Predictors of mobility limitation in older adults: A structural equation modeling analysis

Background: ‪In this study, the factors related to the functional limitation were studied simultaneously using structural equation modeling. Material and methods: ‪ 1201 people aged 50 years and older were selected for this study using a stratified random sampling method from health centers of Bukan city in the northwest of Iran, in 2017. Trained interviewers collected information on demographic characteristics, socio-economic status, physical activity, history of falling/ fear of falling, visual and hearing condition, associated illnesses, social support, cognition, depression, assessed functional limitation and mobility of study participants. The structural equation modeling was used to analyze the data. Results: ‪ The participants’ mean age was 59.2 ±7.97 yrs, of whom 61% were women. The result showed that the proposed conceptual model fitted well CFI (0.97), RMSEA (0.04), SRMR (0.06). Age (β = -0.45, p < 0.001), gender (β = -4.55, p = 0.004), and economic status (β = -3.57, p < 0.001), physical activity (β = -10.35, p = 0.025) and socio-psychological activity (β = -1.59, p < 0.001) negatively, and the variables of educational level (β = 2.34, p = 0.016), marital status (β = 5.43, p = 0.003), cognitive function (β = 0.66, p = 0.001), living environment (ground floor*: β = 16.62, p < 0.001), duplex: (β = 5.19, p = 0.055), positively predicted the mobility limitation. Conclusions: ‪In this study, a range of socio-demographic factors, cognitive function, and living environment were identified as significant predictors of mobility limitation. ‪* There are two or three storey building in many cities of Iran, that the first floor, known as "pilot" or "ground floor", has access to a backyard but it is smaller and cheaper compared to the second or third floor. Older people usually prefer to live there because of no stairs and little garden in the backyard. Szczesna-Kaczmarek A Blood K+ concentration balance after prolonged submaximal exercise. Balt J Health Phys Act 2014; 1(1): 233-244 21 www.balticsportscience. com introduction Ageing is associated with gradual, progressive and spontaneous erosive changes in most organs and physiological functions [1]. As people age, they will gradually lose some of their physiological and psychosocial functions, which degrade their functional status and increase their vulnerability and dependence [2, 3]. In Iran, the ageing population is increasing as well; it is predicted that by the year 2030, about 25–30% of the Iranian population will be made up by the elderly [4]. It is estimated that the elderly population in the United States, which is more than 40%, will be doubled by 2030. Probably, doubling the number of elderly people can affect reducing of people’s health and the challenges of aging, such as the functional limitation [5]. In more than 40% of people aged 65 years and older, limitation of mobility has been reported [6]. Mobility is the ability of an individual to move (independently, or using auxiliary devices or vehicles) in her/his environment (from home to the neighborhood or living environment) [7]. The mobility function is the foundation of an active life that allows older adults to have a dynamic and active life [1]. Functional limitation is associated with various types of risk factors including overweight/obesity, and depression; it results in isolation and pain [8]. The importance of health assessment has been proven as an independent predicting factor of morality in elderly people. Poor health condition significantly leads to an increase in the limitation of mobility and the death rate [2, 7, 9, 10]. A study found that 5–10% of the elderly’s death is due to low/lack of mobility [11]. A socio-economic status (personal characteristics, attitude and understanding) and independence in daily life activities can improve the health of older adults [12]. Physical activity and independence are important health predictors which can reduce the risk of disability and mortality [13, 14]. Improvement in the mental status and the cognition status is associated with regular physical activity [9]. Despite these benefits, physical activity among older adults is less than 150 min per week. National and international organizations have focused on increasing physical activity of older adults [15–17]. As people age, the amount of physical activities decreases, which results in reducing cognitive perception. On the other hand, physical activity improves the perceptual-cognitive status of older persons through two mechanisms: reducing the rate of depression and social stimuli (social activities) [18, 19]. Since no theory model based study has been applied to explain the limitation of mobility in Iranian older adults, the present research aimed to investigate the mobility limitation with a range of different factors, such as demographic characteristics, living environment status, economic status, physical activity, psychosocial support, cognitive-conceptual status, and anthropometric indices, using structural equation modeling. In this research, the proposed conceptual model was derived from the comprehensive theory framework by Weber et al. [10]; upon which Meyer et al. [5] developed a model for identifying various forms of mobility function, which determines different levels of relationship between variables. Meyer et al.’s model provides a comprehensive approach to identifying, preventing, and reducing mobility disorders. The variables related to a mobility function in this model are the perceptual-cognitive status, physical health, psychological support, environmental status, and economic factors. The effects of factors such as gender, culture, and individuals’ biography have been studied as well [5]. Jafari A, Aminisani N, Shamshirgaran SM, Rastgoo L, Gilani N. Predictors of mobility limitation in older adults Balt J Health Phys Act. 2020;12(1):20-31