title: The role of the built environment and assistive devices for outdoor mobility in later life.
abstract: OBJECTIVE
  Despite theoretical advances in our conceptualization of disability, the "environment" remains a largely unspecified term in disablement models. The purpose of this research is to draw upon on a unique state-of-the-art nationally representative data set with innovative measures that provide the opportunity to tease apart and specify the role of different environmental factors in the disablement process.
  
  
  METHODS
  Using multinomial logistic regression with data from the first round of the recently launched National Health and Aging Trends Study (N = 6,578 community-dwelling Americans age 65+), this paper examines the role of the built environment (e.g., stairs or ramps leading up to the home) and mobility devices on reported difficulty going outside by oneself.
  
  
  RESULTS
  Almost three quarters of community-dwelling older Americans live in a residence that has stairs at the entrance. Older adults who use a walker to help them get around are adversely affected by stairs at the entrance to their home, effectively doubling the odds of reporting difficulty going outside independently. Roughly 10% of community-dwelling older Americans live in a residence with a ramp at the entryway, which reduces the odds of outdoor mobility difficulty threefold among those using wheeled mobility devices. However, ramps at the entryway are associated with a higher likelihood of reporting difficulty going outdoors among those who do not use any type of mobility device.
  
  
  CONCLUSIONS
  A better understanding of the complexities of the environment in the disablement process is critical for the planning and development of age-friendly environments allowing older adults to age in place.
authors.affiliation: Institute for Social Research, University of Michigan, Ann Arbor. pjclarke@umich.edu.
authors.forename: Philippa J
authors.initials: PJ
authors.lastname: Clarke
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001107:Architectural Accessibility / Q000706:statistics & numerical data*; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D004779:Environment Design / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006801:Humans; D057187:Independent Living / Q000706:statistics & numerical data*; D007374:Interior Design and Furnishings; D008297:Male; D051346:Mobility Limitation; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012656:Self-Help Devices / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
keywords: Assistive technology; Built environment; Mobility disability