Impact of mobility restrictions on active aging; cross-sectional associations and longitudinal changes parallel to COVID-19 restrictions.

BACKGROUND: Meaningful activities can be done in or around home, but opportunities for participation and active aging decrease when moving in smaller areas. Active aging refers to having an active approach to life in line with one's goals, ability and opportunities. In adults over 75 years with different baseline neighborhood mobility levels, we studied active aging scores two years prior to and amid COVID-19, when governments restricted mobility of residents to slow the COVID-19 outbreak. METHODS: AGNES cohort data were collected in 2017-2018 and spring 2020. Individuals were queried about their will, ability, and opportunity, and extent of doing 17 activities, and subsequently, item, composite and sub-scores of active aging were computed. Neighborhood mobility was assessed as frequency of moving in or beyond own neighborhood (limited, regular, daily=reference). Associations were studied using Generalized Linear Models (cross-sectionally, n = 1007) and General Estimating Equations (prospectively, n = 774). RESULTS: Participants with limited baseline neighborhood mobility had lower active aging scores than those with daily mobility, but the decline over time was similar. Some item scores on opportunity to act and extent of doing, e.g. for making one's day more interesting and advancing matters of faith or worldview, were better retained amid COVID-19 by those with limited mobility, attenuating group differences. CONCLUSIONS: Active aging scores were somewhat compromised in individuals with limited neighborhood mobility, but opportunities for and engagement in several activities seemed to be better retained amid COVID-19 than for those with daily mobility. Thus, active aging may be possible despite mobility restriction.

Coronavirus-related health literacy and perceived restrictiveness of protective measures among community-dwelling older persons in Finland.

BACKGROUND: Older people with limited health literacy may encounter difficulties in finding relevant information on COVID-19, understanding its relevance, and complying with recommended protective measures. Complying with such recommendations has required older as well as younger persons to change their daily lives in ways that have reduced their opportunities for engaging in many activities meaningful to them. AIMS: To find out from what sources older people have obtained information on protective measures, the level of their coronavirus-related health literacy (CHL), and whether CHL is associated with their perceptions of the restrictiveness of coronavirus-related protective measures. METHODS: 696 Finnish men and women aged over 77 answered a mailed questionnaire on their CHL, sources of information and perceptions of the restrictiveness of the recommended protective measures. The association of CHL with perceived restrictiveness was studied using multinomial logistic regression analysis. RESULTS: Television and newspapers were the most frequently reported sources of information. Reporting high confidence in the ability to assess how one's behavior influences coronavirus infection risk was associated with higher odds of perceiving the protective measures to be highly restrictive, when controlling for age, gender, and difficulty in using digital devices (OR 3.21, 95% CI 1.09, 9.46). DISCUSSION: Participants who reported being highly confident about their ability to appraise the influence of their behavior on their susceptibility to coronavirus infection were more likely to perceive that the recommended protective measures had restricted their daily lives. CONCLUSIONS: Health literacy plays a role in complying with recommended restrictions.

Maintenance of high quality of life as an indicator of resilience during COVID-19 social distancing among community-dwelling older adults in Finland.

PURPOSE: Social distancing during the COVID-19 pandemic reduced possibilities for activities of choice potentially threatening quality of life (QoL). We defined QoL resilience as maintaining high quality of life and studied whether walking speed, absence of loneliness, living arrangement, and stress-coping ability predict QoL resilience among older people. METHODS: Community-dwelling 75-, 80-, and 85-year-old persons (n = 685) were interviewed and examined in 2017-2018 and were followed up during COVID-19 social distancing in 2020. We assessed QoL using the OPQOL-brief scale and set a cut-off for 'constant high' based on staying in the highest baseline quartile over the follow-up and categorized all others as having 'low/moderate'. Perceived restrictiveness of the social distancing recommendations was examined with one item and was categorized as 'yes' or 'no' restrictiveness. RESULTS: Better stress-coping ability (OR 1.21, 95% CI 1.14-1.28) and not being lonely (OR 2.67, 95% CI 1.48-4.63) increased the odds for constant high QoL from before to amid social distancing, and the odds did not differ according to the perceived restrictiveness of the social distancing recommendations. Higher walking speed predicted constant high QoL only among those perceiving restrictiveness (OR 1.16, 95% CI 1.07-1.27). Living arrangement did not predict constant high QoL. CONCLUSION: During social distancing, psychosocial resources helped to maintain good QoL regardless how restrictive the social distancing recommendations were perceived to be. Better physical capacity was important for constant high QoL only among those perceiving restrictiveness presumably because it enabled replacing blocked activities with open outdoor physical activities.

Self-rated resilience and mobility limitations as predictors of change in active aging during COVID-19 restrictions in Finland: a longitudinal study.

Social distancing during the COVID-19 pandemic decreased older people's opportunities to lead an active life. The purpose of this study was to investigate whether walking difficulties predict changes in leading an active life during the COVID-19 social distancing recommendation compared to 2 years before, and whether self-rated resilience moderates this association among older people. Data were collected during social distancing recommendation in May and June 2020 and 2 years before (2017-18) among community-living AGNES study participants initially aged 75, 80, or 85 years (n = 809). Leading an active life was assessed with the University of Jyväskylä Active Aging Scale (UJACAS; total score range 0-272) and resilience with the 10-item Connor-Davidson Resilience Scale (0-40). Self-reported walking difficulties over a 2 km distance were categorized into no difficulty, difficulty, and unable to walk. The total UJACAS score declined 24.9 points (SD 23.5) among those without walking difficulty, 27.0 (SD 25.0) among those reporting walking difficulty and 19.5 (SD 31.2) among those unable to walk 2 km. When adjusted for baseline UJACAS score, those unable to walk 2 km demonstrated the greatest decline. Baseline resilience moderated this association: Higher resilience was associated with less declines in UJACAS scores among persons with or without walking difficulty, and with more declines among persons unable to walk 2 km. When opportunities for leading an active life are compromised, those with less physical and psychological resources become particularly vulnerable to further declines in activity.

Use of walking modifications, perceived walking difficulty and changes in outdoor mobility among community-dwelling older people during COVID-19 restrictions.

BACKGROUND: Outdoor mobility enables participation in essential out-of-home activities in old age. AIM: To compare changes in different aspects of outdoor mobility during COVID-19 restrictions versus two years before according to self-reported walking. METHODS: Community-dwelling participants of AGNES study (2017-2018, initial age 75-85) responded to AGNES-COVID-19 postal survey in spring 2020 (N = 809). Life-space mobility, autonomy in participation outdoors, and self-reported physical activity were assessed at both time points and differences according to self-reported walking modifications and difficulty vs. intact walking at baseline were analyzed. RESULTS: Life-space mobility and autonomy in participation outdoors had declined (mean changes -11.4, SD 21.3; and 6.7, SD 5.3, respectively), whereas physical activity had increased (5.5 min/day, SD 25.1) at follow-up. Participants perceiving walking difficulty reported the poorest baseline outdoor mobility, a steeper decline in life-space mobility (p = 0.001), a smaller increase in physical activity (p < 0.001), and a smaller decline in autonomy in participation outdoors (p = 0.017) than those with intact walking. Those with walking modifications also reported lower baseline life-space mobility and physical activity, a steeper decline in life-space mobility and a smaller increase in physical activity those with intact walking (p < 0.001 for both). DISCUSSION: Participants reporting walking modifications remained the intermediate group in outdoor mobility over time, whereas those with walking difficulty showed the steepest decline in outdoor mobility and hence potential risk for accelerated further functional decline. CONCLUSION: Interventions should target older people perceiving walking difficulty, as they may be at the risk for becoming homebound when environmental facilitators for outdoor mobility are removed.

Older adults' activity destinations before and during COVID-19 restrictions: From a variety of activities to mostly physical exercise close to home.

The aim was to study various types of older adult's activity destinations (counts, frequency of visitation, and distance from home) in the pre-COVID-19 era, and to study prospectively how COVID-19-related regulations limiting mobility affected these. Using a map-based questionnaire, 75-85-year-old participants reported activity destinations, that is, any destinations for physical exercise, destinations facilitating one's outdoor mobility, and destinations for other activities, which they had visited several times during the past month. At baseline, a variety of activity destinations was reported, but during COVID-19, destinations reported markedly declined in number, they were reported predominantly for physical exercise, and they were located closer to home.

Life-Space Mobility and Active Aging as Factors Underlying Quality of Life Among Older People Before and During COVID-19 Lockdown in Finland-A Longitudinal Study.

BACKGROUND: Social distancing, that is, avoiding places with other people and staying at home, was recommended to prevent viral transmission during the COVID-19 pandemic. Potentially, reduced out-of-home mobility and lower activity levels among older people may lower their quality of life (QOL). We studied cross-sectional and longitudinal associations of and changes in life-space mobility, active aging, and QOL during COVID-19 social distancing compared to 2 years before. METHODS: Altogether 809 community-living participants initially aged 75, 80, or 85 years of our active aging study (AGNES) conducted in 2017-2018 took part in the current AGNES-COVID-19 survey in May and June 2020. Outdoor mobility was assessed with the Life-Space Assessment (range 0-120). Active approach to life was assessed with the University of Jyväskylä Active Aging Scale (range 0-272), and QOL with the shortened Older People's Quality of Life Questionnaire (range13-65; higher scores better for all). Data were analyzed with General Estimating Equations, General Linear Models, and One-way analysis of variance. RESULTS: Life-space mobility (B -10.8, SE 0.75, p < .001), the active aging score (B -24.1, SE 0.88, p < .001), and the QOL score (B -1.65, SE 0.21, p < .001) were lower during COVID-19 social distancing versus 2 years before. Concurrent life-space mobility and active aging scores, age, and sex explained 48% of QOL at the baseline and 42% during social distancing. Longitudinally, steeper declines in all 3 variables coincided. CONCLUSION: The observed declines indicate compliance with social distancing recommendation, but underline the importance of participation in meaningful life situations as a factor underlying good QOL also during the COVID-19 pandemic.