Factors associated with social participation and community ambulation in older adults with stroke and osteoarthritis

Participating in social activities is important for health and well-being in older adults. The extent to which people are able to participate often depends on their ability to walk outside of their home, in both outdoor (e.g., sidewalk, park) and indoor environments (e.g., shopping mall, community centre). Social participation and community ambulation often decrease with increasing age and also become more difficult when an individual suffers from arthritis or has a stroke. In this study, data from the Canadian Longitudinal Study on Aging will be used to identify factors associated with social participation and community ambulation in Canadian older adults, those with arthritis and those with stroke. Our findings will help us better understand factors that limit and encourage social participation and community ambulation in Canadian older adults. This is important for clinicians working with older individuals and has implications for future research and policy planning.

One purpose of this study aimed to identify factors associated with community ambulation (the ability to move independently outside the home) and social participation in Canadians with stroke, aged 45 -85. Data from the Baseline and Maintaining Contact Questionnaire from the Tracking (telephone interview) cohort were analyzed. Two multivariate logistic regression models were developed with community ambulation and social participation as the outcomes, respectively. The community ambulation model consisted of 855 people with stroke. Factors associated with being less likely to walk outdoors sometimes or often included difficulty in walking 2-3 blocks vs. having no difficulty. Being more likely to walk outdoors was associated with ‘good weather’ months e.g. May vs. January, and being 55-64 years vs. 75-85. The social participation model consisted of 956 people. Participants were more likely to participate weekly or daily if they were female or had depression occasionally vs. rarely and less likely to participate if extremely dissatisfied with life vs. being extremely satisfied, being unable to walk 2-3 blocks vs. no difficulty, or if single, divorced, or separated vs. married. For individuals with stroke, different factors are associated with community ambulation and social participation. However, challenges in walking a distance of 2-3 blocks is associated with being less likely to participate in both community ambulation and social participation.

A second purpose of this study aimed to identify factors associated with community ambulation in Canadians aged 45-85. Data from the Tracking Main Wave and Maintaining Contact Questionnaires were analyzed. Multivariate logistic regression models were developed with community ambulation (frequency of walking outdoors) as the outcome. In the all ages model, people were less likely to walk outdoors sometimes or often if they had lower vs. excellent general health perception, had difficulty walking 2-3 blocks, had pain vs being free of pain, or were female. Those more likely to walk outside were those in the younger age groups and who were evaluated in ‘good weather’ months (e.g., June vs. January). Female and male models included similar significant associated factors. However, the male model also included chronic conditions; those with fewer chronic conditions were more likely to walk outdoors. Differences in factors associated with community ambulation amongst age categories were evident. The number of falls in the previous year was not associated with frequency of outdoor walking in any model. Pain and the ability to walk 2-3 blocks without difficulty are factors which are amenable to improvement with intervention. Being familiar with factors that are associated with community ambulation may assist healthcare professionals to address those factors which could be changed with intervention, thereby improving community ambulation, social participation, and quality of life in adults aged 45 or older.

A third purpose of this study aimed to identify factors associated with social participation in Canadians aged 45-85. Data from the Tracking Main Wave and Maintaining Contact Questionnaires were used in this study. Multivariable logistic regression models were developed. The outcome was frequency of social participation in community-related activities, defined as not participating frequently (participating never, yearly or monthly) or participating frequently (participating weekly or daily). In the all ages model, people were less likely to participate frequently if they had poor vs. excellent general health perception, were depressed all the time vs. rarely, were lonely all the time vs. rarely, were extremely dissatisfied with life vs. extremely satisfied, had difficulty walking 2-3 blocks, lived rurally vs. urban, were younger (45-54 years) or were divorced vs married. Those more likely to participate frequently were female. Female and male models varied in statistically significant associated factors. The female model mirrored the overall model in the variables included. However, the male model did not include depression, loneliness, marital status, rural/urban setting or walking ability. The male model additionally included decreased shoulder movement as a factor associated with being less likely to participate frequently. Factors associated with social participation vary for men and women. Some of these factors are amenable to improvement with rehabilitation intervention, such as the ability to walk 2-3 blocks and decreased shoulder movement. Other factors, such as perception of general health may be indirectly improved by rehabilitation intervention.

A fourth purpose of this study aimed to identify factors associated with community ambulation and social participation in Canadians 45-85 years of age with osteoarthritis (OA). Data from the Canadian Longitudinal Study on Aging Tracking group Main Wave and Maintaining Contact questionnaires. Multivariate logistic regression models were developed for community ambulation and social participation in people with osteoarthritis. The model for community ambulation included 3808 individuals with OA in one or both knees and/or hips. Factors associated with being less likely to walk outdoors “sometimes or often” vs. “never or seldom” included: poor vs. excellent self-rated health, difficulty walking 2-3 blocks vs. no difficulty, severe pain vs. no pain, and female vs. male. Individuals with osteoarthritis were more likely to walk outdoors in good weather months (e.g., July vs. January) and if they were in younger age groups (e.g., 55-64 years vs. 75-85 years). Our model for social participation included 4283 people with osteoarthritis. Individuals were more likely to participate in social activities “weekly or daily” (vs. “never/yearly/monthly”) if they were female vs. male and less likely to participate regularly if they were unable to walk 2-3 blocks vs. no difficulty, more dissatisfied with their life (e.g., extremely dissatisfied vs. extremely satisfied), and if they were younger (e.g., 55-64 years of age vs. 75-85). A number of factors influence community ambulation and social participation in people with OA. The effects of age and sex differ for the two outcomes. The ability to walk 2-3 blocks was positively associated with both models.