title: Perceived environmental barriers to outdoor mobility and feelings of loneliness among community-dwelling older people.
abstract: BACKGROUND
  We examined the association between perceived environmental barriers to outdoor mobility and loneliness among community-dwelling older people. In addition, we studied whether walking difficulties and autonomy in participation outdoors affected this association.
  
  
  METHODS
  Cross-sectional analyses of face-to-face home interview data with 848 people aged 75-90 years (mean age: 80.1 years; 62% women) gathered within the "Life-Space Mobility in Old Age" (LISPE) project. Self-reports of loneliness, environmental barriers to outdoor mobility, and difficulties in walking 2 km were obtained with structured questionnaires. Autonomy in participation outdoors was assessed with the "Impact on Participation and Autonomy" questionnaire.
  
  
  RESULTS
  Altogether, 28% of participants reported experiencing loneliness sometimes or often. These participants also reported more difficulties in walking 2 km, restricted autonomy in participation outdoors, and more environmental barriers to outdoor mobility than people not experiencing loneliness. Snowy and icy winter conditions (odds ratio: 1.59 [95% confidence interval: 1.15-2.20]), long distances to services (odds ratio: 1.57 [1.00-2.46]), and hills in the nearby environment (odds ratio: 1.49 [1.05-2.12]) significantly increased the odds for loneliness, even after adjustments for walking difficulties, autonomy in participation outdoors, perceived financial situation, living alone, and health. Path modeling revealed that environmental barriers increased loneliness either through direct association or indirectly through restricted autonomy in participation outdoors.
  
  
  CONCLUSIONS
  Prospective studies should investigate whether removing environmental barriers to outdoor mobility improves autonomy in participation outdoors and alleviates loneliness among older people.
authors.affiliation: Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland. Merja.rantakokko@jyu.fi.
authors.forename: Merja
authors.initials: M
authors.lastname: Rantakokko
authors.affiliation: Department of Health Sciences, Lund University, Sweden.
authors.forename: Susanne
authors.initials: S
authors.lastname: Iwarsson
authors.affiliation: Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland.
authors.forename: Satu
authors.initials: S
authors.lastname: Vahaluoto
authors.affiliation: Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland.
authors.forename: Erja
authors.initials: E
authors.lastname: Portegijs
authors.affiliation: Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland.
authors.forename: Anne
authors.initials: A
authors.lastname: Viljanen
authors.affiliation: Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland.
authors.forename: Taina
authors.initials: T
authors.lastname: Rantanen
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D003430:Cross-Sectional Studies; D004777:Environment; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008132:Loneliness / Q000523:psychology*; D008297:Male; D051346:Mobility Limitation; D009043:Motor Activity / Q000502:physiology*; D016017:Odds Ratio; D011446:Prospective Studies; D011795:Surveys and Questionnaires
keywords: Aging; Autonomy.; Environment; Loneliness