Life-Space Mobility in the Elderly: Current Perspectives
Authors Johnson J, Rodriguez MA, Al Snih S
Received 5 March 2020
Accepted for publication 10 August 2020
Published 15 September 2020 Volume 2020:15 Pages 1665—1674
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Richard Walker
Jason Johnson,1 Martin A Rodriguez,2 Soham Al Snih1– 3
1Division of Rehabilitation Sciences/School of Health Professions, The University of Texas Medical Branch, Galveston, TX, USA; 2Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA; 3Division of Geriatrics/Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA
Correspondence: Soham Al Snih
Division of Rehabilitation Sciences/School of Health Professions, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0170, USA
Email [email protected]
Abstract: 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.
Keywords: life-space mobility, LSA, LSM, mobility, older adults
Physical mobility affects all aspects of daily life and is a crucial part of independent living. As we age, the ability to maintain mobility becomes even more important, affecting the health and quality of life.1 Mobility in older adults is critical to aging successfully since it is essential to maintain independence and autonomy.2,3 Mobility is determined by cognitive and physical function, psychosocial factors, environmental factors, and transportation.4 These determinants have raised the profile of assessing mobility among older adults beyond the traditional measures of assessing activities of daily living (ADLs), instrumental activities of daily living (IADLs), and walking ability, all focusing on a single specific activity rather than capturing the full continuum of mobility in older adults.4 Life-space mobility (LSM), an emerging concept that allows this assessment, assesses functional, environmental, and social factors that affect how people live their day-to-day lives.5
In 1985, May, Nayak, and Isaacs published the “The life-space diary, a measure of mobility in old people at home.”6 This measure marks the introduction of LSM, both as a concept and as the first instrument used to quantify it. The original goal of the instrument was to measure an individual’s geospatial movements over an interval of time. Inquiring about patient’s recent restrictions in movement was not new to clinicians, but systematically recording it in a comparable format was. While the life-space diary did not gain widespread use in research, the concept proved accessible and adaptable in later, newer instruments. The LSM concept has proven so accessible that it formed the foundation of a comprehensive framework used to address research questions related to mobility in older adults.4
The Nursing Home Life-Space Diameter (NHLSD) instrument, published in 1990 by Tinetti and Ginter, focused on institutionalized patients in a long-term care setting.7 The NHLSD separated a patient’s living area into four spaces: their room, outside the room but within the unit, outside the unit but within the facility, and outside the facility; it measured movement over a two-week period; was validated in 398 residents of 3 nursing homes in New Haven, Connecticut; and the test-retest reliability was 0.92.
The Life-Space Questionnaire (LSQ), published in 1999 by Stalvey et al,8 validated in 200 participants aged 55–85 years with cataracts from an outpatient eye clinic, includes 9 (Yes/No) questions that assess mobility across 9 life-space zones in the preceding 3 days ranging from the participant’s room to traveling outside of the United States. The total scores range from 0 to 9, reflecting the numbers of zones in which an individual has moved. This measure does not take into account frequency and independence of the LSM.
The Life-Space at Home (LSH), published in 2013 by Hashidate et al,9 providing a measure of mobility among outpatient ophthalmology patients, was created by physical therapists who sought to obtain more detail about the distances traveled by their homebound patients.9
The University of Alabama at Birmingham (UAB) Life-Space Assessment (LSA) was developed by Baker et al10 in 2003. The LSA measures mobility in five areas: outside the bedroom, outside the house, in the neighborhood, outside of the neighborhood but in town, and outside town during the past four weeks. Each life-space level is allocated a sub-score based on the average weekly frequency and independence of LSM. The composite score ranges from 0 to 120, with higher scores representing greater mobility. The LSA was validated in a random sample of 306 Medicare beneficiaries from central Alabama 65 years and older. The test-retest reliability at 2-weeks of follow-up for the composite score was 0.96 (95% CI=0.95–0.97). The LSA has emerged as the most widely used instrument in the US and internationally, validated and translated into several languages,11–17 including French-Canadian,11 Finnish,13 Chinese,16 Japanese,15 Spanish,12 Portuguese,12 Danish,14 and German.17 Within the past 10 years, nearly all studies have used the LSA instrument to measure mobility in older adults.
Adoption of LSM in scientific peer-reviewed literature has accelerated in recent years, with more than 20 articles including an LSM instrument published in 2019. Most of these studies involve community-dwelling older adults, a critical group to study as we seek to improve the health and healthcare of older adults. The LSA instrument has been found to predict morbidity, mortality, and healthcare utilization with greater accuracy than many standard measures.18–21
The objectives of this narrative review were: a) to provide a summary of the articles that have assessed validation of the UAB 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 an independent or outcome variable.
In this review, a search strategy was designed in coordination with a medical librarian to assess the review objectives. Articles were selected if they were published within the in the past 20 years (January 2000 to April 2020), written in English, published in peer-reviewed literature, and included LSM as an independent or outcome variable. The search parameters included the terms “lifespace”, “life space”, “life-space”, and “mobility” in article titles. PubMed was searched using the terms: (“lifespace”[Title] OR “life-space”[Title] OR “life space”[Title] AND “mobility”[Title]). Ovid was searched using the terms: ((“lifespace” or “life-space” or “life space”) and “mobility”).m_titl. SCOPUS was searched using the terms: TITLE (“lifespace” or “life-space” or “life space”) and “mobility”). PsychInfo was searched using the terms: ((“lifespace” or “life-space” or “life space”) and “mobility”).m titl. CINAHL was searched using the terms: TI ((“lifespace” or “life-space” or “life space”) and “mobility”). Cochrane was searched using the terms: (“lifespace” or “life-space” or “life space” and “mobility”):ti. Google Scholar was searched using the terms: allintitle: mobility “life space” OR “lifespace” OR “life-space”.
The search, produced 504 results; of these, 324 duplicates, 89 conference abstracts, 2 book chapters, 6 non-English-language, 1 editorial, 2 letter to the editor, 2 thesis, 1 dissertation, 2 registered protocols for clinical trials, 2 registered protocols for systematic reviews, and 1 with average age < 50 years were removed, leaving a total of 72 full-text articles for review from the databases searched. We added 7 more articles manually retrieved (Appendix Figure 1). Of these, 36 articles employing a cross-sectional design and 22 employing a longitudinal/prospective design examined LSM as an outcome variable; 17 longitudinal/prospective design articles examined LSM as primary independent variable; 3 were review articles; and 1 was a systematic review. A total of 79 peer-reviewed articles addressing the objectives of this narrative review were included. Of the 75 cross-sectional or longitudinal design articles, 60 were conducted in community-dwelling older adults, 12 in a clinical setting, and one each in a rehabilitation facility, a nursing home facility, and an independent living facility.
Validity of the UAB LSA Instrument
The UAB LSA has been translated from English into 8 languages and test-retest, construct and criterion validity, and responsiveness have been conducted. Eleven articles were found assessing the translation to other Non-English language and the validity of the LSA instrument. For example, Auger et al11 examined the measurement properties of the French-Canadian version of the LSA for power mobility device (PMD) users presenting with neurological, orthopedic or complex medical conditions. The translation/back translation from English to French with cultural adaptation was performed and pretested with five bilingual users. The intraclass correlation coefficient (ICC) for the composite LSA was 0.87 (95% CI=0.69–0.92) and the concordance was moderate to substantial (kappa=0.47–0.73).
Curcio et al12 assessed the reliability, construct, and convergent validity of the LSA in 150 men and 150 women aged 65–74 years from two Latin American countries (Colombia and Brazil). The LSA was translated into Spanish and Portuguese and back translated by bilingual translators. The test-retest reliability for the composite LSA was substantial in Colombia (ICC=0.70, 95% Confidence Interval (CI)=0.49–0.83). No test-retest was assessed in Brazil. Linear and logistic regression assessed the convergent and validity of the LSA. Low levels of education, low income, depressive symptoms, and poor performance in cognitive test were associated with LSA scores. Women in both countries were significantly more likely than men to have low LSA scores. High performance in the Short Physical Performance Battery (SPPB) was associated with high LSA scores.
Portegijs et al22 examined the distribution, responsiveness, and reproducibility over 1-year of the LSA in older adults aged 75–90 years participating in the Life-Space Mobility in Old Age Study (LISPE) from Finland. The two-week overall ICC was 0.72 (95% CI=0.52–0.84), the ICC was 0.61 during winter time and 0.76 during spring season. Self-reported decline in health or mobility status and age over 85 years were associated with greater decreases in LSM score over 1-year follow up, indicating the responsiveness to changes of the LSA.
Fristedt et al23 examined the concurrent validity of the LSA-Swedish with measures of mobility among 312 community-dwelling participants. The correlations were 0.53 for SPPB, 0.45 for stair climbing, 0.28 for transfers, 0.63 for transportation, 0.55 for food shopping, 0.42 for travel for pleasure, and 0.38 for community activities.
Ullrich et al17 investigated the validity, reliability, sensitivity to change, and feasibility of a modified LSA in older adults with cognitive impairment recruited from rehabilitation wards of a German geriatric hospital. The LSA was translated into German and back-translated by bilingual translators. The test-retest reliability for the composite LSA was 0.91 (95% CI=0.87–0.94). In the construct validity, moderate to high correlation were found between LSA composite score and outdoor physical activities (range, 0.52 to 0.54), motor status (range, 0.39 to 0.41), fear of falling-related psychosocial variables (range, −0.11 to −0.38), physical activity (range, 0.52 to 0.54), and age (−0.32). The sensitivity to change for the LSA composite score was excellent (Standardized Response Mean = 0.80) and the feasibility was also excellent. Cut-off for the LSA were also estimated by Ullrich et al24 among 118 older adults with cognitive impairment and comorbidities. The investigators found that the optimal cut-off point for the LSA to differentiate between those with low (confined to the home) versus high (active outdoors) LSM was < 26.75, with a sensitivity of 0.78 and specificity of 0.84, and a moderate accurate diagnostic validity of 0.81.
Tseng et al16 translated and examined the validity and reliability of the LSA Chinese among 225 community-dwelling older adults. The LSA was translated into Chinese and back translated by two bilingual translators. The ICC was 0.88 (95% CI =0.78–0.94). Criterion validity analysis showed an ICC of 0.53 (p-value < 0.01) for physical ADLs, 0.69 (p-value < 0.01) for IADls, and 0.66 (p-value < 0.01) for the multidimensional functional assessment questionnaire. Construct validity analysis showed an ICC of −0.54 (p-value < 0.01) for depressive symptoms and 0.68 (p-value < 0.01) for the general health subscale of the Medical Outcomes Study Short Form 36.
McCrone et al25 examined the construct/convergent validity, responsiveness, and floor/ceiling effects of the LSA among patients who had musculoskeletal, orthopedic, neurological, or general surgical presentations from a community-based physical interventions in United Kingdom. The convergent validity analysis demonstrated a correlation of 0.37 (p-value < 0.001) for the Performance Oriented Mobility Assessment. Significant improvements were found in the LSA after therapy intervention for the overall sample, with a mean change of 10.5 points (95% CI=8.3–12.8, p-value < 0.01). No floor/ceiling effects was found.
Pedersen et al14 translated the LSA into Danish and examined the content validity among older adults with mobility limitations. The content validity was based on cognitive interviews, finding a wide range of source of error mostly related to comprehension, memory, and decision processes. These errors included difficulties in defining the geographical boundaries of neighborhood, town, and outside of town. Adaptations to the LSA Danish were made to be implemented in clinical practice and used to assess LSM in older Danish adults.
Phillips et al26 generated normative population data for the LSA composite score, regardless of age or health service contact, among 3032 participants from the South Australian Health Omnibus Survey. The mean LSA was 98.3 (SD = 20.3), 5% scored < 60, 11% scored between 60 to 79, 27% scored between 80 to 99, and 57% scored between 100 and 120. Multivariate analysis showed that being female, being older, lower levels of education, living in a rural area, not working, low level of income, and more medical conditions were associated with low LSA scores.
Life-Space Mobility (LSM) as an Outcome Variable
Appendix Table 1 summarizes the characteristics of the 36 cross-sectional design articles and 22 longitudinal/prospective design studies that examined LSM as outcome variable.
Studies examining socio-demographics variables and LSM have found that older age,5,27,28 female gender,5,27–29 and lower level education27,30 are associated with decreased LSA scores. Among comorbidities, stroke,27 the presence of depressive symptoms,27,31,32 undernutrition,33 and obesity27 were found to be associated with lower LSA scores.
Several studies have examined the relationship between physical function, disability, physical activities, and LSM.5,27–29,33–38 For example, Fontenele et al34 found that limitations in ADLs were strongly correlated with lower LSA scores in patients with chronic obstructive pulmonary disease (COPD). In another study conducted in Mexican Americans aged 75 years and older, using the Hispanic Established Population for the Epidemiological Study of the Elderly (HEPESE), Al Snih et al27 showed that those with any limitation in ADLs scored 11.7 points lower in the LSA than those without ADL limitations. Using the Canadian Longitudinal Study on Aging, Kuspinar et al33 found better performance in walking speed and grip strength associated with greater LSM. Peel et al5 using the UAB Study found that high SPPB was associated with LSA score (β=0.282, p-value < 0.001). Portegijs et al35 found that poorer performance in SPPB test was associated with lower LSA score (β=0.22, p-value < 0.01) in participants from the Life-Space Mobility in Old Age (LISPE) study. Tashiro et al38 found that limitations in ADLs, low walking speed, and fear of falling were all independently associated with lower LSA scores in patients recovering from stroke. Rantakokko et al37 examined the associations between motor and non-motor symptoms with LSM in Parkinson’s disease and found that, among motor symptoms, perceived walking difficulties and, among non-motor symptoms, pain were associated with lower LSA scores. Tsai et al39 found that step count (β=0.199, p-value=0.004), moderate activity (β=0.199, p-value=0.004), and low activity (β=0.172, p-value=0.010) were associated with higher LSA scores among participants from the LISPE study.
Auais et al40 examined the association between fear of falling (FOF) and LSM in five cities in Brazil, Canada, and Colombia, found that a 1-point increase in the FOF scale was associated with a 0.15-point decrease in the LSA score, after controlling for demographics, comorbidities, physical function, depressive symptoms, and vision impairment.
Sverdrup et al,41 examining the association between degree of dementia and LSM in nursing home residents using the NHLSD, found that residents with severe dementia had lower LSM compared to those with moderate dementia. Polku et al42 found that participants’ perception of the benefit they received from their hearing aid device correlated positively with a higher LSA score compared to those who perceived less benefit from using a hearing aid.
Sakakibara et al43 examined the effect of wheeled mobility factors on LSA, finding that lower occupancy time and higher distance traveled were associated with greater LSA scores. In another study, Sakakibara et al44 found that those with self-efficacy with a manual wheelchair had higher LSA scores (β=0.25, p-value < 0.01), after controlling for sex, comorbidities, geographic location, need for wheelchair assistance, wheelchair training, and being employed/volunteer.
In examining the association between transportation mode use and LSA scores among those with and without walking difficulties, Viljanen et al45 found that men who were car drivers or had walking difficulty had greater restricted LSM (OR= 3.61, 95% CI=1.33–9.78 vs. OR=28.35, 95% CI=8.56–93.85, respectively). Women who were car drivers or passengers with walking difficulties had greater restricted LSM (OR=4.05, 95% CI=1.06–15.47 vs. OR=18.44, 95% CI=5.98–56.82, respectively).
In an examination of perceived environmental barriers to LSM, Rantakokko et al36 found those reporting one or more environmental barriers in their neighborhood, such as high curbs or lack of sidewalks, had higher odds (OR=2.14, 95% CI=1.34–3.43) of restricted LSM as compared to those reporting no barriers. The authors also showed lower odds ratio of restricted LSM among those reporting four to seven environmental facilitators, such as safe crossings or good lighting.
Appendix Table 1 summarizes the characteristics of the 22 longitudinal/prospective design studies that examined LSA as an outcome variable.20,35,39,46–64 For example, O’Connor et al,55 examining 5-year trajectories of mobility change in older adults with mild cognitive impairment using the LSQ, found older age (β= −0.12, p-value < 0.05) and education (β=0.10, p-value < 0.05) were associated with LSM. A study conducted among independent living residents within a continuing care retirement community found that those who were separated or divorced had higher LSA scores than those married, cohabitating, or widowed.56
Portegijs et al65 found that the rate of decline over 2 years in LSA was greater among pre-frail and frail older adults (β −12.3, p-value < 0.0001 and β −26.0, p-value < 0.0001, respectively) than in non-frail, after adjusting for age and sex among participants from the LISPE study. Tobinaga et al63 examined how strength and balance affect LSA scores after total knee arthroplasty among patients with severe osteoarthritis. The authors concluded that walking self-efficacy and knee extensor muscle strength on the operative side were correlated with preoperative LSA scores; that LSA scores increased significantly 3 months after surgery; and that stairs self-efficacy and knee extensor muscle strength on the operative side were positively correlated with LSA scores at 3 months post-surgery.
Lo et al20 examined the effect of falls and fractures on LSM among participants in the UAB Study of Aging. After 6 months of follow up, the authors found a decline in LSA score of 3.6 points for any fall, 4.7 for those with injury including fractures, 14.2 for those with any type of fracture, and 23.6 for those with hip fracture. Poranen-Clark et al59 examined the relationship between executive function (EF), measured with the Trial Making Test, and LSA scores; they found that better EF at baseline predicted higher LSA scores at 2 years of follow up among participants in the LISPE study. Polku et al,57 examining whether self-reported hearing difficulty at baseline predicts changes in LSM at 2 years of follow-up, found that those without hearing difficulty at baseline had a higher LSA scores than those with mild or major hearing difficulty.
Brown et al51 examined changes in LSA scores among surgical versus non-surgical hospitalized patients over a 4-year period. The authors found similar baseline scores, but a greater initial decline in LSA score in the surgical group. Despite this decline, the surgical group had a more rapid increase in LSA scores following the initial drop in score, compared to those who did not have surgery.
In a study that examined how walking difficulty and task modification for difficulty walking can predict LSA scores, Rantakokko et al60 found that, over a 2-year period, those who had difficulty walking 2 km or who had modified how they walked 2 km had lower LSA scores.
LSM as an Independent Variable
Appendix Table 2 summarizes the characteristics of the 17 longitudinal/prospective studies that have examined LSM as a predictor over time of health outcomes such as cognitive decline, health care utilization (physician visits, hospitalizations, and hospital readmissions), admission to nursing homes, incidence of falls, quality of life, and mortality18,21,66–78 For example, Crowe et al68 examined the relationship between LSA and subsequent change in cognitive function over four years in participants from the UAB Study of Aging. The authors found that greater life-space at baseline predicted less decline over the 4-year period, after controlling for all covariates. Similarly, Silberschmidt et al,77 using the HEPESE study, found that Mexican Americans in the highest life-space category (≥61) experienced slower rates of cognitive decline over a 5-year period compared to those in the lowest category (0–20), after adjusting for all covariates.
In examining clinical exacerbations in patients with COPD leading to emergency room visits or requiring hospitalization, Iyer et al18 found that those with restricted LSM had a significantly reduced score on the 6-minute walk test, more severe dyspnea, worse quality of life, and greater depressive symptoms after one year of enrollment. Lo et al,73 studying neighborhood disadvantage and LSM as predictors of incident falls, found that every 10-point decrease in LSA score increased the risk for one or more falls at six months after baseline assessment.
Kennedy et al19 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. Also, Kennedy et al72 examined whether changes in LSA mobility predict 6-month mortality; they found that, for every 10-point decline in LSA over a 6 month period, the odds of dying over the subsequent 6-month interval increased by 72%. Recovery from low LSA score was associated with decreased mortality. Mackey et al74 examined the relationship between LSA and mortality in participants from the Osteoporotic Fracture in Men Study and found that those with LSA scores ≤ 40 were at high risk for both non-cancer mortality and all-cause mortality. A 24-point decrease in LSA scores was associated with a 19% to 38% increased risk of all-cause mortality over approximately 3 years of follow up, after controlling for all covariates.
Similarly, in studying the relationship between LSA and mortality among women from the Study of Osteoporotic Fractures, Mackey et al21 reported a 2.44 times higher risk of all-cause mortality for those with LSA scores of 0 to 20 points and a 1.5 times greater risk for those with LSA scores of 21 to 60, compared to those with LSA scores of 81 to 120 points over 5.2 years of follow up. No relationship was found with all-cause mortality among women with LSA scores of 60 to 80 points. Findings were similar for cardiovascular, non-cancer, and other types of mortality.
In a study examining whether LSA predicts hospital readmission in patients with COPD or congestive heart failure, Fathi et al69 reported that unrestricted LSA scores at baseline were associated with greater risk of mobility decline post-discharge compared to restricted LSA at baseline, after controlling for all covariates. Also, restricted LSA before hospitalization was associated with a greater risk of hospital readmission within 90 days of discharge, after controlling for all covariates. In another study, Sheppard et al76 reported that restricted LSA scores (<60) were associated with a 4.4 times greater risk of admission to a nursing home compared to unrestricted LSA over 6 years, after controlling for all covariates. The odds of nursing home admission increased 2% for every 1 point decline in LSA score at baseline. In the LISPE study, Rantakokko et al75 found that the decline in quality of life was greater among those whose LSA score decreased >10 points at any time during the follow-up period compared to those whose LSA score remained stable or improved.
De Silva et al79 conducted a systematic review to investigate the relationship between LSM and cognition in older adults. The authors found a random-effect pooled correlation of 0.30 (95% CI=0.19–0.40), and a high heterogeneity I2=9.39%. The correlation coefficients for the relationship between LSA and cognitive function domains ranged from 0.22 to 0.23 for learning and memory, −0.19 to 0.37 for processing speed, and 0.13 to 0.26 for executive function.
The objectives of this narrative review were to provide a summary of the research that have examined the relationship between demographic and health characteristics with LSM in older adults; and a summary of the studies that have validated the most widely used measure of LSM, the UAB-LSA. In this review we found that, in 60 (80%) articles, the research were conducted in community-dwelling older adults, 12 (16%) were conducted in the clinical setting, and 3 (4%) in post-acute or long-term care facilities. Despite of the increasing use of the concept of LSM, this has been limited to community-dwelling older adults from population-based studies such as the University of Alabama at Birmingham Study of Aging, Fragilité, une étude longitudinale de ses expressions, the Canadian Longitudinal Study on Aging, the Life-Space Mobility in Old Age, the Hispanic Established Population for the Epidemiologic Study of the Elderly, the Osteoporotic Fractures in Men Study, the Osteoporotic Fractures in Women Study, the Rush Memory and Aging Project, the Minority Aging Research Study, the International Mobility in Aging Study, the Housing and Independent Living, and the Advanced Cognitive Training for Independent and Vital Elderly trial. Those studies conducted in clinical settings included patients from geriatric, pulmonary, oncology, and orthopedic clinics.
We found socio-demographic variables such older age, female gender, and lower level of education,5,27,28,30 fear of falling,40 limitations in ADLs and IADLs,5,27,34 depressive symptoms,5,27,31,32,80 low physical activity,29,39 poor performance in gait speed and muscle strength,5,27,29,33 vision impairment,33 oral HRQoL,81 and transportation difficulty45 were associated with lower LSM. Changes in LSM were predicted by injurious falls,20,47 hospitalizations,51 low executive function,59 frailty,65 walking difficulty and task modification,60,82 weight loss,61 obesity,27 sedentary behavior,83 hearing difficulty,57 peripheral artery disease,48 and reduced estimated glomerular filtration rate.50 Recovery in LSM has been reported after surgery.48,52,62,63
LSM has been found to be a predictor of cognitive decline over 4-years68 and 5-years77 of follow-up, 90-day hospital readmission,69 exacerbations of COPD requiring emergency room and hospital admission,18,84 falls over 8.5 years,73 mortality,21,72,74,75 quality of life,75,85 and admission to a nursing home.76 Findings of this narrative review has shown that LSM instruments can help investigators and clinicians to assess both the current and future mobility status of older adults.
This work was supported by the National Institute on Aging, the National Institute on Minority Health and Health Disparities, and Texas Resource Center on Minority Aging Research (R01 AG10939, R01 AG017638, 1P30 AG059301-01, and R01 MD010355). Jason Johnson is supported by a training grant from the Agency for Healthcare Research and Quality (T32HS26122). Dr. Rodriguez is a Visiting Scholar at the Sealy Center on Aging and is partly supported by a grant from IIE-Scholar Rescue Fund. The authors acknowledge the assistance of Tara N Atkins, Reference & ILL Librarian, Moody Medical Library/Academic Resources; and Sarah Toombs Smith, PhD, ELS, Sealy Center on Aging, in article preparation. Ms Atkins and Dr. Toombs Smith received no compensation for this effort beyond their university salaries.
Authors declare no conflict of interest.
1. Mollenkopf H, Marcellini F, Ruoppila I, Széman Z, Tacken M. Enhancing Mobility in Later Life. Amsterdam: IOS Press; 2005.
2. Parker M, Baker PS, Allman RM. A life-space approach to functional assessment of mobility in the elderly. J Gerontol Soc Work. 2001;35:35–55. doi:10.1300/J083v35n04_04
3. Taylor JK, Buchan IE, van der Veer SN. Assessing life-space mobility for a more holistic view on wellbeing in geriatric research and clinical practice. Aging Clin Exp Res. 2019;31:439–445. doi:10.1007/s40520-018-0999-5
4. Webber SC, Porter MM, Menec VH. Mobility in older adults: a comprehensive framework. Gerontologist. 2010;50(4):443–450. doi:10.1093/geront/gnq013
5. Peel C, Sawyer Baker P, Roth DL, Brown CJ, Brodner EV, Allman RM. Assessing mobility in older adults: the UAB Study of aging life-space assessment. Phys Ther. 2005;85:1008–1119. doi:10.1093/ptj/85.10.1008
6. May D, Nayak US, Isaacs B. The life-space diary: a measure of mobility in old people at home. Int Rehabil Med. 1985;7(4):182–186. doi:10.3109/03790798509165993
7. Tinetti ME, Ginter SF. The nursing home life-space diameter. A measure of extent and frequency of mobility among nursing home residents. J Am Geriatr Soc. 1990;38:1311–1315. doi:10.1111/j.1532-5415.1990.tb03453.x
8. Stalvey BT, Owseley C, Sloane ME, Ball K. The life space questionnaire: a measure of the extent of mobility of older adults. J Appl Gerontol. 1999;18:9. doi:10.1177/073346489901800404
9. Hashidate H, Shimada H, Shiomi T, Shibata M, Sawada K, Sasamoto N. Measuring indoor life-space mobility at home in older adults with difficulty to perform outdoor activities. J Geriatr Phys Ther. 2013;36:109–114. doi:10.1519/JPT.0b013e31826e7d33
10. Baker PS, Bodner EV, Allman RM. Measuring life-space mobility in community-dwelling older adults. J Am Geriatr Soc. 2003;51:1610–1614.
11. Auger C, Demers L, Gelinas I, et al. Development of a French-Canadian version of the Life-Space Assessment (LSA-F): content validity, reliability and applicability for power mobility device users. Disabil Rehabil Assist Technol. 2009;4(1):31–41. doi:10.1080/17483100802543064
12. Curcio C-L, Alvarado BE, Gomez F, Guerra R, Guralnik J, Zunzunegui MV. Life-space assessment scale to assess mobility: validation in Latin American older women and men. Aging Clin Exp Res. 2013;25:553–560. doi:10.1007/s40520-013-0121-y
13. Kammerlind AS, Fristedt S, Ernsth Bravell M, Fransson EI. Test-retest reliability of the Swedish version of the life-space assessment questionnaire among community-dwelling older adults. Clin Rehabil. 2014;28:817–823. doi:10.1177/0269215514522134
14. Pedersen MM, Kjær-Sørensen P, Midtgaard J, Brown CJ, Bodilsen AC. A Danish version of the life-space assessment (LSA-DK) - translation, content validity and cultural adaptation using cognitive interviewing in older mobility limited adults. BMC Geriatr. 2019;19:1–11. doi:10.1186/s12877-019-1347-0
15. Shimada H, Sawyer P, Harada K, et al. Predictive validity of the classification schema for functional mobility tests in instrumental activities of daily living decline among older adults. Arch Phys Med Rehabil. 2010;91(2):241–246. doi:10.1016/j.apmr.2009.10.027
16. Tseng YC, Gau BS, Lou MF. Validation of the Chinese version of the life-space assessment in community-dwelling older adults. Geriatr Nurs. 2019. doi:10.1016/j.gerinurse.2019.11.014
17. Ullrich P, Werner C, Bongartz M, Kiss R, Bauer J, Hauer K. Validation of a modified life-space assessment in multimorbid older persons with cognitive impairment. Gerontologist. 2019;59(2):e66–e75. doi:10.1093/geront/gnx214
18. Iyer AS, Wells JM, Bhatt SP, et al. Life-space mobility and clinical outcomes in COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:2731–2738. doi:10.2147/COPD.S170887
19. Kennedy RE, Williams CP, Sawyer P, et al. Life-space predicts health care utilization in community-dwelling older adults. J Aging Health. 2019;31:280–292. doi:10.1177/0898264317730487
20. Lo AX, Brown CJ, Sawyer P, Kennedy RE, Allman RM. Life-space mobility declines associated with incident falls and fractures. J Am Geriatr Soc. 2014;62(5):919–923. doi:10.1111/jgs.12787
21. Mackey DC, Lui L-Y, Cawthon PM, Ensrud K, Yaffe K, Cummings SR. Life-space mobility and mortality in older women: prospective results from the study of osteoporotic fractures. J Am Geriatr Soc. 2016;64(11):2226–2234. doi:10.1111/jgs.14474
22. Portegijs E, Iwarsson S, Rantakokko M, Viljanen A, Rantanen T. Life-space mobility assessment in older people in Finland; measurement properties in winter and spring. BMC Res Notes. 2014;7(1):323. doi:10.1186/1756-0500-7-323
23. Fristedt S, Kammerlind AS, Bravell ME, Fransson EI. Concurrent validity of the Swedish version of the life-space assessment questionnaire. BMC Geriatr. 2016;16:181. doi:10.1186/s12877-016-0357-4
24. Ullrich P, Werner C, Eckert T, et al. Cut-off for the life-space assessment in persons with cognitive impairment. Aging Clin Exp Res. 2019;31:1331–1335. doi:10.1007/s40520-018-1062-2
25. McCrone A, Smith A, Hooper J, Parker RA, Peters A. The life-space assessment measure of functional mobility has utility in community-based physical therapist practice in the United Kingdom. Phys Ther. 2019;99(12):1719–1731. doi:10.1093/ptj/pzz131
26. Phillips J, Dal Grande E, Ritchie C, Abernethy AP, Currow DC. A population-based cross-sectional study that defined normative population data for the life-space mobility assessment-composite score. J Pain Symptom Manage. 2015;49(5):885–893. doi:10.1016/j.jpainsymman.2014.09.010
27. Al Snih S, Peek KM, Sawyer P, Markides KS, Allman RM, Ottenbacher KJ. Life-space mobility in Mexican Americans aged 75 and older. J Am Geriatr Soc. 2012;60(3):532–537. doi:10.1111/j.1532-5415.2011.03822.x
28. Suzuki T, Kitaike T, Ikezaki S. Life-space mobility and social support in elderly adults with orthopaedic disorders. Int J Nurs Pract. 2014;20(Suppl 1):32–38. doi:10.1111/ijn.12248
29. Ullrich P, Eckert T, Bongartz M, et al. Life-space mobility in older persons with cognitive impairment after discharge from geriatric rehabilitation. Arch Gerontol Geriatr. 2019;81:192–200. doi:10.1016/j.archger.2018.12.007
30. Eronen J, von Bonsdorff M, Rantakokko M, Portegijs E, Viljanen A, Rantanen T. Socioeconomic status and life-space mobility in old age. J Aging Phys Act. 2016;24:617–623. doi:10.1123/japa.2015-0196
31. Gonzalez BCS, Delgado LH, Quevedo JEC, Cabriaies ECG. Life-space mobility, perceived health, and depression symptoms in a sample of Mexican older adults. Hisp Health Care Int. 2013;11:14–20. doi:10.1891/1540-4126.96.36.199
32. Polku H, Mikkola TM, Portegijs E, et al. Life-space mobility and dimensions of depressive symptoms among community-dwelling older adults. Aging Ment Health. 2015;19:781–789. doi:10.1080/13607863.2014.977768
33. Kuspinar A, Verschoor CP, Beauchamp MK, et al. Modifiable factors related to life-space mobility in community-dwelling older adults: results from the Canadian Longitudinal Study on aging. BMC Geriatr. 2020;20:35. doi:10.1186/s12877-020-1431-5
34. Fontenele IF, Tiuganji CT, MdSM P, Lunardi AC. Activities of daily living and life-space mobility in older adults with chronic obstructive pulmonary. Int J Chron Obstruct Pulmon Dis. 2020;15:69–77. doi:10.2147/COPD.S230063
35. Portegijs E, Rantakokko M, Mikkola TM, Viljanen A, Rantanen T. Association between physical performance and sense of autonomy in outdoor activities and life-space mobility in community-dwelling older people. J Am Geriatr Soc. 2014;62:615–621. doi:10.1111/jgs.12763
36. Rantakokko M, Iwarsson S, Portegijs E, Viljanen A, Rantanen T. Associations between environmental characteristics and life-space mobility in community-dwelling older people. J Aging Health. 2015;27:606–621. doi:10.1177/0898264314555328
37. Rantakokko M, Iwarsson S, Slaug B, Nilsson MH. Life-space mobility in parkinson’s disease: associations with motor and non-motor symptoms. J Gerontol a Biol Sci Med Sci. 2019;74:507–512. doi:10.1093/gerona/gly074
38. H IT T, Takeda T, Nakamura T, Kozuka N, Hoshi F. Life-space mobility and relevant factors in community-dwelling individuals with stroke in Japan: a Cross-sectional Study. Prog Rehabil Med. 2019;4:7.
39. Tsai LT, Portegijs E, Rantakokko M, et al. The association between objectively measured physical activity and life-space mobility among older people. Scand J Med Sci Sports. 2015;25:e368–e373. doi:10.1111/sms.12337
40. Auais M, Alvarado B, Guerra R, et al. Fear of falling and its association with life-space mobility of older adults: a cross-sectional analysis using data from five international sites. Age Ageing. 2017;46:459–465. doi:10.1093/ageing/afw239
41. Sverdrup K, Bergh S, Selbaek G, Roen I, Kirkevold O, Tangen GG. Mobility and cognition at admission to the nursing home - a cross-sectional study. BMC Geriatr. 2018;18:30. doi:10.1186/s12877-018-0724-4
42. Polku H, Mikkola TM, J-P G, et al. Perceived benefit from hearing aid use and life-space mobility among community-dwelling older adults. J Aging Health. 2018;30:408–420. doi:10.1177/0898264316680435
43. Sakakibara BM, Routhier F, Miller WC. Wheeled-mobility correlates of life-space and social participation in adult manual wheelchair users aged 50 and older. Disabil Rehabil Assist Technol. 2017;12:592–598. doi:10.1080/17483107.2016.1198434
44. Sakakibara BM, Miller WC, Eng JJ, Backman CL, Routhier F. Influences of wheelchair-related efficacy on life-space mobility in adults who use a wheelchair and live in the community. Phys Ther. 2014;94:1604–1613. doi:10.2522/ptj.20140113
45. Viljanen A, Mikkola TM, Rantakokko M, Portegijs E, Rantanen T. The association between transportation and life-space mobility in community-dwelling older people with or without walking difficulties. J Aging Health. 2016;28:1038–1054. doi:10.1177/0898264315618919
46. Ahearn B, Mueller C, Boden S, Mignemi D, Tenenbaum S, Bariteau J. Assessment of recovery from geriatric ankle fracture using the Life Space Mobility Assessment (LSA) A Pilot Study. Foot Ankle Int. 2018;3:2473011418795160. doi:10.1177/2473011418795160
47. Ahmed T, Curcio C-L, Auais M, et al. Falls and life-space mobility: longitudinal analysis from the international mobility in Aging Study. Aging Clin Exp Res. 2020. doi:10.1007/s40520-020-01540-0
48. Arya S, Khakharia A, Rothenberg KA, et al. Association of peripheral artery disease with life-space mobility restriction and mortality in community-dwelling older adults. J Vasc Surg. 2020;71:2098–2106.e1. doi:10.1016/j.jvs.2019.08.276
49. Béland FJD, Bier N, Desrosiers J, Kergoat MJ, Demers L. Association between cognitive function and life-space mobility in older adults: results from the FRéLE longitudinal study. BMC Geriatr. 2018;18:15.
50. Bowling CB, Muntner P, Sawyer P, et al. Community mobility among older adults with reduced kidney function: a study of life-space. Am J Kidney Dis. 2014;63:429–436. doi:10.1053/j.ajkd.2013.07.022
51. Brown CJ, Roth DL, Allman RM, Sawyer P, Ritchie CS, Roseman JM. Trajectories of life-space mobility after hospitalization. Ann Intern Med. 2009;150:372–378. doi:10.7326/0003-4819-150-6-200903170-00005
52. Hiyama Y, Kamitani T, Mori K. Effects of an intervention to improve life-space mobility and self-efficacy in patients following total knee arthroplasty. J Knee Surg. 2019;32:966–971. doi:10.1055/s-0038-1672199
53. McCaskill GM, Sawyer P, Burgio KL, et al. The impact of veteran status on life-space mobility among older black and white men in the Deep South. Ethn Dis. 2015;25:255–262. doi:10.18865/ed.25.3.255
54. Nakao M, Izumi S, Yokoshima Y, Matsuba Y, Maeno Y. Prediction of life-space mobility in patients with stroke 2 months after discharge from rehabilitation: a retrospective cohort study. Disabil Rehabil. 2019;1–8.
55. O’Connor ML, Edwards JD, Wadley VG, Crowe M. Changes in mobility among older adults with psychometrically defined mild cognitive impairment. J Gerontol B Psychol Sci Soc Sci. 2010;65B:306–316. doi:10.1093/geronb/gbq003
56. Plys E, Kluge MA. Life-space mobility in a sample of independent living residents within a continuing care retirement community with an embedded wellness program. Clin Gerontol. 2016;39:210–221. doi:10.1080/07317115.2015.1120251
57. Polku H, Mikkola TM, Rantakokko M, et al. Self-reported hearing difficulties and changes in life-space mobility among community-dwelling older adults: a two-year follow-Up study. BMC Geriatr. 2015;15:121. doi:10.1186/s12877-015-0119-8
58. Poranen-Clark T, von Bonsdorff MB, Rantakokko M, et al. Executive function and life-space mobility in old age. Aging Clin Exp Res. 2018;30:145–151. doi:10.1007/s40520-017-0762-3
59. Poranen-Clark T, von Bonsdorff MB, Rantakokko M, et al. The temporal association between executive function and life-space mobility in old age. Gerontol a Biol Sci Med Sci. 2018;73:835–839. doi:10.1093/gerona/glx217
60. Rantakokko M, Portegijs E, Viljanen A, Iwarsson S, Rantanen T. Task modifications in walking postpone decline in life-space mobility among community-dwelling older people: a 2-year follow-up study. Gerontol a Biol Sci Med Sci. 2017;72:1252–1256. doi:10.1093/gerona/glw348
61. Ritchie CS, Locher JL, Roth DL, McVie T, Sawyer P, Allman R. Unintentional weight loss predicts decline in activities of daily living function and life-space mobility over 4 years among community-dwelling older adults. Gerontol a Biol Sci Med Sci. 2008;63:67–75. doi:10.1093/gerona/63.1.67
62. Stewart CML, Wheeler TL
63. Tobinaga T, Obayashi S, Miyamoto R, et al. Factors influencing life-space mobility change after total knee arthroplasty in patients with severe knee osteoarthritis. J Phys Ther Sci. 2019;31:889–894. doi:10.1589/jpts.31.889
64. Choi M, O’Connor ML, Mingo CA, Mezuk B. Gender and racial disparities in life-space constriction among older adults. Gerontologist. 2016;56:1153–1160. doi:10.1093/geront/gnv061
65. Portegijs E, Rantakokko M, Viljanen A, SipilÄ S, Rantanen T. Is frailty associated with life-space mobility and perceived autonomy in participation outdoors? A longitudinal study. Age Ageing. 2016;45(4):550–553. doi:10.1093/ageing/afw072
66. Bentley JP, Brown CJ, McGwin G
67. Boyle PA, Buchman AS, Barnes LL, James BD, Bennett DA. Association between life space and risk of mortality in advanced age. J Am Geriatr Soc. 2010;58(10):1925–1930. doi:10.1111/j.1532-5415.2010.03058.x
68. Crowe M, Andel R, Wadley VG, Okonkwo OC, Sawyer P, Allman RM. Life-space and cognitive decline in a community-based sample of African American and Caucasian older adults. J Gerontol a Biol Sci Med Sci. 2008;63(11):1241–1245. doi:10.1093/gerona/63.11.1241
69. Fathi R, Bacchetti P, Haan MN, Houston TK, Patel K, Ritchie CS. Life-space assessment predicts hospital readmission in home-limited adults. J Am Geriatr Soc. 2017;65:1004–1011. doi:10.1111/jgs.14739
70. Hsu CL, Crockett R, Chan P, Brinke LT, Doherty S, Liu-Ambrose T. Functional connectivity underpinning changes in life-space mobility in older adults with mild cognitive impairment: a 12-month prospective study. Behav Brain Res. 2020;378:112216. doi:10.1016/j.bbr.2019.112216
71. James BD, Boyle PA, Buchman AS, Barnes LL, Bennett DA. Life space and risk of alzheimer disease, mild cognitive impairment, and cognitive decline in old age. Am J Geriatr Psychiatry. 2011;19(11):961–969. doi:10.1097/JGP.0b013e318211c219
72. Kennedy RE, Sawyer P, Williams CP, et al. Life-space mobility change predicts 6-month mortality. J Am Geriatr Soc. 2017;65(4):833–838. doi:10.1111/jgs.14738
73. Lo AX, Rundle AG, Buys D, et al. Neighborhood disadvantage and life-space mobility are associated with incident falls in community-dwelling older adults. J Am Geriatr Soc. 2016;64(11):2218–2225. doi:10.1111/jgs.14353
74. Mackey DC, Cauley JA, Barrett-Connor E, Schousboe JT, Cawthon PM, Cummings SR, Osteoporotic Fractures in Men Research G. Life-space mobility and mortality in older men: a prospective cohort study. J Am Geriatr Soc. 2014;62(7):1288–1296. doi:10.1111/jgs.12892
75. Rantakokko M, Portegijs E, Viljanen A, Iwarsson S, Kauppinen M, Rantanen T. Changes in life-space mobility and quality of life among community-dwelling older people: a 2-year follow-up study. Qual Life Res. 2016;25(5):1189–1197. doi:10.1007/s11136-015-1137-x
76. Sheppard KD, Sawyer P, Ritchie CS, Allman RM, Brown CJ. Life-space mobility predicts nursing home admission over 6 years. J Aging Health. 2013;25:907–920. doi:10.1177/0898264313497507
77. Silberschmidt S, Kumar A, Raji MM, Markides K, Ottenbacher KJ, Al Snih S. Life-space mobility and cognitive decline among Mexican Americans aged 75 years and older. J Am Geriatr Soc. 2017;65(7):1514–1520. doi:10.1111/jgs.14829
78. Xue QL, Fried LP, Glass TA, Laffan A, Chaves PH. Life-space constriction, development of frailty, and the competing risk of mortality: the Women’s Health And Aging Study I. Am J Epidemiol. 2008;167:240–248. doi:10.1093/aje/kwm270
79. De Silva NA, Gregory MA, Venkateshan SS, Verschoor CP, Kuspinar A. Examining the association between life-space mobility and cognitive function in older adults: a systematic review. J Aging Res. 2019;2019:3923574. doi:10.1155/2019/3923574
80. Byles JE, Leigh L, Vo K, Forder P, Curryer C. Life space and mental health: a study of older community-dwelling persons in Australia. Aging Ment Health. 2015;19:98–106. doi:10.1080/13607863.2014.917607
81. Makhija SK, Gilbert GH, Clay OJ, Matthews JC, Sawyer P, Allman RM. Oral health-related quality of life and life-space mobility in community-dwelling older adults. J Am Geriatr Soc. 2011;59(3):512–518. doi:10.1111/j.1532-5415.2010.03306.x
82. Auger C, Demers L, Gelinas I, Miller WC, Jutai JW, Noreau L. Life-space mobility of middle-aged and older adults at various stages of usage of power mobility devices. Arch Phys Med Rehabil. 2010;91(5):765–773. doi:10.1016/j.apmr.2010.01.018
83. Tsai L-T, Rantakokko M, Rantanen T, Viljanen A, Kauppinen M, Portegijs E. Objectively measured physical activity and changes in life-space mobility among older people. J Gerontol a Biol Sci Med Sci. 2016;71(11):1466–1471. doi:10.1093/gerona/glw042
84. Garcia IFF, Tiuganji CT, Simoes M, Santoro IL, Lunardi AC. Systemic effects of chronic obstructive pulmonary disease in young-old adults’ life-space mobility. Int J Chron Obstruct Pulmon Dis. 2017;12:2777–2785. doi:10.2147/COPD.S146041
85. Saajanaho M, Rantakokko M, Portegijs E, et al. Personal goals and changes in life-space mobility among older people. Prev Med. 2015;81:163–167. doi:10.1016/j.ypmed.2015.08.015
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