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      Clinical Interventions in Aging (submit here)

      This international, peer-reviewed Open Access journal by Dove Medical Press focuses on prevention and treatment of diseases in people over 65 years of age. Sign up for email alerts here.

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      Life-Space Mobility in the Elderly: Current Perspectives

      review-article
      1 , 2 , 1 , 2 , 3
      Clinical Interventions in Aging
      Dove
      life-space mobility, LSA, LSM, mobility, older adults

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          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.

          Most cited references71

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          The Life Space Questionnaire: A Measure of the Extent of Mobility of Older Adults

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            Life-space constriction, development of frailty, and the competing risk of mortality: the Women's Health And Aging Study I.

            Frailty is a common clinical syndrome in older adults that carries an increased risk for poor health outcomes. Little is known about the behavioral antecedents of frailty. In this study, the authors hypothesized that constriction of life space identifies older adults at risk for frailty, potentially a marker of already-decreased physiologic reserve. The authors analyzed the 3-year (1992-1995) cumulative incidence of frailty using a previously validated clinical phenotype in relation to baseline life-space constriction among 599 community-dwelling women aged 65 years or older who were not frail at baseline. Frailty-free mortality (i.e., death prior to observation of frailty) was treated as a competing risk. Multivariate survival models showed that, compared with women who left the neighborhood four or more times per week, those who left the neighborhood less frequently were 1.7 times (95% confidence interval: 1.1, 2.4; p < 0.05) more likely to become frail, and those who never left their homes experienced a threefold increase in frailty-free mortality (95% confidence interval: 1.4, 7.7; p < 0.01), after adjustment for chronic disease, physical disability, and psychosocial factors. Together, these data suggest that a slightly constricted life space may be a marker and/or risk factor for the development of frailty that may prove useful as a screening tool or a target of intervention.
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              Trajectories of life-space mobility after hospitalization.

              Life space is a measure of where a person goes, the frequency of going there, and the dependency in getting there. It may be a more accurate measure of mobility in older adults because it reflects participation in society as well as physical ability. To assess effects of hospitalization on life space in older adults, and to compare life-space trajectories associated with surgical and nonsurgical hospitalizations. Prospective observational study. Central Alabama. 687 community-dwelling Medicare beneficiaries at least 65 years of age with surgical (n = 44), nonsurgical (n = 167), or no (n = 476) hospitalizations. Life-Space Assessment (LSA) scores before and after hospitalization (range, 0 to 120; higher scores reflect greater mobility). Mean age of participants was 74.6 years (SD, 6.3). Fifty percent were black, and 46% were male. Before hospitalization, adjusted LSA scores were similar in participants with surgical and nonsurgical admissions. Life-space assessment scores decreased in both groups immediately after hospitalization; however, participants with surgical hospitalizations had a greater decrease in scores (12.1 more points [95% CI, 3.6 to 20.7 points]; P = 0.005) than those with nonsurgical hospitalizations. However, participants with surgical hospitalizations recovered more rapidly over time (gain of 4.7 more points [CI, 2.0 to 7.4 points] per ln [week after discharge]; P < 0.001). Score recovery for participants with nonsurgical hospitalizations did not significantly differ from the null (average recovery, 0.7 points [CI, -0.6 to 1.9 points] per ln [week after discharge]). Life space immediately before and after hospitalization was self-reported, often after hospital discharge. Hospitalization decreases life space in older adults. Surgical hospitalizations are associated with immediate marked life-space declines followed by rapid recovery, in contrast to nonsurgical hospitalizations, which are associated with more modest immediate declines and little evidence of recovery after several years of follow-up. National Institute on Aging.
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                Author and article information

                Journal
                Clin Interv Aging
                Clin Interv Aging
                cia
                clinintag
                Clinical Interventions in Aging
                Dove
                1176-9092
                1178-1998
                15 September 2020
                2020
                : 15
                : 1665-1674
                Affiliations
                [1 ]Division of Rehabilitation Sciences/School of Health Professions, The University of Texas Medical Branch , Galveston, TX, USA
                [2 ]Sealy Center on Aging, The University of Texas Medical Branch , Galveston, TX, USA
                [3 ]Division of Geriatrics/Department of Internal Medicine, The University of Texas Medical Branch , Galveston, TX, USA
                Author notes
                Correspondence: Soham Al Snih Division of Rehabilitation Sciences/School of Health Professions, The University of Texas Medical Branch , 301 University Blvd., Galveston, TX77555-0170, USATel +1409-266-9691Fax +1409-772-8931 Email soalsnih@utmb.edu
                Author information
                http://orcid.org/0000-0001-6949-9012
                Article
                196944
                10.2147/CIA.S196944
                7501960
                32982200
                9733142b-1bb8-46d8-8aa3-ad0b5ae4a96b
                © 2020 Johnson et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 05 March 2020
                : 10 August 2020
                Page count
                Figures: 0, References: 88, Pages: 10
                Categories
                Review

                Health & Social care
                life-space mobility,lsa,lsm,mobility,older adults
                Health & Social care
                life-space mobility, lsa, lsm, mobility, older adults

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