Mobility patterns in later life

Traditionally, mobility has been conceptualised as movement from one location to the other, typically through outdoor movement. This has resulted in a large body of work on mobility patterns, also on older adults, which finds its roots in Hägerstrand's time-geography. Time-geography looks at people's spatial environments and movement as situated in time, using space-time paths. Hägerstrand studied how constraints (and enablers) impact whether and how a person can be at a particular place at a particular time (see Gregory et al., Reference Gregory, Johnston, Pratt, Watts and Whatmore2009). Numerous studies have shown how outdoor mobility or movement between places can contribute to active and healthy ageing (for instance, see Shoval et al., Reference Shoval, Auslander, Cohen-Shalom, Isaacson, Landau and Heinik2010; Winters et al., Reference Winters, Voss, Ashe, Gutteridge, McKay and Sims-Gould2015; Hirsch et al., Reference Hirsch, Winters, Ashe, Clarke and McKay2016; Voss et al., Reference Voss, Sims-Gould, Ashe, McKay, Pugh and Winters2016). Typically, such studies measure objective outdoor mobility patterns in terms of routes, timing and transport modes. These studies have used quantitative methods, such as surveys, travel diaries, accelerometers and, with recent technology developments, GPS tracking, to characterise movement in terms of speed, length, timing and frequency of the movement. These studies have demonstrated that mobility achievements in terms of the frequency and range of outdoor movement patterns tend to decrease with age (Shoval et al. Reference Shoval, Auslander, Cohen-Shalom, Isaacson, Landau and Heinik2010, Reference Shoval, Wahl, Auslander, Isaacson, Oswald, Edry and Heinik2011; Rantanen et al., Reference Rantanen, Portegijs, Viljanen, Eronen, Saajanaho, Tsai and Rantakokko2012; Umstattd Meyer et al., Reference Umstattd Meyer, Janke and Beaujean2013). A specific area of research focuses on the effect of driving cessation on outdoor mobility patterns in later life. Overall, driving cessation does lead to a reduction in outdoor mobility and quality of life (Musselwhite and Haddad, Reference Musselwhite and Haddad2010). It seems that after retirement, older adults make less use of their cars (Siren and Haustein, Reference Siren and Haustein2015). Several studies have shown that older adults require more help with moving around upon driving cessation (Siren and Haustein, Reference Siren and Haustein2015; Isherwood et al., Reference Isherwood, King and Luszcz2017). With regard to the effect of driving cessation on the use of other forms of transport, such as walking, cycling, driving along as a passenger and public transport, the evidence is mixed: both increased use of these other forms (Siren and Haustein, Reference Siren and Haustein2015) as well as no increased use (King and Scott-Parker, Reference King and Scott-Parker2017) have been reported. Furthermore, planning for driving cessation, as well as gradually reducing car use, may contribute to a higher quality of life after cessation (Musselwhite, Reference Musselwhite2011; Musselwhite and Shergold, Reference Musselwhite and Shergold2013).

Within the research area of mobility patterns, there are several studies that have focused on how the outdoor mobility of older adults can contribute to active ageing, often by linking mobility to active forms of transport, such as walking and cycling. These studies have tended to focus on healthy and active older adults (Winters et al., Reference Winters, Voss, Ashe, Gutteridge, McKay and Sims-Gould2015; Hirsch et al., Reference Hirsch, Winters, Ashe, Clarke and McKay2016; Voss et al., Reference Voss, Sims-Gould, Ashe, McKay, Pugh and Winters2016). A few studies have been carried out on the mobility patterns of older adults affected by impairments such as dementia (Shoval et al., Reference Shoval, Wahl, Auslander, Isaacson, Oswald, Edry and Heinik2011) and stroke (Evans et al., Reference Evans, Hanke, Zielke, Keller and Ruroede2012), and on nursing home residents (Karakaya et al., Reference Karakaya, Bilgin, Ekici, Köse and Otman2009). One study by Shoval et al. (Reference Shoval, Wahl, Auslander, Isaacson, Oswald, Edry and Heinik2011) demonstrated that the achieved outdoor mobility of cognitively impaired older adults is more severely restricted than that of healthy older adults. Furthermore, another study found that functional limitations in mobility, such as difficulties with walking, climbing stairs and carrying weights, are associated with being less active (Litwin and Levinson, Reference Litwin and Levinson2018). However, it remains largely unclear how mobility patterns in older adults are affected by physical and cognitive impairments that are associated with later life. Therefore, research should be done to increase understanding of the mobility patterns of healthy and impaired older adults. Relevant impairments associated with ageing could include diabetes, cardiovascular diseases, memory issues, arthrosis and osteoporosis.

Most research on objectively measured mobility patterns has focused on outdoor mobility. The few studies on indoor movement patterns of older adults have relied mainly on subjective self-reported measurements (Mänty et al., Reference Mänty, Ekmann, Thinggaard, Christensen and Avlund2012, Reference Mänty, Ekmann, Thinggaard, Christensen and Avlund2014). This leaves a significant gap in knowledge because older adults spend as much as 80 per cent of their time at home (Baltes et al., Reference Baltes, Maas, Wilms, Borchelt, Little, Baltes and Mayer1999; Sixsmith et al., Reference Sixsmith, Sixsmith, Malmgren Fänge, Nauman, Kucsera, Tomson and Woolrych2014). They spend even more time indoors, or within places, when indoor places beyond the home are included and thus most of their mobility is likely to be indoors. Furthermore, more indoor mobility may explain reduced outdoor mobility, and the reverse may be the case. Hence, indoor movement is a vital link in a comprehensive understanding of mobility patterns in later life. Thus, with the focus on outdoor mobility, many studies have overlooked most physical movement or mobility in later life that takes place indoors. Therefore, it is vital that researchers take up the challenge to include indoor mobility in studies on mobility patterns in later life.

Furthermore, mobility patterns differ between socio-cultural contexts as some are more conducive to physical movement in later life than others (Green et al., Reference Green, Jones and Roberts2014). For instance, older adults may have the freedom to go out and manage their everyday lives; or it may not be considered appropriate for either men or women to venture outdoors; or there are limited opportunities for outdoor physical movement, such as in car-dependent societies. However, there are no comparative studies of mobility in later life, apart from one cross-country comparison of mobility patterns within Europe (Gagliardi et al., Reference Gagliardi, Spazzafumo, Marcellini, Mollenkopf, Ruoppila, Tacken and Szémann2007). Furthermore, most mobility research is carried out in the Western world (Nordbakke and Schwanen, Reference Nordbakke and Schwanen2014; Kwan and Schwanen, Reference Kwan and Schwanen2016). Research is needed that studies and compares the mobility patterns of older adults in diverse socio-cultural contexts in and beyond the Western world.

Summarising the above, the following questions could guide a research agenda with regard to mobility patterns in later life: what do the indoor and outdoor mobility patterns of older adults look like in terms of speed, length, timing and frequency of movement, number and types of places frequented, mode of transport and travel companions? More specifically: how much do older adults move indoors and outdoors, respectively? To what extent do these mobility patterns differ between healthy and impaired older adults? How do the movement patterns of older adults differ between socio-cultural settings?

Methods that could be used to address these questions include GPS tracking, smart insole tracking, activity watch tracking and activity diaries. Measuring indoor movements is technologically challenging, in particular. Accelerometers and/or activity watches used to measure indoor mobility (in terms of physical activity) have problems with accuracy and wear-ability (Voss et al., Reference Voss, Sims-Gould, Ashe, McKay, Pugh and Winters2016). Some advances have been made in measuring indoor mobility using Wi-Fi technology in controlled settings, such as on a university campus (Petrenko et al., Reference Petrenko, Sizo, Qian, Knowles, Tavassolian, Stanley and Bell2014; Torres-Sospedra et al., Reference Torres-Sospedra, Avariento, Rambla, Montoliu, Casteleyn, Benedito-Bordonau and Huerta2015). However, such measurement is still difficult in the real world with less Wi-Fi coverage, especially in indoor spaces beyond the home.

Mobility experiences of older adults

Besides research on mobility patterns, there is an area of research on subjective mobility experiences, which centres on how older adults perceive their mobility in their everyday lives. This area of research has developed after the so-called mobility turn (see Sheller and Urry, Reference Sheller and Urry2006), in response to some of the shortcomings of research on mobility patterns that are grounded in its positivist foundations. Research on mobility experiences is often qualitative and focuses on how older adults choose to exert their physical mobility to engage in specific activities and go to particular places, how they experience movement, how they feel about their physical mobility, and whether there are places that they would like to go but that they cannot reach. These studies have shown that the mobility of older adults is closely related to that of their significant others, and often focuses on engaging in social and leisure activities (Burnett and Lucas, Reference Burnett and Lucas2010; Garder, Reference Garder2014; Aird and Buys, Reference Aird and Buys2015; Goins et al., Reference Goins, Jones, Schure, Rosenberg, Phelan, Dodson and Jones2015). Studies on mobility experiences have also shown that mobility can contribute to wellbeing by providing a sense of autonomy, self-reliance, choice and social usefulness (Mollenkopf et al., Reference Mollenkopf, Hieber and Wahl2011; Ziegler and Schwanen, Reference Ziegler and Schwanen2011; Zeitler and Buys, Reference Zeitler and Buys2015).

Similar to research on mobility patterns, these studies on subjective mobility experiences have mainly been done on relatively active and healthy older adults (Andrews et al., Reference Andrews, Hall, Evans and Colls2012). Some studies using traditional qualitative methods, such as in-depth interviews, have addressed the mobility of impaired older adults, including nursing home residents (Karakaya et al., Reference Karakaya, Bilgin, Ekici, Köse and Otman2009; Klaassens and Meijering, Reference Klaassens and Meijering2015) and stroke survivors (Nanninga et al., Reference Nanninga, Meijering, Schönherr, Postema and Lettinga2018). To the best of my knowledge, no comparative studies have been done on the mobility experiences of older adults with different impairments. Therefore, comparative research that foregrounds the mobility experiences of healthy and impaired older adults is required to articulate the frailties and strengths of older adults. This will include why and where they move, the choices they make and the barriers they experience. Articulating the frailties and strengths of older adults can in part be achieved through tying in with the existing literature on experiences of (powered) assistive devices, such as walkers, mobility scooters and (powered) wheelchairs. Research in this area has shown that using a device is an opportunity that can enhance and facilitate movement, but that it can also enhance stigma and invisibility (Korotchenko and Clarke, Reference Korotchenko and Clarke2016; Labbé et al., Reference Labbé, Mortenson, Rushton, Demers and Miller2020). Furthermore, some older adults may not experience being mobile. Rather, their experiences are of inactivity or stillness (Cresswell, Reference Cresswell2012; Hitchings et al., Reference Hitchings, Venn and Day2018). Thus, to gain better understanding of mobility experiences in later life, further studies on how experiences of stillness and movement alternate could be insightful.

Furthermore, and also similar to the research on mobility patterns, few studies have been done on how older adults experience their movement within places, such as the home. This is a major gap in our understanding of the mobility of older adults especially because they spend increasing amounts of time indoors (Gibson et al., Reference Gibson, Secker, Rolfe, Wagner, Parke and Mistry2012; Rowles and Bernard, Reference Rowles, Bernard, Rowles and Bernard2013; Sixsmith et al., Reference Sixsmith, Sixsmith, Malmgren Fänge, Nauman, Kucsera, Tomson and Woolrych2014; Wiles et al., Reference Wiles, Leibing, Guberman, Reeve and Allen2012, Reference Wiles, Rolleston, Pillai, Broad, The, Gott and Kerse2017). Insights into experiences of indoor movement will generate pivotal insights into what mobility experiences in later life can be. These insights will counter predominant negative conceptions of the home and indoor places in later life. The home in later life is often conceptualised as a place to which people are bound, and which is associated with inactivity and loneliness. Older adults would have to leave the home in order to break out of this (Iwarsson et al., Reference Iwarsson, Wahl, Nygren, Oswald, Sixsmith, Sixsmith and Tomsone2007; Ziegler and Schwanen, Reference Ziegler and Schwanen2011), an assumption that could be challenged when movement within places is studied in further detail. Furthermore, older women have been found to engage more in indoor and home activities (Rioux, Reference Rioux2005; Gagliardi et al., Reference Gagliardi, Spazzafumo, Marcellini, Mollenkopf, Ruoppila, Tacken and Szémann2007; Douma et al., Reference Douma, Steverink, Hutter and Meijering2017), whereas men tend to emphasise independence most (Isherwood et al., Reference Isherwood, King and Luszcz2017). Further insight into the gender dimension of mobility experience could be obtained by studying how engaging in home-based activities colours experiences of mobility. This does align with the more general call for looking into the gendered aspects of daily mobility (Law, Reference Law1999; Uteng and Cresswell, Reference Uteng and Cresswell2008). Finally, and again similar to research on mobility patterns, studies on mobility experiences beyond the Western world as well as comparative studies have been sparse (for an exception, see Uteng and Lucas, Reference Uteng and Lucas2017). Therefore, research into older adults in the global South, as well as cross-cultural comparisons, could strengthen and deepen the understanding of mobility experiences.

Based on the above, the following questions could guide a research agenda on mobility experiences in later life: How are mobility experiences in later life impacted by health? How do older adults experience their indoor movement, in relation to outdoor movement as well as stillness? What is the role of socio-economic status and gender in mobility experiences? What are the differences and similarities in mobility experiences between older adults in different socio-cultural contexts?

Methods that could be used to address these questions include qualitative mobile interviews, in-depth interviews, participant observation, activity diaries as well as quantitative assessment of mobility by short surveys. Such surveys could be administered on paper, or they could be web-based, for instance through a smartphone app. These methods require different skills from older adults and not all methods can be used with all older adults. For example, although this is changing with the ageing of the population, not all older adults can operate a smartphone. Older people with memory issues or other cognitive impairments may have difficulties in expressing themselves orally or in writing.

Mobility beyond outdoor movement

Based on the review of research on mobility patterns and experiences above, it becomes clear that there is a major gap in studying indoor movement as part of mobility, in general, and in connecting in- and outdoor movement, in particular. Connecting patterns of indoor movement, in terms of speed, length, timing and frequency, with their experiences will help to obtain a more comprehensive picture of mobility in later life. Studying indoor mobility will also help to foreground the importance of inactivity or stillness, as well as the alternations between movement and stillness. Foregrounding indoor movement in mobility research in later life will enrich current debates on active and healthy ageing, as it will help to foreground that being indoors does not necessarily equal being inactive and unhealthy (see Hitchings et al., Reference Hitchings, Venn and Day2018). Also, looking at both movement within and between places will help to uncover the enabling and disabling aspects of the physical and social environment for mobility, a recommendation that has been made in earlier research as well (Mollenkopf et al., Reference Mollenkopf, Hieber and Wahl2011; Lloyd and Stirling, Reference Lloyd and Stirling2015; Franke et al., Reference Franke, Sims-Gould, Chaudhury, Winters and McKay2018; Litwin and Levinson, Reference Litwin and Levinson2018; Graham et al., Reference Graham, De Bell, Flemming, Sowden, White and Wright2020; Labbé et al., Reference Labbé, Mortenson, Rushton, Demers and Miller2020). For instance, what is the role of the neighbourhood and broader community in mobility in later life? To what extent can a social network mitigate the negative effects of mobility impairments? What aspects of the physical and social environment act as barriers and enablers to mobility, both with and without use of assistive devices?

Diversity in mobility

What we can conclude from the previous sections is that mobility in later life is mainly studied among relatively healthy older adults in the Western world, which means that diversity in mobility requires further research. I would argue that it is important to look at diversity beyond health status and socio-cultural context, to also include, for instance, diversity in socio-economic status, gender and ethnicity (see also Franke et al., Reference Franke, Sims-Gould, Chaudhury, Winters and McKay2018; Hitchings et al., Reference Hitchings, Venn and Day2018). There is some research on the outdoor mobility patterns and experiences of older adults with a low income, e.g. by Adorno et al. (Reference Adorno, Fields, Cronley, Parekh and Magruder2018) and Franke et al. (Reference Franke, Winters, McKay, Chaudhury and Sims-Gould2017, Reference Franke, Sims-Gould, Chaudhury, Winters and McKay2018), but drawing out the differences and similarities in mobility of older adults from different socio-economic backgrounds would enrich insights into movement in later life.

I identified two promising approaches that will help achieve this, one theoretical and one methodological. A potentially relevant theoretical approach to study diversity in mobility is Sen's (Reference Sen1999) capability approach. The capability approach foregrounds the (different) opportunities that older adults have, as well as potential sources of vulnerability and inequality, and the fact that they can choose which opportunities to put into practice. In the end, the capability approach emphasises achievements, or beings and doings, as outcomes. In the context of this research agenda, these outcomes can be labelled mobility practices. Therefore, using the capability approach enables a shift in focus towards the mobility practices that are meaningful for different (groups of) older adults. These include the role of socio-cultural context and socio-economic status, gender, ethnicity, and physical and cognitive impairments.

A promising methodological approach is grounded visualisation (Knigge and Cope, Reference Knigge and Cope2006). Grounded visualisation was developed to integrate diverse forms of data to uncover the multiple meanings associated with a topic and to contribute to theory building. With foundations in grounded theory and visualisation, this is a rigorous, recursive and reflexive approach to analyse qualitative, spatial and quantitative data, and is attuned to multiple meanings (Franke et al., Reference Franke, Winters, McKay, Chaudhury and Sims-Gould2017). Grounded visualisation contributes to theory building that is grounded in everyday life, and in broader patterns and socio-cultural contexts. Through grounded visualisation, comparison and integration of mobility patterns and experiences could be achieved. This would help to identify similarities and differences in terms of places frequented, routes taken, activities undertaken and social interactions (see also Kwan and Ding, Reference Kwan and Ding2008).

The role of time in mobility

In the introduction to research on mobility patterns, the connection between mobility research and Hägerstrand's time-geography was mentioned. Implicitly, the role of time has been addressed above, but I want to draw it out as an important area for further research more explicitly here. There is some evidence that outdoor mobility in later life varies over time. Older adults tend to avoid going out at night and engage less in outdoor mobility in adverse weather circumstances (Phillips et al., Reference Phillips, Walford, Hockey, Foreman and Lewis2013; Portegijs et al., Reference Portegijs, Iwarsson, Rantakokko, Viljanen and Rantanen2014; Lager et al., Reference Lager, Huigen and van Hoven2016; Meijering and Weitkamp, Reference Meijering and Weitkamp2016; Finlay, Reference Finlay2018). As most studies have tended to focus on mobility in later life at one timepoint, little is known about how indoor and outdoor mobility patterns vary over time, measured on different timescales: time of day, week, month and year. These variations over time should be connected to other circumstances, such as how an older adults feels, the availability of other people and/or services, and weather circumstances. This would facilitate a more longitudinal approach to mobility in later life. When applying a longitudinal approach, a lifecourse perspective may be useful to get insight into the dynamic nature of mobility at a larger timescale (Labbé et al., Reference Labbé, Mortenson, Rushton, Demers and Miller2020).

The concept of mobility is well suited to studying the temporality of movement (Adey et al., Reference Adey, Bissell, Hannam, Merriman and Sheller2014), but it is difficult to put in practice in the collection of empirical data. I would like to emphasise some promising avenues in this regard. First, Ecological Momentary Assessment (Kwan, Reference Kwan2012) is a useful strategy for measuring subjective experiences of mobility in real time. Real-time measurements can be achieved, for instance, through using a smartphone app or through calling participants at different (randomised) times of the day. Second, mobile interviews, conducted while on the move, can provide insight into experiences of routes and associated obstacles are discussed as they are encountered (see Bell et al., Reference Bell, Phoenix, Lovell and Wheeler2015; Lager et al., Reference Lager, Huigen and van Hoven2016). Third, collecting data in different seasons will generate insight into the effect of seasonal weather variations on mobility practices. Thus, foregrounding the role of time in mobility will enable us to understand how and why patterns and experiences of movement in later life differ, depending on time of day, week and year.