Aspectos contextuais associados à mobilidade e espaço de vida em idosos comunitários: revisão sistemática e resultados do International Mobility in Aging Study (IMIAS)

Abstract

Introduction: Mobility in the elderly is the ability to move from home environment to beyond the community where they live. Preservation of mobility is considered essential for active aging, being closely linked to health status and quality of life. The Life-space Mobility (LSM) restriction of community-dwelling elderly can predict the need for future health care. Contextual factors such as life history, social, environmental and personal aspects are considered determinants for the maintenance of the living space in the elderly. Objectives: To know through a systematic review about contextual aspects that interfere or modify the LSM, and to identify the associations between Life-Space Assessment (LSA) and Life course adversities in old age in five populations with different epidemiological contexts. Methods: A systematic review was performed according to PROSPERO protocol CRD42017064552, previously published. A cross-sectional study, lined up to cohort, was conducted with a sample of 1995 elderly individuals living in 5 distinct sites with different epidemiological profiles (Kingston and Saint Hyacinthe in Canada, Tirana in Albania, Manizales in Colombia and Natal-RN in Brazil). The Life Space Assessment (LSA) were analyzed through multivariate analysis (multiple linear regression), adjusted for variables of physical health, mental health, social support and adversities in the course of life. Data were analyzed using SPSS 20.0; bivariate analyses and multiple linear regression between LSA total score and independents variables were performed, the confidence intervals was considerate 95% and the p-value of less than 0.05 was considered statistically significant. Results: The systematic review identified 3484 studies, only 41 were considered by inclusion criteria, and classified with better methodological quality. The literature highlights associations between life space mobility and environmental contextual factors (products / technology and physical characteristics of the environment) and personal (sociodemographic characteristics, life experience, individual psychological characteristics, health and quality of life perception, and mortality index). The cross-sectional study identified that life-space mobility was significantly related to contextual aspects, such as: social support (β = 0.041, pvalue = 0.035), community barriers (β = -0,128, p-value = 0.000), perception of safety (β = 0.093, p-value = 0.000) and social capital (β = 0.045, p-value = 0.026). In addition, we highlight that the total LSA score is inversely related to adulthood adversities (β = -0.114, p-value= 0.000) and directly related to old age adversities (β = 0.073, p-value= 0.001), but there was no association with childhood adversities (economic adversities: p-value = 0.607 and social adversities: p-value = 0.899). Conclusion: Low life space mobility rates are related to environmental and personal contextual factors. We identified that life space mobility is influenced by adulthood and old age adversities, but not by childhood adversities. Positive contextual factors such as social support and a favorable environment, as well as old age adversities (insufficient income and living alone) can be motivating aspects of better life space mobility. The adversities in adulthood as low schooling and semi-skilled manual occupation are predictors of mobility restriction in older people.