The impact of transportation independence on health outcomes and quality of life among older adults in Klang Valley

Abstract

Challenges such as reduced physical ability and sensory impairments among older adults can hinder their access to transportation, potentially impacting their quality of life. To explore this issue, this study examines the impact of transportation patterns on health outcomes and quality of life (QoL) among older adults through a two-phase approach. Phase 1 began with a needs assessment through a scoping review to identify the enablers and barriers for older adults accessing healthcare services. The findings indicated that transportation, service location accessibility and acceptability were the main barriers. The Malay version of the Craig Hospital Inventory of Environmental Factors (CHIEF) was then administered to 119 older adults to examine the association between biopsychosocial factors and transportation patterns. Older adults who were independent in transportation were more likely to be male (95.0 vs 5.0%, p <0.001), have fewer comorbidities (74.8 vs 25.2%, p = 0.041), and be independent in their Instrumental Activities of Daily Living (IADL) (82.2 vs 17.8%, p=0.001) compared to those with restricted transportation. In the final stage of Phase 1, five focus group discussions with 32 participants revealed five main themes: 1) perceptions about outdoor mobility and transportation, 2) driving challenges, 3) determinants of public transportation use, 4) determinants of outdoor mobility, and 5) suggestions to facilitate outdoor mobility and transportation. Phase 2 was a 1-year follow up study involving a sub-sample of 100 participants (63% women, 68.4 + 5.3 years old and 77% independent in transportation). Results showed that restricted transportation in older adults was linked to higher fat mass (Adj OR = 1.20, 95% CI: 1.03 – 1.41, p < 0.05), poorer performance in timed up and go (TUG) (Adj OR = 1.40, 95% CI: 1.03 – 1.88, p < 0.05), lower hand grip strength (HGS) (Adj OR = 0.85, 95% CI: 0.74 – 0.98, p < 0.05) tests and changes in IADL (p < 0.05). At the final stage of Phase 2, the relationship between QoL and transportation independence, the environment within 500 meters of participants' homes, and biopsychosocial characteristics was examined. Binary logistic regression revealed that transportation is associated with better social domain (Adj OR = 5.02, 95% CI: 1.21 – 15.75). After adjusting for age, sex and comorbidities, transportation independence was associated with better physical domain (Adj OR = 4.06, 95% CI: 1.02 – 16.10) and social domain (Adj OR = 4.36, 95% CI: 2.08 – 28.53). Further adjustment with frailty revealed transportation independence is associated with overall QoL score (Adj OR = 5.27, 95% CI: 1.21 – 22.85), physical domain (Adj OR = 2.68, 95% CI: 1.89 – 17.43), psychological domain (Adj OR = 6.02, 95% CI: 1.09 – 33.21) and social domain (Adj OR = 10.45, 95% CI: 2.44 – 44.78). In conclusion, key findings show that independent transportation correlates with fewer comorbidities and greater independence in IADL, while restricted transportation is associated with poorer health outcomes and QoL, emphasizing the need to address these barriers to enhance the well-being of older adults.