Neighborhood deprivation predicts lower muscle strength in the lower extremities.

Neighborhood deprivation predicts lower muscle strength in the lower extremities.

A new study shows that where older people live may be more important than age itself when it comes to maintaining the strength necessary for everyday movements like standing up. It is suggested that neighborhood disadvantages have a hidden influence on the decline in mobility.

Study: Association between neighborhood deprivation and impaired sit-to-stand performance in middle-aged and older adults: A cross-sectional analysis with clinical implications. Image source: aijiro/Shutterstock.com

One in the journal Healthcarepublished study links neighborhood socioeconomic deprivation to poorer mobility outcomes among community-dwelling middle-aged and older adults.

Neighborhood deprivation as a hidden mobility risk

Mobility, an individual's ability to move safely and independently, is a crucial factor in the overall well-being of older people. A gradual decline in mobility with age significantly affects the ability to perform everyday activities and maintain social contacts.

Socioeconomic status at the neighborhood level is a significant factor affecting mobility. Existing evidence shows that living in socioeconomically disadvantaged areas increases the risk of various health problems, chronic diseases, functional disabilities and mortality.

Given rising socioeconomic health inequalities in recent decades, researchers at Auburn University, USA, conducted a study to examine the association between neighborhood-level socioeconomic disadvantage and mobility outcomes in older populations.

Assessment of sit-to-stand and posture changes

The study included a total of 110 community-dwelling middle-aged and older adults. Participants' mobility was assessed using the Instrumented Timed Up and Go (iTUG) test and the Instrumented Five Times Sit-to-Stand (i5TSTS) test.

The iTUG test measures postural changes that are important for everyday activities. Longer duration of postural changes is associated with a higher risk of falls, disability, and mortality in older adults.

The i5TSTS test measures lower limb strength, which is critical for transitioning from sitting to standing positions. Longer standing time is associated with an increased risk of falls and a reduced ability of older people to perform daily activities independently.

Neighborhood-level socioeconomic status was measured using the Area Deprivation Index (ADI), which captures various areas of socioeconomic deprivation, including income, education, employment, and housing conditions within a neighborhood.

Disadvantaged areas show poorer sit-to-stand performance

The study found significant differences in lower limb strength and sit-to-stand transition duration between areas of different socioeconomic status. In particular, participants from disadvantaged areas showed poorer performance in the sit-to-stand test.

Regarding posture change durations, the study found no significant differences between the ADI groups for the total duration of the iTUG. However, the sit-to-stand phase of the posture change test showed a significant association with socioeconomic disadvantage at the neighborhood level.

Other components of the iTUG, such as walking speed and turning, did not show consistent or robust associations with socioeconomic deprivation, although turning performance was marginally significant in some unadjusted analyses.

New objectives for mobility screening and interventions

The study shows that older people from socioeconomically disadvantaged areas experience significantly reduced lower limb strength and function. A similar negative influence of socioeconomic disadvantage on older people's ability to rise from a sitting position (sit-to-stand phase) was also observed.

The observed selective influence on the sit-to-stand phase of postural transitions, which depends primarily on lower limb strength, highlights the specific vulnerability of older people in disadvantaged neighborhoods.

Regarding other phases of postural transitions, such as walking speed and turning, the study found no consistent, significant influence of socioeconomic disadvantage. This suggests that these aspects of postural transitions may be more resilient to neighborhood influences or rely on different physiological systems.

Overall, these observations show that the socioeconomic deprivation of a region does not affect all mobility areas equally. Instead, it has a direct influence on muscle-dependent postural changes.

Various factors related to socioeconomic deprivation, such as lack of resources for physical activity, inadequate nutrition, chronic stress, and lack of access to the healthcare system, may collectively contribute to the observed reduction in mobility outcomes.

The lack of safe sidewalks, adequate lighting, and age-appropriate exercise equipment can potentially make it difficult for older people to regularly attend outdoor exercise classes. Limited access to transportation also limits their ability to reach available resources. This physical inactivity may contribute to the observed differences in sit-to-stand performance.

Similarly, nutritional deprivation, such as lack of access to affordable, nutrient-dense foods and the easy availability of fast food outlets and grocery stores, can lead to nutritional deficiencies that affect muscle mass, strength, and function.

Socioeconomic deprivation is often associated with chronic health conditions such as hypertension, diabetes, obesity, arthritis and cardiovascular disease. All of these diseases can affect muscle function and reduce mobility, especially when standing up. These chronic diseases require regular medical care, but in socioeconomically disadvantaged areas this is often difficult to access or of poor quality, further worsening mobility outcomes.

Overall, the study's observations have implications for the development of targeted interventions, such as sit-to-stand interventions. Implementing mobility screenings at health days and primary care clinics in socioeconomically disadvantaged areas would be helpful in identifying at-risk populations.

Investing in infrastructure development in disadvantaged areas, such as outdoor fitness equipment, benches and safe sidewalks, would be another strategy to improve mobility and overall well-being of older people.

Due to the cross-sectional design, the study was unable to determine the causes of the observed relationships. It remains unclear whether the observed reduction in mobility outcomes is caused by current neighborhood conditions or by long-term exposure to disadvantaged environments. Future research that tracks changes in both neighborhood characteristics and mobility measures over time would provide stronger evidence of causal relationships.

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