Predictors of Community Mobility Limitation Onset In Community-Dwelling Older Adults: Preliminary Findings from the Comprehensive Mobility Framework

Background and Purpose: In light of the major demographic shifts occurring in the U.S., researchers, policymakers, and practitioners have increasingly focused on identifying the factors that can promote elder health, well-being, and the ability to age in place. One such crucial factor is community mobility, defined as the ability to walk at least three blocks independently, which serves as an important indicator of independence and functional competence among older adults. According to the Comprehensive Mobility framework (CMF) proposed by Webber et al. (2010), individual characteristics and contextual conditions influence whether community mobility either improves or worsens with age. While the framework conceptualizes mobility broadly and demonstrates its potential applicability across diverse mobility domains, empirical research has rarely leveraged the framework to examine specific domains of mobility, particularly community mobility. Furthermore, the few existing empirical studies on community mobility limitations have primarily focused on individual-level contributors and have not accounted for contextual factors. Accordingly, the present study aims to identify the factors associated with the onset of community mobility limitations using the CMF.

Methods: Using Rounds 5 to 6 from the National Health and Aging Trends Study, a nationally representative study of Medicare beneficiaries ages 65 and older, we analyzed 4,630 community dwelling older adults. Based on the CMF, we included six categories of determinants in Round 5: (a) cognitive impairment, (b) psychosocial (depression, fear of falling, and social network size), (c) physical (activities of daily living, ADL) (d) environmental (neighborhood social cohesion and disorder), (e) financial strain, and (f) demographics. The onset of community mobility limitations was measured using Rounds 5 to 6 by comparing mobile to mobile versus mobile to non-mobile groups. We conducted binary logistic regression accounting for the survey design of NHATS. Missing data were addressed using multiple imputations.

Results: Older adults with higher levels of depressive symptoms (OR = 1.24, p < .001), greater worry about falling (OR = 1.70, p = .003), greater difficulty with ADL (OR = 1.37, p = .001), older age (OR = 1.53–4.43 across ages 75+, all p ≤ .05) and female gender compared to male (OR = 1.59, p < .001) had higher odds of reporting the onset of community mobility limitations. In contrast, older adults with larger social networks (OR = 0.89, p = .006) and those with no dementia compared to probable dementia (OR = 0.45, p = .006) indicated lower odds of onset.

Conclusions and Implications: The findings showed that the onset of community mobility limitations is shaped by a combination of individual and contextual factors consistent with the CMF. The identified factors can help social workers better recognize older adults who are at high risk of community mobility loss during an initial needs assessment process. Additionally, the protective role of larger social networks underscores the significance of connecting socially isolated older adults to services such as befriending programs to foster their social engagement. Future studies could further clarify the interconnected pathways through which these factors shape community mobility outcomes, and inform more targeted community-level interventions.