Perceived environmental barriers as a predictor of step count changes in older adults

Purpose: To investigate the relationship between environmental perceptions and step counts in older adults living in retirement communities.

Methods: Older adults (average age 83) were recruited from 11 retirement communities randomized to an attention control condition or a walking intervention that addressed environmental barriers. 7-day step counts were measured at baseline and 3 months by accelerometry. Participants completed surveys at baseline about their satisfaction with their walking environment, perceived barriers, and fear of falling in specific environments. A mixed model regression analyses, adjusting for site, age, gender, education, marital status, and baseline step counts, examined the interaction between environmental perceptions and the intervention on daily average step counts at 3 months.

Results: At baseline, those with less satisfaction, more barriers and greater fear had significantly (p<.05) fewer step counts. There was no interaction between barriers or satisfaction with the intervention, i.e. regardless of baseline perceptions participants increased their steps significantly (p <.05). There was a significant interaction (p<.001) between fear of falling and the intervention indicating those with greater fear were less likely to increase their steps. In the control condition, step counts decreased equally in those with high and low fear of falling.

Conclusions: Older adults with negative perceptions of their community environment increased their steps in an intervention that provided environmental supports such as maps, step counts, and counseling to overcome barriers. Further work is needed to increase steps in those most afraid of falling.