Associations between walking limitations and reported activity destinations among older adults.

In old age, walking difficulty may reduce opportunities to reach valued activity destinations. Walking modifications, e.g., slower pace or using a walking aid, may enable individuals to continue going where they wish, and hence postpone the consequences of the onset of walking difficulties. We studied visited activity destinations (type, distance) among older people with varying degrees of walking limitations. Community-dwelling 75-85-year-old people living in Jyväskylä (N = 901) were asked to state whether they had no difficulty walking 2 km, had modified their walking, or had difficulty walking. On a digital map, participants located physical exercise, attractive, and regular destinations they had visited during the past month. Destination counts and median distance to destinations from home were computed. Participants with intact walking reported higher counts of physical exercise (IRR = 1.45, 95% CI [1.31, 1.61]) and attractive destinations (IRR = 1.23, 95% CI [1.10, 1.40]) than those with walking difficulty and also visited these destinations further away from home than the others (b = 0.46, 95% CI [0.20, 0.71]). Those with walking modifications reported higher counts of physical exercise destinations than those with walking difficulty (IRR = 1.23, 95% CI [1.09, 1.40]). Counts of regular destinations and distance traveled were not associated with walking limitations. Walking modifications may help people with walking difficulty reach destinations further away from home, potentially contributing to their sense of autonomy. For those with walking difficulty, a low count of destinations other than regular destinations, e.g., shops or healthcare facilities, may signal their abandonment of recreational activities and a decrease in their life space, potentially leading to reduced well-being.

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.

Neighborhood Walkability, Walking Difficulties, and Participation in Leisure Activities Among Older People: A Cross-Sectional Study and 4-Year Follow-Up of a Subsample.

Objectives: To study cross-sectional and longitudinal associations between objectively assessed neighborhood walkability, walking difficulties, and participation in leisure activities among older people. Methods: Self-reported 2 km walking difficulty (intact, modifications, difficulties) at baseline and participating in organized group, outdoor recreation and cultural activities at baseline and follow-up were studied in community-dwelling persons (N = 848) aged 75-90. A walkability index, calculated using a geographic information system, was categorized into tertiles (lowest, middle, highest). Results: Residence in the highest walkability areas was associated with higher participation in cultural activities and lower participation in outdoor recreation, while the latter was most frequently reported by residents in the lowest walkability areas. Those reporting no difficulties were more likely than those reporting difficulties to participate in all studied activities. Residence in the middle or highest walkability areas predicted higher participation in cultural activities at follow-up. Discussion: Older persons activity profiles associate with neighborhood walkability and walking difficulties.

Active Aging in Senior Housing Residents and Community-Dwelling Older Adults: A Comparative Study in Finland.

OBJECTIVES: Leading an active life in old age underpins positive life experience. This study aimed to compare the levels of active aging in senior housing residents and community-dwelling older people. METHODS: We combined data from the BoAktiv senior house survey (N = 336, 69% women, mean age 83 years) and AGNES cohort study among community-dwelling older adults (N = 1021, 57% women, mean age 79 years). Active aging was assessed with the University of Jyvaskyla Active Aging scale. Data were analyzed with general linear models, and the analyses were stratified by sex. RESULTS: Men in senior houses demonstrated lower active aging scores in general than community-dwelling men. Women in senior houses showed greater will to be active, but poorer ability and possibilities for activity than community-dwelling women. DISCUSSION: Despite the social and supporting environment, senior housing residents' possibilities for leading an active life seem to be compromised, potentially leading to an unmet activity need.

Older Adults' Self-Reported Physical Activity and Distance to and Land Use Around Reported Physical Exercise Destinations.

Little is known about older adults' physical exercise destinations. We studied associations between physical activity (PA) level and physical exercise destinations (total number and surrounding environment) in community-dwelling 75- to 85-year-old adults living in Central Finland. Participants (N = 901) reported the amount of at least moderate-intensity PA and physical exercise destinations. Distance from home, land use, and locations of sport facilities were defined using a geographic information system. A general linear model showed that older adults with higher PA reported higher numbers of physical exercise destinations and destinations further away from home than those reporting lower PA. Binary logistic regression showed that higher PA increased the odds of reporting a distant destination identified as a sports facility and of reporting destinations located in residential, service, forest, and water body areas, respectively. Physical exercise destinations in different environments may attract older people to go out and be more physically active.

Older adults' activity destinations before and during COVID-19 restrictions: From a variety of activities to mostly physical exercise close to home.

The aim was to study various types of older adult's activity destinations (counts, frequency of visitation, and distance from home) in the pre-COVID-19 era, and to study prospectively how COVID-19-related regulations limiting mobility affected these. Using a map-based questionnaire, 75-85-year-old participants reported activity destinations, that is, any destinations for physical exercise, destinations facilitating one's outdoor mobility, and destinations for other activities, which they had visited several times during the past month. At baseline, a variety of activity destinations was reported, but during COVID-19, destinations reported markedly declined in number, they were reported predominantly for physical exercise, and they were located closer to home.

Associations of Environmental Features With Outdoor Physical Activity on Weekdays and Weekend Days: A Cross-Sectional Study Among Older People.

Background: Physical activity (PA) of higher intensity and longer duration mainly accumulates from older adults' out-of-home activities. Outdoor PA is influenced by environmental features; however, the day-to-day variability of PA and its associations with environmental features have not been widely studied. This study focused on the associations of environmental features with accelerometer-measured PA in older people on weekdays and weekend days. Methods: The study population comprised 167 community-dwelling older people aged 75-90 years. Accelerometers were worn on 7 consecutive days and a structured interview on physical functioning, health, and socioeconomic factors was administered. A geographic information system (GIS) was used to assess environmental features within a distance of 500 (number of land types, road network slope, intersection, and residential densities) or 1,000 m (habitat diversity within natural and green areas) from participants' homes. Accelerometer-based PA [number of PA bouts >10 min and minutes of moderate to vigorous physical activity (MVPA)] was analyzed for weekdays and weekend days separately. Associations between environmental features and PA were analyzed using linear regression models. Results: Participants accumulated on average 0.60 PA bouts and 34.2 MVPA minutes on weekdays and 0.50 PA bouts and 31.5 MVPA minutes on weekend days. Especially participants with low overall PA were less active at weekends. Habitat diversity in natural and green areas, intersection density, and residential density were positively associated with numbers of PA bouts and MVPA minutes on weekdays. Moreover, more diversity in natural and green areas was associated with more MVPA minutes on weekend days. A higher road network slope was negatively associated with the number of PA bouts throughout the week and with MVPA minutes on weekend days. Conclusions: Environmental features close to home, especially PA-supportive infrastructural features and services, were more strongly associated with weekday than weekend PA. This suggests that older people's out-of-home activities, typically conducted on weekdays, are related to service use. However, greater diversity of natural areas close to home seemed to motivate older adults to engage in higher MVPA throughout the week.

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.

Hilliness and the Development of Walking Difficulties Among Community-Dwelling Older People.

Objective: The objective of this study is to study the associations of objectively defined hilliness with the prevalence and incidence of walking difficulties among community-dwelling older adults, and to explore whether behavioral, health, or socioeconomic factors would fully or partially explain these associations. Method: Baseline interviews (n = 848, 75-90 years) on difficulties in walking 500 m, frequency of moving through the neighborhood, and perceived hilliness as a barrier to outdoor mobility were conducted. Two-year follow-up interviews (n = 551) on difficulties in walking 500 m were conducted among participants without baseline walking difficulties. Hilliness objectively defined as the mean slope in 500-m road network. Results: Logistic regression showed that hilliness was associated with incident walking difficulties at the 2-year follow-up (odds ratio [OR] = 1.66, 95% confidence interval [CI] = [1.09, 2.51]) but not with the prevalence of walking difficulties at baseline. Adding behavioral, health, or socioeconomic factors to the models did not markedly change the results. Discussion: Greater hilliness should be considered a risk factor for developing walking difficulties among older adults.

Environmental Features Associated With Older Adults' Physical Activity in Different Types of Urban Neighborhoods.

The authors studied associations of nature- and infrastructure-based features with physical activity (PA) in different urban neighborhood types; 848 community-dwelling people aged 75-90 years reported PA and three perceived nature-based destinations and seven infrastructure-based features as outdoor mobility facilitators. Neighborhood type was defined using a geographic information system based on proximity to central service areas and residential density (city center, subcenter, and dense and dispersed areas outside centers). PA was higher in dense areas and the city center. Binary logistic regression showed that perceiving nature-based destinations increased the odds for higher PA in the city center and areas outside centers. In dispersed areas, perceived infrastructure-based facilitators were especially associated with higher PA. Environmental features were not associated with PA in subcenters. Higher residential density, as a proxy for a higher amount of infrastructure, rather than center proximity, may underlie older adults' PA. The spatial context should be acknowledged in studies on environment-PA associations.

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.

Nature as a facilitator for physical activity: Defining relationships between the objective and perceived environment and physical activity among community-dwelling older people.

The aim was to study the correspondence between the objective and perceived environment and to assess their associations with physical activity (PA) in older people. 848 community-dwelling older people aged 75-90 were interviewed on their difficulties in walking 500m, perceiving nature as a facilitator for outdoor mobility, and PA. The presence of water and landscape diversity were objectively assessed inside 500m and 1000m circular buffers around participants' homes. Using logistic regression, participant data were analyzed together with the objectively assessed environmental features. Our results indicate that higher habitat diversity within natural areas correlates with higher PA among older people without walking difficulties and the presence of water correlates with higher PA among those with walking difficulties.

Nature diversity and well-being in old age.

BACKGROUND: The research aim was to study the associations of nature diversity with quality of life (QoL) and depressive symptoms among older people, and whether physical activity explains the associations. METHODS: Community-dwelling people aged 75-90 years (n = 848) living in Central Finland were interviewed in their homes. QoL was assessed with a short version of the World Health Organization Quality-of-Life Assessment (range 0-130, higher score indicates better QoL) and depressive symptoms with the Centre for Epidemiologic Studies Depression Scale (range 0-30, higher scores indicate more depressive symptoms). Self-reported physical activity was assessed by intensity and duration using a single question with seven response options ranging from mostly resting to competitive sports. Nature diversity (Shannon Diversity Index) was assessed objectively within a 500-m buffer around participants' homes using a geographic information system (GIS). RESULTS: Mean QoL was 100.3 (SD 11.8) and mean CES-D 9.6 (SD 6.8). Those in the highest nature diversity tertile had better QoL than those in the lowest tertile (p = .022). Physical activity did not explain the association between nature diversity and QoL. Adjustment for health indicators did not change the results. Nature diversity was not associated with depressive symptoms. CONCLUSION: A diverse environment, especially when this includes elements of nature, is associated with better QoL. Good quality of the green infrastructure and adding natural elements to residential areas may enhance well-being among community-dwelling older people.

Physical Limitations, Walkability, Perceived Environmental Facilitators and Physical Activity of Older Adults in Finland.

The aim was to study objectively assessed walkability of the environment and participant perceived environmental facilitators for outdoor mobility as predictors of physical activity in older adults with and without physical limitations. 75-90-year-old adults living independently in Central Finland were interviewed (n = 839) and reassessed for self-reported physical activity one or two years later (n = 787). Lower-extremity physical limitations were defined as Short Physical Performance Battery score ≤9. Number of perceived environmental facilitators was calculated from a 16-item checklist. Walkability index (land use mix, street connectivity, population density) of the home environment was calculated from geographic information and categorized into tertiles. Accelerometer-based step counts were registered for one week (n = 174). Better walkability was associated with higher numbers of perceived environmental facilitators (p < 0.001) and higher physical activity (self-reported p = 0.021, step count p = 0.010). Especially among those with physical limitations, reporting more environmental facilitators was associated with higher odds for reporting at least moderate physical activity (p < 0.001), but not step counts. Perceived environmental facilitators only predicted self-reported physical activity at follow-up. To conclude, high walkability of the living environment provides opportunities for physical activity in old age, but among those with physical limitations especially, awareness of environmental facilitators may be needed to promote physical activity.