Determinants of Out-of-home Activity in Older Adults with Cognitive Impairment Following Inpatient Rehabilitation: A Secondary Cross-Sectional Analysis of a Randomised Controlled Trial Using Location-Based and Accelerometer-Derived Measures

ObjectiveTo examine physical activity and its spatial context after geriatric rehabilitation and to identify determinants of out-of-home activity in older adults with cognitive impairment.DesignCross-sectional observational study.SettingCommunity, following discharge from geriatric rehabilitation.Participants113 geriatric patients (mean age 82.1 ± 6.0 years; 76.1% female) with cognitive impairment following geriatric rehabilitation.Main MeasuresPhysical activity was assessed over 48 h using a body-worn accelerometer (PamSys®) and location-based tracking derived from the Global Positioning System (Qstarz BT-Q1000XT). Group differences between participants with and without out-of-home activity were analysed. Multivariable logistic regression identified predictors across physical, psycho-social, cognitive, environmental, financial, and personal domains.ResultsOnly 36 (31.9%) of the 113 participants (82.1 ± 6.0 years; 76.1% female) left their homes. Those with out-of-home activity accumulated significantly more daily steps, walking episodes, active time, and less sedentary time than those staying in-home (all p < .01). Receiver operating characteristic analyses identified thresholds of 2140 steps/day (area under the curve 0.81) and 29.6 s mean walking episode duration (area under the curve 0.73) for discriminating between participants with and without out-of-home activity. Physical capacity (OR: 1.30, 95% CI: 1.02-1.65) and cognitive function (OR: 1.29, 95% CI: 1.02-1.62) were independent predictors of out-of-home activity.ConclusionOut-of-home activity is infrequent after rehabilitation in older adults with cognitive impairment and closely reflects overall physical activity. It may serve as a practical marker of mobility and highlights the need for targeted interventions to support community mobility during this vulnerable phase.