Associations of neighborhood walkability and walking behaviors by cognitive trajectory in older adults.
Associations of neighborhood walkability and walking behaviors by cognitive trajectory in older adults.
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DOI：
10.1093/geront/gnab005
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发表时间：
2021-01
期刊：
影响因子：
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通讯作者：
A. Rosso;Alyson B Harding;P. Clarke;S. Studenski;C. Rosano
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作者：
A. Rosso;Alyson B Harding;P. Clarke;S. Studenski;C. Rosano
劳顿的老龄化生态模型表明，环境和流动性之间的联系因认知能力下降等个体因素而异。研究设计和方法在1/8英里的老年人（n=545;平均年龄=82; 57%女性; 33%黑人）的住宅内进行虚拟步行能力审计，这些老年人已参加健康ABC队列10年。主要结局是过去一周自我报告的行走能力，次要结局是行动障碍，自我报告的行走1/4英里困难。过去10年的一般认知功能的线性混合模型计算了参与者特定的斜率;低于0的是认知下降者。Logistic回归模型，调整人口统计学和社区社会经济地位，测试每个步行性变量和每个流动性结果之间的关联。测试了步行能力和认知状态之间的相互作用项，并且步行能力分析根据认知状态分层，其中相互作用的p <0.2。结果：在样本中，57.4%的人报告行走，24.2%的人报告行动障碍，51%的人认知能力下降。人行道质量与认知保持者的行走有关;坡度与下降者有关。混合土地使用（比值比=1.61; 95%置信区间：1.12，2.30）和老年住宅（比值比=2.14; 95%置信区间：1.27，3.60）与更多的步行有关，无论认知状态如何。混合土地使用与下降者的流动性残疾程度较低有关，而遗弃的财产与维护者的流动性残疾程度较高有关。讨论和影响政策层面的干预措施，针对步行，包括改善人行道质量和增加混合土地使用可以支持老年人步行，无论认知状态。
BACKGROUND AND OBJECTIVES Lawton's Ecological Model of Aging suggests that associations between environment and mobility differ based on individual factors such as cognitive decline. RESEARCH DESIGN AND METHODS Virtual walkability audits were conducted within 1/8 mile of residences of older adults (n=545; average age=82; 57% female; 33% Black) who had been enrolled in the Health ABC cohort for 10 years. The primary outcome was self-reported walking in past week and secondary was mobility disability, self-reported difficulty to walk ¼ mile. Linear mixed models of general cognitive function over the prior 10 years calculated participant-specific slopes; those below 0 were cognitive decliners. Logistic regression models, adjusted for demographics and neighborhood socioeconomic status, tested associations between each walkability variable and each mobility outcome. Interaction terms between walkability and cognitive status were tested and walkability analyses stratified on cognitive status where p for interaction <0.2. RESULTS In the sample, 57.4% reported walking, 24.2% reported mobility disability, and 51% were cognitive decliners. Sidewalk quality was related to walking in cognitive maintainers; slope was related in decliners. Mixed land use (odds ratio=1.61; 95% confidence interval: 1.12, 2.30) and senior residence (odds ratio=2.14; 95% confidence interval: 1.27, 3.60) were related to greater walking, regardless of cognitive status. Mixed land use was related to less mobility disability in decliners and abandoned properties were related to greater mobility disability in maintainers. DISCUSSION AND IMPLICATIONS Policy-level interventions targeted at walkability, including improved sidewalk quality and increasing mixed land use could support walking in older adults, regardless of cognitive status.