[How has life expectancy without functional limitations developed in Germany? An analysis with data from the German Ageing Survey (DEAS)]. / Wie hat sich die Lebenserwartung ohne funktionelle Einschränkungen in Deutschland entwickelt? Eine Analyse mit Daten des Deutschen Alterssurveys (DEAS).

INTRODUCTION: The long-term increase in life expectancy raises the question of whether the increased life expectancy is accompanied by an extension of years without health limitations. The study analyzes how life expectancy without functional and mobility limitations from the ages of 46 and 65 and their proportions of remaining life expectancy have changed since 2008. METHODS: We analyze data from the German Ageing Survey of the 2008, 2014, and 2020/21 waves. Life expectancy without functional limitations (disability-free life expectancy-DFLE) was calculated using the Sullivan method. Severe functional limitations (using the Global Activity Limitation Indicator-GALI) and mobility limitations (climbing stairs, walking more than 1 km) were examined. RESULTS: Compression of morbidity in the GALI has been observed in 46- and 65-year-old men since 2014, but not in women of the same age. In terms of mobility, 46- and 65-year-old men show trends towards compression when climbing stairs and 46-year-old men when walking more than 1 km since 2014. The values for women have stagnated for the first two indicators mentioned, but not for 46-year-old women since 2014 when walking more than 1 km. DISCUSSION: Our analyses show different trends in DFLE depending on the indicator, age, and gender and do not allow a clear answer to the question of morbidity compression or expansion. We tend to see morbidity compression in men, whereas trends of stagnation or expansion tend to be seen in women. These results signal challenges in maintaining functional health, especially in women, and point to the need for targeted interventions to improve quality of life and healthy life expectancy.

The Life-Course Perspectives of Mexican American Men With Mobility Limitation.

The life-history narratives of 10 Mexican American men with mobility limitations, age 55-77 years (mean = 63.8, SD = 5.8), were explored using a qualitatively driven, life-history mixed-methods study to understand perceptions of mobility limitations over the life course. Within that methodological and paradigmatic framework, conceptualizations of alterity and masculinity guided interpretation of data. Through an iterative, thematic analysis, we detail the way the men's lives were influenced by growing familial responsibility with age. Quantitative data were integrated into themes of narrative inheritance, family, and masculinity. It was posited that masculinity with mobility limitations shaped and was shaped by ethnic identity and responsibility. This has implications for understanding the experience of Mexican American men over the life course.

Using multiple imputation and intervention-based scenarios to project the mobility of older adults.

BACKGROUND: Projections of the development of mobility limitations of older adults are needed for evidence-based policy making. The aim of this study was to generate projections of mobility limitations among older people in the United States, England, and Finland. METHODS: We applied multiple imputation modelling with bootstrapping to generate projections of stair climbing and walking limitations until 2026. A physical activity intervention producing a beneficial effect on self-reported activities of daily living measures was identified in a comprehensive literature search and incorporated in the scenarios used in the projections. We utilised the harmonised longitudinal survey data from the Ageing Trajectories of Health - Longitudinal Opportunities and Synergies (ATHLOS) project (N = 24,982). RESULTS: Based on the scenarios from 2012 to 2026, the prevalence of walking limitations will decrease from 9.4 to 6.4%. A physical activity intervention would decrease the prevalence of stair climbing limitations compared with no intervention from 28.9 to 18.9% between 2012 and 2026. CONCLUSIONS: A physical activity intervention implemented on older population seems to have a positive effect on maintaining mobility in the future. Our method provides an interesting option for generating projections by incorporating intervention-based scenarios.

Neighborhood Social Cohesion and Mobility Limitations Among Community-dwelling Older Americans: The Mediating Roles of Depressive Symptoms and Mastery.

Neighborhood environment plays an important role in late-life health; yet, the social aspect of neighborhood environment and its impact on mobility limitations have rarely been examined. This nonexperimental, cross-sectional study examines the relationship between neighborhood social cohesion and mobility limitations and the potential mediators (i.e., depressive symptoms, mastery) of this relationship. A total of 8,317 Americans aged 65 years and older were selected from the Health and Retirement Study. Using ordinary least squares regressions, this study shows that neighborhood social cohesion was negatively associated with mobility limitations (B = -0.04, p < .01). A Sobel test of mediation indicated that this relationship was significantly mediated by depressive symptoms (z = -9.10, p < .001) and mastery (z = -8.86, p < .001). Findings suggest that neighborhood cohesion can reduce mobility limitations through mitigating depressive symptoms and increasing mastery. Future research should disentangle the temporal ordering of the mediators.

Dietary quality modifies the association between multimorbidity and change in mobility limitations among older Americans.

To identify potentially modifiable risk-factors in the age-related disablement process, we examined the association between change in mobility limitations and multimorbidity and how dietary quality moderates this association. Information from 3320 adults aged 65 and older in 2012 was drawn from the Health and Retirement Study and the Health Care and Nutrition Study. Mobility limitations reported in 2012 and change in mobility limitations from 2012 to 2014 were regressed on multimorbidity measured as number of chronic conditions in 2012, dietary quality measured in 2013 using the Alternative Healthy Eating Index-2010 (AHEI-2010), and their interaction term using Poisson regression. Respondents reported an average of 2.9 (SD, 2.9) mobility limitations in 2012 and 3.1 (SD, 3.0) mobility limitations in 2014, an average of 2.64 (SD, 1.4) chronic conditions in 2012, and mean AHEI-2010 score in 2013 of 57.1 (SD, 10.9). Greater AHEI-2010 scores were associated with fewer mobility limitations at baseline (p < .001) and slower progression of mobility limitations over the two-year observational window (p < .001). For those with AHEI-2010 scores ≥48.4, dietary quality appeared to moderate the association between multimorbidity and change in mobility limitations. These results suggest that improving dietary quality may be an effective means of reducing the progression of mobility limitations among older adults and that dietary quality may modify the effect of multimorbidity on progressive disablement. Our work adds to research supporting dietary quality as a potentially intervenable factor in the reduction of disablement in aging populations.

The modified Healthy Aging Index is associated with mobility limitations and falls in a community-based sample of oldest old.

BACKGROUND AND AIMS: The Healthy Aging Index (HAI) is useful in capturing the health status of multiple organ systems in older adults. Previous studies have mainly focused on the association of HAI with mortality and disability. We constructed a modified HAI (mHAI) to examine its association with mobility limitations and falls in a community-based sampling of older Chinese adults. METHODS: We investigated 399 community-dwelling older adults aged 80 years or older, and constructed the mHAI with five non-invasive tests (systolic blood pressure, the Montreal Cognitive Assessment test, glucose concentrations, cystatin C levels, and self-reported respiratory problems). RESULTS: The mean mHAI score for the participants in our study was 3.6. After multivariate adjustment, per unit increase in mHAI score was associated with self-reported difficulty in stooping, kneeling, or crouching (odds ratio [OR] = 1.16, 95% confidence interval [CI] 1.00-1.34), and walking 400 m (OR = 1.21, 95% CI 1.03-1.42). Per unit increase in mHAI score was also associated with poor balance (OR = 1.29, 95% CI 1.07-1.55), lower extremity strength limitation (OR = 1.30, 95% CI 1.10-1.52), low handgrip strength (OR = 1.25, 95% CI 1.08-1.46), and slow gait speed (OR = 1.21, 95% CI 1.02-1.42). The association between mHAI and falls was also significant (per unit of mHAI OR = 1.21, 95% CI 1.04-1.40). CONCLUSION: The mHAI can be used as a simple assessment tool to determine mobility status in older adults and identify those at high risk for falls.

A qualitative study of health-care experiences and challenges faced by ageing homebound adults.

BACKGROUND: The ageing of the global population is associated with an increasing prevalence of chronic diseases and functional impairments, resulting in a greater proportion of homebound individuals. OBJECTIVE: To examine the health-care experiences of older homebound adults who have not previously received home-based primary care (HBPC). To explore their impressions of this method of care. DESIGN: Cross-sectional qualitative study using semi-structured interviews. SETTING AND PARTICIPANTS: 18 older homebound individuals in Central Virginia. RESULTS: Our findings revealed that homebound individuals faced significant health challenges, including pain resulting from various comorbidities. They felt that their mobility was restricted by their physical conditions and transportation challenges. These were major barriers to social outings and health-care access. Participants left their homes infrequently and typically with assistance. Regarding office-based care, participants were concerned about long wait times and making timely appointments. Some thought that HBPC would be convenient and could result in better quality care; however, others believed that the structure of the health-care system and its focus on efficiency would not permit routine HBPC. DISCUSSION AND CONCLUSIONS: Older homebound adults in this study faced high burdens of disease, a lack of mobility and difficulty accessing quality health care. Our observations may help researchers and clinicians better understand the health-care experiences and personal opinions of older homebound individuals, informing the development of effective and empathetic home-based care. Participant responses illuminated a need for education about HBPC. We must improve health-care delivery and develop comprehensive, patient-centered HBPC to meet the needs of homebound individuals.

Healthier diet quality and dietary patterns are associated with lower risk of mobility limitation in older men.

PURPOSE: To investigate associations between diet quality, dietary patterns and mobility limitation 15 years later in a population-based sample of older British men. METHODS: We used longitudinal data from 1234 men from the British Regional Heart Study, mean age 66 years at baseline. Mobility limitation was defined as difficulty going up- or downstairs or walking 400 yards as a result of a long-term health problem. Dietary intake was measured using a food frequency questionnaire data from which the Healthy Diet Indicator (HDI), the Elderly Dietary Index (EDI), and three a posteriori dietary patterns were derived. The a posteriori dietary patterns were identified using principal components analysis: (1) high fat/low fibre, (2) prudent and (3) high sugar. RESULTS: Men with greater adherence to the EDI or HDI were less likely to have mobility limitation at follow-up, top vs bottom category odds ratio for the EDI OR 0.50, 95% CI 0.34, 0.75, and for the HDI OR 0.55, 95% CI 0.35, 0.85, after adjusting for age, social class, region of residence, smoking, alcohol consumption and energy intake. Men with a higher score for the high-fat/low-fibre pattern at baseline were more likely to have mobility limitation at follow-up, top vs bottom quartile odds ratio OR 3.28 95% CI 2.05, 5.24. These associations were little changed by adjusting for BMI and physical activity. CONCLUSION: Our study provides evidence that healthier eating patterns could contribute to prevention or delay of mobility limitation in older British men.

Psychosocial working conditions across working life may predict late-life physical function: a follow-up cohort study.

BACKGROUND: Increasing life expectancy has made understanding the mechanisms underlying late-life health and function more important. We set out to investigate whether trajectories of change in psychosocial working conditions are associated with late-life physical function. METHODS: Two Swedish surveys, linked at the individual level, were used (n = 803). A psychosocial job exposure matrix was used to measure psychosocial working conditions during people's first occupation, as well as their occupation every five years thereafter until baseline in 1991. Physical function was measured in 2014. Random effects growth curve models were used to calculate intraindividual trajectories of working conditions. Predictors of physical function were assessed with ordered logistic regression. RESULTS: A more active job at baseline was associated with increased odds of late-life physical function (OR 1.15, CI 1.01-1.32). Higher baseline job strain was associated with decreased odds of late-life physical function (OR 0.75, CI 0.59-0.96). A high initial level followed by an upward trajectory of job strain throughout working life was associated with decreased odds of late-life physical function (OR 0.32, CI 0.17-0.58). CONCLUSIONS: Promoting a healthier workplace by reducing chronic stress and inducing intellectual stimulation, control, and personal growth may contribute to better late-life physical function.

Cumulative physical workload and mobility limitations in middle-aged men and women: a population-based study with retrospective assessment of workload.

PURPOSE: To assess the association between exposure to physical workload throughout working life and risk of mobility limitations in midlife in a population-based Danish cohort. METHODS: The study was cross-sectional with a retrospective exposure assessment, and data were from a questionnaire used in the Copenhagen Aging and Biobank. Cumulative physical workload was estimated by combining information about the participants' employments and data from a job exposure matrix. Daily amount of lifting was standardised in ton-years (lifting 1000 kg/day/year) and grouped in 5 exposure groups (no/minor (1-2 ton-years)/low (3-10 ton-years)/moderate (11-20 ton-years)/high exposure (> 20 ton-years)). The outcome was self-reports of mobility limitations (running 100 m, walking 400 m, and climbing stairs to the 2nd floor) in midlife. The association between exposure and outcome was analysed using logistic regression models. RESULTS: We included 4996 men and 2247 women, mean age 56 years. 21% of men and 10% of women were in the highest exposure-group (> 20 ton-years). Higher cumulative exposure was associated with higher odds for mobility limitations. Exposure to more than 20 ton-years compared to no exposure increased the odds for limitations in walking, age-adjusted odds ratio (OR) 3.2 (95% CI: 2.4-4.3) for men, 2.3 (1.4-3.8) for women. Corresponding results for running: 2.5 (2.2-3.0) for men, 1.6 (1.2-2.2) for women, and for limitations in climbing stairs: 4.2 (3.3-5.2) for men, 1.7 (1.2-2.4) for women. Results were attenuated when confounders were added. CONCLUSIONS: Exposure to physical workload throughout working life is associated with higher odds for mobility limitations in midlife.

Physical Impairments Disrupt the Association Between Physical Activity and Loneliness: A Longitudinal Study.

This study explores the association between physical activity (PA), loneliness, and the presence of physical chronic impairments among single older adults. A longitudinal study (N = 575; mean age 76 ± 8 years) was conducted. The association between self-reported weekly minutes of moderate to vigorous PA, loneliness, and presence of physical impairments was assessed with multilevel analyses at baseline, 3 months, and 6 months. Improvements in moderate to vigorous PA were associated with decreases in loneliness (B = -0.09, SE = 0.04, p = .020); this association became nonsignificant when including the presence of physical impairments in the analyses (p = .824), which in itself was positively associated with loneliness (B = 0.51, SE = 0.10, p < .001). Findings indicate that physical impairments have a larger influence on loneliness than the level of PA. Interventions targeting PA and loneliness should tailor specifically to physical impairments.

The de Morton mobility index is a feasible and valid mobility assessment tool in hospitalized patients with an acute exacerbation of chronic obstructive pulmonary disease.

There is no accepted standard for measuring mobility in hospitalized patients with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The objective of this study was to assess convergent, discriminant, and known-group validity and floor/ceiling effects of the de Morton Mobility Index (DEMMI) in hospitalized patients with AECOPD. Individuals with AECOPD (n = 22) admitted to an acute care hospital medical ward were recruited. Data on the DEMMI, gait speed, daytime energy expenditure, step counts, 6-minute walk distance (6MWD), dyspnea, respiratory and heart rates, quality of life, and oxygen supplementation were collected on day 3 of admission. The DEMMI demonstrated convergent validity with the 6MWD and gait velocity measures (Spearman's ρ 0.69 and 0.61, respectively; p < 0.003) but not with measures of physical activity or respiratory impairment. Discriminant validity was present, with no correlation between the DEMMI and quality of life and resting heart rate. Known-group validity (gait aids vs. no gait aids) was demonstrated (p = 0.009). There was no floor effect but there was evidence of a possible ceiling effect (14% of participants received a perfect score). The DEMMI is feasible and showed moderate to strong validity with measures of observed physical function in hospitalized patients with AECOPD.

Modified Ride-on Cars as Early Mobility for Children with Mobility Limitations: A Scoping Review.

Aim: This study aims to systematically examine and map current available evidence describing the benefits of modified ride-on car use for young children with mobility limitations and identify potential applications to occupational and physical therapy practice while illuminating gaps in knowledge to be explored in future research. Methods: An electronic database search, manual search of bibliographies, contact with existing networks and organizations were used to identify all relevant literature. Studies addressing modified ride-on toy use by children ≤6 years old with identified mobility delays were included. Data were extracted and analyzed independently by the investigators using a standardized process. Results: Thirteen case studies and one case controlled study involving children ≤6 years old with a variety of diagnoses were included in the review. Studies were at the activities and participation levels and focused on mobility, interpersonal interactions and relationships, communication, and Community, Social, and Civic Life. Conclusion: Findings support the use of modified ride-on cars as a form of early mobility to encourage the development of social-emotional and mobility skills in young children with mobility limitations. Future research with valid, reliable outcome measures that address changes in developmental levels across domains is indicated.

The impact of mobility limitations on health outcomes among older adults.

The purpose of this study was to stratify an older adult population for subsequent interventions based on functional ability, and to estimate prevalence, characteristics and impact of mobility limitations on health outcomes. In 2016, surveys were sent to a stratified random sample of AARP® Medicare Supplement insureds; mobility limitations were defined using two screening questions. Responses were stratified to three mobility limitation levels. Multivariate regression models determined characteristics and impact on health outcomes. Among weighted survey respondents (N = 15,989), severe, moderate and no limitation levels were 21.4%, 18.4% and 60.3%, respectively. The strongest predictors of increased limitations included pain and poor health. Individuals with more severe limitations had increased falls, decreased preventive services compliance and increased healthcare utilization and expenditures. Utilizing two screening questions stratified this population to three meaningful mobility limitation levels. Higher levels of mobility limitations were strongly associated with negative health outcomes. Mobility-enhancing interventions could promote successful aging.

Mobility care in nursing homes: development and psychometric evaluation of the kinaesthetics competence self-evaluation (KCSE) scale.

BACKGROUND: Impaired mobility is a prevalent condition among care-dependent persons living in nursing homes. Therefore, competence development of nursing staff in mobility care is important. This study aimed to develop and initially test the Kinaesthetics Competence Self-Evaluation (KCSE) scale for assessing nursing staff's competence in mobility care. METHODS: The KCSE scale was developed based on an analysis of the concept of nurses' competence in kinaesthetics. Kinaesthetics is a training concept that provides theory and practice about movement foundations that comprise activities of daily living. The scale contains 28 items and four subscales (attitude, dynamic state, knowledge and skills). Content validity was assessed by determining the content validity index within two expert panels. Internal consistency and construct validity were tested within a cross-sectional study in three nursing homes in the German-speaking region of Switzerland between September and November 2015. RESULTS: The content validity index for the entire scale was good (0.93). Based on a sample of nursing staff (n = 180) the internal consistency results were good for the whole scale (Cronbach's alpha = 0.91) and for the subscales knowledge and skills (α = 0.91, 0.86), acceptable for the subscale attitude (α = 0.63) and weak for the subscale dynamic state (α = 0.54). Most items showed acceptable inter-item and item-total correlations. Based on the exploratory factor analysis, four factors explaining 52% of the variance were extracted. CONCLUSION: The newly developed KCSE scale is a promising instrument for measuring nursing staff's attitude, dynamic state, knowledge, and skills in mobility care based on kinaesthetics. Despite the need for further psychometric evaluation, the KCSE scale can be used in clinical practice to evaluate competence in mobility care based on kinaesthetics and to identify educational needs for nursing staff.

The Effect of a Non-Powered, Self-Initiated Mobility Program on the Engagement of Young Children with Severe Mobility Limitations in the South African Context.

AIM: To determine the effect of a non-powered, self-initiated mobility program on the engagement of young children with severe mobility limitations, in the South African context. METHODS: A multiple-probe-across-participant design was used. Four children (aged 2-6 years) with severe mobility limitations underwent an intervention that targeted non-powered, self-initiated mobility. The intervention comprised eight sessions over a 2-week period. Engagement was measured during each baseline, intervention and postintervention session using the Individual Child Engagement Record-Revised (ICER-R). The data were presented graphically and analyzed using statistical procedures appropriate for single-subject designs. RESULTS: Participants demonstrated an improvement in engagement during the time in which non-powered, self-initiated mobility program was introduced. A reciprocal deterioration in nonengagement was also demonstrated. The results of the study are discussed in terms of various intrinsic and extrinsic factors. CONCLUSIONS: The use of a non-powered, self-initiated mobility program may be effective in improving engagement in some young children with severe mobility limitations.

Outdoor motivation moderates the effects of accessibility on mobility in old age.

BACKGROUND: Mobility plays a major role in healthy aging and social participation. This study explored whether accessibility problems in the housing environment are negatively associated with mobility in old age and whether this association is moderated by differences in an individual's preference for spending time outside the home (outdoor motivation). MATERIAL AND METHODS: This article reports the results of a research project on mobility in old age. The project included a survey study of 120 community-dwelling older adults between 59 and 92 years of age (mean = 71.7 years, SD = 7.3 years) living in the metropolitan region of Nuremberg, Germany. Objective assessments were conducted in the participants' housing environment to evaluate the magnitude of accessibility problems. RESULTS: Accessibility problems were negatively associated with mobility. Interaction analyses suggested a buffering effect of outdoor motivation on this association, i.e. participants who reported a preference for spending time outside the home had a higher mobility in the face of accessibility problems as compared with those who preferred staying at home. CONCLUSION: Outdoor motivation may have protective effects for older adults when accessibility problems challenge mobility. These findings contribute to improving the understanding of how and under what circumstances older adults stay mobile and active in everyday life. Considering interindividual differences in outdoor motivation may binterventions and public health programs that are aimed at enhancing mobility and social participation in old age.

Mobility Limitations and Fall-Related Factors Contribute to the Reduced Health-Related Quality of Life in Older Adults With Chronic Musculoskeletal Pain.

PURPOSE: To investigate (1) the prevalence of chronic musculoskeletal pain (CMP) among a sample of community-dwelling older adults and (2) health-related quality of life (HRQOL) in people with CMP, particularly the association with mobility limitations and falls-related factors. METHOD: Overall, 295 (response rate 73.5%) community-dwelling older adults were recruited across 10 sites. CMP was assessed using recognized criteria. In the sample of people with CMP, a hierarchical multiple regression analysis was conducted with HRQOL as the dependent variable and a number of independent variables were then inserted into the model. After controlling for demographic and medical variables, mobility (timed up and go (TUG), walking aid use, sedentary behavior) and fall-related factors (falls history, balance confidence, concerns about consequences of falling) were inserted into the model at the second step and changes in adjusted R(2) noted. RESULTS: Within our sample of older adults, 52% had CMP (154/295). Compared to the group without CMP of similar age (n = 141), those with CMP had reduced HRQOL and profound mobility limitations and more falls risk factors (P < 0.001). The mobility and falls explanatory variables increased the variance explained within HRQOL from 14% to 36% (adjusted R(2) change 20%) in those with CMP. Sedentary behavior, pain interference, concerns about the consequences of falling, falls history, TUG scores, and balance confidence all remained significant predictors of HRQOL in the fully adjusted model in the CMP sample. CONCLUSION: Older adults with CMP have pronounced mobility limitations and increased falls risk factors, and these are associated with a marked reduction in HRQOL. Future prospective research is required to build on this cross-sectional study.

How Should Pushing Off or the Use of Assistive Devices Be Incorporated in the Timed Up and Go for Persons With Parkinson Disease?

OBJECTIVES: To determine (1) the relationship between assisted timed Up and Go (TUG) performance and the Parkinson's Disease Questionnaire-39 (PDQ-39), and (2) whether adjusting the TUG score (adding time) improves the relationship between TUG performance and the PDQ-39 in persons with Parkinson disease (PD) who use assistive devices or push off, or both. DESIGN: Cross-sectional. SETTING: Twenty participating National Parkinson Foundation Centers of Excellence. PARTICIPANTS: Data were obtained from participants (N=6624) without exclusion at the 20 participating sites. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The relationship between TUG scores and PDQ-39 mobility scores was determined using the method of linear least squares. Adjusted scores were determined through minimizing the sum of the squared error. RESULTS: The correlation between assisted TUG scores and PDQ-39 mobility scores was slightly lower (R(2)=.384) compared with the correlation between nonassisted TUG scores and PDQ-39 mobility scores (R(2)=.409). Adjusting assisted TUG performance scores for push off and for use of an assistive device resulted in a modest increase in correlation (R(2)=.399). CONCLUSIONS: Applying adjustments to assisted TUG may provide clinically important information for evaluating balance, mobility, and falls, and for determining the most effective therapeutic strategies for persons with PD.

Psychosocial factors at work and the development of mobility limitations among adults in Denmark.

AIM: Psychosocial factors in the working environment have been shown to be associated with mobility limitations, but this has not yet been confirmed in a Danish population. We aimed to examine how psychosocial factors at work are related to developing mobility limitations in Denmark. METHODS: This study is based on data from 2952 middle-aged men and women without mobility limitations in 2000. RESULTS: We found increased risk of incident mobility limitations during 6-year follow up among men who often perceived high work pace (OR 5.45, 95% CI 1.21-24.52) vs. never, who only sometimes or/never perceived the work to be meaningful (OR 6.54, 95% CI 1.55-27.55) vs. always, and who sometimes perceived high emotional demands at work (OR 7.85, 95% CI 1.78-34.65) vs. never. Among women, lower risk of incident mobility limitations was observed among those who in 2000 perceived high work pace sometimes (OR 0.46, 95% CI 0.24-0.87) or often (OR 0.43, 95% CI 0.22-0.85) vs. never in 2000. Also, women who always or often experienced high emotional demands had an increased risk. CONCLUSIONS: The most important finding was that high work pace was strongly associated with increased risk of mobility limitations among men, but associated with lower risk of mobility limitations among women. This knowledge may be used to better target interventions among men and women in midlife from physical deterioration later in life.