1. CDC Healthy Aging Research Network Toward an Integrated Mobility Agenda William A. Satariano, Ph.D., MPH School of Public Health UC Berkeley

2. Presentation Objectives Discuss the significance of mobility for healthy aging Propose an integrated view of mobility Underscore the importance of disparities and equity. Discuss policy implications and strategies to advance an integrated-mobility agenda

3. Why aging? Population is aging. Aging population is becoming increasingly diverse. Issues of health and functioning. Issues of social, political, and economic engagement.

4. Mobility Mobility can be defined as human movement in all of its varied forms. Mobility is part of everyday life in the home, neighborhood, and wider community. Mobility promotes and is indicative of healthy aging.

5. Mobility Mobility refers to movement in all of its forms, including, …. o Basic ambulation o Transferring from a bed to a chair o Walking for leisure and the completion of daily tasks o Driving a car. o Public transport.

6. Mobility A less formal definition, one that is more likely to be offered by the average person: “Being able to go where I want to go, when I want to go, and how I want to go.”

7. Types of Mobility Activities associated with self-care and meeting the needs and challenges of everyday life Walking and other forms of physical activity associated with leisure and everyday tasks Driving Passenger transportation

8. Health Effects of Mobility Self-care and outdoor activities: Indicators and markers of basic independence, limitations, and mobility Also known more formally as Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL)

9. Health Effects of Mobility Walking and physical activity are protective against a variety of chronic health conditions, such as heart disease, cancer, diabetes, dementia, and depression.

10. Health Effects of Mobility Patterns and timing of recovery following diagnosis and treatment of specific physical and cognitive conditions.

11. Health Effects of Mobility Access to goods and services, including good food and other resources to promote health.

12. Health Effects of Mobility Access to health and social services Access to friends and relatives

13. Health Effects of Mobility Air pollution associated with use of specific types of transportation. Opportunities for evacuation in terms of disasters and other emergencies.

14. Health Effects of Mobility Falls and injuries and automobile crashes, “disorders of mobility,” are leading causes of accidental disability and death.

15. Current Issue There is important health research based on each the category of mobility. There is little information, however, about patterns or profiles of integrated mobility.

16. The Question Why is an integrated approach important?

17. Current Issue Research and policies are based on walking, driving, or passenger transit, but older people have lives to live.

18. Current Issue During the course of an average day, older adults are required to satisfy a variety of needs and address different challenges. This will require different types of movement. Walking from the bedroom to the kitchen, walking to the store, driving a car to the health clinic, and later taking the light rail to see a film downtown.

19. Important Questions How do older people “move during the course of their day?” What are the patterns of everyday mobility, involving walking, driving, and the use of passenger transportation? How does it vary across people, places, time of day, and other circumstances? “Mobility deserts”? How can we make it all better?

20. HAN Walking Study: An Example Do you currently drive or have someone who can drive you on a regular basis? o Yes – 82.9% (726/876) o No - 17.1% (150/876)

21. HAN Walking Study: An Example o How many total minutes do older adults walk per week? < 150 minutes per week. 61.9% (543/877) > 150 minutes per week. 38.1% (334/877)

22. HAN Walking Study: An Example o Of the older adults with no regular access to a car, how many minutes per week do they walk? < 150 minutes per week. 60.1% (89/148) > 150 minutes per week. 39.9% (59/148)

23. HAN Walking Study: An Example What are the characteristics of older adults with no regular access to a car and who walk less than 150 minutes per week? What are the health effects of this particular mobility pattern? How do the health effects vary by age, gender, race/ethnicity, and socioeconomic status?

24. The Task We need an integrated view of mobility.

25. The Basic Assumption Not only better, more comprehensive research, but also better, more comprehensive policies and practices.

26. Policy Implications Environmental design principles to encourage mobility in all of its various forms for all older adults irrespective of functional status Example: o Smart Growth and Complete Streets o http://www.completestreets.org/complete- streets-fundamentals/factsheets/disabilities/

27. Policy Implications Integrate design principles into relevant policy, e.g., zoning to facilitate transit-oriented development in all of its forms. www.pedbikeimages.org /Dan Burden

28. Policy Implications New technologies, for example, assistive devices and smart automobiles, to encourage integrated mobility. Equitable distribution?

29. Policy Implications New strategies to reduce the risk of falls associated with programs and policies to encourage walking and physical activity among older adults.

30. Policy Implications More effective integrated mobility programs to facilitate evacuation of older adults during disasters and emergencies.

31. Policy Implications New mobility training programs for older adults.

32. Policy Implications More effective programs to facilitate transition from driving to passenger transportation among older drivers Example: o Senior Mobility Tool Kit. o https://www.mtc.ca.gov/library/oats/senior- mobility

33. Policy Implications Address the “Catch 22” of the intersection.

34. How Do We Proceed? The first step is to develop a more comprehensive, ecological model to describe and explain patterns of integrated mobility.

35. Integrated Mobility and Healthy Aging Susan Webber and colleagues at the University of Manitoba have developed a very useful model of integrated mobility.

36. Integrated Mobility and Healthy Aging Based on an ecological model, Webber and colleagues identify the multiple predictors and multiple outcomes in an integrated model of mobility.

37. Integrated Mobility and Healthy Aging Webber, et al., (2010)

38. A Research Agenda Representative population-based studies. Capture regional, racial/ethnic, SES diversity. Comprehensive assessment (ecological/life space GIS Other

39. A Practice Agenda What will it take to move this integrated approach forward?

40. Strategies to Foster Integrated Mobility: The Big Picture Develop and disseminate research results addressing practice and policy implications of an integrated view of mobility.

41. Strategies to Foster Integrated Mobility Design and conduct programs to recruit and train multidisciplinary teams of students and practitioners to address the research, practice, and policy agenda in this area.

42. Strategies to Foster Integrated Mobility Consider strategies to encourage inter- organizational and inter-departmental programs to promote work in this area.

43. Strategies to Foster Integrated Mobility Current and future plans to promote walking or safe driving or passenger transportation should include an additional section: o Strategies to align with and jointly promote other forms of safe mobility

44. Strategies to Foster Integrated Mobility: The Local Level Example: Convene meetings of stakeholders to discuss mobility-related issues, e.g., community walking programs o Identify stakeholders from the community, public health, transportation, planning, public works, and human services o Review current walking programs administered locally and by other communities o Consider ways to enhance mobility by addressing other issues, e.g., risk of falls and pedestrian safety

45. Strategies at the Local Level Another example: o Consider programs to promote safe driving o Consider with relevant stakeholders the utility and desirability of expanding the curriculum to include the broader topic of safe mobility

46. Final Thoughts Let’s return to what most older adults probably think about when they think about mobility in everyday life. o “Being able to go where I want to go; when I want to go; and how I want to go.” Promotion of healthy aging will require new ways of thinking of mobility. o Developing an integrated view of mobility will move us along that road.

47. Acknowledgements Funding for the Environmental and Policy Change (EPC) for Healthy Aging initiative was made possible in part by a grant (1R13HS018612-01A1) from the Agency for Healthcare Research and Quality. The EPC initiative is the result of work conducted by the CDC Healthy Aging Research Network, which is a Prevention Research Centers program funded by the CDC Healthy Aging Program, through cooperative agreements from CDC's Prevention Research Centers Program: U48-DP- 001911, 001908, 01921, 001924, 001936, 001938, and 001944. Support for the initiative was also provided by the Healthy Communities and Healthy Aging Programs in the Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC). The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services or the Centers for Disease Control and Prevention; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

48. Link to APHA Journal Article Mobility and Aging: New Directions for Public Health Action William A. Satariano, PhD, MPH, Jack M. Guralnik, MD, PhD, Richard J. Jackson, MD, MPH, Richard A. Marottoli, MD, Elizabeth A. Phelan, MD, and Thomas R. Prohaska, PhD Optimal mobility, defined as relative ease and freedom of movement in all of its forms, is central to healthy aging. Mobility is a significant consideration for research, practice, and policy in aging and public health. We examined the public health burdens of mobility disability, with a particular focus on leading public health interventions to enhance walking and driving, and the challenges and opportunities for public health action. We propose an integrated mobility agenda, which draws on the lived experience of older adults. New strategies for research, practice, and policy are needed to move beyond categorical promotion programs in walking and driving to establish a comprehensive program to enhance safe mobility in all its forms. http://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.2011.300631

49. CDC Healthy Aging Research Network William A. Satariano, Ph.D., MPH School of Public Health, UC Berkeley 510-642-6641 bills@berkeley.edu www.agingfriendly.org Be the change you want to see in the world. Mahatma Gandhi