Lower-body function, neighborhoods, and mobility disability in an older population

Background: Promotion of walking is an efficient and effective public health strategy to preserve and enhance health and functioning in an aging population. This is a report of the extent to which elements of the neighborhood environment moderate the association between poor lower-body function and reported difficulty in walking 2-3 city blocks among older adults. Methods: Results are based on a cross-sectional study, consisting of interviews with 884 adults aged 65 and over, identified through senior centers in Alameda County CA, Cook County IL, Allegheny County PA, and Wake/Durham counties NC. A summary measure of lower-body function is derived from direct performance measures of balance, walking speed, and lower-body strength. Neighborhood elements are based on responses to questions from the Neighborhood Environment Walking Scale (NEWS). Main effects are examined with a generalized estimating equation (GEE) in SAS 9.2. Results: There is a significant additive interaction between lower-body function and perceived neighborhood environmental elements (p<0.20). Of older adults with poor capacity, those who report living in neighborhoods with mixed use, absence of barriers, high accessibility to services, and short walking times to destinations report significantly less difficulty walking 2-3 blocks than those residing in other types of neighborhoods. Older adults with strong lower-body function tend to report little difficulty walking 2-3 city blocks, and neighborhood elements have no significant effect. Conclusion: Neighborhood design may be especially important for enhancing walking and mobility among older adults with reduced lower-body function.