Life-Space Predicts Health Care Utilization in Community-Dwelling Older Adults

Kennedy, Richard E.; Williams, Courtney; Sawyer, Patricia; Lo, Alexander X.; Connelly, Kay; Nassel, Ariann; Brown, Cynthia J.

doi:10.1177/0898264317730487

Cited by 33 publications

(36 citation statements)

References 20 publications

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“…Kennedy et al 19 sought to determine whether decline in LSA predicts increased health care utilization among participants in the UAB Study of Aging. The authors found that a 10-point decrease in life-space was associated with 14% increased odds of an emergency department visit and/or hospitalization over the next month, after controlling for all covariates.…”

Section: Resultsmentioning

confidence: 99%

<p>Life-Space Mobility in the Elderly: Current Perspectives</p>

Johnson¹,

Rodriguez²,

Snih³

2020

CIA

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Life-space mobility (LSM) is a concept for assessing patterns of functional mobility over time. LSM is gaining traction in the research of geriatric population health. Several instruments have been developed to measure LSM, such as the University of Alabama at Birmingham Life-Space Assessment (LSA) or the Nursing Home Life-Space Diameter instrument. There has been exponential growth in the use of instruments measuring LSM in studies of older adults since the concept was introduced in 1985. In response to the increased volume of publications with clinical applicability to those working in geriatric health or conducting population-based research in older adults, we conducted a narrative review: a) to provide a summary of the articles that have assessed validation of the University of Alabama at Birmingham LSA instrument, the most widely used instrument to assess LSM in older adults; and b) to provide a summary of the research articles that have examined LSM as independent or outcome variable. Studies for this review were obtained with an organized search format and were included if they were published in the past 20 years, written in English, published in peer-reviewed literature, and included LSM as an independent or outcome variable. Seventy-nine articles were identified: 36 that employed a cross-sectional design and 22 that employed a longitudinal/prospective design to examine LSM as outcome variable; 17 longitudinal/prospective design articles that examined LSM as primary independent variable; 3 review articles; and 1 systematic review. Areas of research included physical function, cognitive function, sensory impairment, mental health, falls, frailty, comorbidities, healthcare use, mortality, and social/environmental factors. These studies showed that LSM instruments can accurately predict morbidity, mortality, and healthcare use.

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Section: Resultsmentioning

confidence: 99%

<p>Life-Space Mobility in the Elderly: Current Perspectives</p>

Johnson¹,

Rodriguez²,

Snih³

2020

CIA

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“…Life-space mobility represented an essential aspect of environmental complexity in older adults (42). Despite not being a direct measure of physical performance, LSA has been described as a comprehensive representation of functioning and a strong predictor of adverse outcomes in older age, including falls, cognitive decline, hospitalization, institutionalization, and death (42)(43)(44)(45)(46). While physical performance (such as walking ability) accounts for a significant portion of its final score, LSA is strongly associated with several other factors that influence mobility, including social connections, cognitive performance, personality traits, and mental health (13,15).…”

Section: Discussionmentioning

confidence: 99%

The Impact of Frailty on the Relationship between Life-Space Mobility and Quality of Life in Older Adults during the COVID-19 Pandemic

Saraiva

Apolinário

Avelino‐Silva

et al. 2021

The Journal of nutrition, health and aging

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Background: The COVID-19 pandemic has led to abrupt restrictions of life-space mobility. The impact of shelter-in-place orders on older adults' health and well-being is still unclear. Objective: To investigate the relationship between life-space mobility and quality of life (QoL) in older adults with and without frailty during the COVID-19 pandemic. Design: Multicenter prospective cohort study based on structured telephone interviews. Setting: Four geriatric outpatient clinics in the metropolitan area of Sao Paulo, Brazil. Participants: 557 community-dwelling adults aged 60 years and older. Measurements: The Life-Space Assessment was used to measure community mobility before and during the COVID-19 pandemic, and a previously validated decrease of ≥ 5 points defined restricted life-space mobility. Frailty was assessed through the FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale. The impact of shelter-in-place orders on QoL was evaluated with the question «How is the COVID-19 pandemic affecting your QoL?», to which participants could respond «not at all», «to some extent», or «to a great extent». We used ordinal logistic regressions to investigate the relationship between restricted life-space mobility and impact on QoL, adjusting our analyses for demographics, frailty, comorbidities, cognition, functionality, loneliness, depression, and anxiety. We explored whether frailty modified the association between life-space mobility and impact on QoL. Results: Participants were on average 80±8 years old, 65% were women, and 33% were frail. The COVID-19 quarantine led to a restriction of community mobility in 79% of participants and affected the QoL for 77% of participants. We found that restricted life-space mobility was associated with impact on QoL in older adults during the pandemic, although frailty modified the magnitude of the association (P-value for interaction=0.03). Frail participants who experienced restricted life-space mobility had twice the odds of reporting an impact on QoL when compared with non-frail individuals, with respective adjusted odds ratios of 4.20 (95% CI=2.36-7.50) and 2.18 (95% CI=1.33-3.58). Conclusion: Older adults experienced substantial decreases in life-space mobility during the COVID-19 pandemic, and this unexpected change impacted their QoL. Providers should be particularly watchful for the consequences of abrupt life-space restrictions on frail individuals.

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“…Lo et al described a significant correlation between LSM and incident falls on multivariate analysis during 6-month follow-up from the UAB Study of Ageing (OR for each ten-point decrement in life space = 1.16, 95% CI 1.03–1.31, P = 0.02) [ 48 ]. Follow-up at 36 months found an association between a decline in UAB LSA score and healthcare utilisation (as measured by self-reported ED visits and hospitalisation episodes) [ 49 ].…”

Section: Associations Between Lsm and Other Outcomesmentioning

confidence: 99%

Assessing life-space mobility for a more holistic view on wellbeing in geriatric research and clinical practice

Taylor¹,

2018

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Life-space mobility (LSM) is a holistic measure of resilience to physical decline and social isolation in later life. To promote its use as an outcome in geriatric studies and in clinical practice, this review paper explains the concept of LSM; outlines available questionnaires for LSM assessment, provides an overview of associations between LSM and other outcomes, and discusses emerging methods to measure LSM using wearable sensors. Based on performed activity around a central geographical anchor, LSM aims to quantify the observed contraction of daily activities associated with ageing. Several questionnaires are available to assess LSM in different contexts: the University of Alabama Life-Space Assessment and the Life-Space Questionnaire (community settings), the Nursing Home Life-Space Diameter (nursing home settings) and Life Space at Home (for house-bound populations). Some studies using GPS trackers to calculate life-space parameters reported promising results. Although these techniques reduce data collection burden, battery life and older people's willingness to wear a tracker require further improvement before they can be used more widely. Regardless of the assessment method used, LSM was associated with measures of functional and cognitive abilities, nursing home admission and mortality. The current availability of instruments, the ongoing development of less burdensome data collection techniques, and evidence of construct validity support a case for promoting integration of LSM assessments into geriatric research studies and clinical practice. Ultimately, this will provide a more holistic view on older people's health and wellbeing.

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Life-Space Predicts Health Care Utilization in Community-Dwelling Older Adults

Abstract: Life-space is a practical alternative in predicting future health care utilization to performance-based measures, which can be difficult to incorporate into clinical or public health practice.

Cited by 33 publications

References 20 publications

<p>Life-Space Mobility in the Elderly: Current Perspectives</p>

<p>Life-Space Mobility in the Elderly: Current Perspectives</p>

The Impact of Frailty on the Relationship between Life-Space Mobility and Quality of Life in Older Adults during the COVID-19 Pandemic

Assessing life-space mobility for a more holistic view on wellbeing in geriatric research and clinical practice

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