title: Life-space and movement behavior in nursing home residents: results of a new sensor-based assessment and associated factors.
abstract: Studies on life-space (LS) and its determinants have previously been limited to community-dwelling subjects but are lacking in institutionalized older persons. The purpose of this study was to provide an advanced descriptive analysis of LS in nursing home residents and to identify associated factors based on an established theoretical framework, using an objective, sensor-based assessment with a high spatiotemporal resolution.
  
  
  
  Cross-sectional study in two nursing homes in Heidelberg, Germany (n = 65; mean age: 82.9 years; 2/3 female). Changes of location in the nursing home (Transits) as well as time spent away from the private room (TAFR) were assessed using a wireless sensor network. Measures of physical, psychosocial, cognitive, socio-demographic, and environmental factors were assessed via established motor performance tests, interviews, and proxy-reports.
  
  
  
  LS of residents was largely restricted to the private room and the surrounding living unit (90%); 10% of daytime was spent outside the living unit and/or the facility. On average, TAFR was 5.1 h per day (±2.3; Range: 0-8); seven Transits (6.9 ± 3.2; Range: 0-18) were performed per day. Linear regression analyses revealed being male, lower gait speed, higher cognitive status, and lower apathy to be associated with more Transits; higher gait speed, lower cognitive status, and less depressive symptoms were associated with more TAFR. LS was significantly increased during institutional routines (mealtimes) as compared to the rest of the day.
  
  
  
  The sensor-based LS assessment provided new, objective insights into LS of institutionalized persons living in nursing homes. It revealed that residents' LS was severely limited to private rooms and adjacent living units, and that in institutional settings, daily routines such as meal times seem to be the major determinant of LS utilization. Gait speed, apathy, and depressive symptoms as well as institutional meal routines were the only modifiable predictors of Transits and/or TAFR, and thus have greatest potential to lead to an enhancement of LS when targeted with interventions.
  
  
  
  Current Controlled Trials ISRCTN96090441 (retrospectively registered).
authors.affiliation: Department of Psychological Aging Research, Institute of Psychology, Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany. carl-philipp.jansen@psychologie.uni-heidelberg.de.
authors.forename: Carl-Philipp
authors.initials: CP
authors.lastname: Jansen
authors.affiliation: Department of Psychological Aging Research, Institute of Psychology, Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany.
authors.forename: Mona
authors.initials: M
authors.lastname: Diegelmann
authors.affiliation: Network Aging Research, Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany.
authors.forename: Eva-Luisa
authors.initials: EL
authors.lastname: Schnabel
authors.affiliation: Department of Psychological Aging Research, Institute of Psychology, Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany.
authors.forename: Hans-Werner
authors.initials: HW
authors.lastname: Wahl
authors.affiliation: Department of Geriatric Research, Agaplesion Bethanien Hospital, Geriatric Center at Heidelberg University, Rohrbacher Str. 149, 69126, Heidelberg, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Hauer
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D004779:Environment Design; D005260:Female; D000072936:Fitness Trackers; D005858:Germany / Q000453:epidemiology; D006707:Homes for the Aged; D006801:Humans; D008124:Locomotion / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology; D009735:Nursing Homes; D011788:Quality of Life / Q000523:psychology; D012189:Retrospective Studies
keywords: Life-space; Nursing home; Sensor-based assessment; Spatiotemporal movement behavior