Mobility Among Older African Americans and Whites

描述(由首席研究人员提供)：75岁及以上的成年人发生急性事件(如住院、摔倒和停止驾驶)的风险很高，与活动能力和社会参与能力下降有关，这是生活质量不可或缺的功能领域。适当的社会支持，较低的症状负担，以及事后服务和资源的使用，可以有助于保持行动能力和参与度，尽管与年龄有关的损伤、疾病和特定任务能力的下降。以前几乎所有关于年龄相关功能改变的流行病学研究都集中在特定的活动相关活动上。UAB对老龄化的研究调查人员使用生活空间评估(LSA)对与年龄相关的社会参与变化有了深入的了解，LSA是他们开发的一种访谈工具，用于评估社区居住的老年人的流动性。LSA反映了评估前四周内五个地理区域内的距离、频率和活动独立性，这些区域从一个人睡觉的房间延伸到城镇以外的地方。现有数据表明，社会人口因素、身体、情绪和认知健康都能预测6个月或更长时间内生活空间的变化。这一应用的基本假设是，75岁后社会参与度的许多下降是由于对特定急性事件的更直接(一个月内)反应的残余效应，而不是逐渐同等的下降。我们建议对500名75岁及以上的社区居住成年人进行一项新的前瞻性观察研究(UAB老年化研究II)，以解决以下目标：1)评估与75岁及以上社区居住成年人中常见的特定事件相关的LSA变化的即时幅度，并跟踪事件发生后生活空间的变化；2)确定一个月内的生活空间变化是否可预测后续不良结果，即ADL/IADL困难、疗养院安置和死亡；以及3)研究社会支持、症状负担、事件后服务和资源在LSA变化中的作用。这项研究将包括2010-2011年的家庭基线评估，以记录已知的生活空间预测因素。每月的后续电话访谈将在三年内评估生活空间、ADL/IADL和生命状态。多水平变化或随机效应回归模型将被用来检查随着时间推移的生活空间轨迹，而Cox比例风险模型将被用来评估不良结果的预测因素。研究结果将被用来确定与特定事件相关的生活空间变化的幅度，确定缓和生活空间流动性急剧变化的因素，并指导制定和测试干预措施，以优化晚年生活空间流动性。

DESCRIPTION (provided by principal investigator): Adults aged 75 years and older are at high risk for acute events (i.e. hospitalizations, falls, and driving cessation), associated with declines in mobility and social participation, functional domains integral to quality of life. Appropriate social support, lower symptom burden, and post- event service and resource use can contribute to maintenance of mobility and participation despite age-related impairments, disease, and declines in task-specific abilities. Nearly all previous epidemiological research on age-related functional change has focused on specific mobility-related activities. UAB Study of Aging investigators have advanced knowledge about age-related changes in social participation using the Life-space Assessment (LSA), an interview tool they developed to evaluate mobility among community-dwelling older adults. The LSA reflects distance, frequency, and independence of movement in five geographically defined zones, extending from the room where one sleeps to beyond town, in the four weeks before the assessment. Available data suggest that socio-demographic factors, physical, emotional, and cognitive health all predict changes in life-space over 6 months and longer periods. The underlying hypothesis of this application is that many declines in social participation after age 75 are due to residual effects of more immediate (within one month) responses to specific acute events, rather than a gradual equivalent decline. We propose a new prospective observational study of 500 community-dwelling adults aged 75 years and older (the UAB Study of Aging II) to address the following aims: 1) Assess the immediate magnitude of LSA changes associated with specific events commonly occurring among community-dwelling adults aged 75 years and older and follow changes in life-space after the occurrence of the events; 2) Determine if life- space changes over one-month predict subsequent adverse outcomes, i.e. ADL/IADL difficulty, nursing home placement and death; and 3) Examine the role of social support, symptom burden and post-event services and resources on changes in LSA. This study will include a baseline in- home assessment in 2010-2011 to document known predictors of life-space. Monthly follow-up telephone interviews will assess life-space, ADL/IADL, and vital status over a three-year period. Multilevel change or random-effects regression models will be used to examine life-space trajectories over time and Cox proportional hazards models to evaluate predictors of adverse outcomes. Findings will be used to identify the magnitude of life-space changes associated with specific events, to identify factors that moderate precipitous life-space mobility changes, and to guide the development and testing of interventions to optimize life-space mobility in late life.