Walking modifications as facilitators of mobility in old age

Abstract

Mobility enables independent living, and it has multiple dimensions; mobility patterns, the ability to move, autonomy in mobility, and the extent of mobility. In old age, functional decline predisposes to walking limitations that are further accentuated by lack of environmental support. In addition, the extent of mobility declines which often coincides with diminished autonomy in mobility. This study explored the role of 2 km walking modifications (e.g., using an aid) in maintaining outdoor mobility among older people. The levels and changes in the extent of mobility and autonomy in mobility were followed over two years in two studies: prior to and during the coronavirus disease 2019 (COVID-19) pandemic restrictions. In addition, this dissertation explored the associations of accelerometer-based free-living walking and environmental features with walking modifications. The data were drawn from two research projects: Life-Space Mobility in Old Age (2012; n = 848, and 2014; n = 761); and Active Ageing – Resilience and External Support as Modifiers of the Disablement Outcome (2017–2018; n = 1021, and 2020; n = 809). The participants in both longitudinal cohort studies were community-dwelling people aged 75 to 93. Participants’ perceived environmental mobility barriers and facilitators, walking modifications and difficulty, life-space mobility, autonomy in participation outdoors, unmet physical activity need, and level of physical activity were assessed with self-reported measures, and free-living walking with accelerometers. Daily walking minutes, walking bouts, and bout intensity and duration were lower and walking fragmentation was higher among those with walking difficulty and intermediate among those using walking modifications when compared to intact walkers. Outdoor mobility facilitators helped to use adaptive walking modifications, thereby potentially slowing down negative changes in life-space mobility, and contributing to the maintenance of autonomy in mobility and in physical activity. During the first wave of the COVID-19 pandemic, the life-space mobility and autonomy in mobility declined among older people despite the use of walking modifications. The findings of this study suggest that among older people the use of adaptive walking modifications and environmental features that support their use are important for both their extent of mobility and autonomy in mobility.