Factors Affecting Life-Space Mobility of Home-Care Older Adults Receiving Home-Visit Rehabilitation Using Path...

Life-space mobility (LSM) limitations are a significant concern associated with facility admission, mortality, and quality of life in older adults. Home-visit rehabilitation (HR) users are particularly vulnerable to LSM restrictions, making its maintenance and improvement a priority in this population. This study aimed to assess LSM using the life-space assessment (LSA) and expand existing conceptual models for independent community-dwelling older adults in Japan. Additionally, we analyzed factors influencing LSM in HR users.

This multicenter cross-sectional study included 105 HR users, comprising 56 men (53.3%) and 49 women (46.7%); mean age 78.5 ± 7.7 years, from urban and rural areas between August 2020 and October 2022. Motor function (grip strength, 30-second chair stand test, CS-30), psychological factors (Self-Efficacy Scale on Going out among community-dwelling Elderly, SEGE), activities of daily living (ADL) ability (functional independence measure, FIM), instrumental ADL (IADL) ability (Frenchay Activities Index, FAI), and environmental factors (home and communication environment, living alone, and day service use frequency), which have been reported in previous studies, were collected for parameters related to LSA. Path analysis examined associations between these factors and LSA.

LSA revealed direct effects on FAI (β = 0.344), FIM-motor score (β = 0.261), living alone (β = -0.196), and day service use frequency (β = 0.184). Indirect effects were observed in CS-30 (β = 0.220), SEGE (β = 0.085), and sex (β = -0.087). The model demonstrated good fit (goodness-of-fit index, GFI, 0.956; adjusted GFI, 0.910; comparative fit index, 1.000; root mean square error of approximation, 0.000).

ADL, IADL, and environmental factors directly affect LSA in home-care older adults using HR, while motor function, psychological factors, and sex have indirect effects. These findings highlight the importance of considering these relationships when designing rehabilitation strategies to support LSM. Future research should examine broader populations, additional variables, and longitudinal data to refine interventions for HR users.