To generate representative data, exclusion of patients with such problems in self-reporting health status may cause a systematic bias.Ĭurrently, with the self-report Life-Space Assessment in Institutionalized Settings (LSA-IS) and the Nursing Home Life-Space Diameter (NHLSD), there are only two LSM surveys published and validated in institutionalized persons. Accuracy of reports on health-related status in hospitalized or institutionalized persons can severely be limited by chronic conditions such as cognitive impairment (CI), which is highly prevalent in this population, or acute medical conditions related to critical illness such as delirium, catastrophic trauma, or exhaustion/fatigue. Some of the factors that lead to institutionalization in hospitals or nursing homes and negatively influence mobility behavior in older, institutionalized persons also affect or restrict the validity of self-report assessments. The organizational structure and routines of these institutions have shown an overwhelming influence on LSM in nursing home residents. Many of these limitations also occur in nursing home settings. Additionally, during hospitalization, aspects related to medical status such as the severity of disease or comorbidity, to treatment such as prescribed bed-rest or medical appliances, to attitudes such as expectations towards mobility or hospital stay, and institutional aspects such as nursing to patient ratio, or availability of equipment influence individuals’ mobility behavior. ward and common areas, garden, neighborhood vs. However, these areas are not transferable to institutionalized persons, as the type of mobility area differs substantially (home vs. Life-space is commonly structured into different life-space zones within and around the home and typically includes areas such as the garden, neighborhood, hometown, etc. While the mobility of community-dwelling older persons and the mobility of older persons in institutions (e.g., hospitals, rehabilitation clinics, or nursing homes) have some similarities (both depend on the physical, cognitive, psychosocial, and personal capacities of an individual ), they also have major differences. Several instruments have been developed to measure LSM in older adults however, with a focus on community-dwelling older persons. Since the concept of LSM was introduced in 1985 by May, it is increasingly being used to characterize the status or time course of LSM impairment, or to initiate, adjust and evaluate therapies or interventions. However, during hospitalization or institutionalization, older patients have a highly sedentary behavior and spend most of their time in a lying or sitting position, with negative consequences such as a higher risk of decline in activities of daily living, new institutionalization, or death, underlining the need for assessment of mobility and interventions to reduce the risk of adverse outcomes. Independent mobility represents a prerequisite to master challenges in everyday life, quality of life, and participation in society and the natural environment. As LSM captures the habitual mobility range, it also reflects functional, environmental, and social factors that affect mobility. The assessment of life-space mobility (LSM) is used to document an individual’s mobility in the environment considering contextual factors.
(4) Conclusions: The LSA-IS-proxy has proven to be feasible, valid, reliable, and sensitive to change in hospitalized, geriatric patients with and without CI. These results were predominantly confirmed for the sub-scores of the LSA-IS-proxy and were comparable between the sub-groups with different cognitive status.
(3) Results: The LSA-IS-proxy total score showed good-to-excellent agreement with the self-reported LSA-IS (Intraclass Correlations Coefficient, ICC 3,1 = 0.77), predominantly expected small-to-high correlations with construct variables ( r = 0.21–0.59), good test–retest reliability (ICC 3,1 = 0.74), significant sensitivity to change over the treatment period (18.5 ± 7.9 days p < 0.001, standardized response mean = 0.44), and excellent completion rates (100%) with no floor/ceiling effects.
(2) Methods: Concurrent validity against the self-reported version of the LSA-IS, construct validity with established construct variables, test-retest reliability, sensitivity to change during early multidisciplinary geriatric rehabilitation treatment, and feasibility (completion rate, floor/ceiling effects) of the LSA-IS-proxy, were assessed in 94 hospitalized geriatric patients (83.3 ± 6.1 years), with and without CI. This study aims to evaluate the psychometric properties of the Life-Space Assessment for Institutionalized Settings by proxy informants (LSA-IS-proxy) for institutionalized, older persons, with and without CI. (1) Background: Life-space mobility assessments for institutionalized settings are scarce and there is a lack of comprehensive validation and focus on persons with cognitive impairment (CI).
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