Racial similarities and differences in predictors of mobility change over eighteen months

Abstract

OBJECTIVES:To define racial similarities and differences in mobility among community-dwelling older adults and to identify predictors of mobility change. DESIGN:Prospective, observational, cohort study. PARTICIPANTS:Nine hundred and five community-dwelling older adults. MEASURES:Baseline in-home assessments were conducted to assess life-space mobility, sociodemographic variables, disease status, geriatric syndromes, neuropsychological factors, and health behaviors. Disease reports were verified by review of medications, physician questionnaires, or hospital discharge summaries. Telephone interviews defined follow-up life-space mobility at 18 months of follow-up. RESULTS:African Americans had lower baseline life-space (LS-C) than whites (mean 57.0 ± ± ± ± standard deviation [SD] 24.5 vs. 72.7 ± ± ± ± SD 22.6; P < .001). This disparity in mobility was accompanied by significant racial differences in socioeconomic and health status. After 18 months of follow-up, African Americans were less likely to show declines in LS-C than whites. Multivariate analyses showed racial differences in the relative importance and strength of the associations between predictors and LS-C change. Age and diabetes were significant predictors of LS-C decline for both African Americans and whites. Transportation difficulty, kidney disease, dementia, and Parkinson's disease were significant for African Americans, while low education, arthritis/gout, stroke, neuropathy, depression, and poor appetite were significant for whites. CONCLUSIONS:There are significant disparities in baseline mobility between older African Americans and whites, but declines were more likely in whites. Improving transportation access and diabetes care may be important targets for enhancing mobility and reducing racial disparities in mobility. 16 found that older African Americans were more likely than whites to show both improvement and decline in measures of physical performance; however, the limited number of African Americans in most prospective studies has made it difficult to assess racial differences in predictors of function. Prospective studies are needed to identify modifiable risk factors for functional loss and to understand the causes for disparities in function for older African Americans and whites. Such data are also needed to guide the development of interventions to eliminate racial differences. Life-space is a spatial measure of mobility describing the area through which a person moves over a specified time period. 6,7,[17][18][19][20] A life-space assessment incorporating where a person goes, the frequency of going there, and the need for assistance, can be used to define the full continuum and changes in mobility among community-dwelling older adults and provides a method to evaluate the impact of sociodemographic factors, diseases, geriatric syndromes, neuropsychological factors, and health behaviors on mobility change. We hypothesize that changes in life-space mobility precede adverse health outcomes such as nursing home placement and death (Fi...

The Impact of Veteran Status on Life-Space Mobility among Older Black and White Men in the Deep South

“…Regardless of the era in which Black veterans served, findings support our second hypothesis and previous research that older Blacks demonstrate lower life-space compared with older Whites, 3,18 which also supports CIT Axiom 3: "Life-course trajectories are shaped by the accumulation of risk, available resources, and human agency." 9 During the lives of our participants, the United States underwent significant social changes, such as the desegregation of the Armed Forces in 1948 and the Civil Rights Movement of the 1960s.…”

“…This finding further supports previous research on lifespace differences between Blacks and Whites. 3,18 In contrast to the post-war years of Black male veterans, White male veterans returning to the Deep South were able to take full advantage of the GI Bill, 31 which could have altered their life-space trajectory.…”

“…2 Racial differences in life-space, a measure of mobility incorporating distance traveled, frequency of travel, and independence of movement, have been documented among older Blacks and Whites; 3,4 less is known about racial differences in life-space mobility of older veterans.…”

Life Space Assessment in Spinal Cord Injury

“…Changes less than 23 points may result simply from measurement error. Reports from Allman et al 32 and Wheeler et al 33 suggested that a change of 10 and 12 points, respectively, was associated with discontinued travel out of town, with even smaller changes potentially being meaningful. 32 They did not report the MDC, which is calculated from the SEM based on the standard deviation.…”

Task Modifications in Walking Postpone Decline in Life-Space Mobility Among Community-Dwelling Older People: A 2-year Follow-up Study

“…This suggests that they were able to maintain their life-space mobility at its previous level for longer and potentially slow down the slope of decline. It is also worth noting that the five-point decrease indicates qualitatively different changes in lifespace mobility depending on the starting value (27)(28)(29). For people who reach areas beyond their neighborhood independently (life-space mobility score over 60) a five-point decline in life-space mobility score may have rather small implications for their lives.…”