Examining the Factors Associated with Community Ambulation in an Older Adult Day Hospital Population

Introduction: The ability of an older adult to walk independently outdoors in their community assists with maintaining independence, a healthy lifestyle and a good quality of life. In clinical practice, mobility is often one of the first activities where a decline is observed and where an older adult becomes dependent. The ability to walk outdoors is often a major goal for older adults attending a day hospital for rehabilitation. Aims and Objectives: The aim of this study was to examine the factors associated with community ambulation in community dwelling older adults attending a day hospital. Methods: A mixed methods study design was used. The main study, a cross sectional study used quantitative methods to assess community dwelling older adults attending a day hospital. The primary outcome measure was a community ambulation questionnaire. A range of other outcome measures were completed assessing motor, cognitive, executive function and behavioural domains. The qualitative substudy used Photovoice Methodology. Participants, all of whom had completed the main study, were provided with single use cameras. They had one week to take photographs of their perceived barriers and facilitators to community ambulation. These photographs formed the basis for focus group discussions. Focus groups were recorded, later transcribed and thematic analysis was used to identify key themes. Results: One hundred and sixty one participants completed the cross sectional study. The median age was 83 years old (IQR 9), female participants represented 64% of the study population and 49.1% of participants lived alone. Frailty (p<0.001), self-efficacy (p<0.001) and gait speed (p 0.03) were all independently associated with community ambulation in an older population attending a day hospital. Eight participants completed the Photovoice substudy and three themes were identified: personal, environmental and strategic factors, all associated with an older adults’ ability to ambulate in the community.Conclusion: This study demonstrated the complexity and multifactorial nature associated with independent community ambulation in older adults. This suggests that physiotherapists should adopt a broader approach to the assessment and treatment of older adults, to promote the achievement of independent community ambulation.