Associations between the Urban Environment and Outdoor Walking Mobility by Cognitive Functioning in a Group of Older Adults in Singapore

Abstract

Abstract Objectives: This study aims to examine the relationship between the outdoor mobility of older adults with and without cognitive impairment and the built environment in three urban neighbourhoods in Singapore. Methods: Outdoor walking mobility in daily life gait speed (DGS) was collected continuously for one week using a previously validated hybrid mobility tracker. Mini-Mental State Examination (MMSE) cut-offs by educational levels were used to differentiate cognitive impairment (CI) and without cognitive impairment (non-CI). The environmental characteristics examined were gross plot ratio and land use. Statistical correlations (one-way ANOVA test and linear regression) were used to examine the associations between older adults’ outdoor mobility and built environment for all CI and non-CI groups. A case example was also used to provide a location-based heatmap on DGS for 2 older adults (CI and non-CI) navigating the same neighbourhood for 3 consecutive days. Results: Thirty-three participants registered a total of 2,428 kilometres with an average DGS of 0.74 m/s outside of their homes over a period of 220 days. The mean (SD) age of the participants was 69.2 (7.14), and 21 (64%) of them were female. Fourteen of the (42%) participants were classified as cognitive impaired. Overall, a higher gross plot ratiowas found to be associated with faster outdoor gait speed (DGS) for the non-CI group (β = 0.04, r = 0.69, p =.03) and slower DGS for the CI group (β = -0.13, r = 0.75, p =.01). The DGS of individuals with CI was slower than that of non-CI individuals, with the greatest difference observed in business and commercial areas; however, the DGS of individuals with CI was faster than that of non-CI individuals within community and residential locations. Conclusions: Individuals with CI had a slower outdoor gait speed and may require higher adaptation to the environment. Although DGS could be used in differentiating older adults with and without cognitive impairment while mobilizing in an urban environment, considerations should also be given to understanding the interaction of DGS with different land use and typology.