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Background: Outdoor mobility enables participation in essential out-of-home activities in old age. Aim: To compare changes in different aspects of outdoor mobility during COVID-19 restrictions versus two years before according to self-reported walking. Methods: Community-dwelling participants of AGNES study (2017–2018, initial age 75–85) responded to AGNES-COVID-19 postal survey in spring 2020 (N= 809). Life-space mobility, autonomy in participation outdoors, and self-reported physical activity were assessed at both time points and differences according to self-reported walking modifications and difficulty vs. intact walking at baseline were analyzed. Results: Life-space mobility and autonomy in participation outdoors had declined (mean changes -11.4, SD 21.3; and 6.7, SD 5.3, respectively), whereas physical activity had increased (5.5 min/day, SD 25.1) at follow-up. Participants perceiving walking difficulty reported the poorest baseline outdoor mobility, a steeper decline in life-space mobility (p= 0.001), a smaller increase in physical activity (p< 0.001), and a smaller decline in autonomy in participation outdoors (p= 0.017) than those with intact walking. Those with walking modifications also reported lower baseline life-space mobility and physical activity, a steeper decline in life-space mobility and a smaller increase in physical activity those with intact walking (p< 0.001 for both). Discussion: Participants reporting walking modifications remained the intermediate group in outdoor mobility over time, whereas those with walking difficulty showed the steepest decline in outdoor mobility and hence potential risk for accelerated further functional decline. Conclusion: Interventions should target older people perceiving walking difficulty, as they may be at the risk for becoming homebound when environmental facilitators for outdoor mobility are removed.

Objectives:To examine the reciprocal associations between walking performance, physical activity (PA), and perceived autonomy in outdoor mobility in 322 older adults. Methods:At baseline and four years later, a 6-min walk test assessed walking performance. A thigh-mounted accelerometer monitored relative PA (acceleration exceeding the individual’s preferred walking intensity on the walk test) and absolute MVPA (acceleration exceeding 3 METs) in free-living. Autonomy in outdoor mobility was self-reported using the IPA subscale. Cross-lagged panel model was used for analyses. Results:Higher relative PA at baseline predicted better walking performance four years later and vice versa (p< .05). Baseline MVPA did not predict subsequent walking performance, but better initial walking performance predicted higher subsequent MVPA (p< .001). In both models, only walking performance predicted perceived autonomy at follow-up (p< .05). Discussion:Accumulating enough PA of a sufficient relative intensity can maintain good walking performance, which in turn helps to maintain perceived autonomy in mobility.

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. 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). 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. 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.

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. 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. 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). 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.

Hearing difficulties are prevalent among older people and can lead to difficulties in social interaction. These difficulties may increase the tendency to remain at home and withdraw from leisure activities. To investigate whether self-reported hearing problems are associated with time spent out-of-home and withdrawal from a leisure activity among older persons. Cross-sectional and longitudinal data on 75- to 90-year-old community-dwelling men and women (n= 767) was used. Self-reports of hearing, diseases, and difficulty walking 2 km were obtained via home interviews at baseline, and withdrawal from a leisure activity via 1- and 2-year follow-up telephone interviews. Time spent out-of-home was obtained from a subsample (n= 532) via seven-day diaries at baseline. Hearing problems were associated with time spent out-of-home (p= 0.025) and withdrawal from a leisure activity (p= 0.025) among persons reporting no walking difficulty, but not among those reporting walking difficulty (p= 0.269 and 0.396, respectively). Among the former, persons with major hearing problems spent significantly less time out-of-home (estimated marginal mean 161 min, 95 % CI 122–212) than those with good hearing (242, 95 % CI 218–270). Persons with major hearing problems also had 3.0 times higher odds (95 % CI 1.3–7.1) for withdrawal from a leisure activity than persons with good hearing during the two-year follow-up. Among older adults without walking difficulty, hearing problems may reduce time spent out-of-home and increase the likelihood for withdrawal from a leisure activity. Decreased leisure and out-of-home activity may have negative effects on older persons’ social, mental and physical functioning.

There is a scarcity of longitudinal studies examining how functional decline develops among very old people. The aim of the current study was to detect and characterize typical patterns of functional decline in a sample of very old people. We utilized longitudinal data from a sample of people aged 80–89 at baseline from Sweden and Germany (N= 847). Three follow-up assessments were completed and 159 participants completed the last assessment 9 years after baseline. Death (45 %) and contact no longer possible (40 %) were main reasons for dropout. We used latent transition analysis (LTA) to estimate the probabilities of latent class membership at each measurement point, as well as the transition probabilities of moving from one class to another. Three latent classes were revealed, labeled Mobility Problem Stayers, Hearing Problem Advancers and Visual Problem Advancers. The first class had a low probability of additional problems throughout the study period, while the two latter had increased probabilities of additional limitations. In terms of class membership change, Mobility Problem Stayers moved either towards Hearing Problem Advancers or towards Visual Problem Advancers. The results suggest that mobility problems are most common when people reach the age of 80+. Further decline is typically characterized by the addition of either visual problems or hearing problems, which are both associated with an increased risk of limitations in upper extremities. These findings warrant further research to analyze the association between the detected typical patterns of functional decline and health-related outcomes.

Older community-living disabled people often have unmet activity needs and participation restrictions potentially reducing their quality of life (QoL). We examined the effects of an individualized out-of-home activity intervention delivered by volunteers on QoL among community-living older people, who have difficulty accessing the outdoors independently. Volunteering, Access to Outdoor Activities and Wellbeing in Older People (VOW; ISRCTN56847832) was a two-arm randomized single-blinded, controlled effectiveness trial (RCT) in Jyväskylä, Finland. The inclusion criteria were: age 65 or over, severe mobility limitation, able to communicate, and agree to participate in a RCT. Each intervention group member was assigned a trained volunteer with whom out-of-home activities were done once a week for 3 months (e.g., running errands or recreational activities). The primary outcome was the environmental subscore of QoL assessed with WHOQOL-BREF. Secondary outcomes were the overall QoL, physical capacity, psychological well-being, and social relationships assessed with WHOQOL_BREF and lower-extremity performance assessed with Short Physical Performance Battery (SPPB). 121 people aged 67–92 years (mean age 81.9 years, SD 5.9, 90 % women) were randomized. No treatment effect on the environmental QoL subscore was observed, but for physical capacity subscore a significant treatment effect was observed (General Linear Model, Group by Time p= 0.001). No effects were observed for the other QoL subscores or for SPPB score. This study suggests that individualized out-of-home activity intervention delivered by volunteers may influence the QoL of old severely mobility-limited community-living people in a positive way. Further studies are needed to better understand how to improve QoL of older disabled community-living people and potentially buffer them against more severe care needs and institutionalization.

Background and aims:The level of physical activity often declines in old age, although many older people would like to be more active than what they are capable of. This leads to unmet physical activity need, the feeling that one’s level of physical activity is inadequate, which is a manifestation of disparity in physical activity in old age. The accumulation of risk factors, including mobility limitations, low socioeconomic status (SES) and lack of social support may increase disparity in physical activity. The aim of this study was to investigate how the accumulation of risk factors is associated with unmet physical activity need in older community-living people. Methods:The study was based on cross-sectional analyses of an observational study with 632 participants. Unmet physical activity need, SES, mobility limitations and availability of social support were self-reported by standardized questionnaires. Results:Having mobility limitations increased the risk of unmet physical activity need almost four-fold compared to those with no mobility limitations; having mobility limitations and either low SES or not having social support increased the risk over four-fold and having mobility limitations, low SES and no social support further increased the risk over seven-fold. Conclusions:We found that accumulation of risk factors increases disparity in physical activity.

Background and aims:The level of physical activity often declines in old age, although many older people would like to be more active than what they are capable of. This leads to unmet physical activity need, the feeling that one’s level of physical activity is inadequate, which is a manifestation of disparity in physical activity in old age. The accumulation of risk factors, including mobility limitations, low socioeconomic status (SES) and lack of social support may increase disparity in physical activity. The aim of this study was to investigate how the accumulation of risk factors is associated with unmet physical activity need in older community-living people. Methods:The study was based on cross-sectional analyses of an observational study with 632 participants. Unmet physical activity need, SES, mobility limitations and availability of social support were self-reported by standardized questionnaires. Results:Having mobility limitations increased the risk of unmet physical activity need almost four-fold compared to those with no mobility limitations; having mobility limitations and either low SES or not having social support increased the risk over four-fold and having mobility limitations, low SES and no social support further increased the risk over seven-fold. Conclusions:We found that accumulation of risk factors increases disparity in physical activity.

Introduction. People with Parkinson’s disease (PD) have lower life satisfaction (LS) than healthy peers. No study has yet identified predictors of LS in people with PD. Such information would be valuable for health care and future interventions that aim to maintain or increase LS. Aim. To examine how LS evolved in people with PD over a 3-year period, as well as to identify predictive factors of LS. Methods. We used data from baseline assessments and a 3-year follow-up of 163 people with PD (baseline, mean age 68 years; median PD duration 8 years, 35% women). LS was assessed with item 1 of the Life Satisfaction Questionnaire (LiSat-11). Dichotomized LS data from the 3-year follow-up were used as the dependent variable in multivariable logistic regression analyses. In the first step, independent variables included baseline information on sex, education, general self-efficacy, motor symptoms, perceived walking difficulties, fall-related activity avoidance, and difficulties with/need help in activities of daily living. At the second step, depressive symptoms were added as an independent variable. Results. The proportion of those who reported being satisfied with their lives reduced from 63.2% at baseline to 49.7% 3 years later (p=0.003). When depressive symptoms were not included in the analysis, general self-efficacy (odds ratio, OR = 1.081; 95% CI = 1.019–1.147) and perceived walking difficulties (OR = 0.962; 95% CI = 0.929–0.997) were significant (p<0.05) predictors of LS 3 years later. With depressive symptoms included, the influence of walking difficulties diminished, and depressive symptoms (OR = 0.730; 95% CI = 0.607–0.877) and general self-efficacy (OR = 1.074; 95% CI = 1.010–1.142) were the only significant predictors of LS 3 years later. Conclusions. LS is reduced over a 3-year period. The study suggests that perceived walking difficulties, general self-efficacy, and depressive symptoms are important predictors of LS in people with PD.