Abstract
BACKGROUND: The purpose of the study was to explore the single and combined contributions of body mass index (BMI) and lower extremity performance as modifiable physical factors, and the influence of use of a private car as an environmental factor on prevalent and incident life-space restriction in community-dwelling older people. METHODS: Community-dwelling people aged 75-90 years (n = 823) participated in the Life-Space Mobility in Old Age (LISPE) two-year follow-up study. Participants who reported that the largest life-space area they had attained, without aid from any device or another person, was the neighborhood or less were considered to have life-space restriction. Incident life-space restriction was the endpoint of Cox's proportional hazard model. BMI, lower extremity performance (Short Physical Performance Battery, SPPB), and use of a private car were predictors. RESULTS: At baseline, people who had both obesity (BMI ≥30.0) and impaired lower extremity performance (SPPB 0-9) had a higher prevalence of life-space restriction (prevalence ratio 3.6, 95% confidence interval, CI, 2.0-6.3) compared to those with normal weight (BMI 23.0-24.9) and intact physical performance (SPPB 10-12). The 581 people without life-space restriction at the baseline contributed 1033 person-years during the two-year follow-up. Incident life-space restrictions were reported by 28.3% participants. A higher hazard ratio (HR) for incident life-space restriction was observed in subjects having both obesity and impaired lower extremity performance (HR 3.6, 95% CI, 1.7-7.4), impaired lower extremity performance only (HR 1.9, 95% CI 0.9-4.1), and obesity only (HR 1.8, 95% CI, 0.9-3.5) compared to those with normal weight and intact performance. Private car passengers (HR 2.0, 95% CI, 1.3-3.0) compared to car drivers had a higher risk of life-space restriction. All models were adjusted for age, sex, chronic diseases, and education. CONCLUSIONS: Older people with impaired lower extremity performance have an increased risk of incident life-space restriction especially if combined with obesity. Also, not driving a car renders older people vulnerable to life-space restriction.