Date Presented 03/28/20
The purpose was to elucidate factors—specifically mobility, behavior, and travel attitudes—that mediate between personal characteristics and participation in out-of-home activities of the elderly. Driving was found to be a major mediator between personal characteristics (e.g., age and education) and participation. The findings demonstrated the multidimensional nature of participation and emphasize the role of OTs in assessing mobility behaviors and travel attitudes of the elderly.
Primary Author and Speaker: Rachel Kizony
Contributing Authors: Pnina Plaut, Dalit Shach-Pinsly, Shlomit Rotenberg, Naomi Schreuer
PURPOSE: The purpose of this study was to elucidate factors, specifically mobility behavior and travel attitudes that mediate between personal characteristics and participation in out-of-home activities of older adults.Participation in out-of-home activities is crucial for active aging and maintaining one’s quality of life. Understanding the factors that explain participation in older adults is important for formulating a comprehensive assessment in occupational therapy. In the modern world, the mode of transportation to daily activities i.e. mobility behavior, may mediate between the well-studied personal characteristics such as age and gender, and participation. Moreover, to date, few studies examined the role of mobility behavior in increasing participation of older adults.
DESIGN: Using a convenience sampling method 277 community dwelling older adults, aged above 65, were recruited to this descriptive cross-sectional study. Participants were included if they were able to walk without an assistance, participated in out-of-home activities at least once a week and were not diagnosed with dementia.
METHOD: Participation was measured with the Activity Card Sort (Baum & Edwards 2001), to obtain the retained activity level, relative to the past (i.e. five years ago). In addition, participants filled in questionnaires about personal characteristics such as their health, emotional state, mobility behavior (i.e. frequency at which they used various modes of transportation) and travel attitudes. Structural Equation Model (SEM) was used to analyse our proposed model of the associations between personal characteristics, mobility behavior, travel attitudes and participation. Additional mediation analyses were applied by the SPSS macro PROCESS (model 6) (Hayes, 2012) to examine the indirect effect of the mobility patterns and attitudes.
RESULTS: The SEM yielded no significant difference between the proposed and observed models, meaning that the combination of variables hypothesized to explain the participation of older adults in out-of-home activities fit the observed data collected in the study. The SEM analysis revealed good goodness-of-fit indicators: Normed Fit Index=.907; Comparative Fit Index=.965; and Root Mean Square Error of Approximation (RMSEA)=.043. The model explained 41% of the variance of participation. Driving was found to be a significant mediator between education, gender, age, socioeconomic level, attitudes towards public transportation and participation. In addition, attitudes towards walking were found to be a significant mediator between age, gender and participation.
CONCLUSION: The findings showed higher level of participation in out-of-home activities, when using any mode of mobility, mostly driving and public transportation. Driving was found to be a major mediator between personal characteristics e.g. age and participation. Indeed, traditionally, younger age was related to continuing to drive and maintaining participation. However, our findings showed an indirect effect of age, where younger age was related to negative attitudes towards using public transportation, these were related to more driving and then to higher levels of participation. These relationships could be due to lack of accessible public transportation that is one of the barriers worldwide leading to negative attitudes and greater dependence on driving. Our findings show the multidimensional nature of participation and indicate the need of occupational therapists to be more involved in assessing mobility behaviors and travel attitudes of older adults. Moreover, the findings indicate the need for more age friendly public transportation.
The study was funded by the Israeli Ministry of Science Technology and Space.
References
Baum, C. & Edwards, D. (2001). Activity Card Sort (ACS). Washington University in St. Louis, School of medicine.
Hayes, A. F. (2012). PROCESS: A versatile computational tool for observed variable mediation, moderation, and conditional process modeling [White paper]. Retrieved from http://www.afhayes.com/public/process2012.pdf
