Pilot study on the Chinese version of the Life Space Assessment among community-dwelling elderly
Introduction
Mobility is defined as the ability to move around effectively for specific purposes. Mobility restrictions pose threats to autonomy and life quality, especially to elderly people (O’Connor, Edwards, Wadley, & Crowe, 2010; Parker, Baker, & Allman, 2011; Stalvey, Owsley, Sloane, & Ball, 1999). Life space is an index that reflects a person’s mobility (O’Connor et al., 2010, Parker et al., 2011; Peel, Baker, & Roth, 2005; Stalvey et al., 1999). This concept was derived from two theories, namely “Person-in-environment” theory and ecology models (Parker et al., 2011). Consequently, life space emphasizes the interaction between the individual and the environment (Parker et al., 2011). Compared with the previous evaluation concepts and tools, life space encompasses more factors in real life, such as demographic data, general health, physical activity ability, psychological and cognitive conditions, and social involvement (Allman, Baker, Maisiak, Sims, & Roseman, 2004; Boyle, Buchman, Barnes, James, & Bennett, 2010; James, Boyle, Buchman, Barnes, & Bennett, 2011; Murata, Kondo, Tamakoshi, Yatsuya, & Toyoshima, 2006).
Life space evaluation tools have been developed in various studies. The Life Space Diary (LSD), established by May, Nayak, and Isaacs (1985), was the first life space evaluation tool. Respondents were asked to record their actual life space in a diary format, including information such as the weather, incidence of falls, and whether the individual had been in five concentric areas (bedroom, house, garden and area around dwelling, residential block, and the area across a traffic artery). A month later, scores were calculated using a formula. Additionally, respondents were asked to assess gait and balance ability. The LSD scores were positively correlated with walking speed and negatively correlated with average swinging stride (May et al., 1985). In 1990, Tinetti and Ginter (1990) established another tool, the Nursing Home Life Space Diameter (NHLSD), based on the LSD. The NHLSD was developed to assess the extent and frequency of mobility in skilled nursing facility residents. In 1999, Stalvey et al. (1999) developed the Life Space Questionnaire (LSQ). The LSQ contains more accurate space levels than the LSD and NHLSD. The investigation time span is three days, which is much shorter than that of previous tools. In 2003, Baker, Bodner, and Allman (2003) developed a new life space evaluation tool, namely, the Life Space Assessment (LSA). Different from previous tools assessing life space, LSA takes frequency and independence into account, in addition to life space sphere. Put it another way, LSA do not take a one-sided approach to evaluate life space level. As a result, LSA can reflects elders’ actual situation. In their study (Baker et al., 2003), the LSA showed good reliability and validity.
Currently, the LSA has been translated into several languages, including Japanese (Murata et al., 2006), French-Canadian (Auger et al., 2009), Finnish (Rantanen et al., 2012), Spanish (Curcio et al., 2013), and Swedish (Kammerlind, Fristedt, Ernsth Bravell, & Fransson, 2014). Translation to native languages and cross-cultural adaptations are critical for a new instrument if used in another country with another language (Beaton, Bombardier, Guillemin, & Ferraz, 2000). However, life space and LSA have never been introduced in mainland China. To test the applicability of the instrument in Chinese elderly and to introduce a new method to measure elderly people’s health status and quality of life, we conducted a pilot study with the Chinese version of the Life Space Assessment (LSA-C) among community-dwelling elderly people.
Section snippets
Design and sample
This study was conducted in Pudong New Area of Shanghai, which had a total of 5.154 million inhabitants in 2012 (“Analysis of Pudong New Area demographic data”, 2012). The sample pool consisted of elderly health records from 44 community health service centers in Pudong. Samples were randomly selected in stage sampling way from health records that were collected by community health centers in compliance with government policy. People with paralysis or dementia and those living in nursing homes
Results
The study included 100 elderly people (50 males and 50 females) who were aged 65 years and older in the end. There were 32 (24.24%) people refused to participate in this study. The average age of all the participants was 72.23 years (±5.05). The composite life space (LS-C) score of the elderly in this study was 71.87 (±20.24) (95%CI:67.85–75.88) (Table 1). Score of LS-C after two weeks was 71.16 (±22.31) and the test–retest reliability of the Chinese version of the LSA-C was 0.76 (P = 0.000).
The
Discussion
The worldwide population is aging at an unprecedented rate. This growth negatively affects development and places substantial demand on elderly support, medical expenses, and social services. This situation is more serious in developing countries than in developed countries because developing countries simultaneously face both development and aging threats. To address this dilemma, “Active Aging” was developed by the Second World Assembly on Aging in 2002 (The United Nations, 2002). This
Conclusions
This study is the first to introduce the LSA to mainland China. This study demonstrated that the LSA is a sensitive tool for measuring mobility among the Chinese community-dwelling elderly. The LSA-C has acceptable reliability and validity and is significantly correlated with other health evaluation tools with respect to, e.g., health status, daily function, physical performance, presence of depression and cognitive status. Consequently, the Chinese version is suitable for research on our aging
Limitations
This was a pilot study conducted among community-dwelling elders and the objective of this study was only to test the reliability and validity of the LSA-C rather than investigating the overall situation about life space mobility of community-dwelling elderly. The limited sample size may (1) restrict the exploration of the association between the LSA-C and other parameters and (2) not reflect the overall situation regarding life space mobility among older adults. As a result, research with a
Conflict of interest
We confirm that there are no real or potential conflict of interests associated with this research and there has been no financial support for this work that could have influenced its outcomes.
Acknowledgments
This study was supported by all the community health centers in Pudong New Area of Shanghai.
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