The role of the built environment and assistive devices for outdoor mobility in later life

Abstract

Objective: Despite theoretical advances in our conceptualization of disability, the "environment" remains a largely unspecified term in disablement models. The purpose of this research is to draw upon on a unique state-of-the-art nationally representative data set with innovative measures that provide the opportunity to tease apart and specify the role of different environmental factors in the disablement process.

Method: Using multinomial logistic regression with data from the first round of the recently launched National Health and Aging Trends Study (N = 6,578 community-dwelling Americans age 65+), this paper examines the role of the built environment (e.g., stairs or ramps leading up to the home) and mobility devices on reported difficulty going outside by oneself.

Results: Almost three quarters of community-dwelling older Americans live in a residence that has stairs at the entrance. Older adults who use a walker to help them get around are adversely affected by stairs at the entrance to their home, effectively doubling the odds of reporting difficulty going outside independently. Roughly 10% of community-dwelling older Americans live in a residence with a ramp at the entryway, which reduces the odds of outdoor mobility difficulty threefold among those using wheeled mobility devices. However, ramps at the entryway are associated with a higher likelihood of reporting difficulty going outdoors among those who do not use any type of mobility device.

Discussion: A better understanding of the complexities of the environment in the disablement process is critical for the planning and development of age-friendly environments allowing older adults to age in place.

Keywords: Assistive technology; Built environment; Mobility disability.

Figure 1.

Conceptual model: the dynamic nature of disability (adapted from WHO 2001).

Figure 2.

(a) Odds ratios of risk for some/lot outdoor mobility difficulty by use of walker and stairs at entry (National Health and Aging Trends Study: 2011). Note: Predicted values for the intercept are calculated for an African American female, age 85 years or more, with less than a high school education, widowed, living in a single unit house. (b) Odds ratios of risk for some/lot outdoor mobility difficulty by use of wheelchair/scooter and ramp at entry (National Health and Aging Trends Study: 2011). Note: Predicted values for the intercept are calculated for an African American female, age 85 years or more, with less than a high school education, widowed, living in a single unit house.

Figure 2.

(a) Odds ratios of risk for some/lot outdoor mobility difficulty by use of walker and stairs at entry (National Health and Aging Trends Study: 2011). Note: Predicted values for the intercept are calculated for an African American female, age 85 years or more, with less than a high school education, widowed, living in a single unit house. (b) Odds ratios of risk for some/lot outdoor mobility difficulty by use of wheelchair/scooter and ramp at entry (National Health and Aging Trends Study: 2011). Note: Predicted values for the intercept are calculated for an African American female, age 85 years or more, with less than a high school education, widowed, living in a single unit house.