Perceived environmental barriers to outdoor mobility and changes in sense of autonomy in participation outdoors among older people: a prospective two-year cohort study.

OBJECTIVE The aim was to study whether perceived environmental barriers to outdoor mobility affect changes in sense of autonomy in participation outdoors among community-dwelling older people over a two-year period. METHODS Community-dwelling people aged 75-90 years (n = 848) in central Finland were interviewed on two occasions, face-to-face at baseline and over the telephone two years later. Perceived environmental barriers to outdoor mobility were assessed using a 15-item structured questionnaire, and the sum scores categorized into tertiles (0, 1 and 2 or more barriers). Autonomy in participation outdoors was assessed with the 'Impact on Participation and Autonomy' (IPA) questionnaire using the autonomy outdoors subscale (score range 0-20, higher scores indicating more restricted autonomy). RESULTS Scores for autonomy in participation outdoors were available for 848 participants at baseline (mean 6.2, SD = 3.8) and for 748 participants at the two-year follow-up (mean 6.7, SD = 3.9). At baseline, those reporting multiple environmental barriers had the most restricted autonomy, while those reporting no environmental barriers had the least restricted autonomy (p < .001). Over the follow-up, autonomy in participation outdoors declined more among those reporting multiple environmental barriers compared to those reporting none (age- and sex-adjusted group*time β = .629, s.e. = .277, p = .023). Adjustment for cognitive functioning, education, number of chronic conditions and change in walking difficulty did not influence the association. CONCLUSION Perceived environmental barriers to outdoor mobility accelerate the decline in autonomy in participation outdoors among older community-dwelling people. Understanding factors affecting autonomy can help in finding ways to support the sense of autonomy as people age.