnish men and women were interviewed face-to-face in their homes. Health literacy was measured with the HLS-EU-Q16 and health literacy score, ranging from 0 to 50, computed. The reproducibility of the instrument was test-retested. Chi-square tests were used to compare health literacy scores between participants by different socioeconomic variables, and Spearman correlation coefficients were calculated to study the associations of health literacy with cognition, depressive symptoms, chronic conditions, life-space mobility and physical performance. RESULTS: The mean health literacy score for all participants was 35.05 (SD 6.32). Participants who rated their financial situation and self-rated health as very good had the highest health literacy scores (38.85, SD 5.09 and 39.22, SD 6.77, respectively). Better health literacy was associated with better cognitive status, fewer depressive symptoms and chronic conditions, higher life-space mobility and better physical performance. CONCLUSIONS: The HLS-EU-Q16 is a feasible measure for research purposes among older Finns. The associations between health literacy and indicators of health and functioning need to be more closely investigated in larger samples with a wider age-range.

Active aging - resilience and external support as modifiers of the disablement outcome: AGNES cohort study protocol.

BACKGROUND: Population aging increases the need for knowledge on positive aspects of aging, and contributions of older people to their own wellbeing and that of others. We defined active aging as an individual's striving for elements of wellbeing with activities as per their goals, abilities and opportunities. This study examines associations of health, health behaviors, health literacy and functional abilities, environmental and social support with active aging and wellbeing. We will develop and validate assessment methods for physical activity and physical resilience suitable for research on older people, and examine their associations with active aging and wellbeing. We will examine cohort effects on functional phenotypes underlying active aging and disability. METHODS: For this population-based study, we plan to recruit 1000 participants aged 75, 80 or 85 years living in central Finland, by drawing personal details from the population register. Participants are interviewed on active aging, wellbeing, disability, environmental and social support, mobility, health behavior and health literacy. Physical activity and heart rate are monitored for 7 days with wearable sensors. Functional tests include hearing, vision, muscle strength, reaction time, exercise tolerance, mobility, and cognitive performance. Clinical examination by a nurse and physician includes an electrocardiogram, tests of blood pressure, orthostatic regulation, arterial stiffness, and lung function, as well as a review of chronic and acute conditions and prescribed medications. C-reactive protein, small blood count, cholesterol and vitamin D are analyzed from blood samples. Associations of factors potentially underlying active aging and wellbeing will be studied using multivariate methods. Cohort effects will be studied by comparing test results of physical and cognitive functioning with results of a cohort examined in 1989-90. CONCLUSIONS: The current study will renew research on positive gerontology through the novel approach to active aging and by suggesting new biomarkers of resilience and active aging. Therefore, high interdisciplinary impact is expected. This cross-sectional study will not provide knowledge on temporal order of events or causality, but an innovative cross-sectional dataset provides opportunities for emergence of novel creative hypotheses and theories.

The Temporal Association Between Executive Function and Life-Space Mobility in Old Age.

Background: Life-space mobility, an indicator of community mobility, describes person's movements in terms of the distance from home, the frequency of movement, and the need of assistance for movement. Executive function (EF) is a higher-order cognitive function that supervises motor control and plays a key role in a person's ability to function independently. Cognitive impairment often co-occurs with restricted life-space mobility; however, the direction of the longitudinal associations between EF and life-space mobility is unclear. The aim of this study was to investigate the temporal associations between EF and life-space mobility among community-dwelling older people. Methods: One hundred eight community-dwelling persons aged 76 to 91 years participated in the 2 year follow-up study. EF was measured with the Trail Making Test. The Life-Space Assessment (range 0-120, higher scores indicate more mobility) was used to assess life-space mobility. Cross-lagged model design was used to examine longitudinal relationship between EF and life-space mobility. The model was adjusted for age and gender. Results: Average age of participants at baseline was 82.2 (SD 4.1) years and 59% were women. Better EF at baseline predicted higher life-space mobility at follow-up (path coefficient = 3.81, 95% confidential interval; 0.84, 6.78, p = .012), whereas baseline life-space mobility did not predict EF at follow-up. Conclusion: EF was a determinant of life-space mobility. Supporting EF may enhance maintaining independence and active participation in old age.

Executive function and life-space mobility in old age.

BACKGROUND: Life-space assessment incorporates all movements in terms of the distance from home, the frequency of movement and the need of assistance for movement. Executive function (EF) is an important higher order cognitive ability that controls and guides people's goal-directed actions. We examined the cross-sectional and longitudinal associations between EF and life-space mobility, and investigated if perceived walking difficulties, lower extremity performance, and transportation difficulties explain the association. METHODS: 157 community-dwelling persons aged 76-91 years participated in the study at the baseline, and 103 of them in 2-year follow-up study. Based on the distribution on the Trail Making Test participants were categorized into tertiles of EF. Life-space mobility was assessed using the Life-Space Assessment (range 0-120). Perceived walking difficulties and transportation difficulties were self-reported, and lower extremity performance was assessed with the short physical performance battery (SPPB). Adjustments were made for gender, age, number of chronic conditions, and years of education. RESULTS: Average age of participants at the baseline was 82.6 (SD 4.2) years and 61% were women. Individuals with poor EF had lower life-space mobility compared to those with good EF. SPPB and transportation difficulties explained the association. Over the 2-year follow-up, those with poor EF at the baseline showed steeper decline but the difference did not quite reach statistical significance (p = 0.068). CONCLUSIONS: People with better executive function had higher life-space mobility. This was explained by better lower extremity performance and absence of transportation difficulties. Cognitive decline may hinder access to community amenities, which in turn may further accelerate cognitive decline.