Identification of Older People at Risk of ADL Disability Using the Life-Space Assessment: A Longitudinal Cohort Study

doi:10.1016/j.jamda.2015.12.010

Journal of the American Medical Directors Association

Volume 17, Issue 5, 1 May 2016, Pages 410-414

https://doi.org/10.1016/j.jamda.2015.12.010 Get rights and content

Abstract

Objectives

Life-space mobility, assessed with the Life-Space Assessment (LSA), reflects an individual's mobility in terms of the spatial area, frequency, and need for assistance. The aims were to study associations between life-space mobility and disability status in activities of daily living (ADL), and to define cutoff scores for baseline LSA and LSA change over time identifying individuals who developed ADL inability during 2 years of follow-up. Robustness of the cutoff scores was tested accounting for potential confounders.

Design

Longitudinal analyses of the “Life-space mobility in old age” cohort study.

Setting

Home-based interviews at baseline and phone interviews 2 years later.

Participants

A total of 755 community-dwelling 75- to 90-year-old people living in Central Finland.

Measurements

LSA score (range 0–120) and ADL disability status (no difficulty, difficulty in ≥1 tasks, or inability in ≥1 tasks) were determined based on self-reports.

Results

Participants who developed difficulty or inability in ADL over time presented lower LSA scores at baseline and larger declines compared to those who remained without task difficulty or inability during the follow-up, respectively. Sensitivity and specificity analyses showed that baseline LSA ≤52.3 (0.86 and 0.74, respectively) and LSA decline of >11.7 (0.76 and 0.71, respectively) identified participants who developed ADL inability over the follow-up. Multinomial regression showed that, after adjustment for potential confounders, these cutoff scores increased the odds to develop new difficulty in ADL tasks, and the odds to develop ADL inability among those with baseline difficulty.

Conclusion

Our results suggest that restrictions and declines in life-space mobility may be early signs of increasing vulnerability to disability in old age. These longitudinally defined cutoff points may help to find clinical applications for the LSA.

Section snippets

Methods

These data are from the “Life-Space mobility in old age” (LISPE) cohort comprising 75- to 90-year-old community-dwelling people living in Muurame and Jyväskylä in Central Finland. The study design and methods have been published previously.20, 21 Briefly, a random sample of 2550 was drawn from the population register. These persons were informed about the study by a letter and interviewed over the phone to determine interest and eligibility for participation (living independently, able to

Results

The median age of the participants at baseline was 80.4 (IQR 7.4), and 62% of them were women. Median baseline LSA score was 64 (IQR 30.4) and during the 2-year follow-up, the LSA score declined 2 (IQR 22) points. Table 1 shows that at baseline, LSA scores decreased with increasing ADL disability, but the change in LSA scores over the 2 years of follow-up did not differ according to baseline ADL disability status. When accounting for ADL disability status at follow-up, lower baseline LSA scores

Discussion

Based on sensitivity and specificity analyses on the development of ADL inability during the 2-year follow-up, we defined LSA ≤52.3 as the cutoff value for life-space mobility. This cutoff point was associated with higher odds to present difficulty or inability in ADLs at baseline and with development of new difficulty and inability at the follow-up, even after adjustment for factors known to be correlated with development of ADL disability. The current cutoff score is not much different from

Conclusion

Our results suggest that restrictions and declines in life-space mobility may be early signs of increasing vulnerability for poor health outcomes in community-dwelling older people. Baseline LSA ≤52.3 was associated with markedly higher odds of developing new difficulty or inability in ADL within 2 years. In addition, an LSA decline of greater than 11.7 points over time seems meaningful to community-dwelling older people, as it was associated with higher odds to develop new difficulty or

Acknowledgments

We thank the participants for their time and effort to participate in our study. The Gerontology Research Center is a joint effort between the University of Jyväskylä and the University of Tampere.

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Our results revealed that activities linked to life-space, particularly those related to physical activity, were associated with incident disability. Restricted and declining life-space mobility is considered an early sign of incident disability.7 In addition, engagement in activities is reported to reduce the risk of disability.
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General community setting. Participants comprised 4432 older adults [mean age: 75.9 ± 4.3 (70-96) years; 2100 men (47.4%)].
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: The authors declare no conflicts of interest.

: This work was supported by the Academy of Finland (grant 255403, Future of Living and Housing, program ASU-LIVE to TR, grant 285747 to MR) and the Finnish Ministry of Education and Culture to TR and EP. The sponsors played no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

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Original StudyIdentification of Older People at Risk of ADL Disability Using the Life-Space Assessment: A Longitudinal Cohort Study

Abstract

Objectives

Design

Setting

Participants

Measurements

Results

Conclusion

Section snippets

Methods

Results

Discussion

Conclusion

Acknowledgments

Arch Phys Med Rehabil

Arch Phys Med Rehabil

J Psychiatr Res

Mobility and aging: New directions for public health action

Am J Public Health

Measuring life-space mobility in community-dwelling older adults

J Am Geriatr Soc

Correlates of life space in a volunteer cohort of older adults

Exp Aging Res

Psychological perspectives on successful aging: The model of selective optimization with compensation

Moving through greater life-space areas and objectively measured physical activity of older people

PLoS One

Life-space constriction, development of frailty, and the competing risk of mortality: The women's health and aging study I

Am J Epidemiol

Life-space mobility predicts nursing home admission over 6 years

J Aging Health

Establishing a hierarchy for the two components of restricted activity

J Gerontol A Biol Sci Med Sci

Assessing mobility in older adults: The UAB study of aging life-space assessment

Phys Ther

Resilience in mobility in the context of chronic disease and aging: Cross-sectional and prospective findings from the University of Alabama at Birmingham (UAB) study of aging

Test-retest reliability of the swedish version of the life-space assessment questionnaire among community-dwelling older adults

Clin Rehabil

Original Study
Identification of Older People at Risk of ADL Disability Using the Life-Space Assessment: A Longitudinal Cohort Study