Despite some studies [10–14], gaps remain in research on the interaction between older adults and their environment. Among limited findings, arthritis has consistently been associated with high levels of PR and disability in both cross-sectional and longitudinal studies [2, 15–21]. Also, features of the “built environment” and poor “walkability” of neighborhoods have been identified as barriers for individuals with varying levels of physical impairment [11]. Combining both health status and environmental perspectives provides an ideal context in which to examine how older adults with chronic health conditions participate in their communities.

Studies of participation in older adults demonstrate that PR is associated with several health, disability, demographic, and socioeconomic characteristics as well as suggesting discordance between physical limitations and PR [2, 5, 32, 33]. It is also well-established that functional limitations are associated with chronic conditions, older age, increased health care expenditures, and lower quality of life [34, 35]. This paper extends the literature through the examination of selected chronic conditions, as single and comorbid conditions, with associated community PR and specific environmental barriers.

Stroke and vision and hearing impairments were associated with high levels of community PR as expected; alternatively, respondents with arthritis reported among the lowest prevalence of community PR. Surprisingly, obesity was associated with low levels of community PR, despite cross-sectional and longitudinal studies consistently showing declining mobility in tandem with increasing adiposity in older adults [36].

Large condition-associated absolute burden was expected and observed with arthritis. Also, higher prevalence of community PR among respondents with arthritis comorbidity was consistent with a priori expectations. Arthritis has been shown to increase levels of physical inactivity among adults with heart disease [37] and diabetes [38], as well as being linked to negative physical and mental health outcomes, including increased activity limitation [35, 39], work limitation [40], frequent mental distress [41], and serious psychological distress [42].

There is consistent evidence in the literature that absent or poorly maintained sidewalks, lack of access to transportation, and heavy motor vehicle traffic [43–45] have negative impacts on mobility in older adults. For example, Clarke et al. found that adults with severe lower extremity physical impairments who lived in neighborhoods with fair/poor streets were 4.5 times more likely to report severe mobility disability than those living in neighborhoods with streets free from cracks, potholes, and broken curbs [11]. Also, a recent US study estimated that each year more than 9,000 older pedestrian fall-related injuries involve a curb [46]. Our findings regarding sidewalks/curbs and transportation as barriers support these known associations. Attitudes of the public [44] and “other persons' rudeness” [47] have also been identified as community barriers in other studies; in these studies, as in ours, physical barriers were more frequently reported by respondents. Participants in a Meyers et al. study also cited religious buildings, friends' or relatives' houses, restaurants, and other places for recreation or leisure as destinations participants, particularly those ≥50, wanted to but were unable to reach, suggesting these may be important destinations related to community PR in that sample as well [47].

Interestingly, there were insufficient responses from survey participants to create reliable estimates regarding policy barriers to community PR. This may reflect that, while community dwelling older adults in the USA do not report encountering policies that explicitly limit their community participation, these same adults may not be aware of or recognize that policy changes could facilitate their ability to maintain community participation [11, 13, 44, 45, 48–50]. As described in the Disablement Process [48] and the ICF [1], intervening factors of the physical environment, which can be influenced by policy, “speed-up and slow-down” disablement in the presence of functional limitations. A growing literature links environmental barriers to PR, particularly among older adults [5, 10, 11, 13, 49–51]. Many of these studies simultaneously reinforce that “for those adults at greatest risk for disability, the disablement process could be reversed or attenuated” [11, 48] through policy-supported efforts to improve community infrastructure, such as sidewalk repairs, creating greener street environments, removing obstacles, and adding or maintaining street lighting, which can assist individuals with impairments to remain engaged in their communities [10, 11, 13, 50].

Among the features consistently associated with greater community mobility are intact pavement [11, 45], greater land use density [45, 49, 52], greater land use diversity [13, 45, 49], and shorter distance to nonresidential destinations [45, 49]. In a study examining neighborhood design and walkability, Frank et al. reported that “walking levels could increase 2-fold if older adults had access to multiple destinations within short distances” [49], and Li and colleagues found a positive relationship between housing density, green and open spaces, number of nearby recreational facilities, and number of street intersections, among other features, and walking activity in older adults [52]. Based on these and other findings, Saelens and Handy concluded that “evidence on correlates appears sufficient to support policy changes” and recommended efforts related to land use patterns and transportation systems [45]. Regulatory and fiscal policies that affect zoning codes, land use development, street networks, housing density, intersection characteristics (e.g., cross walks, safety islands, and countdown timers), and city planning have also been recommended as important opportunities to reduce barriers in the built environment [43, 45, 46, 49, 53]. Based on a comparative study of the USA, The Netherlands, and Germany, Pucher and Dijkstra recommended that policies to improve urban design, support traffic calming, and provide better pedestrian facilities could be applied in the USA to increase walking safety [54]. The potential decrease in community barriers and community PR offered by policy change is important because even small environmental changes can postpone, reverse, and possibly prevent disability in vulnerable older adults (e.g., those with chronic conditions or functional limitations) [1, 8, 10, 11, 13, 44, 46–50, 52, 53, 55, 56]. Furthermore, changes to improve the built environment for older adults could benefit community members of all ages [10, 45, 46, 54].

This study is subject to at least four limitations. First, data were from survey participants' self-reports and may be subject to recall bias, although such self-reports are considered valid for surveillance purposes [57]. Second, cross-sectional data cannot be used to infer causation; therefore, we cannot determine the temporal sequencing of the chronic conditions and community PR. Third, there was limited statistical power to examine sex and race/ethnicity differences. Previous literature suggests that disability may be experienced or perceived differently by men and women [12, 14], and future studies with the ability to examine these possible differences are warranted. Finally, the list of potential barriers shown to respondents to identify community PR was not exhaustive. There could be additional environmental and other barriers that result in community PR; therefore, our findings may underestimate community PR among older adults.