Relationship between mobility decline and occupational participation: A cross-sectional study of community-dwelling older adults

Objective: This study examined the association between mobility decline and occupational participation among community-dwelling older adults using multivariable analysis that adjusted for potential confounders. Methods: A total of 212 older adults were assessed using the locomotive syndrome stage test. Two comparisons were analyzed: (1) Non-mobility decline (stage 0) versus mobility decline (stages 1–3) and (2) preclinical decline (stage 1) versus apparent decline (stages 2–3). Hierarchical binary logistic regression was used to identify associated factors. Results: In the early comparison, older age (odds ratio (OR) = 1.20) was associated with higher odds of mobility decline, whereas greater monthly group exercise time (OR = 0.99) was protective (both p < 0.05). In the advanced comparison, older age (OR = 1.09) and ongoing illness (OR = 3.31) were associated with higher odds, while current employment (OR = 0.10), greater monthly group exercise (OR = 0.99), stronger grip strength (OR = 0.89 per kg), and higher occupational participation scores (Self-Completed Occupational Performance Index, a subjective measure of participation; OR = 0.94) were protective (all p < 0.05). Conclusion: Occupational participation was not associated with early mobility decline but was related to advanced decline. These findings provide stronger evidence than previous univariate studies and suggest preventive occupational therapy may prioritize accessible exercise in early stages, while highly individualized support for participation becomes critical in advanced stages.