Background-Life-space mobility, reflecting participation patterns as well as physical ability, may be useful in assessing important functional changes after hospitalization.

With the aging of the US population, the proportion of African–Americans will increase and older adults in rural areas will become more isolated. Gender differences in health and function can be expected to be worse in historically underserved populations. Maintenance or improvement of mobility is critical to maintaining not only quality of life, but also physical and mental health. The University of Albama at Birmingham Study of Aging was designed to understand racial differences in mobility among older adults, and the study cohort is balanced by race, gender and rural–urban residence. Thus, the study can provide insights into the impact of aging on the health and function of African–American and white men and women in both rural and urban areas. The study demonstrates that mobility is a complex functional domain impacted by sociodemographic, general-health and mental-status factors. As modifiable risk factors of life-space mobility decline are identified, this will lead to the development and testing of interventions designed to enhance mobility among diverse populations of older adults in both rural and urban settings.

Background Life-space, a measure of movement through one’s environment, may be viewed as one aspect of environmental complexity for older adults. We examined the relationship between life-space and subsequent change in cognitive function. Methods Participants were 624 community-dwelling Medicare beneficiaries (49% African American) who completed in-home assessments at baseline and follow-up 4 years later. The Life-Space Assessment was used at baseline to measure extent, frequency, and independence of participants’ movement within and outside the home. Cognitive decline was measured with the Mini-Mental State Examination (MMSE). Results In a regression model adjusted for baseline MMSE, age, gender, race, residence (rural/urban), and education, greater life-space at baseline predicted reduced cognitive decline (β = −.177, p < .001). This association remained statistically significant in subsequent models that examined what proportion of the observed association was explained by baseline physical activity, physical function, vascular risk factors, comorbidity, and psychosocial factors. Physical function accounted for the largest proportion (37.3%) of the association between life-space and cognitive decline. There was no significant interaction between life-space and race, gender, or age in predicting cognitive decline. In a logistic regression analysis, participants in the highest quartile of life-space had 53% reduced odds of substantial cognitive decline (≥4 points on MMSE) compared to those in the lowest quartile. Conclusions These preliminary findings suggest that life-space may be a useful identifier of older adults at risk for cognitive decline. Future research should investigate the potential reciprocal relationship between life-space and cognitive function as well as the interrelationship between these factors and physical function.

Our study suggests that undernutrition, as measured by low BMI and unintentional weight loss, is a greater mortality threat to older adults than is obesity or intentional weight loss.

Objectives To determine the prevalence and correlates of nocturia in community-dwelling older adults. Design Planned secondary analysis of cross-sectional data from the University of Alabama at Birmingham Study of Aging population-based survey. Setting Participants’ homes. Participants One thousand older adults (aged 65 to 106 years) recruited from Medicare beneficiary lists between 1999 and 2001. The sample was selected to include 25% African American women, 25% African American men, 25% white women, and 25% white men. Measurements In-person interviews included socio-demographic information, medical history, Mini-Mental State Examination, and measurement of body mass index (BMI). Nocturia was defined in the main analyses as getting up 2 or more times per night to void. Results Nocturia was more common among men than women (63.2% vs. 53.8%, OR=1.48, 95% CI=1.15–1.91, P=.003) and more common among African Americans than whites (66.3% vs. 50.9%, OR=1.89, CI=1.46–2.45, P< .0001). In multiple backward elimination regression analysis in men, nocturia was significantly associated with African American race (OR=1.54) and BMI (OR=1.22 per 5 kg/m2). Higher MMSE was protective (OR=0.96). In women, nocturia was associated with older age (OR=1.21 per 5 years), African American race (OR=1.64), history of any urine leakage (OR=2.17), swelling in feet and legs (OR=1.67), and hypertension (OR=1.62). Higher education was protective (OR=0.92). Conclusion Nocturia in community-dwelling older adults is a common symptom associated with male gender, African-American race, and some medical conditions. Given the significant morbidity associated with nocturia, any evaluation of lower urinary tract symptoms should include assessment for the presence of nocturia.

Objective To explore the association between baseline life-space mobility and nursing home (NH) admission among community-dwelling older adults over six years. Methods Using data from a prospective, observational cohort study consisting of a random sample of 1000 Medicare beneficiaries ≥ 65 years of age stratified by race (African American and non-Hispanic White), sex, and rural/urban residence. Baseline life-space mobility was assessed during in-home interviews. Participants were contacted by telephone every six months to ascertain NH admissions, Life-Space Assessment (LSA) scores and vital status (living or deceased). Using multivariate logistic regression, the significance and independence of the relationship of life-space mobility with NH admission was examined. Results Over six years, the odds of NH admission increased 2% for every one point lower baseline life-space score independent of previously recognized risk factors. Discussion The LSA may be a useful tool to identify older adults at risk for NH admission.

PURPOSE-To determine incidence and predictors of incident urinary incontinence over 3 years in community-dwelling older adults. MATERIALS & METHODS-A population-based, prospective cohort study was conducted with a random sample of Medicare beneficiaries, stratified to be 50% African American, 50% men, and 50% rural. In-home baseline assessment included standardized questionnaires and short physical performance battery. Three annual follow-up interviews were conducted by telephone. Incontinence was defined as any degree of incontinence occurring at least once a month in the past 6 months.RESULTS-Participants were 490 women and 496 men, age 65 to 106 years (mean=75 years). Prevalence of incontinence at baseline was 41% in women and 27% in men. Three-year incidence of incontinence was 29% (84/290) in women and 24% (86/363) in men. There were no differences by race in prevalent or incident incontinence. In multivariable logistic regression models for women, significant independent baseline predictors of new incontinence included: stroke (OR 3.4, p=.011), incontinence < monthly (OR 3.3, p=.001), past or current post-menopausal estrogen (OR 2.3, p<.006), slower time to stand from a chair 5 times (OR 1.3, p<.045), and higher Geriatric Depression Scale Score (OR 1.2, p=.016). For men, significant independent baseline predictors of new incontinence included: incontinence < monthly (OR 4.2, p<.001) and lower score on the composite Physical Performance Score (OR 1.2, p<.001).CONCLUSIONS-Prevalence of incontinence among community-dwelling older adults was high with an additional 29% of women and 24% of men reporting incident incontinence over 3 years of follow-up. Infrequent incontinence is a strong risk factor for developing at least monthly incontinence in both men and women.

OBJECTIVE To examine the factors associated with life-space mobility in older Mexican Americans. DESIGN Cross-sectional study involving a population-based survey. SETTING Hispanic Established Population for the Epidemiologic Study of the Elderly survey conducted in the southwestern of United States (Texas, Colorado, Arizona, New Mexico, and California). PARTICIPANTS 728 Mexican American men and women aged 75 years and older. MEASUREMENTS In-home interviews assessed socio-demographic factors, self-reported physician-diagnoses of medical conditions (arthritis, diabetes, heart attack, stroke, hip fracture, and cancer), depressive symptoms, cognitive function, body mass index (BMI), upper and lower extremity muscle strength, short physical performance battery (SPPB), activities of daily living (ADLs), instrumental activities of daily living (IADLs), and the life-space assessment (LSA). RESULTS Mean age of participants was 84.2 years (SD, 4.2). Sixty-five percent were female. Mean score of LSA was 41.7 (SD, 20.9). Multiple regression analysis showed that older age, being female, limitation in ADLs, stroke, high depressive symptoms and BMI ≥35 kg/m2 were significantly associated with lower scores in LSA. Education and high performances in lower extremity function and in muscle strength were factors significantly associated with higher scores in LSA. CONCLUSION Older Mexican Americans had restricted life-space with approximately 80% limited to their home or neighborhood. Age, gender, stroke, high depressive symptoms, BMI ≥ 35 Kg/m2, and ADL disability were related to decreased life-space. Future studies are needed to examine the association between life-space and health outcomes and to characterize the trajectory of life-space over time in this population.