Life-Space Mobility, Falls, and Healthcare Use Among Community Dwelling Mexican-American Older Adults

Physical mobility affects all aspects of daily life and is a crucial part of independent living. Life-space mobility (LSM) is a valuable concept for measuring both mobility and independence of older adults in their day-to-day lives. Aims are: 1) to determine the threshold values of restricted LSM among Mexican American older adults in comparison to the original life-space assessment (LSA) validation on measures of disability, depressive symptoms, physical function, and mortality; 2) to evaluate LSM as a predictor of falls and fear of falling with and without visiting a hospital or Emergency Department (ED) among Mexican American older adults over time; and 3) to determine the association between LSM and healthcare use of Mexican American older adults over time. We included 799 respondents aged 80 and older from the Hispanic Established Population for the Epidemiologic study of the Elderly survey (2010/11-2016). The independent variable was restricted life-space mobility. Outcome variables included falls/fear of falling, and acute/post-acute healthcare use. Covariates were age, sex, education, marital status, nativity, living arrangement, pain, cognitive and physical function, comorbidities, depressive symptoms, and sensory deficits. Receiver operating characteristic curve analysis showed that the new threshold for LSM restriction in this population was a LSA of ≤35 points for disability, physical function, depressive symptoms, and mortality which was lower than the initial score of ≤60 points found in the original LSA validation cohort. Generalized Estimating Equations models showed that the new restricted LSM (LSA ≤35) is associated with falls with visits to the hospital or ED [odds ratio (OR)=1.58 95% Confidence Interval (CI)=1.03-2.44], fear of falling (OR=1.88, 95% CI=1.36-2.60), and hospital admissions (OR=1.57, 95%CI=1.13-2.19) after controlling for all covariates. No significant association was found between restricted LSM and post-acute care. In conclusion, there is a lower threshold for restricted LSM among Mexican American older adults and that the lower threshold more accurately predicts falls that required a hospital or ED visits, fear of falling, and acute healthcare use. This suggests that the new LSA threshold may be a better assessment tool for health outcomes among Mexican American older adults.