title: Time Out-of-Home and Cognitive, Physical, and Emotional Wellbeing of Older Adults: A Longitudinal Mixed Effects Model.
abstract: BACKGROUND
  Time out-of-home has been linked with numerous health outcomes, including cognitive decline, poor physical ability and low emotional state. Comprehensive characterization of this important health metric would potentially enable objective monitoring of key health outcomes. The objective of this study is to determine the relationship between time out-of-home and cognitive status, physical ability and emotional state.
  
  
  RESULTS
  Participants included 85 independent older adults, age 65-96 years (M = 86.36; SD = 6.79) who lived alone, from the Intelligent Systems for Assessing Aging Changes (ISAAC) and the ORCATECH Life Laboratory cohorts. Factors hypothesized to affect time out-of-home were assessed on three different temporal levels: yearly (cognitive status, loneliness, clinical walking speed), weekly (pain and mood) or daily (time out-of-home, in-home walking speed, weather, and season). Subject characteristics including age, race, and gender were assessed at baseline. Total daily time out-of-home in hours was assessed objectively and unobtrusively for up to one year using an in-home activity sensor platform. A longitudinal tobit mixed effects regression model was used to relate daily time out-of-home to cognitive status, physical ability and emotional state. More hours spend outside the home was associated with better cognitive function as assessed using the Clinical Dementia Rating (CDR) Scale, where higher scores indicate lower cognitive function (βCDR = -1.69, p<0.001). More hours outside the home was also associated with superior physical ability (βPain = -0.123, p<0.001) and improved emotional state (βLonely = -0.046, p<0.001; βLow mood = -0.520, p<0.001). Weather, season, and weekday also affected the daily time out-of-home.
  
  
  CONCLUSIONS
  These results suggest that objective longitudinal monitoring of time out-of-home may enable unobtrusive assessment of cognitive, physical and emotional state. In addition, these results indicate that the factors affecting out-of-home behavior are complex, with factors such as living environment, weather and season significantly affecting time out-of-home. Studies investigating the relationship between time out-of-home and health outcomes may be optimized by taking into account the environment and life factors presented here.
authors.affiliation: Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, United States of America.
authors.forename: Johanna
authors.initials: J
authors.lastname: Petersen
authors.affiliation: Department of Neurology, Oregon Health & Science University, Portland, OR, United States of America.
authors.forename: Daniel
authors.initials: D
authors.lastname: Austin
authors.affiliation: Department of Neurology, Oregon Health & Science University, Portland, OR, United States of America.
authors.forename: Nora
authors.initials: N
authors.lastname: Mattek
authors.affiliation: Department of Neurology, Oregon Health & Science University, Portland, OR, United States of America.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Kaye
mesh_terms: D000339:Affect; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D003072:Cognition Disorders / Q000453:epidemiology; D003863:Depression; D004644:Emotions; D005260:Female; D018577:Homebound Persons; D006801:Humans; D057187:Independent Living; D008132:Loneliness; D008297:Male; D051346:Mobility Limitation; D009922:Oregon; D010146:Pain / Q000453:epidemiology; D010549:Personal Satisfaction; D010809:Physical Fitness; D011788:Quality of Life; D012919:Social Behavior; D013997:Time Factors; D016138:Walking; D014887:Weather