Quality of Life and Barriers in the Urban Outdoor Environment in Old Age

OBJECTIVES: To examine the association between barriers in the outdoor environment and perceived quality of life (QoL) in old age and to assess whether fear of moving outdoors and unmet physical activity need contribute to this association. DESIGN: Cross-sectional. SETTING: Community and research center. PARTICIPANTS: Five hundred eighty-nine, community-dwelling people aged 75 to 81 took part in face-to-face home-interviews and examinations in the research center. MEASUREMENTS: QoL was assessed using the LEIPAD questionnaire. Environmental barriers were studied based on self-reports of lack of resting places or long distances (distances), noisy traffic or dangerous crossroads (traffic), and hilly terrain or poor street condition (terrain). Fear of moving outdoors and unmet physical activity need were self-reported, and maximal walking speed was measured over 10 m. A path analyses model using LISREL was used for the statistical analyses. RESULTS: QoL was worse among those who reported more barriers in their outdoor environment, experienced fear of moving outdoors or unmet physical activity need, and had slower walking speed and more chronic diseases. In the path model, in which 36% of the variation in QoL was explained, terrain, traffic and distances influenced QoL through fear of moving outdoors or unmet physical activity need, whereas distances had a direct association with QoL. CONCLUSION: An outdoor environment that encumbers outdoor mobility increases perceptions of fear of moving outdoors and unmet physical activity need and is associated with poor QoL in older people. More research is needed to confirm the temporal order and causality of these observations. J Am Geriatr Soc 58:2154-2159, 2010.