Life-Space Mobility Trajectories After Elective Surgery in Older Adults
Year: 2026
Type: article
Study design: Observational Study
Abstract: Importance: The number of older adults living with frailty who undergo surgery is rapidly increasing worldwide. Life-space mobility (LSM) can capture physical and social dimensions of recovery and has been linked to functional decline and reduced quality of life. Objective: To examine postoperative recovery using LSM among older adults living with frailty and to identify factors associated with restricted mobility and readmission. Design, Setting, and Participants: This cohort study within the larger Functional Improvement Trajectories After Surgery study used a convergent mixed-methods exploratory design. Seventeen hospitals across Canada included older adults aged 65 years or older with a clinical frailty score (CFS) of 3 or more who underwent major elective noncardiac surgery from March 2021 to June 2023. Data were analyzed from September to October 2025. Exposure: Elective noncardiac surgery among older adults. Main Outcomes and Measures: LSM (range 0-120, with higher scores indicating more mobility) was measured at 1 to 2 months and 6 months postoperatively, with retrospective presurgery LSM captured at 1 to 2 months. Multivariable linear mixed-effects models and multivariable mixed-effects logistic regression were used to identify factors associated with LSM trajectories, restricted mobility (ie, LSM < 60), and hospital readmission. Results: This study included 204 participants (mean [SD] age, 72.8 [5.6] years; 108 males [53%]). The mean (SD) LSM was 65.1 (26.7) presurgery, 56.6 (26.7) at 2 months postsurgery, and 64.9 (25.9) at 6 months postsurgery. Eighty participants (39.2%) had restricted mobility presurgery, 114 (56.4%) at 2 months postsurgery, and 84 (41.2%) at 6 months postsurgery. Restricted mobility was associated with being a woman (odds ratio [OR], 4.72; 95% CI, 2.27-9.84), greater frailty (OR, 10.42; 95% CI, 3.56-30.49), and concurrent need for support from formal or informal caregivers (OR, 5.43; 95% CI, 2.72-10.86). Elevated-risk surgery was associated with hospital readmission at 6 months (OR, 3.18; 95% CI, 1.48-7.25). Conclusions and Relevance: In this nested cohort study, mean LSM recovered by 6 months postsurgery, but 41% of older adults still had restricted mobility. Being a woman, having greater frailty, and needing support from caregivers were associated with poor recovery. Integrating life-space assessments into individualized perioperative care planning may enhance evaluation of functional recovery, inform shared decision-making, and guide support strategies.
Source: JAMA Network Open
Authors: Nai-Wen Ku, Nelly Toledano, Nicholas Legacy, Keying Xu, Duminda N. Wijeysundera, Kristen R. Haase, Eric Pitters, Fay Bennie, Anne Stephens, Gianni R. Lorello, Kerry Kuluski, Daniel I. McIsaac, Tyler R. Chesney, Naveed Siddiqui, Karim S. Ladha, C. David Mazer, Noah Crampton, Stuart A. McCluskey, Matteo Parotto, Lisa Del Giudice, Angela Jerath, Janet van Vlymen, Su-Yin MacDonell, Melinda Davis, Alexander J. Gregory, Eric Jacobsohn, Katherine S. McGilton, Emily Hladkowicz, Shabbir M. H. Alibhai, Martine Puts
Institutions: University of Toronto, St. Michael's Hospital, Unity Health Toronto, University of British Columbia, University Health Network, Toronto Western Hospital, Women's College Hospital, The Wilson Centre, Trillium Health Centre, University of Ottawa, Ottawa Hospital, Ottawa Hospital Research Institute, Sinai Health System, Toronto General Hospital, Sunnybrook Health Science Centre, Kingston Health Sciences Centre, Providence Health Care, St. Paul's Hospital, University of Calgary, Libin Cardiovascular Institute of Alberta, University of Manitoba, Toronto Rehabilitation Institute, KITE Research Institute, Princess Margaret Cancer Centre
Language: English
Topic: Frailty in Older Adults
Subfield: Geriatrics and Gerontology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,000
OpenAlex ID: W7170035087