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Updated 11:00 PM September 15, 2008




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Potholes and cracked sidewalks disable many older people

The growing number of potholes, broken curbs and cracked sidewalks in American cities are more than eyesores emblematic of the nation's economic troubles.

These kinds of conditions quadruple disabilities among older adults who already are struggling with leg strength and balance, according to a U-M study published in the September issue of the American Journal of Epidemiology.

"Becoming disabled is not just a response to aging or health problems," says Philippa Clarke, lead author of the article and a social epidemiologist at the Institute for Social Research (ISR). "The environment plays an important role as well."

Supported by grants from the National Institutes of Health, Clarke and colleagues used data from an innovative study to examine how the physical conditions of city streets and sidewalks affected whether middle-aged and older adults in varying shape were able to get around.

The Chicago Community Adult Health Study, conducted in 2002, included interviews with 1,195 men and women age 45 or older. The study also included observations and ratings of neighborhood street and sidewalk conditions.

The vast majority of respondents reported no trouble getting around, while 20 percent reported at least some difficulty walking two to three blocks, and 18 percent reported more than some difficulty with leg strength and balance.

On average, more than 60 percent of the residential blocks had some or many cracked sidewalks, potholes and broken curbs. To isolate the impact of street and sidewalk condition, the researchers controlled for other aspects of the neighborhood environment, including graffiti, garbage, litter, broken glass, cigarette butts, empty liquor bottles or abandoned cars, drug paraphernalia or condoms, that could also serve as social or physical barriers to mobility.

The researchers found that advanced age, a greater number of health problems and cigarette smoking increased the odds that people had problems getting around.

Controlling for physical health problems, the researchers found that among people with leg weakness and balance problems, those living on streets in fair or poor condition were over four times as likely as those living on streets in good condition to report a lot of difficulty walking two or three blocks.

"These results show that physical impairments are not necessarily catastrophic for mobility," Clarke says. "The negative consequences of severe restrictions in lower extremity strength and balance can be minimized when adults live in environments with fewer obstacles."

If street quality could be improved even a little, adults at greatest risk of disability would benefit, Clarke and colleagues say.

"They would be better able to work, engage in recreation and social interactions, access health-care facilities, or simply go shopping for their daily needs," Clarke says. "Just improving sidewalks, curbs and streets could postpone and maybe even prevent disability in groups at high risks."

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