Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2024 Feb 9.
Published in final edited form as: Clin Gerontol. 2023 Feb 9;46(5):745–758. doi: 10.1080/07317115.2023.2177573

Changes in Older Adults’ Frequency of Going Outside between 2020 and 2021: Associations with Health Status and Environmental Factors

Namkee G Choi 1,*, Bryan Y Choi 2, C Nathan Marti 1
PMCID: PMC10409875  NIHMSID: NIHMS1872002  PMID: 36760067

Abstract

Objectives:

To examine the changes in the frequency of going outside among U.S. older adults between 2020 and 2021 (post-COVID vaccine) and correlates of those changes.

Methods:

We used the 2019–2021 National Health and Aging Trend Study (NHATS) (N=3,063, age 70+) and multinomial logistic regression to analyze associations of increased and decreased frequencies in going outside with physical, psychosocial, and cognitive health, environmental (COVID concerns and transportation) factors, and social media use as the independent variables.

Results:

In 2021 compared to 2020, 13% and 16% of those age 70+ reported increased and decreased frequencies, respectively. Increased frequency was associated with social media use. Decreased frequency was associated with poor physical health, depression/anxiety, and perceived memory decline. COVID concerns and transportation problems, as well as female gender, age 90+, and being non-Hispanic Black, were also significant correlates of decreased frequency.

Conclusions:

Most U.S. adults age 70+ appear to have resumed their 2019 level of frequency of going outside in 2021 after the COVID vaccines became available; however, 16% reported decreased frequency of going outside in 2021 compared to 2020.

Clinical Implications:

Older adults with physical, mental, and cognitive health challenges need help to increase their frequency of going outside.

Keywords: Mobility, Life-space, Going outside, COVID, health, depression/anxiety, Environment

Introduction

Mobility in late life—broadly defined as the ability to move oneself within community environments that expand from one’s home to the neighborhood and to regions beyond, either by walking or using assistive device(s) or transportation (Weber et al., 2010, p. 443)—is an important factor for maintaining physical activities, social connectedness, independence, and overall quality of life (Cornwell & Waite, 2009; Satariano et al., 2012; Umstattd Meyer et al., 2013). Research has shown multiple benefits of going outside one’s dwelling and engaging in physical and social activities (e.g., taking a walk, working in garden/field, visiting family/friends, attending religious services, traveling, volunteering) for older adults’ physical and mental health (Choi et al., 2015; Kono et al., 2007). Conversely, limited out-of-home mobility or restricted life-space (i.e., the area—within and beyond one’s home—through which a person travels over a specific time period; Baker et al., 2003, p. 1610) has shown to negatively affect older adults’ physical, mental, and cognitive health, in part due to reduced overall physical activity, social engagement, and other life activities (e.g., shopping for food, obtaining healthcare services) that are necessary for keeping up physical and mental health (Fujita et al., 2006; Satariano et al., 2012; Tsai et al., 2016). Declines in life-space mobility over six months were associated with incidents of falls and fractures in a sample of U.S. older Medicare beneficiaries (Lo et al., 2014). A systematic review also found small-to-moderate associations between mobility and cognitive health, in particular, executive function, learning, memory, and processing speed (De Silva et al., 2019).

The COVID-19 pandemic, brought forth by a highly contagious virus named SARS-CoV-2, has had significant negative impact on life-space mobility of people of all ages around the world. During the COVID-19 outbreak in 2020, physical distancing (e.g., curtailing in-person contact with other people and social engagement) was an essential public health strategy in most places to slow the person-to-person transmission of COVID-19 (Centers for Disease Control and Prevention [CDC], 2022). Because people with chronic illnesses and immunocompromised conditions are at an increased risk of severe illness from COVID-19, physical distancing and home confinement was an especially important safety measure for older adults (CDC, 2022). Studies of older adults in many countries reported decreased physical activity and activity destinations and increased sedentary behaviors during COVID-19 home confinement (Carvalho et al., 2021; Fernández-García et al., 2021; Joseph et al., 2021; Lage et al., 2021; Portegijs et al., 2022; Sepulveda-Loyola et al., 2021). Our study of a representative sample of U.S. older adults age 70+ found that 32% decreased frequency of going-outside and 13% never/rarely went outside during the COVID outbreak in 2020 (Choi et al., 2022a).

Decreased physical and social activities and increased psychosocial stressors from the pandemic (e.g., fear of exposure to COVID-19, worry about healthcare access for COVID and other medical conditions, reduced social support, social isolation, and loneliness from home confinement) also contributed to development or worsening of depression/anxiety especially among older adults with other existing risk factors such as multiple comorbidity burden and disability (Briggs et al., 2021; Choi et al., 2022a; Fu et al., 2022; Liao et al., 2021; Shimokihara et al., 2022; van den Besselaar et al., 2021). Research has shown that depression/anxiety in turn put older adults at an increased risk of developing or worsening physical/functional health problems (Dong et al., 2020; Simning & Seplaki, 2020), leading to increased healthcare utilization and costs (Buczak-Stec et al., 2022; Porensky et al., 2009; Schousboe et al., 2019).

Older adults with depressive symptoms or depression also have increased risk of cognitive impairment (Johnco et al., 2015; Wei et al., 2019). A study of adults age 55+ during the COVID-19 pandemic showed that elevated loneliness and anxiety symptoms, both relative to other adults and to one’s usual levels, were acutely associated with worse perceived cognitive function and abilities over a 9-month period (Kobayashi et al., 2022). Another study assessing the impact of the pandemic among older adults also found that cognitive health worries, less social interaction, and lower levels of physical activity were associated with higher depression/anxiety symptoms and loneliness (Sutton et al., 2022). Older adults need physical activity as moderate-to-vigorous physical activity has been found to modify the depression-cognition relationship and preserve cognition function (Hu et al., 2019; Nuzum et al., 2020).

COVID vaccines became available in mid-December, 2020 in the U.S., with adults age 65+ among the first groups prioritized for vaccination. By May 1, 2021, 82% of older adults received ≥1 vaccine dose, and the rates of COVID infection, ED visits, hospital admissions, and deaths among older adults were substantially lower than those among adults age 18–49 (Christi et al., 2011). Vaccinated older adults likely increased their frequency of going outside, motivated by the desire to reconnect with and reengage in the community if they had physical, mental, and cognitive capacity to do so. On the other hand, some older adults may have not been able to increase their frequency of going outside for a variety of reasons including poor health, COVID safety concerns, and other personal circumstances. To date, however, little research has been done on changes in older adults’ frequency of going outside between 2020 (pre COVID vaccine) and 2021 (post COVID vaccine) and its correlates. Since older adults were one of the most socially isolated groups during the COVID-19 pandemic, it is important to examine changes in their frequency of going outside the home in 2021 and how the changes may have been associated with physical, mental, and cognitive health as well as environmental factors (COVID-related regulations and concerns and transportation as barriers). In the present study, based on a representative sample of U.S. Medicare beneficiaries aged 70+, we examined increases and decreases versus no change in their frequency of going outside between 2020 and 2021 and the correlates of the changes using the socioecological mobility framework.

Conceptual framework and the study hypothesis

In the socioecological mobility framework (Weber et al., 2010), mobility is determined by physical, psychosocial (e.g., depression, coping behaviors, relationship with others), cognitive (e.g., executive functioning, memory), environmental (both social and built), and financial factors intersecting with gender and cultural and biographical influences. Later studies found that physical and psychosocial health tend to be consistently significant determinants, while the significance of other factors varied depending on the study sample (Giannouli et al., 2019; Umstattd Meyer et al., 2013).

The COVID-19 pandemic and the unprecedented large-scale lockdowns of physical and social activity venues were a unique social-environmental context that was undeniably one of the most significant factors affecting life-space mobility. Many vaccinated older adults may still have been rightly cautious about venturing into crowded indoor spaces, using public transportation, or asking others for a ride. COVID safety concerns and transportation problems should thus be examined as environmental factors affecting older adults’ frequency of going outside. Another factor unique to the COVID pandemic was the substitution of in-person contact with virtual contact (e.g., video-calling and social media use with family/friends, telemedicine use). Given the remaining COVID safety concerns and the convenience of virtual contact, especially for those with transportation and other mobility challenges, some older adults may continue to rely on virtual contact for part of their social engagement. Healthcare providers may also continue to use telemedicine or hybrid visits even as the pandemic comes under control (Benis et al., 2021).

Hence the study hypothesis: changes in the frequency of going outside would be significantly associated with (a) physical health (number of chronic illnesses, pain level, mobility device use); (b) mental health (depression/anxiety symptoms); (c) cognitive health (clock drawing test scores, perceived memory decline); (d) environmental factors (COVID concerns and transportation problems); (e) social activity via virtual contact; and (f) sociodemographic factors. Specifically, we hypothesized that decreased frequency of going outside would be associated with poor physical, mental, and cognitive health, COVID concerns and transportation problems, and virtual social activity engagement. This study’s findings will help identify factors affecting increased or decreased outside-home mobility post-vaccine availability among older adults and the need for services for those with decreased mobility.

Methods

Data and sample

We used the 2019, 2020, and 2021 U.S. National Health and Aging Trend Study (NHATS) public use data files. NHATS collects data annually from a nationally representative panel of older Medicare beneficiaries. The initial sample persons (age 65+) were first interviewed in 2011 and replenishment samples were added in 2015 (Freedman et al., 2022). All these sample persons were 70+ years in 2021. Data were collected in-person from May through October of 2019 and 2021, and via telephone (due to the COVID-19 outbreak) from June through November of 2020. In this study, we focused on 3,063 NHATS respondents, representing approximately 28.3 million Medicare beneficiaries aged 70+, who were living in their own homes or residential care communities (not a nursing home) in all three years and self-interviewed. We excluded those who were proxy-interviewed (due mostly to dementia and illness) to ensure that all responses (e.g., depressive/anxiety symptoms and self-rated memory) were self-reported. This study based on de-identified public-use data was exempt from the authors’ institutional review board review.

Measures

Past-month frequency of going outside in 2019–2021:

At each annual interview, respondents were asked, “In the last month, how often did you leave your home/building to go outside?”. The response categories were: every day (7 days a week), most days (5–6 days a week), some days (2–4 days a week), rarely (once a week or less), and never. In this study, we used the following three categories: every day/most days, some days, and rarely/never.

Changes in the frequency of going outside between 2020 and 2021:

Respondents reported changes in their frequency of going outside between 2020 and 2021 in response to a question, “Compared to a year ago, do you now leave your home/building more often, less often, or about the same?” In this study, we used the following three categories: no change (=about the same), increased frequency (=more often), and decreased frequency (=less often).

Sociodemographic variables:

These were age group (70–74, 75–79, 80–84, 85–89, 90+ years); gender; race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, or Other); marital status (married/partnered, divorced/separated, widowed, never married); residence (in own home vs. care community); and income (up to $42,999, $43,000-$65,999, $66,000-$99,999, or $100,000+ in 2019).

Physical health conditions in 2021:

These included: (1) number (0–8) of diagnosed chronic medical conditions (heart attack or heart disease, hypertension, stroke, arthritis, osteoporosis, diabetes, lung disease, cancer); (2) past-month pain level (no bothersome pain, bothersome but non-activity-limiting pain; activity-limiting pain); and (3) past-month use of mobility device (cane, walker, wheelchair, or scooter) to “help get around more easily, safely, or on one’s own (no=0, yes=1).

Past-month depression/anxiety symptoms in 2021:

These were assessed with the Patient Health Questionnaire-4 (PHQ-4) (Kroenke et al., 2009; Löwe et al., 2010); and (2) number of people in the social network. The PHQ-4 includes the first two items (PHQ-2) from the 9-item PHQ-9 for depression (Kroenke et al., 2003) and the first two items (GAD-2) from the 7-item Generalized Anxiety Disorder Scale (Spitzer et al., 2006). The PHQ-2 captures cognitive/affective symptoms of anhedonia and depressed mood: (a) had little interest or pleasure in doing things; and (b) felt down, depressed, or hopeless. The GAD-2 represents the core anxiety symptoms: (a) felt nervous, anxious, or on edge; and (b) have been unable to stop or control worrying. A 4-point scale (0=not at all; 1=several days; 2=more than half the days; 3=nearly every day) was used for each PHQ-9 item for a sum score of 0–12. For symptom severity, the sum score is operationally categorized as normal (0–2), mild (3–5), and moderate/severe (6–12) (Kroenke et al., 2009).

Cognitive health in 2021:

This was assessed with: (1) clock drawing test (Lin et al., 2013) score (accurate/reasonably accurate, mildly distorted, or moderately/severely distorted/unrecognizable/unable to do) as a measure of cognitive impairment, and (2) self-rated memory compared to a year ago (better or the same or worse).

Environmental factors in 2021:

Respondents were asked if COVID concerns and transportation problems ever kept them from any past-month social activity (no=0, yes=1).

Virtual social contact in 2021:

This was assessed with video-calling (via Face Time, Zoom, or other online video call platform) with family/friend and visiting online social network sites (e.g., Facebook or LinkedIn) in the past month (no=0, yes=1).

Descriptive purpose only:

To better understand older adults’ health status and physical and social activities in 2021, we reported: (1) dementia diagnosis, ability to walk 3 blocks, driving, past-year falls, past-year overnight hospital stay, self-rated health, loneliness, and COVID vaccination and infection statuses; (2) past-month physical activity: walking for exercise and working out, swimming, running or biking, or playing a sport; and (3) past-month social activity: visiting in-person with family/friend not living with; attending religious services; participating in clubs, classes or other organized activities; going out for enjoyment (dinner, a movie, gamble, concert, theater); volunteering; and working for pay (as a job is likely to allow interactions with other people).

Analysis

All analyses were conducted with Stata/MP 17’s svy function (College Station, TX) to account for NHATS’s stratified, multistage sampling design (Freedman et al., 2022). All estimates presented in this study are weighted except sample sizes. We first presented going outside frequency in 2019, 2020, and 2021 among the study population and racial/ethnic and gender differences. Second, we used χ2 tests and ANOVA to describe three groups by changes in their going-outside frequency (no change, increased, decreased) with respect to sociodemographic characteristics, physical health, depression/anxiety symptoms, cognitive health, environmental factors, and virtual contact. We also used χ2 tests to describe these three groups’ other health-related characteristics and physical and social activities. Third, we used multinomial logistic regression to test the study hypothesis (correlates of the changes in the frequency of going outside between 2020 and 2021, controlling for the 2020 frequency of going outside). Given their lack of significance in preliminary multivariable analysis, we excluded the following sociodemographic variables from the final multinomial logistic regression model: marital status, residence, and income. As a preliminary diagnostic, we used variance inflation factor (VIF), using a cut-off of 2.50 (Allison, 2012), from linear regression models to assess multicollinearity among covariates. VIF diagnostics indicated that multicollinearity among covariates was not an issue. Results are presented as relative risk ratios (RRR) with 95% confidence intervals (CIs), and statistical significance was set at p<0.05.

Results

Past-month frequency of going outside in 2019–2021 and racial/ethnic and gender differences

Figure 1 shows that 88.4%, 76.1%, and 82.8% of the study population reported going outside every day/most days in 2019, 2020, and 2021, respectively. The proportions that rarely/never went outside were 2.2%, 9.7%, and 5.0% in 2019, 2020, and 2021, respectively. Figure 1 also shows significant racial/ethnic differences in going-outside frequencies in all three years (F(2.90, 159.57)=39.38 in 2019; F(3.08, 169.51)=46.45 in 2020; and F(2.69, 147.86)=27.34 in 2021, p<.001 for all three years). In 2020, compared to 7.1% of non-Hispanic White older adults, 18.5% of Black and 32.2% of Hispanic older adults reported rarely/never going outside. In 2021, compared to 3.8% of non-Hispanic White older adults, 10.2% of Black and 13.9% of Hispanic older adults reported rarely/never going outside. Additional analysis also showed significant gender differences in going-outside frequencies in all three years, with higher proportions of women than men reporting going outside every day/most days in all three years (92.9% vs. 84.9% in 2019; 85.2% vs. 68.8% in 2020; and 90.6% vs. 76.5% in 2021, p<.001 for all three years). There was no significant difference in age group compositions among three racial/ethnic groups (F(4.57, 251.61)=2.13, p=.068) and between genders (F(2.38, 130.97)=2.37, p=0.088).

Figure 1.

Figure 1.

Open in a new tab

Frequency of going outside by year, 2019–2021 and racial/ethnic differences

Changes in the frequency of going outside, 2020–2021 and health and other characteristics

Table 1 shows that 70.7% of the study population reported no change in their frequency of going outside between 2020 and 2021, 12.9% reported increased frequently, and 16.4% decreased frequency. Among the decreased-frequency group, 19.6% rarely/never went outside during the past month in 2021, which was similar to 20.3% in 2020 but a significant increase from 7.0% in 2019, and the proportion that went outside every day/most days in the past month declined by 3 percentage points between 2020 and 2021 and by 20 percentage points between 2019 and 2021. On the other hand, the 2021 frequency of going outside in the no-change and increased-frequency groups were close to the 2019 frequency of going outside.

Table 1.

Self-reported changes in going-outside frequency, 2020–2021: Sociodemographic, health, and environmental factors and virtual contact

N (%) All
3,063 (100%)		 No change
2,120 (70.7%)		 Increased frequency
341 (12.9%)		 Decreased frequency
602 (16.4%)		 χ2 / ANOVA p
Past-month frequency of going outside in 2021 (%) <.001
  Every day/most days 82.8 88.5 90.0 52.5
  Some days 12.2 9.2 8.7 27.9
  Rarely/never 5.0 2.3 1.3 19.6
Past-month frequency of going outside in 2020 (%) <.001
  Every day/most days 76.1 81.4 73.3 55.5
  Some days 14.1 11.1 18.1 24.2
  Rarely/never 9.7 7.5 8.6 20.3
Past-month frequency of going outside in 2019 (%) <.001
Every day/most days 88.4 91.1 93.7 72.9
Some days 9.4 7.6 6.1 20.1
Rarely/never 2.2 1.4 0.2 7.0
Sociodemographics
Age group (%) <.001
70–74 29.8 30.4 39.3 19.7
75–79 33.4 32.6 35.5 35.1
80–84 20.1 21.0 15.4 20.1
85–89 11.1 11.1 7.5 14.1
90+ 5.6 4.9 2.3 11.0
Female (%) 55.4 49.0 70.7 71.0 <.001
Race/ethnicity (%) .002
Non-Hispanic White 80.1 81.3 83.5 72.2
Non-Hispanic Black 7.7 6.5 6.9 13.2
Hispanic 6.7 6.5 3.0 10.3
Other 5.6 5.7 6.6 4.3
Marital status (%) <.001
Married/partnered 53.7 57.1 54.2 38.8
Divorced/separated 14.2 13.6 14.7 16.0
Widowed 29.0 26.3 28.4 41.1
Never married 3.1 3.0 2.7 4.1
Income (in 2019, %) <.001
Under $43,000 45.0 42.6 39.4 60.0
$43,000-$65,999 18.2 18.7 18.1 15.8
$66,000-$99,999 15.9 16.9 17.0 10.6
$100,000 or higher 20.9 21.8 25.5 13.6
Residence (%) <.001
In their own home 95.9 96.2 96.2 94.2
In residential care community 4.1 3.8 3.8 5.8
Physical health conditions in 2021
No. of chronic medical conditions, M (SE) 2.68 (0.02) 2.52 (0.03)a 2.66 (0.08)a 3.35 (0.07) b <.001
Pain level (%) <.001
  No bothersome pain 44.4 49.3 38.4 28.0
  Bothersome but not activity limiting 25.8 25.0 34.9 22.2
  Activity-limiting 29.8 25.7 26.7 49.8
Mobility device (cane, walker, or wheelchair) use (%) 27.3 23.0 18.8 52.6 <.001
Depression/anxiety symptoms
  PHQ-4 score, M (SE) 1.29 (0.01) 1.24 (0.04)a 1.23 (0.04)a 1.58 (0.04)b <.001
  Symptom severity level (%) <.001
  Normal (0–2) 76.9 81.0 80.7 56.3
  Mild symptoms (3–5) 16.8 14.0 15.5 29.7
  Moderate/severe symptoms (6–12) 6.3 5.0 3.8 14.1
Cognitive health in 2021
Clock drawing test (%) <.001
  Accurate/reasonably accurate 71.5 71.7 80.9 63.2
  Mildly distorted 17.1 17.3 9.3 22.6
  Moderately/severely distorted/unrecognizable 7.2 6.9 5.6 9.9
  Missing 4.2 4.1 4.2 4.3
Memory compared to 2020 (%) <.001
  Better or the same 82.0 85.0 84.8 67.0
  Worse 18.0 15.0 15.2 33.0
Environmental factors, 2021
COVID concerns 50.9 47.8 46.6 67.5 <.001
Transportation problem 4.4 2.7 1.7 14.0 <.001
Virtual social contact, 2021
Video calling with family/friend 32.3 32.1 43.5 24.0 <.001
Visiting social network sites 38.4 38.1 54.0 27.4 <.001
Open in a new tab
a,b:

denote significantly different pairs at p<.001

The decreased-frequency group included higher proportions of those age 85+, non-Hispanic Blacks or Hispanics, widowed individuals, those with income<$43,000. Compared to the no-change group, the increased-frequency and decreased-frequency groups also included higher proportions of women. Compared to the no-change and increased-frequency groups, the decreased-frequency group had more physical health problems. Compared to 5.0% of the no-change group and 3.8% of the increased-frequency group, 14.1% of the decreased-frequency group had moderate/severe depression/anxiety symptoms. Additional analysis showed that the mean 2020 PHQ-4 scores were significantly higher than the mean 2019 PHQ-4 scores and that the 2021 PHQ-4 scores were significantly lower than the mean 2020 PHQ-4 scores in all three groups (p<.001 for all paired analyses).

The decreased-frequency group also had the least robust cognitive health as shown in both clock drawing test scores and perceived change in memory. The increased-frequency group included the highest proportion with accurate/reasonably accurate clock drawing (F(2.76, 152.03)=3.89, p=0.01 when compared to the no-change group). Compared to 15.0% of the no-change group and 15.2% of the increased-frequency group, 33.0% of the decreased-frequency group perceived that their memory was worse in 2021 than in 2020. Compared to less than one half of the other two groups, two thirds of the decreased-frequency group reported COVID concerns was a barrier to social activity, and 14.0%, compared to less than 3% of the other two groups, reported transportation to be a barrier. Additional analysis showed that the largest percentage of Black older adults reported COVID concerns (65.2%; F(2.47, 135.82)=5.09, p=.004) and transportation problems (7.8%; F(2.69, 147.87)=3.90, p=.013). Compared to 32.1% of the no-change group and 43.5% of the increased-frequency group, 24.0% of the decreased-frequency group did video calls with family/friends. Compared to 38.1% of the no-change group and 54.0% of the increased-frequency group, 27.4% of the decreased-frequency group visited online social network site in the past month.

More health-related characteristics and past-month physical and social activities

Table 2 shows that the decreased-frequency group was the most disadvantaged of the three groups with respect to other indicators of health and functioning and loneliness. For example, 47.2% of the decreased-frequency group, compared to 31.9% of the no-change group and 29.5% of the increased-frequency group, reported any fall in the past year, with more than half of those who fell reporting 2+ falls; and 32.0% of the decreased-frequency group, compared to less than 15% of the other two groups had overnight hospital stay. The decreased-frequency group also had a lower COVID vaccination rate than the other two groups, but the three groups did not significantly differ on COVID infection rate. Additional analysis showed no significant difference in vaccination rates by age group, gender, or race/ethnicity.

Table 2.

Other health-related characteristics and past-month physical and social activities by changes in going-outside frequency, 2020–2021 (%)

N (%) All
3,063 (100%)		 No change
2,120 (70.7%)		 Increased frequency
341 (12.9%)		 Decreased frequency
602 (16.4%)		 χ2 p (all 3 groups)
Other health-related characteristics
Dementia diagnosis (%) 3.6 3.4 1.6 6.0 .003
Able to walk three blocks (%) 73.4 78.3 82.6 45.2 <.001
Drove in the past year (%) 82.9 86.5 88.5 63.0 <.001
Past-year fall (%) <.001
No fall 65.9 68.1 70.5 52.8
Once 19.2 18.3 18.6 23.3
More than once 14.9 13.6 10.9 23.9
Past-year overnight hospital stay (%) 17.2 14.2 14.7 32.0 <.001
Self-rated health (1 [poor] to 5 [excellent]), M (SE) 3.32 (0.02) 3.42 (0.05)a 3.52 (0.05)a 2.71 (0.05)b <.001
Loneliness (1 [never] to 5 [every day]), M (SE) 1.84 (0.02) 1.78 (0.02)a 1.76 (0.07)a 2.13 (0.05)b <.001
Had COVID (%) 10.1 10.2 7.1 12.1 .230
Received COVID vaccination (%) 90.1 90.5 93.8 85.5 .003
Past-month physical activity (%)
Walking for exercise 66.8 68.6 75.0 52.4 <.001
Working out, swimming, running or biking, or playing a sport 41.7 45.6 43.6 23.4 <.001
Past-month social activity (%)
Visiting in person with family/friend not living with1 82.5 85.2 86.4 67.7 <.001
Attending religious services 51.6 50.6 62.9 46.9 <.001
Participating in clubs, classes or other organized activities 35.2 35.6 49.8 22.1 <.001
Going out for enjoyment (to dinner, a movie, to gamble, or to hear music or see a play) 69.6 72.2 81.6 48.7 <.001
Volunteering 19.6 20.3 25.6 11.6 <.001
Working for pay 15.3 17.2 18.1 5.0 <.001
Open in a new tab
1

At the sample person’s or other’s home

a,b:

denote significantly different pairs at p<.001

A lower proportion of the decreased-frequency group than the other two groups engaged in physical and social activities. For example, only a little more than half of them, compared to 69–75% of the other two groups, went out for a walk; 67.7%, compared to 85+% of the other two groups, visited with family/friend in the past month; and 48.7%, compared to 72–82% of the other two groups, went out for enjoyment in the past month.

Correlates of increased and decreased frequencies of going outside: Multinomial logistic regression results

Table 3 shows that the likelihood of increased frequency of going outside in 2021, compared to no change in the frequency, was higher among those who reported bothersome but non-activity-limiting pain (RRR=1.70, 95% CI=1.16–2.50), those who reported visiting social network sites (RRR=1.46, 95% CI=1.03–2.07), and women (RRR=2.39, 95% CI=1.73–3.31), but it was lower among those with mildly distorted clock drawing (RRR=0.56, 95% CI=0.36–0.88) and in all 80+ age groups compared to the 70–74 age group.

Table 3.

Correlates of changes in going-outside frequency between 2020 and 2021: Multinomial logistic regression results

Vs. No change
Increased frequency
RRR (95% CI)		 Decreased frequency
RRR (95% CI)
Past-month frequency of going outside in 2020: vs. every day/most days
  Some days 1.79 (1.13–2.84)* 1.93 (1.38–2.70)***
  Rarely/never 1.58 (0.99–2.54) 1.83 (1.24–2.69)**
Number of diagnosed medical conditions 1.07 (0.95–1.21) 1.19 (1.06–1.33)**
Past month pain level: vs. No bothersome pain
  Bothersome but not activity limiting 1.70 (1.16–2.50)** 1.21 (0.88–1.68)
  Activity-limiting 1.20 (0.77–1.85) 1.85 (1.33–2.59)***
Mobility device use vs. no use 0.80 (0.58–1.11) 1.66 (1.21–2.28)**
Depression/anxiety (PHQ-4 score) 0.97 (0.90–1.05) 1.12 (1.05–1.18)***
Clock drawing test score: vs. accurate/reasonably accurate
  Mildly distorted 0.56 (0.36–0.88)* 1.11 (0.83–1.49)
  Moderately/severely distorted/unrecognizable 0.84 (0.54–1.29) 0.99 (0.64–1.55)
  Missing 0.96 (0.40–2.32) 1.08 (0.61–1.89)
Perceived worse memory than in 2020: vs. same of better memory 1.07 (0.76–1.50) 2.06 (1.59–2.68)***
Barrier to social engagement: COVID 0.89 (0.70–1.13) 1.55 (1.13–2.11)**
Barrier to social engagement: Transportation problem 0.76 (0.40–1.45) 2.23 (1.35–3.68)**
Use of video calling with family/friend 1.25 (0.86–1.82) 0.90 (0.64–1.27)
Use of social network media 1.46 (1.03–2.07)* 0.83 (0.61–1.13)
Age group: vs. 70–74 years
  75–79 years 0.81 (0.57–1.15) 1.45 (0.99–2.11)
  80–84 years 0.59 (0.42–0.82)** 1.14 (0.77–1.66)
  85–89 years 0.60 (0.38–0.97)* 1.25 (0.79–1.99)
  90+ years 0.39 (0.19–0.81)* 1.87 (1.16–3.02)*
Female vs. male 2.39 (1.73–3.31)*** 1.67 (1.25–2.24)*
Race/ethnicity: vs. Non-Hispanic White
  Non-Hispanic Black 1.12 (0.77–1.63) 1.64 (1.16–2.32)**
  Hispanic 0.42 (0.18–1.01) 1.23 (0.71–2.13)
  All other 1.32 (0.51–3.41) 1.04 (0.46–2.32)
Model statistics N=3,060; design df=55; F (46,10)=11.71; p<.001
Open in a new tab
*

p<.05

**

p<.01

***

p<.001

The likelihood of decreased frequency of going outside in 2021, compared to no change in the frequency, was significantly positively associated with the number of diagnosed medical conditions (RRR=1.19, 95% CI=1.06–1.33); activity-limiting pain (RRR=1.85, 95% CI=1.33–2.59); mobility assistive device use (RRR=1.66, 95% CI=1.21–2.28); depression/anxiety scores (RRR=1.12, 95% CI=1.05–1.18); perceived worse memory (RRR=2.06, 95% CI=1.59–2.68); COVID concerns (RRR=1.55, 95% CI=1.13–2.11); and transportation problems (RRR=2.23, 95% CI=1.35–3.68). Those age 90+ (RRR=1.87, 95% CI=1.16–3.02) compared to those age 70–74, women (RRR=1.67, 95% CI=1.25–2.24) compared to men, and non-Hispanic Blacks (RRR=1.64, 95% CI=1.16–2.32) compared to non-Hispanic Whites were also more likely to report decreased frequency. These results mostly support the study hypothesis.

Discussion

In this study, we examined changes in the frequency of going outside between 2020 (pre-COVID vaccine) and 2021 (post-COVID vaccine) among U.S. adults age 70+. The findings show that 13% reported increased frequency, and 16% reported decreased frequency. In the no-change and increased-frequency groups, a majority (89% and 90%) reported going outside every day/most days in the past month; however, in the decreased-frequency group, only half did so and one fifth rarely/never went outside. While both no-change and increased-frequency groups resumed their frequency of going outside in 2021 close to the 2019 level, the decreased-frequency group was well below the 2019 level. Our findings also show that those who reported going outside some days in 2020 were equally likely to have increased or decreased their frequency of going outside in 2021. This suggests that this group of older adults included those whose infrequent going outside in 2020 was primarily due to COVID-related environmental factors as well as those who likely had other reasons.

Multivariable analysis based on the socioecological mobility framework shows that decreased frequency of going outside between 2020 and 2021 was associated with poor physical, mental, and cognitive health, and more perceived/real environmental barriers in 2021. Judging from high fall incidents, overnight hospital stays, and perceived memory decline, the decreased-frequency group appears to include those whose physical and cognitive health challenges may have increased during the pandemic. Their health challenges may be due in part to the aging process itself. At the same time, disruptions to necessary care for older adults with chronic conditions and to accessibility of social services and home health services during the pandemic likely contributed to their health problems (Beckman et al., 2021). Older adults, especially those with multiple chronic conditions, reported cancellation or avoidance of medical care during the first months of the pandemic (Schuster et al., 2021). A study based on the 2020 NHATS found that in-person healthcare visits decreased by 31% in 2020 compared to 2019, although telephone calls increased by 13% and telehealth use increased to 21.1% (Choi et al., 2022b).

Given the cross-sectional survey-based data, a caution is required for interpreting the high rate of depression/anxiety symptoms among the decreased-frequency group as the symptoms may have been due to restricted life-space mobility, not the other way around. Regardless of the changes in the frequency of going outside, depression/anxiety symptoms, on average, were lower in 2021 than in 2020, showing that these older adults were feeling better as the worst of the pandemic may be behind. This also suggests psychological resilience and positive life perspectives, despite the pandemic, among many older adults (Van Vleet et al., 2022). Nevertheless, the finding that 14% of the decreased-frequency group had moderate/severe depression/anxiety symptoms points to their unmet mental health need. The overall lower depression/anxiety symptoms among U.S. older adults in 2021 contrast to the finding that depressive symptoms among Brazilian and Israeli older adults increased or still prevailed even after getting vaccinated (Greenblatt-Kimron et al., 2022; Vidal Bravalhieri et al., 2022). The increased depressive symptoms among Israeli older adults were attributed to a COVID-related negative world view (Greenblatt-Kimron et al., 2022).

As hypothesized, the unique context of the COVID pandemic, even post-vaccine, was significantly associated with decreased frequency of going outside among the study population. With new mutated COVID-19 variants’ spread, it is understandable that weariness and fear of COVID persisted in 2021. More research is needed to examine whether or not COVID-related concerns continued in 2022. The likelihood of reporting decreased frequency of going outside between 2020 and 2021 was 2.23 times higher among those who reported transportation barriers. Pre-pandemic transportation problems were significant barriers to older adults’ social participation (Townsend et al., 2021). Transportation problems for socioeconomically disadvantaged and disabled people became even bigger barriers during the pandemic, as along with the costs of traveling, a lack of driver or car availability was amplified because of the pandemic (Cochran et al., 2022).

Virtual connections with family/friends increased during the pandemic (Choi et al., 2022b). Contrary to our hypothesis, video-calling with family/friends was not associated with the changes in the frequency of going out, whereas visits to online social network sites were associated with increased frequency of going outside. This shows that virtual contact is a complement to, not a substitute for, in-person contact among older adults. Many older adults received technology help from their social support system to use telehealth services during the pandemic (Chung et al., 2021), suggesting that social media users likely have had good support networks.

Our findings also show significant disparities in life-space mobility by gender, age group, and race. While some women reported increased frequency of going outside, other women, those age 90+, and Black older adults reported decreased frequency. Our previous study based on the 2019–2020 NHATS showed that more women than men, those age 90+, non-Hispanic Blacks, and Hispanics decreased their frequency of going outside during the pre-vaccine pandemic in 2020 (Choi et al., 2022a). The present study findings indicate that these same groups of older adults did not recover from their decreased frequency of going outside in 2021. Despite their equally high vaccination rate, nearly two thirds of Black older adults reported COVID concerns as a barrier to their social activity.

In conclusion, most U.S. adults age 70+ appear to have resumed their 2019 level of frequency of going outside in 2021 after the COVID vaccines became available. However, a little over 16% reported that their frequency of going outside decreased between 2020 and 2021, with one fifth of these older adults rarely or never going outside. This group of older adults, including a higher proportion of racial/ethnic minorities compared to the group that resumed their 2019 level of going-outside frequency, were the most disadvantaged in their physical, mental, and cognitive health and also reported more environmental barriers to going outside. More research is needed to examine whether or not the pandemic-related disruptions in health and social care contributed to worsening health disparities among these older adults. Given the importance of mobility for maintaining physical and social activities and independence in late life, older adults with physical, mental, cognitive health challenges should be provided assistance to go outside the home to participate in physical and social activities. Those with significant depression/anxiety should be provided with mental health treatment, preferably evidence-based psychotherapy (Cuijpers et al., 2017; Kok & Reynolds, 2017) and physical activity-promoting interventions (Zubala et al., 2017). Measures for assuring safety from COVID transmission and innovative solutions for transportation problems are also essential for enhancing mobility among older adults with physical, mental, and cognitive health challenges, and Black older adults in particular.

The study’s limitations are: (1) self-reported frequencies of going outside and comparison between 2020 and 2021 may have been subject to recall bias especially among those experiencing depression/anxiety and cognitive health challenges; (2) the percentage of those who rarely/never went outside is likely an underestimation since older adults who were proxy-interviewed were excluded. These older adults often with cognitive and/or other serious health issues were more likely to be homebound with or without the pandemic; (3) although going-outside frequencies were specific to the preceding month, seasonal and geographic variations in life-space mobility were not factored in the changes over the three study years; (4) all results based on survey data are correlations, not causations; and (5) although over 96% of U.S. older adults have Medicare coverage, those not covered by Medicare are least likely to have healthcare and social resources and are not represented in the study sample.

Clinical Implications.

  • Older adults with physical, mental, and cognitive health challenges need help increasing their life-space and physical and social activities, including evidence-based psychological treatment and physical activity promotion.

  • COVID concerns need to be assuaged with continued safety measures in aging service settings and other places serving older adults,

  • Older adults who do not own a car or no longer drive need affordable and accessible transportation services.

Funding Source:

This study was supported by grant, P30AG066614, awarded to the Center on Aging and Population Sciences at The University of Texas at Austin by the National Institute on Aging. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Footnotes

Declaration of Conflict of Interest: The authors declare that there is no conflict of interest.

Data Availability Statement:

This study is based on de-identified public-domain data (The National Health and Aging Trend Study).

References

  1. Allison P (2012). When can you safely ignore multicollinearity? https://statisticalhorisons.com/multicollinearity/
  2. Baker PS, Bodner EV, & Allman RM (2003). Measuring life-space mobility in community-dwelling older adults. Journal of the American Geriatrics Society, 51(11), 1610–1614. 10.1046/j.1532-5415.2003.51512.x. [DOI] [PubMed] [Google Scholar]
  3. Beckman AL, Mechanic RE, Shah TB, & Figueroa JF (2021). Accountable Care Organizations during Covid-19: Routine care for older adults with multiple chronic conditions. Healthcare (Amsterdam, Netherlands), 9(1), 100511. 10.1016/j.hjdsi.2020.100511 [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Benis A, Banker M, Pinkasovich D, Kirin M, Yoshai BE, Benchoam-Ravid R, Ashkenazi S, & Seidmann A (2021). Reasons for utilizing telemedicine during and after the COVID-19 pandemic: An internet-based nnternational study. Journal of Clinical Medicine, 10(23), 5519. 10.3390/jcm10235519 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Briggs R, McDowell CP, De Looze C, Kenny RA, & Ward M (2021). Depressive symptoms among older adults pre- and post-COVID-19 pandemic. Journal of the American Medical Directors Association, 22(11), 2251–2257. 10.1016/j.jamda.2021.09.003 [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Buczak-Stec EW, Löbner M, Stein J, Stark A, Kaduszkiewicz H, Werle J, Heser K, Wiese B, Weyerer S, Wagner M, Scherer M, Riedel-Heller SG, König HH, & Hajek A (2022). Depressive symptoms and healthcare utilization in late life. Longitudinal evidence from the AgeMooDe Study. Frontiers in Medicine, 9, 924309. 10.3389/fmed.2022.924309 [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Carvalho J, Borges-Machado F, Pizarro AN, Bohn L, Barros D (2021). Home confinement in previously active older adults: A cross-sectional analysis of physical fitness and physical activity behavior and their relationship with depressive symptoms. Frontiers in Psychology, 12, 643832. doi: 10.3389/fpsyg.2021.643832. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Centers for Disease Control and Prevention. (2022a). COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/your-health/about-covid-19.html
  9. Choi NG, Kim J, DiNitto DM, & Marti CN (2015). Perceived social cohesion, frequency of going out, and depressive symptoms in older adults: Examination of longitudinal relationships. Gerontology & Geriatric Medicine, 1, 2333721415615478. 10.1177/2333721415615478 [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Choi NG, Hammaker S, DiNitto DM, & Marti CN (2022a). COVID-19 and loneliness among older adults: Associations with mode of family/friend contacts and social participation. Clinical Gerontologist, 45(2), 390–402. 10.1080/07317115.2021.2013383 [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Choi NG, DiNitto DM, Marti CN, & Choi BY (2022b). Telehealth use among older adults during COVID-19: Associations with sociodemographic and health characteristics, technology device ownership, and technology learning. Journal of Applied Gerontology, 41(3), 600–609. 10.1177/07334648211047347 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Christie A et al. (2021). Decreases in COVID-19 cases, emergency department visits, hospital admissions, and deaths among older adults following the introduction of COVID-19 vaccine - United States, September 6, 2020-May 1, 2021. MMWR. Morbidity and Mortality Weekly Report, 70(23), 858–864. 10.15585/mmwr.mm7023e2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Chung GS, Ellimoottil CS, & McCullough JS (2021). The role of social support in telehealth utilization among older adults in the United States during the COVID-19 pandemic. Telemedicine Reports, 2(1), 273–276. 10.1089/tmr.2021.0025 [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Cochran AL, McDonald NC, Prunkl L, Vinella-Brusher E, Wang J, Oluyede L, & Wolfe M (2022). Transportation barriers to care among frequent health care users during the COVID pandemic. BMC Public Health, 22(1), 1783. 10.1186/s12889-022-14149-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Cornwell EY, & Waite LJ (2009). Social disconnectedness, perceived isolation, and health among older adults. Journal of Health and Social Behavior, 50(1), 31–48. 10.1177/002214650905000103 [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Cuijpers P, Quero S, Dowrick C, & Arroll B (2019). Psychological treatment of depression in primary care: recent developments. Current Psychiatry Reports, 21(12), 129. 10.1007/s11920-019-1117-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. De Silva NA, Gregory MA, Venkateshan SS, Verschoor CP, & Kuspinar A (2019). Examining the association between life-space mobility and cognitive function in older adults: A systematic review. Journal of Aging Research, 2019, 3923574. 10.1155/2019/3923574 [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Dong L, Freedman VA, & Mendes de Leon CF (2020). The association of comorbid depression and anxiety symptoms with disability onset in older adults. Psychosomatic Medicine, 82(2), 158–164. 10.1097/PSY.0000000000000763 [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Fernández-García ÁI, Marin-Puyalto J, Gómez-Cabello A, Matute-Llorente Á, Subías-Perié J, Pérez-Gómez J, Lozano-Berges G, Mañas A, Guadalupe-Grau A, González-Gross M, Ara I, Casajús JA, Vicente-Rodríguez G (2021). Impact of the home confinement related to COVID-19 on the device-assessed physical activity and sedentary patterns of Spanish older adults. BioMed Research International, 5528866. doi: 10.1155/2021/5528866. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Freedman VA, Schrack J Skehan M, & Kasper JD (2022). National Health and Aging Trends Study User Guide: Rounds 1–11 Beta Release. Baltimore: Johns Hopkins University School of Public Health. Available at www.NHATS.org. [Google Scholar]
  21. Fu M, Guo J, & Zhang Q (2022). The associations of pandemic-related difficulties with depressive symptoms and psychological growth among American older adults: Social support as moderators. Journal of Health Psychology, 13591053221124374. Advance online publication. 10.1177/13591053221124374 [DOI] [PubMed] [Google Scholar]
  22. Fujita K, Fujiwara Y, Chaves PH, Motohashi Y, Shinkai S (2006). Frequency of going outdoors as a good predictors for incident disability of physical function as well as disability recovery in community-dwelling older adults in rural Japan. Journal of Epidemiology, 16(6), 261–270. doi: 10.2188/jea.16.261. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Giannouli E, Fillekes MP, Mellone S, Weibel R, Bock O, & Zijlstra W (2019). Predictors of real-life mobility in community-dwelling older adults: an exploration based on a comprehensive framework for analyzing mobility. European Review of Aging and Physical Activity, 16, 19. 10.1186/s11556-019-0225-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Greenblatt-Kimron L, Hoffman Y, Ben-Ezra M, Goodwin R, & Palgi Y (2022). COVID-19 post-vaccination depression in older Israeli adults: The role of negative world assumptions. Global Mental Health, 1–4. doi: 10.1017/gmh.2022.11. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Hu L, Smith L, Imm KR, Jackson SE, & Yang L (2019). Physical activity modifies the association between depression and cognitive function in older adults. Journal of Affective Disorders, 246, 800–805. 10.1016/j.jad.2019.01.008 [DOI] [PubMed] [Google Scholar]
  26. Johnco C, Wuthrich VM, & Rapee RM (2015). The impact of late-life anxiety and depression on cognitive flexibility and cognitive restructuring skill. Depression and Anxiety, 32(10), 754–762. 10.1002/da.22375 [DOI] [PubMed] [Google Scholar]
  27. Joseph RP, Pituch KA, Guest MA, Maxfield M, Peckham A, Coon DW, Kim W, Langer SL (2021). Physical activity among predominantly White middle-aged and older US adults during the SARS-CoV-2 pandemic: Results from a national longitudinal survey. Frontiers in Public Health, 9, 652197. doi: 10.3389/fpubh.2021.652197. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Kobayashi LC, O’Shea BQ, Joseph C, & Finlay JM (2022). Acute relationships between mental health and cognitive function during the COVID-19 pandemic: Longitudinal evidence from middle-aged and older US adults. SSM-Mental Health, 2, 100097. 10.1016/j.ssmmh.2022.100097 [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Kok RM, & Reynolds CF 3rd (2017). Management of depression in older Adults: A review. JAMA, 317(20), 2114–2122. 10.1001/jama.2017.5706 [DOI] [PubMed] [Google Scholar]
  30. Kono A, Kai I, Sakato C, Rubenstein LZ (2007). Frequency of going outdoors predicts long-range functional change among ambulatory frail elders living at home. Archives of Gerontology and Geriatrics, 45 (3), 233–242. doi: 10.1016/j.archger.2006.10.013. [DOI] [PubMed] [Google Scholar]
  31. Kroenke K, Spitzer RL, & Williams JB (2003). The Patient Health Questionnaire-2: Validity of a two-item depression screener. Medical Care, 41(11), 1284–1292. 10.1097/01.MLR.0000093487.78664.3C [DOI] [PubMed] [Google Scholar]
  32. Kroenke K, Spitzer RL, Williams JB, & Löwe B (2009). An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics, 50(6), 613–621. 10.1176/appi.psy.50.6.613 [DOI] [PubMed] [Google Scholar]
  33. Lage A, Carrapatoso S, Sampaio de Queiroz Neto E, Gomes S, Soares-Miranda L, Bohn L (2021). Associations between depressive symptoms and physical activity intensity in an older adult population during COVID-19 lockdown. Frontiers in Psychology, 12, 644106. doi: 10.3389/fpsyg.2021.644106. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Liao YH, Fan BF, Zhang HM, Guo L, Lee Y, Wang WX, Li WY, Gong MQ, Lui L, Li LJ, Lu CY, & McIntyre RS (2021). The impact of COVID-19 on subthreshold depressive symptoms: a longitudinal study. Epidemiology and Psychiatric Sciences, 30, e20. 10.1017/S2045796021000044 [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Lin JS, O’Connor E, Rossom RC, Perdue LA, Burda BU, Thompson M, & Eckstrom E (2013). Screening for cognitive impairment in older adults: An evidence update for the U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality (US). [PubMed] [Google Scholar]
  36. Lo AX, Brown CJ, Sawyer P, Kennedy RE, & Allman RM (2014). Life-space mobility declines associated with incident falls and fractures. Journal of the American Geriatrics Society, 62(5), 919–923. 10.1111/jgs.12787 [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Löwe B, Wahl I, Rose M, Spitzer C, Glaesmer H, Wingenfeld K, Schneider A, & Brähler E (2010). A 4-item measure of depression and anxiety: validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population. Journal of Affective Disorders, 122(1–2), 86–95. 10.1016/j.jad.2009.06.019 [DOI] [PubMed] [Google Scholar]
  38. Nuzum H, Stickel A, Corona M, Zeller M, Melrose RJ, & Wilkins SS (2020). Potential Benefits of Physical Activity in MCI and Dementia. Behavioural Neurology, 2020, 7807856. 10.1155/2020/7807856 [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Porensky EK, Dew MA, Karp JF, Skidmore E, Rollman BL, Shear MK, & Lenze EJ (2009). The burden of late-life generalized anxiety disorder: Effects on disability, health-related quality of life, and healthcare utilization. American Journal of Geriatric Psychiatry, 17(6), 473–482. 10.1097/jgp.0b013e31819b87b2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Portegijs E, Keskinen KE, Tuomola EM, Hinrichs T, Saajanaho M, & Rantanen T (2021). Older adults’ activity destinations before and during COVID-19 restrictions: From a variety of activities to mostly physical exercise close to home. Health & Place, 68, 102533. doi: 10.1016/j.healthplace.2021.102533. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Satariano WA, Guralnik JM, Jackson RJ, Marottoli RA, Phelan EA, & Prohaska TR (2012). Mobility and aging: new directions for public health action. American Journal of Public Health, 102(8), 1508–1515. 10.2105/AJPH.2011.300631 [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Schuster NA, de Breij S, Schaap LA, van Schoor NM, Peters M, de Jongh RT, Huisman M, & Hoogendijk EO (2021). Older adults report cancellation or avoidance of medical care during the COVID-19 pandemic: results from the Longitudinal Aging Study Amsterdam. European Geriatric Medicine, 12(5), 1075–1083. 10.1007/s41999-021-00514-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Schousboe JT, Vo TN, Kats AM, Langsetmo L, Diem SJ, Taylor BC, Strotmeyer ES, & Ensrud KE (2019). Depressive symptoms and total healthcare costs: Roles of functional limitations and multimorbidity. Journal of the American Geriatrics Society, 67(8), 1596–1603. 10.1111/jgs.15881 [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Sepúlveda-Loyola W, Rodríguez-Sánchez I, Pérez-Rodríguez P, Ganz F, Torralba R, Oliveira DV, Rodríguez-Mañas L (2020). Impact of social isolation due to COVID-19 on health in older people: Mental and physical effects and recommendations. The Journal of Nutrition, Health, and Aging, 24(9), 938–947. doi: 10.1007/s12603-020-1469-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Shimokihara S, Maruta M, Akasaki Y, Ikeda Y, Han G, Kamasaki T, Tokuda K, Hidaka Y, Akasaki Y, & Tabira T (2022). Association between frequency of going out and psychological condition among community-dwelling older adults after the COVID-19 pandemic in Japan. Healthcare (Basel, Switzerland), 10(3), 439. doi: 10.3390/healthcare10030439. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Simning A, & Seplaki CL (2020). Association of the cumulative burden of late-life anxiety and depressive symptoms with functional impairment. International Journal of Geriatric Psychiatry, 35(1), 80–90. 10.1002/gps.5221 [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Spitzer RL, Kroenke K, Williams JB, & Löwe B (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. 10.1001/archinte.166.10.1092 [DOI] [PubMed] [Google Scholar]
  48. Sutton E, Catling J, Segaert K, & Veldhuijzen van Zanten J (2022). Cognitive health worries, reduced physical activity and fewer social interactions negatively impact psychological wellbeing in older adults during the COVID-19 pandemic. Frontiers in Psychology, 13, 823089. 10.3389/fpsyg.2022.823089 [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Townsend BG, Chen JT, & Wuthrich VM (2021). Barriers and facilitators to social participation in older adults: A systematic literature review. Clinical Gerontologist, 44(4), 359–380. 10.1080/07317115.2020.1863890 [DOI] [PubMed] [Google Scholar]
  50. Tsai LT, Rantakokko M, Rantanen T, Viljanen A, Kauppinen M, & Portegijs E (2016). Objectively measured physical activity and changes in life-space mobility among older people. Journals of Gerontology: Biological Sciences and Medical Sciences, 71(11), 1466–1471. 10.1093/gerona/glw042 [DOI] [PubMed] [Google Scholar]
  51. Umstattd Meyer MR, Janke MC, & Beaujean AA (2014). Predictors of older adults’ personal and community mobility: using a comprehensive theoretical mobility framework. The Gerontologist, 54(3), 398–408. 10.1093/geront/gnt054 [DOI] [PubMed] [Google Scholar]
  52. Van Vleet B, Fuller HR, Hofmann B, & Huseth-Zosel A (2022). Untapped insight: a longitudinal qualitative analysis of older adults’ advice during the COVID-19 pandemic. Innovation in Aging, 6(7), igac071. 10.1093/geroni/igac071 [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. van den Besselaar JH, MacNeil Vroomen JL, Buurman BM, Hertogh C, Huisman M, Kok A, & Hoogendijk EO (2021). Symptoms of depression, anxiety, and perceived mastery in older adults before and during the COVID-19 pandemic: Results from the Longitudinal Aging Study Amsterdam. Journal of Psychosomatic Research, 151, 110656. 10.1016/j.jpsychores.2021.110656 [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Vidal Bravalhieri AA, Oliveira Rodrigues N, Batiston AP, de Souza Pegorare A, & Christofoletti G (2022). Impact of social isolation on the physical and mental health of older adults: A follow-up study at the apex of the COVID-19 pandemic in Brazil. Dementia and Geriatric Cognitive Disorders, 51(3), 279–284. doi: 10.1159/000525661. [DOI] [PubMed] [Google Scholar]
  55. Webber SC, Porter MM, & Menec VH (2010). Mobility in older adults: A comprehensive framework. The Gerontologist, 50(4), 443–450. 10.1093/geront/gnq013 [DOI] [PubMed] [Google Scholar]
  56. Wei J, Ying M, Xie L, Chandrasekar EK, Lu H, Wang T, & Li C (2019). Late-life depression and cognitive function among older adults in the U.S.: The National Health and Nutrition Examination Survey, 2011–2014. Journal of Psychiatric Research, 111, 30–35. 10.1016/j.jpsychires.2019.01.012 [DOI] [PubMed] [Google Scholar]
  57. Zubala A, MacGillivray S, Frost H, Kroll T, Skelton DA, Gavine A, Gray NM, Toma M, & Morris J (2017). Promotion of physical activity interventions for community dwelling older adults: A systematic review of reviews. PloS One, 12(7), e0180902. 10.1371/journal.pone.0180902 [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

This study is based on de-identified public-domain data (The National Health and Aging Trend Study).

RESOURCES