Journal of Urban Health

, Volume 90, Issue 6, pp 997–1009 | Cite as

Optimizing Mobility in Later Life: The Role of the Urban Built Environment for Older Adults Aging in Place

  • Philippa ClarkeEmail author
  • Nancy Ambrose Gallagher


Hazards in the urban built environment can create barriers to mobility among older adults aging in place. We investigated the relationship between urban built environment characteristics and 15-month trajectories of mobility disability in a sample of 1,188 older adults living in Detroit, MI, a city that has undergone rapid economic and structural decline. Data come from the Michigan Minimum Data Set for Home Care (2001–2008), an enumerative database of older adults in Michigan who qualify for federal or state-funded home and community-based long-term care through a Medicaid waiver program. Standardized assessments are made at intake and every 90 days by case managers. Built environments were assessed with a virtual audit using the “Street View” feature of Google Earth. A summary accessibility score was created for each block based on a count of the number of accessible features (e.g., continuous barrier-free sidewalks and proximity of public transportation). Using growth mixture models, two latent trajectories of outdoor mobility were identified: one capturing occasional outdoor mobility (representing 83 % of the sample) and one capturing almost no mobility outside the home. Controlling for sociodemographic and health risk factors, individuals living in more accessible environments had a 18 % higher odds of being in the more mobile group (OR = 1.18, 95 % CI = 1.01, 1.41). These findings emphasize the importance of the built environment for mobility among urban-dwelling older adults.


Aging Mobility Built environment 



This research was supported in part by Grant Number K01EH000286-01 from the Centers for Disease Control and Prevention (CDC). The contents of this paper are solely the responsibility of the authors and do not necessarily represent the official views of the sponsors.


  1. 1.
    Ettinger WH. Physical activity and older people: a walk a day keeps the doctor away. J Am Geriatr Soc. 1996; 44(2): 207.PubMedGoogle Scholar
  2. 2.
    US Department of Health and Human Services. Patterns and trends in physical activity. Physical Activity and Health: A Report of the Surgeon General. Atlanta: GA; Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996. p.175–185.Google Scholar
  3. 3.
    Stuck AE, Walthert JM, Nikolaus T, Büla CJ, Hohmann C, Beck JC. Risk factors for functional status decline in community-living elderly people: a systematic literature review. Soc Sci Med. 1999; 48(4): 445–469.PubMedCrossRefGoogle Scholar
  4. 4.
    Wong CH, Wong SF, Pang WS, Azizah MY, Dass MJ. Habitual walking and its correlation to better physical function: implications for prevention of physical disability in older persons. J Gerontol A Biol Sci Med Sci. 2003; 58(6): M555–M560.CrossRefGoogle Scholar
  5. 5.
    Pahor M. Effects of a physical activity intervention on measures of physical performance: results of the lifestyle interventions and independence for Elders Pilot (LIFE-P) study. J Gerontol A Biol Sci Med Sci. 2006; 61(11): 1157.PubMedCrossRefGoogle Scholar
  6. 6.
    Guralnik JM. Maintaining mobility in late life. I. Demographic characteristics and chronic conditions. Am J Epidemiol. 1993; 137(8): 845–857.PubMedGoogle Scholar
  7. 7.
    Fried LP, Bandeen-Roche K, Chaves PHM, Johnson BA. Preclinical mobility disability predicts incident mobility disabilityin older women. J Gerontol A Biol Sci Med Sci. 2000; 55(1): M43–M52.PubMedCrossRefGoogle Scholar
  8. 8.
    Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995; 332(9): 556–561.PubMedCrossRefGoogle Scholar
  9. 9.
    Simonsick EM, Guralnik JM, Volpato S, Balfour J, Fried LP. Just get out the door! Importance of walking outside the home for maintaining mobility: findings from the Women's Health and Aging Study. J Am Geriatr Soc. 2005; 53(2): 198–203.PubMedCrossRefGoogle Scholar
  10. 10.
    Le Masurier GC, Bauman AE, Corbin CB, Konopack JF, Umstattd RM, Van Emmerik REA. Assessing walking behaviors of selected subpopulations. Med Sci in Sports & Exercise. 2008; 40(7): S594–S602.CrossRefGoogle Scholar
  11. 11.
    Asano M, Miller WC, Eng JJ. Development and psychometric properties of the ambulatory self-confidence questionnaire. Gerontology. 2007; 53(6): 373–381.PubMedCrossRefGoogle Scholar
  12. 12.
    Gallagher N, Clarke P, Loveland-Cherry C, Ronis D, Nyquist L, Gretebeck KE. Environmental and psychosocial influences on neighborhood walking in older adults with and without mobility limitations. Res Gerontol Nurs. 2012; 5: 238–250.PubMedCrossRefGoogle Scholar
  13. 13.
    Guralnik JM, Ferrucci L, Pieper CF, et al. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci. 2000; 55(4): M221–M231.PubMedCrossRefGoogle Scholar
  14. 14.
    Simonsick EM, Newman AB, Visser M, et al. Mobility limitation in self-described well-functioning older adults: importance of endurance walk testing. J Gerontol A Biol Sci Med Sci. 2008; 63(8): 841–847.PubMedCrossRefGoogle Scholar
  15. 15.
    Debnam K, Harris J, Morris I, Parikh S, Shirey L. Durham County socially isolated older adults: an action-oriented community diagnosis. University of North Carolina at Chapel Hill School of Public Health, Department of Health Behavior and Health Education; 2002.Google Scholar
  16. 16.
    Markham JP, Gilderbloom JI. Housing quality among the elderly: a decade of changes. Int J Aging Hum Dev. 1998; 46(1): 71–90.PubMedCrossRefGoogle Scholar
  17. 17.
    Humpel N, Owen N, Leslie E. Environmental factors associated with adults' participation in physical activity. Am J Prev Med. 2002; 22: 188–199.PubMedCrossRefGoogle Scholar
  18. 18.
    Addy CL, Wilson DK, Kirtland KA, Ainsworth BE, Sharpe P, Kimsey D. Associations of perceived social and physical environmental supports with physical activity and walking behavior. Am J Public Health. 2004; 94: 440–443.PubMedCrossRefGoogle Scholar
  19. 19.
    Booth ML, Owen N, Bauman A, Clavisi O, Leslie E. Social-cognitive and perceived environment influences associated with physical activity in older Australians. Prev Med. 2000; 31(1): 15–22.PubMedCrossRefGoogle Scholar
  20. 20.
    Patterson PK, Chapman NJ. Urban form and older residents' service use, walking, driving, quality of life, and neighborhood satisfaction. Am J Heal Promot. 2004; 19: 45–52.CrossRefGoogle Scholar
  21. 21.
    Fisher KJ, Li F, Michael Y, Cleveland M. Neighborhood-level influences on physical activity among older adults: a multilevel analysis. J Aging Phy Activity. 2004; 11: 45–63.Google Scholar
  22. 22.
    Berke EM, Koepsell TD, Moudon AV, Hoskins RE, Larson EB. Association of the built environment with physical activity and obesity in older persons. Am J Public Health. 2007; 97(3): 486–492.PubMedCrossRefGoogle Scholar
  23. 23.
    Michael Y, Beard T, Choi D, Farquhar S, Carlson N. Measuring the influence of built neighborhood environments on walking in older adults. J Aging Phy Activity. 2006; 14: 302–312.Google Scholar
  24. 24.
    Li F, Fisher KJ, Brownson RC, Bosworth M. Multilevel modelling of built environment characteristics related to neighbourhood walking activity in older adults. J Epidemiol Community Health. 2005; 59(7): 558–564.PubMedCrossRefGoogle Scholar
  25. 25.
    Li F, Fisher KJ. A multilevel path analysis of the relationship between physical activity and self-rated health in older adults. J Phys Act Heal. 2004; 1: 398–402.Google Scholar
  26. 26.
    Balfour JL, Kaplan GA. Neighborhood environment and loss of physical function in older adults: evidence from the Alameda County Study. Am J Epidemiol. 2002; 155: 507–515.PubMedCrossRefGoogle Scholar
  27. 27.
    Schootman M, Andresen EM, Wolinsky FD, Malmstron TK, Miller JP, Miller DK. Neighborhood conditions and risk of incident lower-body functional limitations among middle-aged African Americans. Am J Epidemiol. 2006; 163: 450–458.PubMedCrossRefGoogle Scholar
  28. 28.
    Clarke P, Ailshire JA, Bader M, Morenoff JD, House JS. Mobility disability and the urban built environment. Am J Epidemiol. 2008; 168(5): 506–513.PubMedCrossRefGoogle Scholar
  29. 29.
    Gill TM, Allore HG, Han L. Bathing disability and the risk of long-term admission to a nursing home. J Gerontol A Biol Sci Med Sci. 2006; 61A: 821–825.CrossRefGoogle Scholar
  30. 30.
    Cohen MA, Tell EJ, Wallack SS. Client-related risk factors of nursing home entry among elderly adults. J Gerontol. 1986; 41: 785–792.PubMedCrossRefGoogle Scholar
  31. 31.
    Jette AM, Branch LG, Sleeper LA, Feldman HR, Sullivan LM. High-risk profiles for nursing home admission. Gerontologist. 1992; 32: 634–640.PubMedCrossRefGoogle Scholar
  32. 32.
    Alexander NA, Goldberg A. Common gait disturbances: a clinical overview. In: Hausdorff JM, Alexander NB, eds. Gait Disorders: Evaluation and Management. Boca Raton: FL; Taylor & Francis Group; 2005: 1–18.Google Scholar
  33. 33.
    Morris JN, Fries BE, Steel K, Ikeggami N, Bernabei R, Carpenter GI. Comprehensive clinical assessment in community setting: applicability of the MDS-HC. J Am Geriatr Soc. 1997; 45: 1017–1024.PubMedGoogle Scholar
  34. 34.
    Fries BE, Shugarman LR, Morris JN, Simon SE, James M. A screening system for Michigan's home- and community-based long-term care programs. Gerontologist. 2002; 42: 462–474.PubMedCrossRefGoogle Scholar
  35. 35.
    Clarke P, Ailshire J, Melendez R, Bader M, Morenoff J. Using Google Earth to conduct a neighborhood audit: reliability of a virtual audit instrument. Health & Place. 2010; 16(6): 1224–1229.CrossRefGoogle Scholar
  36. 36.
    Rundle AG, Bader MDM, Richards CA, Neckerman KM, Teitler JO. Using Google Street View to audit neighborhood environments. Am J Prev Med. 2011; 40(1): 94–100.PubMedCrossRefGoogle Scholar
  37. 37.
    Michael YL, Keast EM, Chaudhury H, Day K, Mahmood A, Sarte AFI. Revising the senior walking environmental assessment tool. Prev Med. 2009; 48(3): 247–249.PubMedCrossRefGoogle Scholar
  38. 38.
    Muthen BO. Latent variable analysis: growth mixture modelling and related techniques for longitudinal data. In: Kaplan D, ed. Handbook of quantitative methodology for the social sciences. Newbury Park: Sage; 2004: 345–368.Google Scholar
  39. 39.
    Lehning AJ. City governments and aging in place: community design, transportation and housing innovation adoption. Gerontologist. 2012; 52(3): 345–356.PubMedCrossRefGoogle Scholar
  40. 40.
    Gallagher N, Gretebeck K, Robinson J, Torres E, Murphy S, Martyn K. Neighborhood factors relevant for walking in older, urban, African American adults. J Aging Phys Activity. 2010; 18(1): 99–115.Google Scholar

Copyright information

© The New York Academy of Medicine 2013

Authors and Affiliations

  1. 1.Institute for Social ResearchUniversity of MichiganAnn ArborUSA
  2. 2.Michigan State UniversityEast LansingUSA

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