BACKGROUND: This study aimed to analyze the needs and utilization of the home and community integrated healthcare and daily care services (\"home and community care services\" for short) among older adults in China and to investigate the inequity in services utilization.
METHODS: Cross-sectional data were obtained from the 2018 China Health and Retirement Longitudinal Study. Needs and utilization rates of the home and community care services in older adults of 60 years old and above were analyzed. Binary logistic regression analysis was performed to explore the factors associated with services utilization among older adults with limited mobility. Concentration index, horizontal inequity index, and Theil index were used to analyze inequity in services utilization. Decomposition analyses of inequity indices were conducted to explain the contribution of different factors to the observed inequity.
RESULTS: About 32.6% of older adults aged 60 years old and above had limited mobility in China in 2018, but only 18.5% of them used the home and community care services. Among the single service utilization, the highest using rate (15.5%) was from regular physical examination. Limited mobility, age group, income level, region, self-assessed health, and depression were statistically significant factors associated with utilization of any one type of the services. Concentration indices of any one type service utilization and regular physical examination utilization were both above 0.1, and the contribution of income to inequity were both over 60%. Intraregional factor contributed to about 90% inequity of utilizing any one type service, regular physical examination and onsite visit.
CONCLUSIONS: This current study showed that older adults with needs of home and community care services underused the services. Pro-rich inequities in services utilization were identified and income was the largest source of inequity. The difference of the home and community care service utilization was great among provinces but minor across regions. Policies to optimize resources allocation related to the home and community care services are needed to better satisfy the needs of older adults with limited mobility, especially in the low-income group and the central region.

BACKGROUND: We estimated the short-term effects of an educational workshop and 10-week outdoor walk group (OWG) compared to the workshop and 10 weekly reminders (WR) on increasing outdoor walking (primary outcome) and walking capacity, health-promoting behavior, and successful aging defined by engagement in meaningful activities and well-being (secondary outcomes) in older adults with difficulty walking outdoors.
METHODS: In a 4-site, parallel-group randomized controlled trial, two cohorts of community-living older adults (≥ 65 years) reporting difficulty walking outdoors participated. Following a 1-day workshop, participants were stratified and randomized to a 10-week OWG in parks or 10 telephone WR reinforcing workshop content. Masked evaluations occurred at 0, 3, and 5.5 months. We modeled minutes walked outdoors (derived from accelerometry and global positioning system data) using zero-inflated negative binomial regression with log link function, imputing for missing observations. We modeled non-imputed composite measures of walking capacity, health-promoting behavior, and successful aging using generalized linear models with general estimating equations based on a normal distribution and an unstructured correlation matrix. Analyses were adjusted for site, participation on own or with a partner, and cohort.
RESULTS: We randomized 190 people to the OWG (n = 98) and WR interventions (n = 92). At 0, 3, and 5.5 months, median outdoor walking minutes was 22.56, 13.04, and 0 in the OWG, and 24.00, 26.07, and 0 in the WR group, respectively. There was no difference between groups in change from baseline in minutes walked outdoors based on incidence rate ratio (IRR) and 95% confidence interval (CI) at 3 months (IRR = 0.74, 95% CI 0.47, 1.14) and 5.5 months (IRR = 0.77, 95% CI 0.44, 1.34). Greater 0 to 3-month change in walking capacity was observed in the OWG compared to the WR group (βz-scored difference = 0.14, 95% CI 0.02, 0.26) driven by significant improvement in walking self-efficacy; other comparisons were not significant.
CONCLUSIONS: A group, park-based OWG was not superior to WR in increasing outdoor walking activity, health-promoting behavior or successful aging in older adults with difficulty walking outdoors; however, the OWG was superior to telephone WR in improving walking capacity through an increase in walking self-efficacy. Community implementation of the OWG is discussed.
BACKGROUND: ClinicalTrials.gov NCT03292510 Date of registration: September 25, 2017.

There are few validated contextual measures predicting adoption of evidence-based programs. Variation in context at clinical sites can hamper dissemination. We examined organizational characteristics of Veterans Affairs hospitals implementing STRIDE, a hospital walking program, and characteristics\' influences on program adoption. Using a parallel mixed-method design, we describe context and organizational characteristics by program adoption. Organizational characteristics included: organizational resilience, implementation climate, organizational readiness to implement change, highest complexity sites versus others, material support, adjusted length of stay (LOS) above versus below national median, and improvement experience. We collected intake forms at hospital launch and qualitative interviews with staff members at 4 hospitals that met the initial adoption benchmark, defined as completing supervised walks with 5+ unique hospitalized Veterans during months 5 to 6 after launch with low touch implementation support. We identified that 31% (n = 11 of 35) of hospitals met adoption benchmarks. Seven percent of highest complexity hospitals adopted compared to 48% with lower complexity. Forty-three percent that received resources adopted compared to 29% without resources. Thirty-six percent of hospitals with above-median LOS adopted compared to 23% with below-median. Thirty-five percent with at least some implementation experience adopted compared to 0% with very little to no experience. Adopters reported higher organizational resilience than non-adopters (mean = 23.5 [SD = 2.6] vs 22.7 [SD = 2.6]). Adopting hospitals reported greater organizational readiness to change than those that did not (mean = 4.2 [SD = 0.5] vs 3.8 [SD = 0.6]). Qualitatively, all sites reported that staff were committed to implementing STRIDE. Participants reported additional barriers to adoption including challenges with staffing and delays associated with hiring staff. Adopters reported that having adequate staff facilitated implementation. Implementation climate did not have an association with meeting STRIDE program adoption benchmarks in this study. Contextual factors which may be simple to assess, such as resource availability, may influence adoption of new programs without intensive implementation support.

BACKGROUND: Globally, the population is rapidly ageing, stemming from a recent decline in mortality, and an increase in life expectancy. About 727 million people globally were aged ≥65 in 2020, and 1 in 6 people will be ≥65 years by 2050. About 7% of Ghana\'s population was over 60 years in 2010, and projected to be 12% by 2050. However, the aged are confronted with degenerative conditions that translate into difficulty with mobility. The study was conducted to investigate the difficulty with mobility among the aged in Ghana.
METHODS: The study utilised a cross-sectional dataset of the 2014/2015 (wave 2) Study on Global Ageing and Adult Health and included 1,856 participants aged ≥50 years. The survey command was applied to adjust for sampling biases and the design of the study. At 5% alpha level, a chi-square test of independence was conducted to determine the association between dependent and independent variables. At 95% confidence interval and 5% alpha level, three-level multilevel logistic regression models were performed. The fixed-effects were presented in odds ratio and the random effects were presented using the Intra-Class Correlation. All analysis were performed using STATA statistical software version 16.0.
RESULTS: Out of the 1,856 participants, 40.3% had difficulty with mobility. Additionally, age (80 and above) [AOR = 3.05, 95%CI = 1.78-5.22], self-reported poor/bad health status [AOR = 2.39, 95%CI = 1.35-4.23], having severe/extreme difficulty performing household activities [AOR = 25.12, 95%CI = 11.49-44.91], experienced severe/extreme bodily pains [AOR = 4.56, 95%CI = 2.16-9.64], severe/extreme sleep problems [AOR = 4.15, 95%CI = 1.68-10.29], and participants with difficulty with sight/vision [AOR = 1.56, 95%CI = 1.16-2.10] had higher odds of difficulty with mobility.
CONCLUSIONS: The aged in Ghana had relatively higher prevalence (40.3%) of difficulty with mobility which is influenced by demographics, health status, and degeneration associated with ageing. This highlights the need to provide social support and strengthen social capital for the aged in Ghana, especially those with difficulty with vision, experiencing bodily pains and had poor health status. Additionally, the Government and stakeholders should provide assistive devices for the aged and geriatric care including recreational fields and care homes to address the health and physical needs of the aged in Ghana.

OBJECTIVE:  Exercise therapy is a pivotal component in the multidisciplinary approach to managing tuberculosis (TB)-related peripheral neuropathy (PN). A personalized exercise protocol maximizes therapeutic benefits while minimizing the risk of symptom exacerbation. This study aimed to determine the effect of multicomponent exercise programs on pain and functional mobility in antitubercular drug therapy-induced PN in pulmonary TB survivors.
METHODS: In the approved experimental study, 110 participants with antitubercular study drug-induced PN were randomly assigned to two groups, and data were analyzed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States). The study\'s purpose was to evaluate the efficacy of a multicomponent exercise program on PN symptoms.
RESULTS: The study assessed a multicomponent exercise regimen\'s effectiveness in individuals with TB-related PN. The experiment group demonstrated noteworthy pain reduction (p < 0.0001), improvement in neurological symptoms (p < 0.0001), and better functional outcomes in the 12-minute walk test (p < 0.0001) and sit-and-reach test (p < 0.0001). Conversely, the control group exhibited less significant improvements. The low p-values indicate the intervention\'s effectiveness, emphasizing its impact on pain reduction, neurological symptoms, and functional abilities in comparing the experimental and control groups.
CONCLUSIONS: The study demonstrated the significant effectiveness of an eight-week multicomponent exercise program in individuals with pulmonary TB-related PN, showcasing notable improvements in pain reduction and functional mobility compared to a conventional single-component regimen in the control group.

OBJECTIVE: To synthesise evidence evaluating non-pharmacological interventions targeting mobility among people with advanced cancer, considering the type, efficacy and contextual factors that may influence outcome.
METHODS: Systematic review of studies of non-pharmacological interventions in adults (≥ 18 years) with advanced (stage III-IV) cancer, and assessing mobility using clinical or patient-reported outcome measures. Searches were conducted across three electronic databases (MEDLINE, EMBASE and CINAHL) up to June 2024. Methodological quality was assessed using Joanna Briggs Institute tools and contextual factors were evaluated through the Context and Implementation of Complex Interventions framework. A narrative synthesis was conducted due to clinical heterogeneity of included studies.
RESULTS: 38 studies encompassing 2,464 participants were included. The most frequent mobility outcome measure was the 6-min walk test (26/38 studies). Exercise was the most common intervention, (33 studies: 27 aerobic and resistance, 5 aerobic, 1 resistance versus aerobic training) and improvements in mobility were found in 21/33 outcomes. Electrotherapy interventions led to significant improvements in mobility in 3/5 studies. Geographical factors (e.g. distance, transport, parking requirements) potentially limited participation in 18/38 studies. A lack of ethnic diversity among populations was evident and language proficiency was an inclusion criterion in 12 studies.
CONCLUSIONS: Exercise and neuromuscular electrical stimulation appear to improve mobility outcomes in advanced cancer. The evaluation of other non-pharmacological interventions targeting mobility should consider access and inclusivity, and be adaptable to the needs of this population.

Older adults have higher rates of emergency department (ED) admissions when compared to their younger counterparts. Mobility is the ability to move around, but also encompasses the environment and the ability to adapt to it. Walking aids can be used to improve mobility and prevent falls. According to international guidelines, they must be available in Geriatric EDs. This study aims to evaluate the efficacy of a program of training and provision of walking aids (WA), associated or not with telemonitoring, on fear of falling, mobility, quality of life and risk of falls up to 3 and 6 months in older adults cared for in an ED. A randomized controlled trial will be carried out in the ED. Participants will be randomized and allocated into three groups, as follows: A) walking aid group will be trained for the use of a walking aid and receive guidance on safe gait; B) walking aid and telemonitoring group will receive training for the use of a walking aid, guidance on safe gait, and telemonitoring (every two weeks for first three months); C) Control group will receive only guidance on safe gait. Patients will undergo a baseline evaluation encompassing sociodemographic and clinical data, mobility in life spaces, gait speed, muscle strength, functionality, quality of life, fear of falling, history of falls, cognition and mood before the intervention. Gait time and fear of falling will be assessed again after the intervention in ED. Finally, mobility in life spaces, functionality, quality of life, fear of falling, history of falls, cognition, and mood will be assessed 3 and 6 months after discharge from the geriatric ED through a telephone interview. Provision of walking aids in the geriatric ED is currently recommended. This study will be the first randomized controlled trial that will evaluate the impact of training and provision of these devices in the ED. Trial registration number: NCT05950269.

BACKGROUND: Mobility limitations (e.g., using wheelchair) have been closely linked to diminished functional independence and quality of life in older adults. The regulation of mobility is pertaining to multiple neurophysiologic and sociodemographic factors. We here aimed to characterize the relationships of these factors to the risk of restricted mobility in older adults.
METHODS: In this longitudinal study, 668 older adults with intact mobility at baseline completed the baseline assessments of clinical characteristics, cognitive function, sleep quality, activities of daily living (ADL), walking performance, beat-to-beat blood pressure, and structural MRI of the brain. Then 506 of them (mean age = 70.7 ± 7.5 years) responded to the follow-up interview on the mobility limitation (as defined by if using wheelchair, cane, or walkers, or being disabled and lying on the bed) after 18 ± 3.5 months. Logistic regression analyses were performed to examine the relationships between the baseline characteristics and the follow-up mobility restriction.
RESULTS: At baseline, compared to intact-mobility group (n = 475), restricted-mobility group (n = 31) were older, with lower score of ADL and the Montreal Cognitive Assessment (MoCA), greater score of Pittsburgh Sleep Quality Index (PSQI), poorer cardio- and cerebral vascular function, and slower walking speeds (ps < 0.05). The logistic regression analysis demonstrated that participants who were with history of falls, uncontrolled-hypertension, and/or greater Fazekas scale (odds ratios (ORs):1.3 ~ 13.9, 95% confidence intervals (CIs) = 1.1 ~ 328.2), walked slower, and/or with lower ADL score (ORs: 0.0026 ~ 0.9; 95%CI: 0.0001 ~ 0.99) at baseline, would have significantly greater risk of restricted mobility (p < 0.05; VIFs = 1.2 ~ 1.9).
CONCLUSIONS: These findings provide novel profile of potential risk factors, including vascular characteristics, psycho-cognitive and motor performance, for the development of restricted mobility in near future in older adults, ultimately helping the design of appropriate clinical and rehabilitative programs for mobility in this population.

UNASSIGNED: This study explores the influence of COVID-19 public health mandates on people with mobility disabilities in the United States in their everyday lives. It highlights the intersection of disability with social determinants of health, emphasizing the need for a comprehensive policy response.
UNASSIGNED: Qualitative data were collected through 76 semi-structured interviews with people with mobility disabilities. Interviews focused on experiences with COVID-19 mandates and community access, analyzed using thematic analysis and coded for emergent subthemes.
UNASSIGNED: The relationship between community participation and COVID-19 compliance was complex for people with disabilities. Inaccessible environments and inflexible policies made it difficult for people with disabilities to practice good safety measures, while widespread noncompliance by community members limited their community participation. The findings revealed additional mixed lived experiences of COVID-19 policies on community participation, accessibility, and access to resources and support. While technology facilitated some aspects of community participation, issues with accessibility, public transportation, and personal assistance services were exacerbated.
UNASSIGNED: COVID-19 policies have complex implications for people with mobility disabilities. Findings suggest a need for inclusive policymaking, improved disability awareness, and continued support for accessible technology and services. Future research should further explore these dynamics to inform policy and practice.

Mobility is crucial for independent living in old age. Older people with reduced physical ability (frailty) begin to limit their personal range of activities to their immediate living environment and ultimately to their immediate home. Diseases of the musculoskeletal system as well as neurological, psychological, cognitive, sensory, and circulatory disorders can limit functional competence (ability to live independently).In the Longitudinal Urban Cohort Ageing Study (LUCAS), from which selected results are reported in this article, participants were categorized into different functional classes (Robust, postRobust, preFrail, Frail) using the LUCAS functional index. The results show that losses in functional competence were associated with impaired mobility and reduced car driving. Impaired mobility led to restricted radius of action.The aim of healthcare in old age is to preserve independence and quality of life as long as possible. Car driving is an important part of older peoples\' activities of daily living. Therefore, primary care physicians should address car driving regularly because preventive measures to strengthen functional health also strengthen car driving ability in older persons.
UNASSIGNED: Mobilität ist auch im höheren Alter maßgeblich für die selbstständige Lebensführung. Ältere Menschen beginnen bei geringerer körperlicher Leistungsfähigkeit (Gebrechlichkeit, engl. Frailty) ihren persönlichen Aktionsradius auf das nähere Wohnumfeld und schließlich die unmittelbare Häuslichkeit zu begrenzen. Erkrankungen des Bewegungsapparates, neurologische, psychische, kognitive, Sinnes- oder Kreislaufstörungen können die funktionale Kompetenz (Fähigkeit, unabhängig zu leben) einschränken.In einer Längsschnittstudie zur Alterung urbaner Kohorten (LUCAS), aus der in diesem Artikel ausgewählte Ergebnisse berichtet werden, wurden die Teilnehmenden mittels des LUCAS-Funktions-Index unterschiedlichen Funktionsklassen zugeordnet (Robust, postRobust, preFrail und Frail). Die Ergebnisse zeigen, dass zunehmende Verluste funktionaler Kompetenz mit abnehmender Mobilität und weniger häufigem selbstständigen Autofahren verknüpft waren. Beeinträchtigungen der Mobilität engten den Aktionsradius ein.Das Ziel der gesundheitlichen Versorgung im Alter ist es, Unabhängigkeit und Lebensqualität der Menschen lange zu erhalten. Autofahren ist ein wichtiger Teil der Alltagsaktivitäten älterer Menschen. Deshalb sollte insbesondere hausärztlich auch regelmäßig wiederholt die Frage nach dem Autofahren gestellt werden, denn präventive Maßnahmen zum Erhalt funktionaler Gesundheit dienen auch dem Erhalt der Fahreignung älterer Menschen.